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Case Report

Exploring the Addictive Nature of Fantasy Games Beyond Skill Mastery

Amrutha C. Madhu, MD; A. M. Ashfaq U. Rahman, MD; and N. A. Uvais, MBBS, DPM  

Published: December 21, 2023

Fantasy games captivate players, offering immersive escapes and diverse subgenres.1 Multiplayer options foster teamwork, allowing users to manage teams, make live decisions, and compete in real-time against other players, and engagement in sports fantasy games has surged among students aged 16–19 years, especially males.2 Every move impacts outcomes, enhancing player engagement. These platforms encourage social interaction via chats, forums, and leaderboards. Valuable sponsorship and advertising opportunities have emerged for the sports industry as well. Recently, India has emerged as a powerhouse in this realm. The fantasy sports user base data from 2021 show approximately 130 million registered users.3–5 In the United States, the number of users was found to be around 30–50 million.6 The introduction of fantasy sports, particularly cricket, played a pivotal role in fueling this growth in India. Fantasy cricket taps into the deep-rooted passion for the game, providing fans with an interactive engaging experience. The rise of online payment systems and digital transactions coupled with enticing cash prizes and rewards has further incentivized participation and engagement.

Case Report

Mr A was a 20-year-old man from a middle socioeconomic background who worked in phone retail. His parents brought him to the hospital due to his accumulating 2 lakh rupee (US $2,411.10) debt from online fantasy gaming and borrowing. He had left home after arguments and was staying with his grandmother. Isolated in his room, he exhibited disrupted sleep and appetite and was irritable when confronted. After his phone was taken away, he stayed with his grandmother and made new gaming friends, resulting in more losses. Seeking help for gaming addiction, Mr A had no prior personal or family history of psychiatric disorders.

Mr A began playing games during the COVID-19 pandemic due to unemployment. Introduced by friends to fantasy gaming, he initially spent little but won small amounts. Victories boosted his pride and income, leading to increased spending and making more friends. Gradually, losses piled up, yet he believed one big win could compensate. These losses led to him stealing from his parents and place of employment. The obsession grew, impacting his job, social life, and family relationships. He isolated himself, interacting only with online partners. Family intervention finally convinced him to seek medical help.

After an interview, he was found to meet the criteria for a gambling disorder per the DSM-5. He scored 42 out of a maximum score of 48 on the Gambling Symptom Assessment Scale7 (GSAS). A diagnosis of gambling disorder was made, and he was started on appropriate psychotherapy and pharmacotherapy.


The rise of fantasy game culture has had a significant impact on various aspects of society. It has transformed the perception of gaming from a recreational activity to a legitimate career option. In India, any fantasy game requires approval from the Federation of Indian Fantasy Sports and is legally accepted as a skilled game.5 The emergence of professional gamers, live streaming platforms, and e-sport tournaments has provided opportunities for talented individuals to showcase their skills and earn a living through gaming. This has prompted a shift in societal attitudes, such as those of parents and educators, especially when the players win money, with gaming being recognized as a viable profession, fostering creativity, teamwork, and problem-solving abilities.

As the majority of players engage in fantasy games for recreational purposes, there is a subset that may develop addictive behaviors. Addiction arises when the pursuit of gaming becomes excessive and interferes with an individual’s daily life, leading to negative consequences. There are some motivational elements such as regard, reward, arousal, escape, involvement, entertainment, and social interaction that fuel the addiction. The reward structure of games is carefully designed to trigger a continuous cycle of achievement and reinforcement.8 Accomplishing challenging quests, acquiring rare items, and winning real money create a desire for further progression.

The social interaction through online media fosters a sense of belonging and camaraderie, especially for those who have social anxiety and difficulty forming friendships in real life, making it harder for the individuals to disengage from the games. The games offer an escape from real-life stressors for some, providing a refuge where they can temporarily detach. This detachment can lead to excessive gaming as a coping mechanism, potentially exacerbating addictive tendencies.9 Certain personality traits such as predisposition to impulsivity for sensation seeking may increase the likelihood of addiction. When players are addicted, they can be excessively preoccupied with their fantasy team, spend significant amounts of time and money on the activity, neglect important aspects of life, and experience distress when unable to engage in the game, as seen in the case of Mr A.

The DSM-5 has 9 criteria for diagnosis of a gambling disorder, of which one must fulfill ≥ 4.10 The patient should have a persistent and problematic gambling behavior leading to significant impairment or distress for a 12-month period. Mr A fulfilled 7 of the 9 criteria and had a significantly high score on the GSAS, indicating that even in those without risk factors such as impulsivity or personality traits, these games have significant addictive potential. Critics often argue that fantasy games blur the lines between skill-based gaming and gambling, raising concerns about the addictive potential and financial loss.

Other than addiction, fantasy games also have the potential for the exacerbation or development of mood disorders. Since these individuals invest significant time and emotional energy on gaming, disappointments or failures have negative impacts on mood and emotional well-being. Social isolation in real-life surroundings leads to decreased social support, and difficulty maintaining healthy relationships can eventually lead to feelings of loneliness. Gaming can also trigger obsessive-compulsive disorder, as players may feel the need to constantly check scores and statistics and make changes to their teams, thereby disrupting daily life.11 They might also start measuring their self-worth through their performance in these games. Consistent failures, perceived incompetence, and comparisons to other’s success can negatively impact their self-esteem.12

To prevent the younger generation from getting dragged into potential addiction and gambling disorders, the regulatory authorities need to work toward striking a balance between ensuring consumer protection and fostering a healthy gaming ecosystem, which necessitates the implementation of responsible gaming practices and stricter regulations. It can start with education and increasing awareness about the signs and risks of gaming addiction to identify the problematic behaviors early on. The game developers can take an active role in reducing addiction risks by implementing features that encourage healthy gameplay habits like built-in breaks and time-tackling tools. Parents can also play a vital role by keeping an open line of communication and setting and monitoring screen time. Also, the government can establish resources for individuals struggling with gaming addiction such as counseling services, helplines, and support groups, which can provide necessary guidance and assistance for these individuals to overcome their difficulties.

Article Information

Published Online: December 21, 2023.
© 2023 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2023;25(6):23cr03586
Submitted: June 20, 2023; accepted September 6, 2023.
To Cite: Madhu AC, Rahman AMAU, Uvais NA. Exploring the addictive nature of fantasy games beyond skill mastery. Prim Care Companion CNS Disord. 2023;25(6):23cr03586.
Author Affiliations: Department of Psychiatry, Government Medical College, Kozhikode (Madhu, Rahman); Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut (Uvais).
Corresponding Author: N. A. Uvais, MBBS, DPM, Iqraa International Hospital and Research Centre, Calicut, Kerala, India (
Relevant Financial Relationships: None.
Funding/Support: None.
Patient Consent: Consent was received from the patient to publish the case report, and information has been de-identified to protect anonymity.

Volume: 25

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