The purpose of this presentation is to describe two cases of teenage addiction to on-line gaming where the subjects required medical attention due to unintentional, self-inflicted injuries to the tongue and upper lip during the course of the game.

Case study of two teenage boys, both aged 15, who attended the Specialized Outpatient Unit for Internet and PC Addiction in our Clinic, due to incessant on-line video-gaming that had a number of detrimental effects to their well-being.

The first teenager had repeatedly bitten his tongue due to stress experienced during gaming while the second had bitten his upper lip. In both cases their injuries required emergency medical assistance and thorough examinations for other possible causes (e.g spasms) for their injuries were negative. The first teenager was diagnosed with Internet Addiction Disorder and separation anxiety - pathological attachment to mother, he scored 78 on WISC-III. A behavioral intervention for separation anxiety and a CBT program for IAD was successful; his on-line gaming was limited to 2 hours/day on follow-up. The second teenager was diagnosed with IAD and co-morbid depressive disorder. Fluoxetine (30mg/day) was initiated and his mood improved while his computer usage time fell from 16 to 4 hours/day. A CBT program was initiated and he's under treatment with good progress.

Teenagers addicted to on-line gaming can experience severe stress which they may instinctively attempt to alleviate with self-inflicted wounds. Co-morbidity with other psychiatric disorders should be carefully assessed. Treatment can be pharmaceutical or psychotherapeutic.