The World Health Organization’s International Classification of Diseases (ICD) is a medical classification list, containing codes and definitions for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Its 10th revision, ICD-10, began in 1983 and was completed in 1992. The 11th revision is currently being drafted, and recently it included a new disorder that will prove controversial: the gaming disorder. It is classified under disorders due to substance use or addictive behaviors, alongside the gambling disorder. The full definition is as follows.
Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline, manifested by: 1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context); 2) increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and 3) continuation or escalation of gaming despite the occurrence of negative consequences. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern of gaming behaviour may be continuous or episodic and recurrent. The gaming behaviour and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.
Another associated disorder is ‘hazardous gaming,‘ under problems associated with health behaviors, which specifies the detrimental effects that excessive gaming can have on people, both physically and psychologically. In a Q&A in their website, the following clarifications are included:
Why is gaming disorder being included in ICD-11?
A decision on inclusion of gaming disorder in ICD-11 is based on reviews of available evidence and reflects a consensus of experts from different disciplines and geographical regions that were involved in the process of technical consultations undertaken by WHO in the process of ICD-11 development.
The inclusion of gaming disorder in ICD-11 follows the development of treatment programmes for people with health conditions identical to those characteristic of gaming disorder in many parts of the world, and will result in the increased attention of health professionals to the risks of development of this disorder and, accordingly, to relevant prevention and treatment measures.
Should all people who engage in gaming be concerned about developing gaming disorder?
Studies suggest that gaming disorder affects only a small proportion of people who engage in digital- or video-gaming activities. However, people who partake in gaming should be alert to the amount of time they spend on gaming activities, particularly when it is to the exclusion of other daily activities, as well as to any changes in their physical or psychological health and social functioning that could be attributed to their pattern of gaming behaviour.
The inclusion of the disorder in these exact terms seems to be an intentional provocation to spark discussion and controversy that could refine the nomenclature and its definitions further. As it stands right now, there isn’t an established consensus among psychologists behind the classification. On March 2018, a paper authored by 37 psychologists was titled “A weak scientific basis for gaming disorder: Let us err on the side of caution.” Some choice quotations from the paper include:
Much confusion remains – even among authors supporting the diagnosis – regarding what, exactly, gaming disorder is. […] We maintain that the quality of the existing evidence base is low. […] Formalizing a disorder with the intention to improve research quality neglects the wider non-clinical societal context. […] Robust scientific standards are not (yet) employed. […] Moral panic might be influencing formalization and might increase due to it. […] An addiction should be clearly and unambiguously established before formalizing new disorders in disease classification system.
Used as it is to moral panic related to gaming, the games industry prepared a swift response. Several industry bodies across the world drafted a statement, with the Entertainment Software Association leading the united front.
It is extremely important to note that the proposed draft circulating is not final and it is still under discussion and review. Experts worldwide are urging caution regarding the World Health Organization’s proposed ‘gaming disorder’ as it may lead to misdiagnosis of real mental health conditions. There is no objective evidence to define and diagnose this disorder and the research supporting inclusion is highly contested and inconclusive. With the significant opposition from the medical and scientific community, the WHO should consider the mounting evidence put before them before making a decision on the inclusion of a ‘gaming disorder’ in the final version of ICD-11 next year.
We received a comment from David Hanson, Co-CEO of blockchain-based, PC game publishing platform Ultra, where he talks about the diagnosis with some level-headed insight.
Those adversely affected by gaming addiction are in the minority and I hope the WHO’s report that gaming addiction is a mental health disorder doesn’t cause parents to worry needlessly. Doing too much of anything, be it playing video games, watching TV, or even studying is not healthy. It’s all about moderation and striking the right balance. When it comes to gaming, it’s important for parents to allow their children to indulge in their hobby but also implement some screen-free time. Taking the kids to the park, encouraging them to play sport or bringing them to museums or science fairs can help achieve this. From my own personal experience, having lived my childhood behind screens gaming alone and with my friends, I turned my passion for gaming into a career and used it in a productive and positive manner.
Jo Twist, CEO of UKIE, wrote an article for GamesIndustry.biz, with similar conclusions, but also decrying the irresponsible reaction of mainstream media. While there isn’t enough evidence to support a gaming disorder as such, there is definitely a case to be made that an obsessive-compulsive disorder coupled with a gaming habit can lead to extreme fringe cases such as the Chinese player of MOBA Arena of Valor last year, the Russian teen DotA 2 player in 2015, and the Taiwanese Diablo III player in 2012 — all cases of extreme compulsion leading to death by exhaustion. In China, there is now regulation such as time limits and curfews in online gaming. There is also something to be said about exorbitant expenses with loot boxes and microtransactions, which brought on a lot of discussions last year.
Concerns about gaming addiction are nothing new and the discussion is definitely worth having. Unfortunately, to put it all under a blanket term such as ‘gaming disorder’ will just help fuel the usual smear campaigns and stigma of gaming culture that have resurfaced in the past few years. Nothing can be accomplished without reasonable and honest discussion both from the side of gaming culture and from the side of mainstream society.