PUBG, Call of Duty, Mortal Combat, Candy Crush, Fruit Ninja, FIFA, Fortnite, Dota – most of us with smartphones have played at least one of these video games at some point in our lives.

The reward maybe nothing more than collecting ammunition, killing an enemy, scoring a goal or even slicing as many fruits as possible. We still get easily carried away by the stunning animation and the gameplay.

Gaming is fun. For a lot of children and young adults, it might also seem like a rite of passage, or just a hobby.

But for some, video games could be addictive and a real mental health condition.

Earlier, those under 18 in China were allowed to play for one and a half hours a day on most days. But now, they are limited to just one hour a day on weekends and holiday evenings.

While China has a history of taking totalitarian measures, is gaming addiction really a cause for concern?

Many people associate addiction with drugs and alcohol, but gaming can be an addiction too, under certain circumstances.

According to the World Health Organisation (WHO), 'gaming disorder' is defined "as a pattern of gaming behaviour characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences."

But not everyone agrees with this. The WHO's designation drew flak from gamers and experts, saying it was classified without much evidence.

However, when it gets out of hand, it's a legitimate medical condition for some.

18-year-old Pavani, started playing PUBG in January this year amid the COVID-19 lockdown.

"Initially, I used to play for 1-2 hours a day. But then, I wanted to get better at my game and used to be hooked on to the game for more than half a day," Pavani says.

Pavani was rushed to the hospital with severe headache in an unconscious state. She suffered from cortical vein thrombosis in the brain.

Not all of them will have such serious consequences. For something to be addictive, it doesn't require a physical component, researchers say.

Indranil Mukherjee's 11-year-old son, Srijan Mukherjee, sleeps late, reluctantly wakes up at the nick of time before classes begin in the morning, and sometimes, skips breakfast, too.

Srijan is always on his mobile phone or the laptop playing online games, complains his father.

Srijan's gaming has increased from 2-4 hours last lockdown to more than 4 hours now.

"We have restricted their liberty in many ways. They have no extracurricular activities, and it's easy for them to access these games due to online classes," his father says, adding that it's not possible to keep an eye on him all the time.

For Rakshith, who's in the 9th grade, the no-school, lockdown situation has been brutal with no friends hang out with.

“We knew he was getting addicted, but we didn’t know what to do since he wasn’t going out or meeting friends," she adds.

At some point, parents and family members need to stop and ask, "when and how does gaming become more than fun? When does it become an addiction?"

Dr. Manoj Sharma, heads the Service for Healthy Use of Technology (SHUT) Clinic at National Institute of Mental Health Sciences (NIMHANS) in Bengaluru, which is India’s first clinic exclusively dealing with technology-related mental health issues.

Dr. Sharma says these are the factors responsible for addiction:

• Peer pressure

• The type of expectations shared among peers – ranking, earnings, etc.

• Various intermittent rewards - These can be in terms of certain accessories, ranks.

• Some children who don't do well in academics or find that novelty in real life scenario may get addicted

• Some may have certain other psychological issues like attention deficit disorder where inattention, impulsivity and hyperactivity are the core features.

• If there are family issues, they may find solace in gaming.

• Free time and boredom

The acknowledgement they get from their gaming friends, their need for affiliations, freedom to talk in ways which are not acceptable in the offline world and easy accessibility are some of the other factors, Dr Sharma, says.

• Preoccupation with playing games – where a person has a continuous desire to play.

• Loss of control - Once they start playing, they lose their control.

• Playing despite knowing the consequences – The child knows that he/she is jeopardising academics, social life, health, but still continue to play.

"So if these three are found in the last 12 months, we can says the child has addiction to gaming, Dr Sharma says.

Any change in the child’s routine is something the parents can keep an eye on.

Changes in the sleeping pattern, communication, lack of interest in other offline activities like going out and physical activities, behavioural disturbances and psychological issues - these are the signs to look out for, Dr Sharma says.

• Work on good, open communication

• Have a non-judgmental attitude

• Recognise the signs

• Bring certain rules on use of technology at home

But gaming is not all doom and gloom. It can be therapeutic too when it's not excessive.

As with all addictions, what's important to remember is that you're not alone and the good news is that help is ALWAYS available. You just have to recognise the signs and seek help.

So, do we need a policy like in China to curb the addiction? It may be a bit far-fetched.

"If we work more on public involvement in bringing change, it will be the better strategy," Dr Sharma, says.