The video game industry is worth billions of dollars and has enjoyed mainstream attention for years, with both good and bad press. While there are things to debate when it comes to representation in games and ethics in gaming journalism, a more tangible issue has emerged that could directly affect all gamers: the World Health Organization’s recent inclusion of gaming addiction as a mental disorder in the 11th revision of the International Classification of Diseases.
Gaming, like any other activity, can certainly be enjoyed to excess. However, how could WHO categorize gaming addiction in general as a mental disorder when there are so many different subcategories in video games with their own addictive properties including the gambling-like nature of loot boxes? How can we help reassure gamers who are worried about the potential for this revelation being blown out of proportion by the news media?
How did we get to the point where a disorder involving gaming garnered attention by the World Health Organization (WHO)?
According to Shadloo et al. (2017), an increasing number of mental health services have reported people asking for help controlling their gaming. The system is currently unequipped for this in two ways. Firstly, clinicians are unsure what disordered gaming truly looks like. Secondly, there is no clear treatment path for those who feel they are addicted to video games. This means that not only is the mental health system unequipped to help people, but people may be unable to access help if their insurance refuses to cover treatment. I can imagine that it is this set of circumstances that prompted the WHO into action.
How is gaming addiction differentiated from any other form of addiction?
Research continues to show that gaming is a complex behavior, and these complexities may be ignored if it’s treated like any other behavioral addiction. For example, being preoccupied with your addiction (e.g. itching to sit in a dark room and gamble your paycheque on slot machines) is a symptom of addiction. However, in the context of gaming, thinking about going home and playing the hottest new release is perfectly normal. Ignoring factors like this has meant that people have incorrectly been flagged as meeting the criteria for addiction when they don’t experience poor mental health.
We also have to be mindful of gaming as a hobby that is both social and entertaining. Research has found that what would typically be classified as ‘excessive gaming’ is actually a way for lonely teenagers to meet their social needs that are being unfulfilled in school. The entertaining aspect of gaming acts as a good coping/distraction mechanism when life is far from ideal. Research by Weinstein, Przybylski and Murayama (2017) found that excessive gaming was related to feeling incompetent, powerless and feeling like they did not belong. Those who did not feel this way after a follow-up period no longer reported gaming excessively.
Could this disorder be a symptom of some other underlying issue, as the diagnostic criteria does not appear to be clear or present to the average person? Could this lead to misdiagnosis or using gaming disorder as a blanket term for multiple mental issues?
I would speculate that Gaming Disorder will likely coincide with diagnoses of depression and/or anxiety disorders. I understand the skepticism of treating the coping mechanism rather than what needs to be coped with, but recovery can be a difficult process. If someone is forced to go cold turkey from their coping mechanism while also attending therapy to confront deep personal issues or trauma, you can imagine this is going to be a very stressful period. Helping the person while also helping them not play games to a degree that is destroying their lives seems like the best approach for the person. I would think that this is how treatment will go if someone receives another diagnosis alongside Gaming Disorder.
When the ICD-11 goes under the scrutinous eye of different countries, are there some areas of the world where the disorder will see more of an impact than others?
I would think that Asian countries will be paying particular attention to this diagnosis. Some young people in these countries are placed under great parental and societal pressure to succeed in school; after a full day of school, they are expected to attend ‘cram schools’ for further study. These are also countries where internet cafés are prevalent, so a young person may sneak away and play video games to gain some reprieve from their stressful lifestyle. This helps strengthen gaming as both something that is a fun distraction and a coping mechanism. It is my hope that firmer criteria and strict treatment regulation will reduce the prevalence of harmful ‘detox camps’ in these countries.
Do you foresee this classification as being used as more fuel for certain groups within the media (both old and new) to further stigmatize gamers?
It is no secret that some media outlets will do anything to get peoples’ attention, including irresponsibly and incorrectly reporting on mental health. I am definitely unhappy at some of the reporting I’ve seen regarding Gaming Disorder, particularly the BBC. However, the reactionary nature of the internet means that you don’t only get the initial misinformation, but also people’s reactionary rhetoric which is also harmful. On one hand you have people thinking that 20 hours of gaming per week means that you have Gaming Disorder, while on the other you have reactionary rhetoric saying that this is just like homosexuality being a mental health disorder.
I have two recommendations for counteracting this. The first is to please share and discuss rational and educational content on Gaming Disorder to help people learn. The second is to please, please not give in to angry rhetoric before you have read said educational content. The only way we can drown out media sensationalism is to keep ourselves and those around us educated and level-headed.
Was the WHO irresponsible for making this classification without a clear outline of criteria?
I don’t envy the WHO right now as they have been facing backlash over this decision. In fact, [half of their video] (see below) on the mental health section of the ICD-11 was dedicated solely to addressing the inclusion of Gaming Disorder.
I feel that the WHO was caught between a rock and a hard place. To illustrate, the ICD-10 was released in 1992 and wasn’t even implemented in America until 2015. With the ICD-11’s release a few days ago, that gives roughly a 26 year period of testing, implementation and use between iterations of the ICD. Do we wait 26 more years before we begin offering insurance options to people who feel they are unable to control their gaming?
I really wish Gaming Disorder was added to the beta draft of the ICD-11 sooner than September 2016 to allow for proper assessment and validation. However, the current proposed timeline of implementation suggests that the ICD-11 won’t be ready for clinical use until 2022, so we have around 4 years of research to anticipate.
If gaming disorder is covered by health insurance in the near future, is there enough validated information available to health professionals to create effective programs to treat individuals?
I don’t believe that there is enough validated information available to treat Gaming Disorder. There is going to need to be a lot of research on developing a suitable treatment protocol for Gaming Disorder, which we will hopefully get more information on before 2022.
A number of years ago, I worked on a research project auditing psychiatric case notes. One of these cases involved a young person who did not attend school and spent all day playing video games. The clinician recognized that they had Social Anxiety Disorder and aimed to build the young person’s social skills outside of video games. They would be given homework tasks such as having full conversation with online friends on Skype and having lunch outside with a cousin. This young person’s treatment plan was built around treating the person and equipping them with skills that they were using video games to compensate for. I wanted to make this example public to help calm some of the rhetoric that clinicians are evil and just want to take video games away.
As gaming comes in many different forms with several subcategories that can be considered addictive (loot boxes, grinding, competitive play, etc.) could this disorder be one of the most complex to properly diagnose?
It is definitely complex, and this is a criticism of Gaming Disorder that was made in a paper by James and Tunney (2017). While there are some components of gaming addiction that are more typical of gambling addiction (e.g. spending all of your money on loot boxes), this is not the same as someone who spends all day gaming while not engaging in any sort of gambling. I will be keeping an eye on the diagnostic criteria to see if it is changed to acknowledge any of the nuances of gaming.
Do you have any final wisdom for gamers who may be concerned about these latest developments?
I would like to encourage people to share helpful and educational content regarding Gaming Disorder. The media is currently getting a lot of things wrong and it is disheartening to see people spread misinformation and succumb to angry rhetoric. We need to talk and share information, not curse mental health workers.
I would also invite people to have a bit more empathy surrounding the matter. I understand that the media incorrectly reporting on gaming is frustrating, but I have seen people say things like those who are uncontrollably addicted are ‘ruining gaming for the rest of us’. People have lived different lives, have experienced different traumas and have different capacities to cope with life. Please do not take your anger at the media out on suffering human beings or mental health workers who try to help them.
James, R. J., & Tunney, R. J. (2017). The relationship between gaming disorder and addiction requires a behavioral analysis: Commentary on: Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal (Aarseth et al.). Journal of Behavioral Addictions, 6(3), 306-309.
Shadloo, B., Farnam, R., Amin-Esmaeili, M., Hamzehzadeh, M., Rafiemanesh, H., Jobehdar, M. M., … & Rahimi-Movaghar, A. (2017). Inclusion of gaming disorder in the diagnostic classifications and promotion of public health response: Commentary to the “Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal”: A perspective from Iran. Journal of Behavioral Addictions, 6(3), 310-312.
Weinstein, N., Przybylski, A. K., & Murayama, K. (2017). A prospective study of the motivational and health dynamics of Internet Gaming Disorder. PeerJ, 5, e3838.