June 20, 2018 -- The World Health Organization is recognizing “gaming disorder” as a diagnosable condition.
But the organization’s decision to include the new term in the 11th edition of its International Classification of Diseases (ICD), which it released Monday, has sparked controversy among psychiatric experts who question whether there’s enough research to call it a true disorder.
According to the American Psychological Association, an estimated 160 million American adults play video games, but the percentage of people that could qualify for the disorder is extremely small. Players’ ages range from under 18 to over 50, and the male-to-female ratio is almost equal.
The WHO’s official definition of “gaming disorder” includes:
- A pattern of behavior for at least 12 months in which gaming is out of control
- The pattern of behavior must show an “increased priority given to gaming” to the point that gaming “takes precedence over other interests and daily activities.”
- A “continuation or escalation of gaming despite the occurrence of negative consequences,” or behavior that affects one’s relationships, education, or occupation. This could mean that a teenager may play video games instead of doing homework and end up failing a test.
Child and adolescent psychiatrist Victor Fornari, MD, sees many families who struggle to control the amount of time their children spend in front of a screen.
“A family usually has rules about TV time. Here, a child wouldn’t stop, despite the promise of negative consequences,” he says.
Fornari says aggressive games involving teamwork and killing enemies tend to be the most addictive for young people. He also says some games have become so popular that schools around the world are warning parents to monitor their child’s access to them.
Including gaming disorder in the ICD-11 could mean health insurance coverage for people seeking treatment.
“I think the ICD-11 category will give us a chance to learn how to identify and diagnose the disorder. Now that there’s an ICD-11 code, health care providers will be able to ask for reimbursement from health insurance companies,” Fornari says.
People who do seek help right now likely find it difficult. Fornari says that there are few treatment programs around because mental health professionals really don’t know how to treat the disorder yet. Rehab centers and wilderness camps exist, but there is little proof of how well they work, and they are often expensive.
He says it is unclear if gaming disorder will require treatment similar to other mental disorders or addictions.
“You always have to wonder when someone’s behavior is obsessive. It’s possible that someone with obsessive-compulsive disorder would compulsively play the game, but they would likely show other compulsions as well, like checking things, counting things, and washing hands,” Fornari says.
Doubts About Defining the Condition
Some experts are reluctant to include gaming disorder in the ICD.
The Society for Media Psychology and Technology, a division of the American Psychological Association, said in a statement that the “current research base is not sufficient” enough to classify the disorder.
It argues that although video game addiction research has been going on for nearly 30 years, it’s not clear how to define the condition, the symptoms, how common it is, or if it is an independent disorder or a symptom of a pre-existing disorder.
The European Games Developer Federation (EGDF) also criticized the move.
The group said in a statement it was “concerned” by the WHO’s action to include it, “despite significant opposition from the medical and scientific community. The evidence for its inclusion remains highly contested and inconclusive.”
In the U.S., the American Psychological Association has proposed adding gaming disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although it’s not yet an official condition, the association recognizes the following symptoms:
- Heavy focus on Internet gaming
- Withdrawal symptoms when Internet gaming is taken away (sadness, anxiety, irritability)
- Tolerance, the need to spend more time gaming
- Not being able to play less, unsuccessful attempts to quit playing
- Giving up other activities, and loss of interest in activities that were once enjoyed
- Continuing to play despite problems
- Deceiving family members or others about the amount of time spent on Internet gaming
- The use of Internet gaming to relieve negative moods, such as guilt or hopelessness
- Risk, having jeopardized or lost a job or relationship due to Internet gaming
To be diagnosed with gaming disorder, a patient must have at least five of the listed symptoms.
In a 2017 study done in the U.S., United Kingdom, Canada, and Germany, close to 19,000 gamers completed a survey about symptoms of gaming disorder. More than 65% of participants did not report any symptoms of gaming disorder. Only 2.4% of the sample endorsed at least five of the symptoms needed to be diagnosed.
In a commentary on that study, Patrick M. Markey, PhD, a psychology professor at Villanova University, and Christopher J. Ferguson, PhD, department chairman of psychology at Stetson University, questioned gaming disorder as a condition.
“Current data suggest that the proposed Internet gaming disorder category is a poor indicator of actual problems,” they wrote. “Therefore, its use in clinical settings, as presently delineated, may ultimately cause more harm than good.”
They also asked why the DSM-5 singles out gaming disorder as a proposed category, but not other things that could be addictive, including working, exercising, or eating.
“This important study suggests that video game addiction might be a real thing, but it is not the epidemic that some have made it out to be.”
Fornari says the WHO action will bring about research on diagnosed cases that will help doctors understand more about the condition.
“I think any time changes like this occur, an initial period of time will be needed to test it out,” he says. “How often the diagnosis is made and the range of clinical cases, like in any other mental disorder, will have to be studied. When a new disorder is proposed, we need to see if it will survive the test of time.”