My colleagues Huu Kim Le, Annabel Callan, Daragh Poynton, Daniela Vecchio and Wai Chen at Fiona Stanley Hospital, Australia, and I recently published a case report on GTP: “Game Transfer Phenomena in a Clinical Case with Psychosis and Gaming Disorder” in the Psychiatry International journal.

Our case report describes a 24-year-old male, patient G, diagnosed with paranoid schizophrenia and Gaming Disorder. Patient G has a story of drug use and reported experiencing GTP when he was young.

The case shows how playing video games and using media are manifesting in the patient’s symptoms (delusions, hallucinations). I want to highlight that the video game experiences of patient G are not isolated incidents. In fact, they are quite similar to what other players have reported in previous studies on GTP. This suggests that there may be common patterns and effects of video game play that can impact individuals in similar ways. It is essential for healthcare professionals to be aware of these findings in order to provide adequate support and treatment for patients who may be struggling with gaming-related issues.

In a clinical interview, patient G shared his experiences related to video games in his early years. Here, are some of his experiences (Le, et al., 2023 p 290-292):

Patient G believed he could teleport himself using a game element from World of Warcraft. “’Why don’t I just use my ‘Hearthstone’ to teleport home?’. He subsequently reached to grab this item from a backpack, as he would do whilst playing this MMORPG to activate a Hearthstone. After a couple of seconds, Patient G realised that he was not wearing a backpack and that a Hearthstone was a virtual item that could not be used in reality.”

Once “he shouted to his friends that they needed to escape the villain from the game, prompting him to run away. He reported that this felt real; however, he was under the influence of cannabis at the time.”

He also reported that “he could become incredibly hungry when characters from in the game cooked food. He reported that seeing the ‘delicious food’, such as cheese platters and soup, caused him to become so hungry that it prompted him to go and eat food.”

After playing Yu-Gi-Oh!, a collectable trading card game “when he went to lie down, he closed his eyes, and all he could see were virtual Yu-Gi-Oh! cards. The visuals lasted for an hour, and within that time, he also began to see the trading cards with his eyes open. He explained that these were static images of the cards and that he could consciously choose which specific ones were in his vision; however, he was unable to stop these involuntary visual imageries—despite wanting to. The imageries only ceased when he got up from bed and began to walk around about an hour after it had begun….Patient G described this experience as ‘scary’, explaining that he was just trying to rest, did not want to keep seeing the cards, and was hoping that it would end as soon as possible.”

Re-experiencing images from the game “when he had a shower or closed his eyes to try to sleep, he could see some of the graphics from the game. Notably, he reported visions of ‘green blurs’ flying around. This imagery tended to only last for seconds. He explained that the graphics in this game are ‘the most beautiful of any game’, so he enjoyed experiencing these visions because they were ‘cool to look at’”.

Some remarks based on our case report

  • Patient G’s experiences with video games are not unique and are actually quite similar to what other players have reported in previous studies on GTP.
  • GTP are common among gamers and are characterised by abnormal perceptions, intrusive thoughts, and temporal changes in behaviours related to the content of video games. It’s important to note that GTP do not necessarily reach the level of delusional intensity required for a diagnosis of psychosis.
  • It is important to be aware that excessive gaming and gaming-related thoughts and perceptions (GTP) can be present during adolescence and may precede the diagnosis of schizophrenia later in adulthood. While the causal significance of these antecedents for the development of psychosis is currently unknown, it is crucial to routinely screen for both Gaming Disorder and GTP in general clinical settings for both psychotic and non-psychotic cases. This is especially important given the popularity of video game playing and the prevalence of GTP.
  • Taking reports of hallucinatory and psychosis-like experiences seriously is important, even if they come from non-clinical players. This is because GTP can often be mistaken for actual psychotic symptoms. So it’s better to err on the side of caution, especially when those who experience them start question their own sanity.
  • In some cases, GTP may be an early sign of developing mental illness. This has important implications for early intervention and prevention of illness onset and complications. However, more research is needed to fully understand the role of GTP in prodromal and psychotic illnesses.

Download a copy of the full paper.

Based on my studies, it is evident that individuals with mental disorders or those who use drugs are more susceptible to GTP (Game Transfer Phenomena). However, it is crucial to note that the majority of gamers who have reported experiencing GTP in my studies do not have any clinical disorder or use drugs. Furthermore, the experiences happened while they were not under the influence of any substances, including medication. In this table you can look at some prevalence (Ortiz de Gortari & Diseth, 2022).

System Shock 2… Walking…I notice a security camera. INSTANTLY, I panic and reach for my pistol, praying that I still have enough ammo to take it out, oh god oh god… then I realized that it was broad daylight not a space station, and that I neither have a pistol (Yamj)
After playing Oblivion for the first time 15 hours straight, I became extremely disorientated and extremely confused because there wasn’t a bar telling me where my destination was located. I actually got slightly lost that night on the way to my friend’s house. Not really a hallucination, but still…weird (Kepchux).
There is a large football court with some five-meter-high buildings around it when I then walk out in the football field I try to find all the weaknesses and strong points as well as hiding places then I sometimes wants to shout orders to my friends and start running into cover. I did this one time, but people just started staring at me (Charlie).
Once, I stand at store in the lighting bulbs department trying to remember why I needed to buy one. Then I remember I need it for a room in the video game I was playing (Draven).
The first time I got ‘Meteos,’ I played it constantly for days. It was not possible to sleep for a while after that because every time my eyes were closed, I would see the Meteos pieces falling. (Mars)
At one point, my mom asked me to pick up my sister, and I swore I saw the dead rising scoop timer pop up in the corner of my eye (Maury)
When playing Battlefield 2 once saw a landmine on the road, and I swerved to avoid it. Hilarity ensued, and by hilarity, I mean a ticket (Masterhit)

Further reading

Le, H. K., Ortiz de Gortari, A. B., Callan, A., Poynton, D., Vecchio, D., & Chen, W. (2023). Game Transfer Phenomena in a Clinical Case with Psychosis and Gaming Disorder. Psychiatry International4(3), 286-296.
Ortiz de Gortari, A. B., & Diseth, Å. (2022). Multidimensional assessment of Game Transfer Phenomena: Intrusive cognitions, perceptual distortions, hallucinations and dissociations. Frontiers in Psychology, 13.
Cudo, A., Zabielska-Mendyk, E., & Ortiz de Gortari, A. B. (2022). Psychometric assessment and gender invariance of the Polish adaptation of the Game Transfer Phenomena Scale. Advances in Psychology, 18(1), 48-63.
Ortiz de Gortari, A. B., & Griffiths, M. D. (2016). Severity levels of Game Transfer Phenomena: Associated factors and impact. Journal of Behavioral Addictions, 5(S1), 16-17.
Ortiz de Gortari, A. B., & Griffiths, M. D. (2016). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. International Journal of Human-Computer Interaction, 32(6), 470-480. IF: 1.118
Ortiz de Gortari, A. B., & Griffiths, M. D. (2014). Automatic Mental Processes, Automatic Actions and Behaviours in Game Transfer Phenomena: An Empirical Self-Report Study Using Online Forum Data. International Journal of Mental Health and Addiction, 4(12), 1-21. IF: 1.179
Ortiz de Gortari, A. B., & Griffiths, M. D. (2014). Altered Visual Perception in Game Transfer Phenomena: An Empirical Self-Report Study. International Journal of Human-Computer Interaction, 30(2), 95-105. IF: 1.118