Adolescent Aggression: A Narrative Review on the Potential Impact of Violent Video Games

Abstract

Background: Exposure to violent content through video games can shape perceptions of aggression as normative or acceptable, potentially desensitizing adolescents to violence and increasing the likelihood that they will engage in aggressive behavior in their real-world interactions. This narrative review examines the relationship between violent video games (VVGs) and youth aggression, addressing (i) VVG exposure through the lens of Social Learning Theory and the General Aggression Model; (ii) the biological determinants of aggressive behavior, including neurophysiological correlates and the potential modulatory role of the gut microbiome; (iii) and current evidence on the influence of VVG exposure on adolescent aggression. Results: VVG exposure may promote moral disengagement and reinforce aggressive behavior through rewarding violent actions, potentially leading to real-life aggression. Exposure to VVGs increases aggression by elevating cortisol levels, activating the sympathetic nervous system, stimulating the brain’s reward system, and disrupting neurotransmitter balance. Alterations in gut microbiome composition could occur as a result of engaging in VVGs, potentially mirroring the physiological responses observed in violent real-world activities. The relationship between VVGs and aggression among adolescents has been widely explored, with studies generally indicating that VVG exposure can lead to desensitization to violence, reduced empathy, and diminished prosocial behavior. VVGs have also been linked to both bullying perpetration and victimization dynamics among adolescents, contributing to mental health issues, which in turn exacerbate problematic gaming behaviors. Conclusions: While there is evidence suggesting that exposure to VVGs is associated with increased adolescent aggression, discrepancies in the literature highlight the need for further research aimed at improving our understanding of this phenomenon. The studies on this topic reveal significant limitations, including a predominance of cross-sectional designs, methodological shortcomings, small sample sizes, and challenges in generalizing results. Factors such as the developmental stages of the participants, the exclusion of females, and unmeasured variables during long follow-up periods further complicate interpretations. Moreover, parental responsibility and the effectiveness of age ratings require closer examination.

1. Introduction

Aggression is an inherent aspect of human social behavior that, together with motor and visceral expressions, is associated with actions aimed at achieving a specific objective or directed towards threatening stimuli with the intent to inflict harm, whether for offensive or defensive purposes (Rasia-Filho et al., 2008), thereby serving several vital functions, including securing resources such as food and territory, establishing social hierarchies, and competing with rivals to ensure reproductive opportunities (Krämer et al., 2008). Reactive aggression elicited in social interactions is highly dependent on inhibitory control, particularly among individuals with high trait aggressiveness, significantly influencing levels of reciprocal violence (Anderson et al., 2008a; Krämer et al., 2007), which are ultimately shaped by cognitive, emotional, and contextual factors (Koch et al., 2024). Specifically, aggression has been strongly linked to hostile perceptions of others, further amplified by relational vulnerabilities, which predispose individuals to heightened anger, independently of whether negative emotions manifest as enduring traits or temporary states (Burt et al., 2009; Maalouf et al., 2022). Interestingly, research on animal behavior suggests that certain forms of aggression may be inherently rewarding, a phenomenon mediated by dopaminergic systems that mirror those in reward-processing mechanisms identified in humans (Couppis & Kennedy, 2008). In this sense, animals invest considerable energy in performing aggressive actions and appear to derive pleasure from such encounters (Fish et al., 2002), so it is plausible to state that aggressive behavior in human populations may also have intrinsically rewarding qualities.

Aggression is highly prevalent among adolescents but generally declines in young adulthood, with childhood adversities related to violence exposure and mental health issues playing a significant role in the development of aggressive behavior (Huesmann et al., 2021; Salo et al., 2022; Vivar et al., 2014). The prevalence of violence among youth represents a significant public health crisis in society, reflecting deep-rooted issues related to alienation, social status, family disruption, and community trauma, which perpetuate fear and instability (Bushman et al., 2016). Social sources of influence shape behavior by allowing individuals to acquire knowledge about their environments and the statuses of others through observation, leading to strategic modulation of actions in response to interpersonal and contextual dynamics (Bandura, 1977; Desjardins et al., 2012; Splan & Forbes, 2022). This emphasizes that aggression should be viewed as a continuum rather than a discrete category (Isen et al., 2022).

Because of its pervasive power as a stimulus, digital media has the potential to exert a significant influence in the learning and emergence of violent behavior. For example, exposure to violent content in digital media, particularly through video games, can shape perceptions of aggression as normative or acceptable, potentially desensitizing young viewers to violence and increasing the likelihood that they will engage in aggressive behavior in their real-world interactions (Anderson et al., 2007; Delhove & Greitemeyer, 2021; Hogan & Strasburger, 2020; Ybarra et al., 2022). Adolescents, whose cognitive and emotional regulatory systems are still maturing and who have not yet fully developed their identities and their moral and ethical values, may be particularly vulnerable to these influences, as their ability to critically evaluate and filter violent content is still developing (Dumontheil, 2014; Fleming, 2005; Kroger et al., 2010; Sebastian et al., 2008; Wong et al., 2010). In fact, this period is marked by diminished self-control, with adolescents exhibiting heightened sensitivity to environmental cues, leading to stronger emotional reactivity and a limited capacity to regulate their behavioral responses, changes that are linked to ongoing developments in brain connectivity, particularly within the limbic system (Casey, 2015).

Violent video games (VVGs) can be defined as digital games that involve scenarios where players engage in aggressive behaviors, such as physical combat, the use of weapons, or the performance of harmful actions against other characters. Although VVGs have been a central focus in the debate regarding their potential link to aggressive behavior in adolescents, this issue remains unresolved, with mixed findings in the recent literature. Some studies have shown no clear correlations between VVG exposure and increased aggression (Ferguson, 2015; Kühn et al., 2019), while other research suggests that certain individual, contextual, and social variables may influence (or be influenced by) these effects (Anderson & Bushman, 2001; Brockmyer, 2022; Orozco-Marín et al., 2024; Teng et al., 2019), including moral disengagement (the justification of aggression by detaching actions from moral standards), desensitization (reduced emotional responses due to repeated exposure), empathy (the ability to recognize and experience the feelings of others), or prosocial behavior (diminished helpfulness or cooperation), to name a few. Furthermore, advances in technology and distribution methods have increased access to and use of VVGs, but regulatory systems have not grown in parallel, raising concerns about their effectiveness in protecting younger audiences from inappropriate content (Olejarnik & Romano, 2023).

Considering the progressive increase in the consumption of violent digital content among adolescents, especially video games, and the significant potential implications this may entail, the objective of this narrative review is to examine the relationship between VVGs and aggressive behavior within the context of this population. In order to provide a comprehensive perspective, the review addresses: (i) VVG exposure through the lens of relevant theoretical approaches, specifically Social Learning Theory (SLT) and the General Aggression Model (GAM); (ii) the biological determinants of aggressive behavior, including neurophysiological correlates and the potential modulatory role of the gut microbiome; and (iii) current evidence on the influence of VVG exposure on adolescent aggression. Through this framework, we seek to establish a descriptive synthesis of the current state of knowledge, clarifying interrelations, highlighting critical aspects for future research, and facilitating an understanding of the diverse influences associated with this topic. This includes emerging areas for which there is very limited evidence (e.g., the potential involvement of the gut microbiome) and contradictory findings on the extent to which exposure to VVGs significantly impacts adolescent aggression. In addition, this review discusses how VVG exposure might intersect with other dynamics, such as bullying and mental health, potentially escalating aggression and violent outcomes.

2. Method

To provide an integrative overview of the topic examined, the present study consists of a narrative review (Sukhera, 2022), which constitutes a suitable approach for synthesizing a broad range of perspectives and findings on the relationship between VVG exposure among adolescents and aggressive behaviors, including theoretical frameworks, biological correlates, experimental and review-based evidence, as well as related phenomena and social dynamics. A literature search was conducted across the PubMed, Dialnet, and SciELO databases, ensuring access to a wide spectrum of research. No language or publication period restrictions were applied, allowing for a potentially broader inclusion of studies. Keywords were selected and combined using Boolean operators to capture studies examining aggressive behavior in the context of VVG exposure. The search strategy included a variety of term combinations, adjusted to the specific scope, in order to ensure comprehensive coverage. The study selection process was methodical, involving an initial retrieval based on the predefined search criteria. Each article was subjected to a two-step screening process to ensure relevance. First, titles and abstracts were reviewed, and studies not directly aligned with the research focus were excluded. Next, full-text assessments of the remaining articles were conducted to evaluate their pertinence. Inclusion criteria were defined to ensure the selection of studies directly relevant to the topic. Studies were included if they examined (i) the effects of adolescent exposure to VVGs, specifically in relation to aggressive behaviors; (ii) bullying dynamics associated with VVG exposure; (iii) insights into the underlying mechanisms of aggression; (iv) insights into the mechanisms by which exposure to violent content might contribute to aggressive tendencies; (v) biological correlates regarding aggressive behavior and the relationship between VVG exposure and aggression, including physiological and microbial determinants; and (vi) psychosocial correlates regarding aggressive behavior and the relationship between VVG exposure and aggression, including victimization and mental health implications. Additionally, theoretical articles offering a deeper understanding of aggression and behavioral responses linked to violent content were included to support the conceptual framework, as well as studies on phenomena potentially related to the central topic under investigation. The exclusion criteria were as follows: (i) studies focusing on sexualized media; (ii) studies on real-life violent imagery or video content; (iii) studies on video games used as interventions for violence prevention; (iv) theses and proceedings; (v) articles without relevant or sufficient data; and (vi) articles that did not maintain a clear focus on the effects of the variables corresponding to the central topic of this study. Reference lists from prior studies were also reviewed to identify further studies of potential value. Studies in languages other than English and Spanish were reviewed with the support of online translation tools to ensure consistency and accuracy in the extraction of relevant information. The search and data extraction were conducted between October 2024 and January 2025. During the database search, strictly following the described selection strategy, articles considered irrelevant based on initial assessments were excluded from this review.

3. Theoretical Frameworks on VVG Exposure

It is possible to contemplate the impact of VVGs through several theoretical perspectives (Demirtaş-Madran, 2023), among the most prominent of which are SLT and the GAM. SLT is particularly influential due to its pioneering role in explaining how aggression is adopted as a behavior through observational learning and reinforcement, emphasizing the role of media in shaping aggressive behaviors. Furthermore, SLT laid the groundwork for the development of subsequent theoretical postulates, influencing later models such as the GAM, which integrates cognitive, emotional, and physiological factors, offering a detailed understanding of how repeated exposure to violence can foster long-term aggressive tendencies. The GAM stands out in the context of VVG exposure, where it has been extensively applied to explain aggression-related outcomes.

3.1. Social Learning Theory

Albert Bandura stated that learning would be extremely difficult, not to mention dangerous, if people had to rely solely on the effects of their own actions to know what to do. He referred to the role of vicarious learning in the acquisition of behavior, which is reflected in SLT (Bandura, 1977). This theory explains that learning consists of a cognitive process that takes place in a social context; consequently, the acquisition of new behaviors can occur through observation and imitation, even in the absence of motor reproduction or reinforcement. Thus, this theory places the origin of violence in the modeling that occurs in social interactions across different contexts. Bandura was interested in the human tendency to imitate behaviors observed in others and asserted that models are a powerful source for acquiring new behaviors and modifying those already known (Bandura, 1973).

In 1961, Bandura developed a seminal experiment demonstrating that aggressive behavior is acquired through social learning (Bandura et al., 1961). In this study, an experimental situation involving two groups of children was set up: one of them would observe an adult treating an inflatable doll violently, while the other group would observe an adult interacting non-aggressively with the same doll. Later, when both groups of children interacted with the doll, the group that had observed the aggressive model was more aggressive toward the doll than the other group. In 1963, Bandura modified his original study to test whether there would be a difference in the aggressive behavior imitated when the observed model appeared on film compared to when presented face to face (Bandura et al., 1963). The experiment showed that children imitate aggressive behavior exhibited by others toward a model, regardless of how it is presented. This second experiment helped to clarify the debate over whether violent media have the capacity to influence young people to become aggressive. In 1965, Bandura conducted a third experiment to test whether learned behavior could be influenced by vicarious reinforcement (Bandura, 1965). The results of this third experiment revealed that children who observed the model being punished exhibited less aggressive behavior. This experiment was repeated, using rewards, to encourage the children to imitate the observed behavior. In this case, the results indicated that incentives may exert a significant effect on increasing aggressive behavior (Bandura, 1965).

A recent longitudinal study by Teng et al. (2019), based on SLT, suggests that VVGs provide a context for observational learning that promotes moral disengagement among players. Thus, this study posits that by rewarding immoral actions in VVGs, such as car theft or killing characters, players may be encouraged to morally disengage, leading to behavioral outcomes associated with increased aggression. Previous studies have supported this premise (Anderson et al., 2010; Huesmann, 2007, 2010), and these findings are further supported by evidence from operant conditioning, which shows that rewarding specific violent actions in VVGs, such as head shots, can condition players toward real-life aggressive behavior (Bushman, 2019). Indeed, SLT provides an optimal prism through which to understand the potential effects of VVGs. In VVGs, players are not passive observers; they actively engage in and observe aggressive behavior, reflecting Bandura’s assertion that behavior can be acquired through vicarious learning. Just as the children in Bandura’s experiments observed and imitated aggressive actions toward the doll, players in VVGs may internalize and later imitate the aggressive behaviors of in-game characters. This process of imitation is particularly concerning in interactive media because video games allow players to directly embody and control these violent models.

The reinforcement mechanisms within video games are also consistent with Bandura’s findings that imitation is reinforced when the observed behaviors are rewarded rather than punished. In many VVGs, players are rewarded with points, achievements, or narrative progression for successful acts of violence, which could strengthen the internalization of these aggressive behaviors. This reinforcement is similar to the postulates of SLT stating that individuals are more likely to imitate aggressive models when these models are rewarded or face no consequences. As a result, the aggressive actions in VVGs that are associated with positive outcomes may promote a form of learned aggression that persists beyond the virtual environment. Moreover, SLT emphasizes that social learning occurs in any setting where individuals observe and interact with behavioral models, whether these are real or virtual. This extends the impact of social learning to the digital realm, where VVGs serve as powerful platforms for modeling aggressive behavior. Consequently, exposure to violence in video games may not only desensitize individuals to real-world aggression but also shape social and cognitive processes that can lead to more aggressive attitudes, behaviors, and dynamics in broader social contexts. Figure 1 presents a hypothetical model that illustrates the process by which VVGs influence aggression (according to Bandura, 1973, 1977).

3.2. General Aggression Model

The GAM is an integrative framework partially derived from SLT (Anderson & Bushman, 2002; Anderson & Groves, 2013). The GAM’s postulates can be divided into two primary categories of processes: proximal processes, which refer to immediate factors that directly influence aggressive behavior, and distal processes, which involve broader, long-term factors that shape behavioral tendencies, subsequently affecting short-term aggressive responses. Proximal processes can be understood through a single-cycle episode, beginning with two forms of input: situational factors and individual differences, such as mood or trait aggression. These inputs influence internal states, such as affect, cognition, and physiological arousal, which interact and contribute to aggressive behavior. The model suggests that aggression is primarily mediated by aggressive cognitions, although affect and arousal also play a role. The cycle continues with decision and appraisal processes, through which individuals evaluate the cause of an event, leading to either impulsive or thoughtful actions. Hostile attributions, whether impulsive or considered, can escalate violence, with the outcome influencing future encounters and contributing to a violence escalation cycle (Anderson & Bushman, 2002; Anderson & Carnagey, 2004; Anderson & Groves, 2013). In turn, distal processes focus on how repeated exposure to aggression-related stimuli (e.g., media violence) contributes to aggressive personality development. Two main factors influence this development: biological modifiers, such as neurotransmitter levels and mental health conditions, and environmental modifiers, such as prolonged exposure to violence and parenting or cultural influences. The GAM posits that these factors interact, forming aggressive or non-aggressive personalities, with observational learning playing a crucial role. Individuals learn and reinforce aggression-related cognitive structures, which influence their behavioral responses in future social encounters. If aggressive behavior is reinforced by the environment, these behaviors are more likely to occur in the future (Anderson & Bushman, 2002; Anderson & Carnagey, 2004; Anderson & Groves, 2013).

As noted above, the GAM postulates that media violence influences the cognitive structures that individuals retrieve when making attributions to a significant event. As a result, it increases the likelihood that a triggering event is perceived as hostile, guiding the perceived appropriate behavioral response. In this regard, a minor triggering event is more likely to initiate a violence escalation cycle for individuals with high trait aggressiveness than for non-aggressive individuals (Anderson & Groves, 2013). This process is particularly relevant in the context of adolescent exposure to VVGs. According to the GAM, repeated exposure to VVGs plays a key role in shaping long-term aggressive tendencies since these games provide a continuous stream of aggression-related stimuli, which adolescents interact with and internalize, reinforcing aggression-related cognitive structures and potentially leading to aggressive behavior (Anderson & Dill, 2002). In addition, VVGs may contribute to the development of aggressive personality traits over time, particularly in individuals who already possess certain risk factors, such as high levels of trait aggression or a predisposition to hostility, and the interactive nature of video games amplifies this process, as players are required to make decisions and enact aggressive behaviors within the game, thereby strengthening the association between aggression and reward. Furthermore, the hostility within a gaming environment might provide an additional dimension with respect to how VVGs influence aggressive behavior, emphasizing the role of adverse environments in intensifying aggression associated with VVG exposure.

Thus, the GAM suggests that exposure to VVGs may increase the likelihood of adolescents acting aggressively by activating aggressive cognitive structures and reinforcing aggression-related knowledge networks. Therefore, VVGs could serve not only as a direct source of violent stimuli but also as a tool for shaping long-term behavioral tendencies, increasing the probability of aggressive responses to real-world situations. This occurs because VVGs may heighten expectations of aggression in conflict scenarios, even without provocation (Anderson & Dill, 2002). Figure 2 shows the influence of VVGs on aggressive behavior among adolescents within the GAM framework (according to Anderson & Bushman, 2002; Anderson & Carnagey, 2004; Anderson & Dill, 2002; Anderson & Groves, 2013).

4. Biological Determinants of Aggressive Behavior

A broad range of physiological and biochemical factors, including neurotransmitter systems (Rasia-Filho et al., 2008), brain structures (Krämer et al., 2007), hormonal pathways (Terburg et al., 2009), and the impact of neuropeptides and gut microbiome imbalances (dysbiosis) (Mikami et al., 2023), have been identified as key determinants in the modulation of aggressive responses, thereby constituting potential targets for the expression and regulation of social aggression.

4.1. Neurophysiological Correlates

Aggression has been linked to reduced hippocampal volume and a positive developmental interaction between the amygdala and prefrontal cortex (Bos et al., 2018), while other studies have associated aggressive behavior with the development of the right hippocampus (Roberts et al., 2021) as well as lower levels of aggression with positive development of the amygdala and cortex (Gulledge et al., 2023). Investigation of the relationship between brain structures and aggression has indicated that reward-related areas, including the nucleus accumbens and the lateral habenular nucleus, could be functionally involved in promoting aggressive behavior (Aleyasin et al., 2018).

Aggressive behavior is a complex neural activity in the brain that is influenced by multiple hormones and neuropeptides, including dopamine, serotonin (5-HT), testosterone, cortisol, and norepinephrine (Gulledge et al., 2023; Mahadevia et al., 2021), as well as the neuropeptides oxytocin and vasopressin (Calcagnoli et al., 2014; Koolhaas et al., 2010). The testosterone/cortisol ratio has been found to be higher in males exhibiting aggressive behavior, supporting the testosterone/cortisol hypothesis of social aggression (Terburg et al., 2009). Testosterone activates brain regions linked to aggression, while cortisol acts as an antagonist to this effect (Batrinos, 2012). Furthermore, 5-HT has been associated with the severity and type of aggressive behavior (Klasen et al., 2019). This neurotransmitter is epigenetically regulated, and genes like MAOA and its family members have been suggested to be associated with aggression (Palumbo et al., 2018). These genes encode the mitochondrial enzyme monoamine oxidase A, which catalyzes the oxidative deamination of amines, such as norepinephrine, dopamine, and 5-HT (Vaeroy et al., 2019). Increased aggression in animals is associated with the hypersensitivity of 5-HT1A autoreceptors and impaired 5-HT reuptake function, suggesting a potential relationship in the neurochemical cascade that results in 5-HT deficiency, a characteristic feature of these aggressive animals (de Boer, 2018). In addition, another bioactive substance that impacts aggression is glucocorticoid, whose levels are regulated by the hypothalamic–pituitary–adrenal axis. Glucocorticoid administration to brain regions enhances aggression, creating a positive feedback loop between the neural circuits governing aggression and the stress response. This escalation in aggressive behavior subsequently stimulates further glucocorticoid production, reinforcing a vicious cycle (Haller et al., 2005). Moreover, recurrent external factors, such as alcohol consumption and early-life stress, have been shown to trigger aggressive behavior, primarily through the modulation of 5-HT function within the frontal cortex and the deprivation of social interaction during early development, respectively (Chiavegatto et al., 2010; Haller et al., 2014; Heinz et al., 2011; Miczek et al., 2015; Takahashi, 2025; Tóth et al., 2008; Veenema, 2009).

Social experiences can lead to structural and functional changes in the brain, shaping emotional responses and behavioral traits, as they impact several neural pathways, such as those associated with serotonin, dopamine, gamma-aminobutyric acid (GABA), glutamate, oxytocin, and stress-related hormones (Curley et al., 2011). Negative social feedback often triggers aggressive feelings and behaviors, and neuroimaging studies have shown that brain regions such as the insula and the medial prefrontal cortex respond to socially salient feedback, both negative and positive (Achterberg et al., 2016). In this regard, individuals with stronger activation in the lateral prefrontal cortex following negative feedback are better able to regulate impulsive responses, suggesting that executive control may play a key role in aggression regulation. This relationship between neural activation and aggression regulation was further explored in a study where participants who experienced social rejection showed varying aggression levels based on their executive functioning (Chester et al., 2014). Those with lower executive control exhibited a stronger link between brain activation in regions such as the dorsal anterior cingulate cortex and aggressive behaviors, while there was a weaker or even opposite effect for individuals with higher executive functioning, underscoring the significance of individual regulatory capabilities. During adolescence, self-control and the ability to regulate emotions, desires, and actions are still developing, making adolescents more vulnerable to impulsive behavior and heightened risk-taking (Casey, 2015). As the brain undergoes significant developmental changes, particularly in areas like the lateral prefrontal cortex, which is responsible for exerting top-down control over subcortical regions involved in emotional responses (Achterberg et al., 2016), adolescents are more likely to struggle with emotional regulation, influencing their impulsivity and shaping how they respond to social feedback and aggression.

As previously stated, the GAM asserts that the violence in VVGs constitutes a situational factor that affects cognitive, emotional, and physiological processes, leading to both immediate and lasting impacts on aggressive and social behavior (Anderson & Bushman, 2018). Specifically, exposure to VVGs leads to more aggressive thoughts and increases cortisol levels, activating the sympathetic nervous system and stress responses, which trigger a fight-or-flight reaction that elevates the likelihood of becoming aggressive (Gentile et al., 2017). Violent success in video games, at a neurophysiological level, activates the brain’s reward system, specifically the dorsal striatum, while non-violent success activates the ventral striatum, highlighting differential neural processing based on the nature of success in a game (Klasen et al., 2020). Excessive VVG playing has been associated with significant gray matter loss in several brain regions and decreased white matter integrity. Gray matter density has been negatively correlated with years of gaming, and both gray and white matter changes have been associated with higher levels of aggression, hostility, and internet addiction, suggesting profound structural brain changes associated with VVG use (Mohammadi et al., 2020). Moreover, exposure to VVGs can disrupt cortico-limbic emotion regulation networks, which are critical for managing psychological processes such as aggression and anxiety (Lai et al., 2019). Altered 5-HT transmission plays a key role in this process, affecting the cognitive control of emotional responses (Švob Štrac et al., 2016). Specifically, imbalances in the concentration of inhibitory and excitatory 5-HT receptors can influence how individuals respond to violent stimuli (Mitroshina et al., 2023; Popova et al., 2022). This dysregulation can increase impulsivity and aggressive behavior by decreasing the brain’s ability to effectively manage emotional responses (Veneziani et al., 2024). Therefore, repeated exposure to VVGs may lead to a reliance on maladaptive emotional responses, exacerbating problems such as aggression and impulsivity (Wolf et al., 2018).

4.2. The Role of the Gut Microbiome

The gut microbiome, which starts developing before birth and evolves throughout life, influences brain functions via the gut–brain axis (Bana & Cabreiro, 2019; Borrego-Ruiz & Borrego, 2024a; Morais et al., 2021). Studies employing animal models suggest that the gut microbiome plays a crucial role in aggression (Mikami et al., 2023), with gut microbiome dysbiosis serving as the trigger for aggressive behaviors (Miri et al., 2023). Early human studies have indicated that reduced Prevotella abundance in infancy correlates with behavioral problems, while greater maternal bacterial alpha diversity is associated with fewer internalizing symptoms among children (Dawson et al., 2021; Loughman et al., 2020). Several studies also suggest a connection between the gut microbiome and social behavior (Münger et al., 2018; Sarkar et al., 2020). In addition, recent findings show altered microbiome compositions in aggressive individuals, mainly characterized by an increase in the abundance of Prevotella spp. and a decrease in the abundance of Bacteroides spp., Blautia spp., Bifidobacterium spp., Collinsella spp., and Faecalibacterium spp. (H. Deng et al., 2022). Furthermore, numerous preclinical studies have demonstrated that gut microbiome alterations influence aggression, often via changes in microbiome diversity and metabolite profiles as well as through shifts in bacterial taxa such as Anaeroplasmataceae, Catenibacterium, Clostridium, Lachnospiraceae, Lacticaseibacillus rhamnosus, and Megamonas (Cusick et al., 2022; Grinberg et al., 2022; Jia et al., 2021; Kirchoff et al., 2019; Leclercq et al., 2017; Mondo et al., 2020; Ren et al., 2020; Shor et al., 2022; Sylvia et al., 2017; Uzan-Yulzari et al., 2024; Voulgari-Kokota et al., 2024; Watanabe et al., 2021).

Table 1. Preclinical studies on the relationship between aggression and the gut microbiome.

Reference	Animal Model	Exposure Targets and Focus of Study	Microbial Effects/Results
Leclercq et al. (2017)	Mouse	Pregnant females were treated with either penicillin or penicillin and L. rhamnosus strain JB-1 until weaning of pups.	Penicillin exerts long-term effects on the gut microbiome in both sexes, enhancing cytokine expression in the frontal cortex, altering blood–brain barrier integrity, and modifying behavior. Mice treated with this antibiotic displayed impaired anxiety-like and social behaviors alongside increased aggression. However, concurrent supplementation with L. rhamnosus JB-1 mitigated some of these changes.
Sylvia et al. (2017)	Siberian hamster	A broad-spectrum antibiotic was administered on a short-term basis, and effects of single versus repeated antibiotic treatment were explored.	The administration of a broad-spectrum antibiotic induces dysbiosis of the gut microbiome and has strong, sex-specific effects on aggression in rodents. Specifically, two antibiotic treatments resulted in substantial reductions in aggressive behavior in males, without affecting other social behaviors, whereas females treated with antibiotics showed a decrease in aggression after just one treatment. A correlation was found between the abundance of Mycoplasmatota (formerly Tenericutes) and Cyanobacteriota in hamsters exhibiting reduced aggressive behavior.
Kirchoff et al. (2019)	Dog	Aggressive and non-aggressive dogs.	Differences in the beta-diversity of the gut microbiome were observed between aggressive and non-aggressive dogs, suggesting a potential link between the structure of the gut microbiome and the aggression in dogs. Notably, the relative abundances of several bacterial species, including Lactobacillus, Dorea, Blautia, Turicibacter, and Bacteroides, were altered in aggressive dogs in comparison to their non-aggressive counterparts.
Mondo et al. (2020)	Dog	Dogs with aggressive, phobic, or normal behavior.	The relative abundances of Catenibacterium and Megamonas were higher in the gut microbiomes of dogs presenting aggressive behavior. The levels of testosterone and cortisol were not closely associated with gut microbiome dysbiosis.
Ren et al. (2020)	Siberian hamster	Hamsters housed under either LD or SD photoperiods for 9 weeks.	SD responder females showed increased aggression. The relative abundance of members of the family Anaeroplasmataceae in females was associated with aggression.
Jia et al. (2021)	Fly	Conventionally reared and GF flies and GF embryos with mixed bacteria.	The microbiota induced aggressive behaviors in both fly males and females. GF males showed a substantial decrease in inter-male aggression, which was reversed through microbial recolonization with Lactiplantibacillus plantarum.
Watanabe et al. (2021)	Mouse	GF and Ex-GF mice.	Ex-GF mice with an altered gut microbiome displayed significantly lower levels of aggressive behavior compared to GF mice. When GF mice received fecal microbiota transplants from Ex-GF mice, the groups that were administered feces at 0 and 6 weeks of age showed less frequent aggressive behaviors than the GF mice.
Cusick et al. (2022)	Siberian hamster	Four groups of pregnant females: antibiotics-only, stress-only, antibiotics and stress, and control.	Maternal antibiotic exposure modified the gut microbiomes of both male and female offspring and resulted in sex-specific effects on offspring development and aggressive behavior. Female offspring born to stressed mothers exhibited higher aggression compared to other females. However, female offspring from mothers exposed to the combined treatment displayed lower aggression levels, while no such effect was observed for male offspring, suggesting that changes in the maternal gut microbiome reduced the impact of prenatal stress in a sex-specific manner.
Grinberg et al. (2022)	Fly	Flies grown on media supplemented with a mixture of antibiotics, specifically tetracycline, rifampicin, and streptomycin (Abx). Levilactobacillus brevis-monocolonized flies, L. plantarum monocolonized flies, or untreated flies (control).	Male flies treated with Abx displayed significantly more aggressive behavior. Additionally, these flies showed elevated levels of cVA and (Z)-9 Tricosene, pheromones linked to aggression in flies, along with higher expression of the associated pheromone receptors and transporters. Supplementation with L. plantarum or L. brevis reduced aggression compared to the Abx-treated flies.
Shor et al. (2022)	Siberian hamster	Hamsters were randomly assigned to four treatment groups: hamsters housed under LD conditions, which received FMT from an SD donor; hamsters housed under SD conditions that received FMT from an LD donor; hamsters housed under LD conditions that received FMT from an LD donor; and hamsters housed under SD conditions that received FMT from an SD donor.	Seasonal variations in the gut microbiome influence seasonal changes in aggressive behavior. FMT from LD hamsters administered to SD hamsters led to a reversal of seasonal aggression, with SD hamsters exhibiting aggression levels characteristic of LD hamsters. Additionally, there were correlations between aggression and various bacterial taxa, such as Muribaculum, Desulfovibrio, and candidatus Saccharibacteria.
Uzan-Yulzari et al. (2024)	Mouse	Comparison of behavior profiles of control, GF, and antibiotic-treated mice, as well as re-colonized GF mice, to understand the impact of the gut microbiome on aggression.	The results showed a connection between gut microbiome depletion and enhanced aggressive behavior, accompanied by substantial changes in urine metabolite profiles and brain gene expression. FMT from infants exposed to antibiotics (ciprofloxacin, metronidazole, and vancomycin) in early life (and sampled one month later) into mice resulted in increased aggressive behavior in comparison to mice that received FMT from unexposed infants.
Voulgari-Kokota et al. (2024)	Mouse	To investigate if the mice’s microbiomes would change as a consequence of the developed coping strategy, fecal samples were collected before and after an RI test.	The relative abundances of Ruminococcaceae UCG-5 and the Gram-negative bacterium cTPY-13 in rats sampled prior to the RI test showed a negative correlation with aggression. Following the RI test, various bacterial taxa were linked to distinct coping strategies, with Clostridium sensu stricto 1 being strongly associated with less aggressive rats and higher abundances of Bifidobacterium. Additionally, the Lachnospiraceae family was not only correlated with increased aggression but also identified as the main contributor of betaine reductase, an enzyme responsible for catalyzing betaine production, which was found to be elevated in more aggressive rats. Given that betaine is associated with higher energy levels and testosterone production, this could provide a mechanistic explanation for the connection between Lachnospiraceae and aggression.

LD: long-day; SD: short-day; GF: germ-free; Ex-GF: ex-germ-free; FMT: fecal microbiota transplantation, RI: resident–intruder.

shows several animal models pertaining to the relationship between aggressive behavior and the gut microbiome.

Gut microorganisms are capable of producing neurotransmitters, including GABA, dopamine, serotonin, norepinephrine, and acetylcholine (Borrego-Ruiz & Borrego, 2024b; Lynch & Hsiao, 2023; Miri et al., 2023). The gut microbiome modulates several neurological processes via neurotransmitters, microbial metabolites, and cytokines (Borrego-Ruiz & Borrego, 2024b). Importantly, there is considerable overlap between the neurochemicals produced by the brain that regulate the gut microbiome and those implicated in aggression and antisocial behavior (de Almeida et al., 2015; Sylvia & Demas, 2018). This underscores the potential influence of the gut microbiome on aggressive behavior, as neurochemicals shared between the gut and brain regulate both communication pathways. In addition, a recent study indicated that participation in video-gaming activities can influence gut microbiome composition (Kulecka et al., 2023). The findings from this study suggest that while physical activity significantly alters the gut microbiota, the effects of esports participation are not as pronounced as those seen in athletes, despite some differences in bacterial species. This raises the question of whether similar alterations in gut microbiome composition could occur as a result of engaging in VVGs, potentially mirroring the physiological responses observed in violent real-world activities. Although no direct evidence currently supports this hypothesis, the potential for VVG-induced aggression to modulate the gut microbiome remains an area for further investigation.

5. Influence of VVG Exposure on Adolescent Aggressive Behavior

The relationship between VVGs and aggression has been explored from different perspectives, with mixed results, suggesting that such a relationship is likely influenced by individual and contextual factors, especially during early adolescence (Coyne & Stockdale, 2021; Jiménez-Toribio, 2019; Ritchie et al., 2024; Staude-Müller, 2011; von Salisch, 2020). In this regard, numerous studies have concluded that exposure to VVGs can lead to desensitization to real-world violence, decrease empathy, increase the likelihood of aggressive behavior, and reduce prosocial responses (Anderson & Bushman, 2001; Anderson et al., 2008b; Brockmyer, 2022; de Medeiros et al., 2020; Etxeberria Balerdi, 2011; Funk, 2005; Gentile & Stone, 2005; Orozco-Marín et al., 2024; Vera-Santana et al., 2021; Willoughby et al., 2012), in part due to cognitive and personality changes (Bartholow et al., 2005). Individual differences, particularly trait aggressiveness and levels of empathy, appear to significantly influence the attractiveness and use of VVGs among adolescents; furthermore, lower educational attainment may be associated with greater appreciation of and time spent playing both violent and nonviolent games (Engelhardt et al., 2011; Lemmens et al., 2006). In turn, other personality traits, such as narcissism, which has been linked to verbal and physical aggression, as well as lower self-esteem, which has been associated with increased hostility, also seem to influence the extent to which individuals are attracted to and engage in VVGs (Olejarnik & Romano, 2023). Addo et al. (2021) found that VVG exposure increased aggression and decreased empathy in young adults, with adverse environmental factors reinforcing this relationship. Greitemeyer (2022) stated that VVGs increase aggression and decrease prosocial behavior, while prosocial games have the opposite effect, with cognitive and emotional factors mediating these effects and possibly also influencing the player’s social network. Zhao et al. (2021) reported that VVG exposure is positively related to both proactive and reactive aggression in children and adolescents, with anger and moral disengagement mediating both types of aggression, while cognitive impulsivity mediates only reactive aggression. Moreover, long-term VVG exposure was associated with increased dehumanization of others, which in turn mediated the relationship between VVGs and aggressive behavior, suggesting that the effect of VVGs on aggression may operate through the perception of others as less human (Jiang et al., 2022). In addition, low trait agreeableness and having deviant peers have been shown to be predictors of aggression in the context of VVG exposure (Chen et al., 2022; López-Fernández et al., 2021). However, Verheijen et al. (2021) found that while adolescents tend to form friendships based on similar levels of aggression and VVG exposure, peer influence does not increase aggression through friends’ VVG exposure. On the other hand, it has been reported that once family and social factors were controlled for, the relationship between VVG playing and aggression among adolescents diminished or became insignificant, suggesting that family background and social influences may be more significant predictors of youth violence than VVG exposure (DeCamp & Ferguson, 2017).

Table 2. Recent studies on the effects of VVGs on aggression among adolescents.

Reference	Participants	Context/Design	Main Findings
Salih et al. (2020)	N = 303 (24.1% female; 75.9% male). Age range: 4–17 years old.	Saudi Arabia. Cross-sectional, quantitative study.	Frequent VVG playing is associated with increased aggression, attention difficulties, hyperactivity, sleep disturbances, and negative impacts on academic performance, with adolescent males being particularly affected.
Cote et al. (2021)	N = 2722 (30.01% female; 69.99% male). Mean age: 14.36 years old.	The United States. Longitudinal, quantitative study.	Parental restrictions on VVG playing were significantly associated with reduced combative behavior among adolescents. Authoritative parenting styles, characterized by warmth and supervision, were linked to lower levels of fighting compared to other styles.
Felemban et al. (2021)	N = 203 (43.8% female; 56.2% male) Age range: 7–12 years old.	Saudi Arabia. Cross-sectional, quantitative study.	A substantial proportion of children showed a preference for VVGs, with many of them exhibiting frustration, aggression, and mood changes, and even considering replicating game actions in real life.
Goldstick et al. (2021)	N = 409 (59.9% female; 40.1% male) Age range: 14–20 years old.	The United States. Cross-sectional, quantitative study.	Significant gender differences were observed in the association between video-gaming frequency and severe aggression, with large positive effects for females and no significant effects for males. This trend was consistent regardless of whether participants preferred VVG genres.
Ruiz-Fernández et al. (2021)	N = 916 (47.3% female; 52.7% male). Mean age: 15.26 years old.	Spain. Cross-sectional, quantitative study.	Exposure to VVGs was related to lower rates of CPV against both parents. However, higher engagement levels, particularly with respect to the “flow” dimension of engagement, were positively correlated with CPV against the mother and father, suggesting that while VVG consumption may reduce CPV overall, increased engagement can offset this effect.
Verheijen et al. (2021)	N = 796 (49% female; 51% male) Mean age: 12.6 years old.	The Netherlands. Longitudinal, quantitative study.	Adolescents formed friendships based on similar aggression levels and VVG exposure, but peer influence did not increase individual aggression. This suggests that concerns over peer-driven VVG exposure leading to aggression may be overstated.
Zhang et al. (2021)	N = 192 (50% female; 50% male). Mean age: 12 years old.	China. Cross-sectional, quantitative study.	Children who actively played a VVG displayed higher levels of aggressive cognition and behavior than those who observed the game. This effect was more pronounced among boys in the violent gameplay condition. Aggressive cognition partially mediated the effect of VVGs on aggressive behaviors.
Zhao et al. (2021)	N = 2095 (48.9% female; 51.1% male). Mean age: 11.12 years old.	China. Cross-sectional, quantitative study.	Anger and moral disengagement are significant mediators in the relationship between VVG exposure and both proactive and reactive aggression, while cognitive impulsivity only mediated reactive aggression.
Akel et al. (2022)	N = 388 (100% male). Age range: 13–17 years old.	Lebanon. Cross-sectional, quantitative study.	Insecure attachment styles were associated with higher engagement in VVGs. Specifically, a dismissive attachment style was linked to less violent gaming, while a fearful attachment style was associated with more violent gaming, which may suggest a potential connection between insecure attachment and aggression-related behaviors.
Ferguson et al. (2022)	N = 305 (66.9% female; 33.1% male). Mean age: 19.32 years old.	The United States. Cross-sectional, quantitative study.	Variations in video game difficulty can increase hostility, while violent content does not affect hostility or aggressive behavior. These results partially support frustration theory but challenge the idea that VVG content leads to increased aggression.
van Heyst et al. (2022)	N = 58 (50% female; 50% male). Mean age: 25.88 years old.	Australia. Cross-sectional, quantitative study.	Playing a VVG increased visual attention towards weapons, with notable sex differences emerging, indicating that men may be more susceptible to the cognitive-behavioral effects of VVGs. Both genders showed decreased attention to non-weapon items after playing the VVG, suggesting that violent gaming may alter visual search dynamics.
Ybarra et al. (2022)	N = 1586 (50% female; 50% male). Age range: 10–15 years old.	The United States. Longitudinal, quantitative study.	Higher exposure to violent media in youth, especially in video games, music, and television, was associated with an increased risk of serious violent behavior in adolescence and adulthood.
Miedzobrodzka et al. (2023)	N = 56 (100% male). Age range: 12–16 years old.	The Netherlands. Cross sectional, quantitative study.	Habitual exposure to VVGs did not significantly affect the empathy of adolescents with respect to pain. While violent gameplay temporarily decreased empathetic responses, a strong pain response persisted afterward, which suggests that diminished empathy could be linked to increased aggression.
X. Deng et al. (2024)	N = 9214 (54.17% female; 45.83% male). Mean age: 15.8 years old.	China. Cross-sectional, quantitative study.	There were significant associations between IGD symptoms and factors such as male gender, gaming frequency, and exposure to VVGs. Those in the high-levels-of-gaming group displayed the most severe IGD symptoms, alongside heightened psychological distress and aggression, while casual gamers reported fewer psychological issues. Furthermore, younger age and severe IGD symptoms were associated with increased aggression.
Lacko et al. (2024)	N = 3010 (49% female; 51% male). Age range: 11–18 years old.	Czech Republic. Longitudinal, quantitative study.	There was a positive correlation between VVG exposure and levels of cognitive empathy, verbal aggression, and physical aggression among adolescents, with boys showing higher exposure than girls. However, within-person analyses revealed that increased VVG exposure did not change aggression or empathy levels. Instead, adolescents with rising affective empathy tended to reduce their exposure, while those with increased physical aggression consumed more VVGs.
Wagener et al. (2024)	N = 54 (100% male). Mean age: 24.48 years old.	Luxembourg and Germany. Cross-sectional, quantitative study.	In the VVG condition, participants showed a significant decrease in cortisol levels over time, with higher Machiavellianism scores correlating with a stronger decrease. Conversely, in the non-violent condition, higher Machiavellianism was associated with increased cortisol levels. No significant effects on implicit aggressive cognition were observed, indicating that VVG exposure does not necessarily lead to increased aggression.

VVGs: violent video games. CPV: child-to-parent-violence. IGD: internet-gaming disorder.

shows the findings of several studies on the relationship between VVG exposure and aggressive behavior in young populations.

AlHazzaa et al. (2023), through a systematic review, highlighted a significant association between VVG exposure and aggression among children and adolescents, particularly for early adolescents and males, with longer playing time associated with increased aggressive behavior. Jahic et al. (2021) found that VVG playing was a consistent risk factor for aggression, particularly among adjudicated youth with psychopathic traits. Chen et al. (2023) reported that justifying violence in video games leads to increased aggressive behavior, suggesting that VVGs with justified violence may be more related to aggression than those with unjustified violence. Furthermore, an experimental study conducted by Zhang et al. (2021) found that actively playing VVGs, as opposed to passively watching them, increased aggressive cognition and behaviors in children, with boys showing higher levels of aggression than girls when playing VVGs. Exelmans et al. (2015) reported that VVGs made a significant contribution to delinquent behavior in adolescents over and above that of multiple risk variables, such as peer delinquency, sensation seeking, prior victimization, and alienation. X. Deng et al. (2024) found that Chinese adolescents with severe internet-gaming disorder (IGD) symptoms exhibited higher levels of aggression, with male gender, younger age, psychological distress, and VVG exposure identified as key predictors of increased aggressive behavior. This was partially confirmed by the results of the study by S. Li et al. (2023), which found a moderate relationship between IGD and aggression, with the findings indicating that individuals with higher IGD levels tend to exhibit more aggressive behavior. Furthermore, Lee et al. (2021) examined the effects of VVGs on aggression using two different statistical methods: one method showed that heavy players experienced a decrease in both verbal and physical aggression after playing VVGs, suggesting that such games may help relieve aggressive feelings (known as the catharsis hypothesis); in contrast, the other method showed that heavy players exhibited increased aggression after playing VVGs, supporting the idea that these games may stimulate aggressive behavior (known as the stimulation hypothesis). Moreover, Y. Li (2022) found that exposure to VVGs was positively associated with cyber-aggressive behavior among college students, with anger moderating this relationship and attitudes toward violence acting as a partial mediator. In turn, Zheng et al. (2021) found that playing online VVGs significantly predicted online aggressive behavior, with anger rumination partially mediating this relationship and self-control moderating the effect of anger rumination on online aggressive behavior.

5.1. Social Dynamics and Mental Health

Digital media can act as a powerful socializing agent that may shape behavior in ways that may contribute to the onset of violence in young populations. Adolescents play video games as a social leisure activity, but it is unclear whether peer influence plays a role in VVG dissemination and the spread of aggression (Chen et al., 2022; López-Fernández et al., 2021; Verheijen et al., 2021). Habitual VVG players often believe that these games reduce aggression by improving their mood, but while their mood improves after playing, aggression levels do not decrease, suggesting that players misinterpret mood elevation as a cathartic reduction in aggressive feelings (Kersten & Greitemeyer, 2022).

A critical issue regarding adolescents’ exposure to VVGs is the potential impact on the dynamics related to bullying, a phenomenon consisting of intentional and malicious behaviors that persist over time and involve an imbalance of power between the aggressor and the victim (Olweus, 1993). Several studies have identified playing VVGs as a key risk factor for bullying perpetration and victimization among young populations (Castro-Sánchez et al., 2020; Chacón-Cuberos et al., 2018; Da et al., 2023; Hogan & Strasburger, 2020; Rojas-Jiménez & Castro-Sánchez, 2020; Xie et al., 2023). Lam et al. (2013) reported that adolescents who experienced cyberbullying and victimization were twice as likely to have played VVGs, while those who admitted to bullying others were nearly four times as likely to have engaged in these games. More recently, Wang and Zhou (2023) reported that VVG exposure was significantly associated with cyberbullying perpetration, with moral disengagement playing a mediating role especially for adolescents who had higher levels of callous/unemotional traits. Furthermore, Richard et al. (2021) found that different forms of bullying victimization were linked to problematic video gaming (excessive or compulsive gaming), with mental health problems playing a mediating role in this case. Specifically, victims of verbal bullying were more likely to develop problematic gaming habits due to both internalizing problems (such as anxiety and depression) and externalizing problems (like aggression). For victims of physical bullying, problematic gaming was primarily linked to externalizing behaviors, while victims of cyberbullying tended to develop gaming problems through internalizing symptoms. Therefore, it is plausible to hypothesize that bullying contributes to mental health issues, which in turn may lead victims to engage in problematic video gaming as a coping mechanism. Additionally, excessive video gaming, particularly VVGs, may further exacerbate existing mental health disorders and potentially trigger aggressive behaviors, creating a negative feedback loop that could lead to increasingly severe consequences. In fact, bullying victimization and the intense emotions that it elicits in victims, such as humiliation, have been linked to profoundly alarming outcomes, including mass violence and suicide (Borrego-Ruiz & Fernández, 2024), and playing VVGs has been related to carrying weapons to school (Ybarra et al., 2014), which could significantly aggravate the consequences of a violent outburst by a student. Regarding this, Zhai et al. (2020) revealed that adolescents at risk for problematic gaming reported higher levels of weapon carrying, weapon threats, feeling unsafe at school, and serious fights resulting in injury, and these authors also linked longer gaming time to increased weapon carrying and feelings of insecurity, with sensation-seeking behaviors moderating these associations. Thus, these dynamics suggest that the immersive escape offered by video games may initially seem like a refuge but ultimately can contribute to a more profound detachment from reality. Consequently, it can be argued that the emotional distress resulting from bullying, combined with the compulsive nature of problematic gaming, may escalate into an issue with tragic repercussions for both the individual and society.

Recently, the COVID-19 pandemic has profoundly impacted not only certain vulnerable populations in several dimensions of health (Borrego-Ruiz, 2024a) but also significantly changed the habits of younger age groups. The necessary closures and social-distancing measures have forced many adolescents to adapt to new routines, leading to a dramatic shift in their leisure activities. With limited access to outdoor spaces and opportunities for in-person social interactions, video games became a popular form of entertainment and social engagement among youth (Davis et al., 2023). In fact, the COVID-19 pandemic significantly increased the prevalence rates of playing video games, including VVGs (Penzkofer et al., 2024). This reliance on gaming not only provided a means of passing time but also served as a virtual network for maintaining social relationships during a period of isolation as well as a coping mechanism for alleviating stress, anxiety, depression, and loneliness. However, at-risk youth populations, particularly males, experienced detrimental effects deriving from this habit (Pallavicini et al., 2022). Conversely, the study conducted by Cosquer et al. (2024), which took place after the pandemic, revealed that while VVG use was linked to poorer mental health outcomes overall, gender differences were also evident, with the effects being more pronounced for females. Specifically, among boys, there was no significant association between video game type and mental health, except for a higher percentage of self-harm behaviors in VVG players. In contrast, girls who played VVGs exhibited significantly worse mental health across multiple indicators, including higher rates of suicide attempts, depression, self-harm, and risky behaviors. This could indicate that, during the COVID-19 period, the impact of VVG use on mental health may have varied between genders, possibly due to differential effects related to factors such as excessive video game playing, reduced opportunities for social interaction, or the influence of the pandemic itself. In this regard, there appears to be a trend suggesting that playing VVGs is associated with negative health outcomes among children and adolescents, including increased depressive symptoms, problematic internet behaviors, poor sleep, avoidant tendencies, a greater risk of gaming addiction, and an increased risk of suicidal ideation (Charmaraman et al., 2020; Förtsch et al., 2021; Hou et al., 2022; Nelson et al., 2016; Tortolero et al., 2014). In addition, playing VVGs was also associated with bullying victimization and perpetration both before and during the COVID-19 pandemic (Da et al., 2023; Xie et al., 2023). Thus, the current increase in video game consumption raises important concerns about potential effects on mental health, social behavior, and attitudes toward violence, particularly regarding potential desensitization when VVGs are involved. This underscores the pivotal role that strategies aimed at breaking this negative cycle could play, such as promoting healthier gaming habits, increasing family supervision and social support, and enhancing awareness of the potential risks associated with excessive play.

5.2. Contradictory Evidence on VVGs and Aggression

Exposure to VVGs has been extensively linked to an increased likelihood of engaging in maladaptive social behaviors, potentially due to changes in the perception of and response to distressing stimuli (Ritchie et al., 2024). Specifically, exposure to VVGs may be a potential risk factor for increased aggressive behavior, aggressive cognition, and aggressive affect, as well as decreased empathy and prosocial behavior, supporting the predictions of social-cognitive models across different research designs (Anderson et al., 2017). Despite these associations, findings from both behavioral assessments and neuroimaging studies suggest that VVG exposure does not necessarily lead to alterations in empathy-related brain activity or modifications in behavioral evaluations, contrary to what might be expected based on the nature of the content (Ritchie et al., 2024).

In contrast to several findings positively correlating VVGs with aggression, the study conducted by Goodson et al. (2021) found no evidence of neural desensitization to violent stimuli among video game players, challenging the hypothesis that VVGs lead to reduced neural responses to violence. Ferguson et al. (2022) reported that while greater difficulty in video games can increase hostility, violent content does not significantly affect aggression, providing partial support for frustration theory but not for theories regarding the effects of violent content. Cunningham et al. (2016) found no evidence that the sale of VVGs leads to an increase in violent crime, potentially challenging the assumption that VVGs cause violent behavior. Lengersdorff et al. (2023) reported no evidence that short-term exposure to VVGs decreases empathy or desensitizes players to real-life violence, suggesting that the effects of VVGs may vary depending on ecological validity and the characteristics of the player population, warranting further investigation in different contexts and among vulnerable groups. Moreover, Kühn et al. (2019) reported no significant negative effects of long-term exposure to VVGs on aggression, prosocial behavior, impulsivity, or mental health, suggesting the need for a more realistic scientific perspective on the impact of violent games. Through an analysis of 101 studies, Ferguson (2015) showed that video games, whether violent or not, have minimal effects on increasing aggression or decreasing prosocial behavior among children and adolescents. Years later, this author reported that VVGs have minimal effects on aggression and violence in youth and that recent pre-registered studies have largely yielded null results, highlighting the need to revise professional guild policy statements to reflect these findings (Ferguson, 2020). In addition, Ferguson et al. (2020) reviewed the APA’s findings regarding a task force technical report on VVGs and found that this technical report revealed negligible relationships between VVGs and both aggressive and prosocial behaviors. In this regard, minor relationships with aggressive affect and cognition were observed, while stronger relationships with desensitization were found, suggesting that previously reported effect sizes may be inflated due to sub-optimal practices and researcher expectancy effects, particularly in experimental studies. The authors concluded that the evidence calls for a more cautious interpretation of the effects of VVGs on aggression than that provided in the APA technical report and resolution statement. On the other hand, one possible explanation for these contradictory findings is the failure to account for confounding variables, such as video game performance and prior gaming experience. A recent study showed that players with higher performance levels and greater experience tend to report lower levels of hostility, reduced negative affect, and enhanced positive affect, with experience exerting an indirect effect on hostility via improved performance (Ewell et al., 2025). Consequently, future research could benefit from examining the phenomenology of gameplay when assessing the risks and benefits associated with this activity.

Nevertheless, in the context of this question, Hilgard et al. (2017) also note the presence of significant publication bias in experimental studies of VVGs, suggesting that the effects on aggressive behavior and affect are much smaller than reported. In fact, outcome-reporting bias (ORB) occurs when researchers selectively report outcomes based on their statistical significance, often leading to inflated effect size estimates in meta-analyses. This bias is prevalent in studies of VVGs, where only significant findings, such as the association between VVGs and aggression, are highlighted. To address ORB, the CORB method was proposed, which incorporates an estimate of variability in effect sizes as a moderator in a meta-regression model (van Aert & Wicherts, 2024). This approach may lead to more precise effect-size estimates and thus a clearer understanding of the impact of VVGs on behavior. Therefore, it is worth emphasizing the importance of accounting for bias in research, which suggests that the effects of VVGs may have been overestimated in several studies. Furthermore, the aforementioned discrepant results highlight the complexity of understanding the effects of VVGs on cognition and behavior. For this reason, it is essential for public policies and parental guidance to be informed by a comprehensive understanding of the available research rather than relying on oversimplified assumptions. A more reflective approach could involve re-examining existing guidelines and fostering public debates that consider the diversity of individual responses to VVG exposure, the role of environmental factors, and the need for targeted interventions for vulnerable populations.

6. Discussion

In order to provide a current perspective on the mechanisms through which violent gaming experiences may influence aggression in young populations, this review has focused on examining the relationship between exposure to VVGs among adolescents and aggressive behavior, grounded in an integrative analysis of empirical studies and comprehensive articles on the topic, theoretical frameworks, novel perspectives, and research addressing the biological determinants of aggression. Following our examination of the literature, various key points deserve to be highlighted: (i) VVG exposure may promote moral disengagement and reinforce aggressive behavior through rewarding violent actions, potentially leading to real-life aggression (Anderson et al., 2010; Bushman, 2019; Huesmann, 2007, 2010; Teng et al., 2019); (ii) exposure to VVGs increases aggression by elevating cortisol levels, activating the sympathetic nervous system, stimulating the brain’s reward system, and disrupting neurotransmitter balance, while excessive VVG use leads to brain structural changes associated with greater aggressive behavior (Anderson & Bushman, 2018; Gentile et al., 2017; Klasen et al., 2020; Lai et al., 2019; Mitroshina et al., 2023; Mohammadi et al., 2020; Popova et al., 2022; Švob Štrac et al., 2016); (iii) dysbiosis of the gut microbiome has been linked to increased aggression in animal models possibly due to alterations in neurotransmitter production (Bana & Cabreiro, 2019; Cusick et al., 2022; de Almeida et al., 2015; Grinberg et al., 2022; Jia et al., 2021; Kirchoff et al., 2019; Leclercq et al., 2017; Mondo et al., 2020; Ren et al., 2020; Shor et al., 2022; Sylvia et al., 2017; Uzan-Yulzari et al., 2024; Voulgari-Kokota et al., 2024; Watanabe et al., 2021), highlighting the emerging role of gut–brain interactions in the regulation of aggressive behavior in response to environmental stimuli, such as exposure to VVGs; (iv) the relationship between VVGs and aggression in adolescents has been widely explored, with studies generally indicating that VVG exposure can lead to desensitization to violence, reduced empathy, and diminished prosocial behavior (Anderson et al., 2008b; Coyne & Stockdale, 2021; de Medeiros et al., 2020; Etxeberria Balerdi, 2011; Funk, 2005; Gentile & Stone, 2005; Jiménez-Toribio, 2019; Ritchie et al., 2024; Staude-Müller, 2011; Vera-Santana et al., 2021; von Salisch, 2020; Willoughby et al., 2012); (v) VVGs have been linked to both bullying perpetration and victimization dynamics among adolescents, contributing to mental health issues, which in turn exacerbate problematic gaming behaviors (Castro-Sánchez et al., 2020; Chacón-Cuberos et al., 2018; Da et al., 2023; Hogan & Strasburger, 2020; Richard et al., 2021; Rojas-Jiménez & Castro-Sánchez, 2020; Xie et al., 2023); and (vi) many doubts remain about the strength of the positive relationship between VVGs and aggressive behavior among adolescents (Cunningham et al., 2016; Ewell et al., 2025; Ferguson, 2020; Ferguson et al., 2020, 2022; Goodson et al., 2021; Hilgard et al., 2017; Lengersdorff et al., 2023; Ritchie et al., 2024).

Although the general trend indicates that VVG exposure promotes aggressive behaviors, and even though it has been concluded that it seems very convincing that violent media on screen is a key risk factor for greater aggression (Anderson et al., 2017), there are significant discrepancies that highlight the need for a more critical and balanced approach when analyzing the relationship between VVGs and aggression, taking into account the methodological limitations and potential biases reported in the existing literature (Ferguson, 2015, 2020; Hilgard et al., 2017). Through this review, several limitations have been identified in the studies analyzed, which highlight the need for caution when interpreting their findings. Although many of the reviewed studies suggest an association between VVG use and increases in several violence-related outcomes, such as aggressive behavior, aggressive affect, aggressive cognitions, and a decrease in prosocial behavior, empathy, and moral engagement, the limitations detected can be synthesized as follows: (i) the majority of the studies employed a cross-sectional design, limiting the ability to infer causal relationships between VVG use and aggressive responses; (ii) methodological concerns were common, including issues concerning study design, scale validation, reliance on self-reported data, a limited selection of video games, and weaknesses in statistical analysis; (iii) many studies had very small sample sizes, reducing the reliability of their results and conclusions; (iv) while the effects of VVG use have been studied for children over 10 years old, adolescents, and young adults, research on children under 10 years old remains limited; (v) gender differences in the association between VVG use and aggression have not been adequately explored; (vi) samples often fail to represent the diversity of current population demographics; (vii) moderators such as ethnicity, socioeconomic status, and culture have been insufficiently examined; (viii) many risk factors and violence sources for increased aggression and reduced prosocial behavior were not accounted for in the reviewed studies; and (ix) the long duration of follow-ups in some studies introduced the possibility of unmeasured factors influencing within-person associations.

Taking into account the aforementioned shortcomings and limitations, several recommendations may be proposed, such as (i) disseminating the main conclusions of robust studies, mainly those with a transnational, exploratory, and longitudinal design, to adolescents, parents, teachers, judges, and other professionals working with young populations in schools and communities; (ii) examining the nature of the association between VVG use and negative outcomes separately for males and females; (iii) considering the influence of other risk factors for aggressive outcomes; (iv) conducting longitudinal studies to establish the relationship between the degree of exposure to VVGs and negative outcomes while also considering the persistence of these outcomes over time; (v) analyzing the relationship between aggressive outcomes and the characteristics of a game, including the type and degree of violence, as well as the player’s perception of the game; (vi) studying the role of competition and cooperative gaming in mediating the negative effects associated with VVG use; (vii) developing and implementing interventions to educate children, adolescents, and families about the effects of VVG use; (viii) requiring the video game industry to clearly and accurately label game content so that parents are fully informed before purchasing; (ix) encouraging parents to educate themselves about video game ratings; and (x) urging governments to create their own rating systems and agencies, requiring all entertainment media products to be rated by a government department prior to distribution and sale.

Synthesizing and analyzing the findings and discussion in this review also allow for the identification and more extensive discussion of several important considerations that are often overlooked in the current discourse on VVGs and their impact on adolescent aggression. For instance, the definitions of violence and aggression may vary across geographical contexts (affecting the conceptualization of what constitutes a VVG), as these behaviors are socially constructed and influenced by cultural norms. In collectivistic societies, behaviors such as social exclusion or discrimination may be perceived as more socially normative forms of aggression compared to individualistic societies, where physical aggression is more stigmatized. This cultural variation can be a significant challenge when attempting to generalize research findings at a broad level. Future studies could adopt a cross-cultural comparative approach, incorporating diverse geographic and sociocultural perspectives to better understand how VVGs influence aggression in various contexts. Furthermore, employing standardized and universally accepted definitions of aggression in research can help reduce this variability and increase the comparability of results. Additionally, it is crucial to consider the sociocultural level within the same geographical context, as varying subgroups with different socio-cultural backgrounds may experience the effects of VVG exposure differently.

The widely generalized trend, both within and outside the scientific community, of suggesting that VVGs have a significant impact on adolescent aggression can generate bias and influence the study designs and the interpretations made by the researchers, potentially causing them to either overestimate or underestimate the effects of VVGs. Such biases may arise from the historical stigmatization of video games, which were long perceived as detrimental to social and cognitive development. While this view is not necessarily erroneous, it reflects the lasting influence of negative stereotypes associated with gaming. On the other hand, those advocating for the harmlessness of VVGs may also exhibit confirmation bias, reinforcing their beliefs by downplaying any negative consequences. To address these biases, researchers should maintain methodological rigor by adopting more balanced research designs that acknowledge the complexity of the issue and consider both the potential harm and benefits of VVGs. In addition, an increased focus on longitudinal studies could provide deeper insights into the long-term effects of video game exposure and mitigate the influence of short-term, context-specific factors.

Some frameworks operate under the assumption that VVG exposure directly leads to violent behavior. However, this approach fails to account for the broader social and psychological contexts that might influence an individual’s propensity for aggression. Adolescents may turn to VVGs as a coping mechanism to escape from other life stressors, such as family problems, academic pressure, or peer conflict, which could predispose them to heightened aggression. These underlying factors are often overlooked in research, which primarily focuses on the direct effects of game content on cognition or behavior. In this respect, it could be beneficial to incorporate additional variables, such as social environment, family dynamics, and mental health. On the other hand, the effects of VVGs on aggression may not be as straightforward as previously assumed. It can be stated that the frequency of play constitutes a predictor of aggression, implying that performance and experience should be considered crucial factors when investigating the behavioral consequences of VVG exposure. Therefore, researchers should adopt a more holistic approach by examining the phenomenology of gameplay, considering not only the content of a game but also the players’ skill levels, engagement, and prior experience.

Another crucial factor that has not been sufficiently addressed in the existing research is the role of developmental trajectories, particularly the differences in the psychological and emotional development of adolescents compared to children, young adults, or even varying stages within adolescence itself. Adolescence is characterized by significant cognitive, emotional, and social changes, which can influence how individuals respond to external stimuli, such as VVGs. The impacts of VVGs on aggression may differ across developmental stages and, even within the adolescent population, may be further influenced by factors such as maturity level. Research comparing younger adolescents with older adolescents or young adults could offer important insights into how aggression, emotional regulation, and susceptibility to external stimuli evolve over time. Furthermore, studies should explore how the maturation of cognitive and emotional processing, such as the development of empathy, moral reasoning, and impulse control, may mitigate or exacerbate the potential effects of VVG exposure. The integration of developmental theories into this area of research would allow for a more precise understanding of the ways in which VVGs interact with key developmental factors. Longitudinal studies, tracking participants across different age groups and stages of development, would offer valuable contributions to this line of inquiry, providing insights into how the effects of VVGs on aggression and behavior change as individuals mature.

The effects of video game content, genre, and context have not been sufficiently accounted for in many studies on VVGs and aggression, yet these variables are essential in shaping the potential impact of gameplay. The genre and content of a game (whether it is violent or non-violent, and which kind of violence) can have varying effects on emotional and behavioral outcomes. For example, a violent game that involves realistic simulations of aggression may have a different impact on players than a more abstract representation of violence. Moreover, the context in which gaming occurs, such as social or solitary, could further influence the outcomes. Playing in a social setting may moderate the effects of VVG exposure by fostering social interaction and providing emotional support, whereas solitary play could increase feelings of isolation or reinforce negative emotions. Furthermore, the role of environmental and social factors, including family dynamics, peer relationships, and broader societal influences, should be incorporated into future research. For example, adolescents from high-stress environments or those with limited social support may be more vulnerable to the negative effects of VVGs than those in more supportive, stable settings. The interaction between game content, context, and social environment requires a more thorough examination, as these factors may act as moderators or mediators of the relationship between VVG exposure and aggression.

Despite widespread criticism and the growing body of evidence linking VVGs to aggressive behavior, adolescents continue to engage with these games, which seems paradoxical given the potential risks. This ongoing consumption suggests a disconnect between the awareness of the negative impact of VVGs and their actual regulation. In this context, the role of families in monitoring and regulating adolescent gaming activities becomes pivotal. Parents play an indispensable role in shaping their children’s media consumption habits, because it is possible that many parents fail to exert adequate control over the time and content of the video games their children engage in. One key reason for this issue can be the lack of awareness or understanding among parents regarding the potential risks of VVG exposure. Many of them may not fully appreciate how these games could influence their children’s behavior, or they may underestimate the impact of excessive exposure on mental health and social functioning. Moreover, the appeal and ubiquity of VVGs make it challenging for parents to intervene effectively. The digital nature of gaming allows for easy access and the opportunity to play VVGs without direct supervision, an issue further exacerbated by the prevalence of online gaming and peer influence. To address this issue, it is essential to raise awareness among parents about the potential risks of VVGs. Educational campaigns and resources could be developed to help parents understand the psychological, emotional, and behavioral consequences of excessive gaming. Additionally, promoting strategies for effective monitoring, such as setting clear rules about screen time, restricting access to violent content, and encouraging open discussions about the games their children are playing, could help parents play a more active role. It may also be beneficial to integrate or optimize parental control systems into gaming consoles and online platforms that allow for better oversight and regulation of the types of games adolescents can access. Moreover, as adolescents tend to seek autonomy, parental control should be balanced with providing alternative, non-violent entertainment options that align with their adolescent’s interests. Finally, raising awareness in schools and communities about the importance of parental involvement in digital media consumption could foster a more proactive approach to addressing the potential risks posed by VVGs.

Another critical issue related to the continued consumption of VVGs by adolescents is the efficacy of the current rating systems and the responsibility of stakeholders in the gaming industry. Despite age classifications and explicit content warnings, many teenagers gain access to VVGs, raising important concerns. Age ratings, such as those provided by the Entertainment Software Rating Board (ESRB) and Pan European Game Information (PEGI) systems, are intended to prevent younger audiences from accessing games that may not be appropriate for their developmental stage. However, these labels seem to fail to prevent the playing of VVGs by adolescents. One reason for this can be the lack of enforcement at the point of sale. Many retailers do not adequately monitor or enforce age restrictions, sometimes selling VVGs to minors, either due to insufficient staff training, a lack of awareness of the potential risks, or complete indifference. In addition, the rise of online platforms has complicated the enforcement of these restrictions, with adolescents often bypassing age controls by purchasing or downloading games without parental supervision. The issue of ineffective age ratings also extends to the creators and distributors of video games. Game developers, aware of the popularity and profitability of violent content may intentionally create games with adult themes to target a broader audience, including those outside the intended age demographic. While their role in the creation of a game’s content is often justified by market demand, this aspect raises ethical concerns regarding the responsibility of game developers to consider the potential impact of violent content on younger audiences. Distributors and retailers, in turn, share a similar responsibility to ensure that games are sold only to the appropriate age groups, particularly when a game’s content is considered unsuitable for minors. Thus, there is a need for stricter enforcement of age restrictions at points of sale, particularly in physical stores and online platforms. Retailers should implement more robust identity checks to ensure that age ratings are adhered to, and staff should receive regular training on the importance of these regulations. Additionally, parents must be encouraged to become more involved in the purchasing process, whether by setting up parental controls on online gaming platforms or directly supervising purchases. On the side of the game developers, creating content that is designed to be age-appropriate and socially responsible should be prioritized, even if it means rethinking the profitability model based on violent content. Furthermore, gaming rating systems themselves could be updated to include more detailed content descriptions that go beyond violence, addressing the aspects related to the social and psychological impact of VVGs. Finally, regulatory authorities could work closely with retailers and game distributors to enforce the proper implementation of age restrictions, potentially using digital tools and algorithms to prevent the sale of VVGs to minors or appropriately inform their families.

Beyond the topic raised in this review, it is worth mentioning that digital games have the potential to serve as educational tools in addressing complex social issues such as substance use (Monarque et al., 2023; Pasquim et al., 2019). For instance, playing Tetris has been shown to significantly reduce the intensity of craving for substances (e.g., alcohol, nicotine, and caffeine) in real-world settings (Skorka-Brown et al., 2015). Furthermore, other studies show that playing Super Mario games can lead to cognitive benefits (Perrot et al., 2019) and that engaging in esports video games could effectively promote active participation in real sports among adolescents (Ningning & Wenguang, 2023). However, it should be considered that just as video games can be beneficial (Brühl & Sahakian, 2016; Looi et al., 2024), certain aspects that can be critical in influencing youth must also be taken into account, especially in terms of what they learn or gain from their use (Garakani et al., 2021). In particular, the aforementioned issue in relation to drugs is a highly sensitive area since minors are characterized by having great curiosity and a desire to experiment (Borrego-Ruiz, 2024b), which can be intensified by drug-related stimuli in video games (Barrientos-Gutiérrez et al., 2012; Forsyth & McDaniel, 2021). To illustrate this point, the study by Cranwell et al. (2016) found that exposure to popular video games with alcohol and tobacco content was significantly correlated with an increased likelihood of substance use among adolescents, with players being more likely to try smoking or consume alcohol, despite this content not being flagged by the PEGI system. Furthermore, Fahs et al. (2022) found a significant association between higher exposure to VVGs and increased dependence on alcohol and smoking among male adolescents. In turn, the use of certain substances, such as alcohol, has been linked to aggressive behavior in young populations (Crane et al., 2021; Hong et al., 2022; Milgram, 1993), providing an additional influence to consider. Thus, while video games can be powerful educational tools and foster personal development and VVGs or games involving substance use can have a place in entertainment, it is crucial to actively monitor access to these games based on the susceptibility of individuals to their influence. For example, a national survey of psychiatric institutions in the United States revealed inconsistent policies regarding the use of VVGs among patients (Wasser et al., 2020). Accordingly, the lack of standardized guidelines may reflect broader uncertainties in the research on the effects of VVGs, particularly with regard to aggression and emotional regulation. This also highlights the need for clear, evidence-based guidelines that balance the potential risks with the therapeutic benefits of gaming. Therefore, establishing consistent approaches could help mitigate risks while promoting a controlled environment that maximizes the therapeutic potential of video game use. Moreover, addressing the outcomes of VVG exposure, especially among youth, must be a priority, as understanding its underlying mechanisms and developing effective interventions are essential steps for promoting safer environments, healthier interpersonal coexistence, and overall community development for future generations.

The current review has potential limitations that must be appropriately specified. (i) Although a quantitative analysis of the data could offer additional insight into the strength of the findings on the relationship between VVGs and adolescent aggression, the aim of this work was to provide a descriptive synthesis of the existing literature. In this regard, a formal quantitative analysis was not included, but relevant studies employing diverse methodologies have been considered, providing a comprehensive overview of the topic. (ii) The broader scope of this review, which integrates diverse perspectives, may limit the replicability of the findings due to the lack of standardized methodologies commonly found in systematic approaches. (iii) Some key research may have been excluded due to the inclusion criteria or data availability, potentially impacting the comprehensiveness of this review. Additionally, a more extensive search across additional databases could have broadened the scope of the included studies. (iv) This research could have been affected by publication bias, as studies with negative or non-significant results may have been less likely to be published or accessible, limiting the overall view of the topic. (v) The heterogeneity of the studies included in terms of design, sample characteristics, and methodologies may have influenced direct comparisons or associations between them, limiting the interpretation of the results. (vi) While this review includes a variety of studies, not all relevant subgroups were sufficiently explored. This could have affected the applicability and generalizability of the conclusions. (vii) Many of the studies that have been reviewed did not adequately control for potentially confounding factors, which may have significantly impacted the results of the review.

7. Conclusions

Aggression is a behavior that is influenced by both biological and social factors. Neurotransmitters and hormones modulate aggressive responses in animals. However, better understanding their role in human aggression will require the establishment of technological advances, such as next-generation meta-omics analysis and throughput sequencing techniques. Given the limited number of studies examining the relationship between the gut microbiome and aggression, it is challenging to draw definitive conclusions about their connection at this stage. Therefore, as clinical research in this area continues to grow, it will soon be possible to better clarify the extent to which the gut microbiome plays a role in aggression.

The role of digital media, particularly VVGs, in shaping aggressive tendencies among adolescents appears to be somewhat determinant, although there are conflicting results on this topic. While there is evidence suggesting that exposure to VVGs is associated with increased aggression, discrepancies in the literature highlight the need for further research aimed at improving our understanding of this phenomenon. More specifically, and based on the review performed, the studies on this topic reveal significant limitations, including the predominance of cross-sectional designs, methodological shortcomings, small sample sizes, and challenges in generalizing results. Factors such as the developmental stages of the participants, the exclusion of females, and unmeasured variables during long follow-up periods further complicate interpretations. Addressing these issues is essential for a more accurate understanding of the relationship between VVGs and adolescent aggression. In addition, to further clarify this relationship, it is essential to continue research in areas such as the effects of game content and genre, game duration and context, the potential influence of environmental and social factors, and the role of individual differences. Longitudinal studies could provide valuable information on the potential pathways between VVGs and aggressive behavior over time. Examining the effects of social interactions within gaming communities, and their potential to normalize aggression, would further enrich our understanding of how digital media shapes youth behavior. Additionally, several critical aspects must be considered to fully address the relationship between VVG exposure and adolescent aggression, including cultural variables, biases and confounding variables inherent in research, the influence of broader social and psychological factors on aggression, and the different roles of developmental trajectories and gender. Moreover, parental responsibility and the effectiveness of age ratings require closer examination. In this respect, interventions should aim to educate families about the potential impacts of VVG use, while governments and the video game industry must enhance content labeling and implement stricter rating systems to better protect young audiences. In order to effectively address the negative impacts of aggression on interpersonal relationships, future research should aim to examine the influences of violent media and peer dynamics to ensure a balanced assessment of their impact on youth behavior.