"Mania or Digital Behavioral Addiction? An ICD-11 Diagnostic Dilemma in a Patient with Persistent Mobile Gaming, Gambling Behavior, Impulsivity, Agitation, and Cognitive Dysfunction"

Gaming Disorder and Gambling Disorder are recognized in the International Classification of Diseases, 11th Revision (ICD-11) as disorders due to addictive behaviours; however, distinguishing between these conditions and other psychiatric or neurocognitive disorders can be challenging, particularly within modern digital environments where gaming and gambling increasingly overlap. We report the case of a 32-year-old married man with no previous psychiatric history who developed persistent mobile gaming–related online gambling over three years after downloading a smartphone gaming application. Progressive engagement in casino-style games resulted in severe financial losses, impaired control over gambling, unsuccessful attempts to stop, social and family conflict, and significant functional impairment. Family-imposed restrictions intensified his gambling urges rather than reducing them. During the three months preceding presentation, he developed progressive cognitive symptoms, including impaired short-term memory, confusion, reduced concentration, and difficulty performing routine tasks, prompting psychiatric evaluation. Mental status examination demonstrated mild disorientation, impaired delayed recall, limited insight, and impaired judgment without evidence of psychosis or substance use. Previous pharmacological treatment with topiramate, fluoxetine, and low-dose risperidone was ineffective. The clinical presentation was most consistent with severe ICD-11 Gambling Disorder with overlapping features of Gaming Disorder. This case illustrates the diagnostic complexity created by digitally mediated gambling platforms that integrate gaming and gambling mechanics, producing overlapping addictive, cognitive, and affective symptoms. It highlights the importance of comprehensive longitudinal assessment to distinguish behavioral addiction from primary mood or neurocognitive disorders and emphasizes the need for integrated behavioral and psychosocial interventions rather than reliance on pharmacotherapy alone.