Gaming Disorder

The international health community has decided that if you play video games like Fortnite or World of Warcraft a lot, you might suffer from a mental-health issue: Gaming Disorder. It’s a behavioral condition that the World Health Organization has added to the proposed 11th revision of its International Statistical Classification of Diseases and Related Health Problems, or ICD-11, the first update to the classification since 1992.

If you play a lot of chess or Settlers of Catan on a card table in the den, don’t worry, you’re fine—according to WHO, gaming disorder is a digital affliction. If you play obsessively online with other people, to the detriment of other activities, that’s one possible sign of trouble. But playing offline and alone—Candy Crush, say, or even Tetris—is also a potential red flag. Generally speaking, a player would have to game excessively over a year or more for the pathology to apply, and that activity would have to produce profound negative consequences for their social, familial, or work life.

The ICD-11 categorizes gaming disorder as an addictive disorder in the same category as drug abuse. But instead of a substance—a thing one consumes—underlying the addiction, a behavior does—an activity one performs. When the ICD-11 is adopted at the World Health Assembly in May 2019, gaming disorder will join one other behavioral disorder in the classification, gambling disorder.

But wait: Can people truly be addicted to games, like they can to gambling, or to heroin? And even if they can, why is gaming the only official computer-related behavioral addiction? Why not internet or smartphone addiction? Perhaps the issue isn’t that gaming should or shouldn’t be a mental disorder, but that the public is so willing to assume negative behaviors are the result of individual mental defects, rather than more complex social, political, and economic factors.

In the United States, health-care professionals primarily rely on the ICD for its medical definitions, which help clinicians identify and diagnose conditions. ICD codes are used for insurance purposes, making a disease or disorder with a diagnosis code more likely to enjoy coverage for treatment. Though U.S. psychologists and psychiatrists tend to reference the Diagnostic and Statistical Manual of Mental Disorders, or DSM, on mental-health issues, internationally, the ICD’s mental-health diagnostics serve a purpose similar to its medical codes. Should the ICD-11 be adopted, gaming disorder would become coded internationally as an acknowledged mental-health condition, possibly paving the way for better support for its treatment—whether or not that treatment is warranted.

Though the current proposal comes from the WHO, gaming disorder made an earlier appearance as a “condition for further study” in the fifth edition of the DSM, published in 2013. The American Psychiatric Association’s take was called Internet Gaming Disorder. Akin to an addiction to heroin or alcohol, the proposed diagnostic criteria roughly tracked those for substance abuse, such as withdrawal, tolerance, a desire to stop, and negative impact on life activities. Internet Gaming Disorder’s inclusion in the DSM drew concern from gamers, who objected to the implication that their hobby was an intoxicant and therefore an intrinsic danger. Psychologists also worried that comparing gaming to substance abuse amounted to a mixed metaphor, because games don’t provoke physical reactions like tolerance and withdrawal the way narcotics do.

The WHO working group that advanced the ICD-11 version of gaming disorder learned some lessons from their colleagues in the APA. For one, the disorder is expanded to online or offline gaming activities. Diagnosis requires that an individual’s gaming “takes precedence over other life interests and daily activities,” and that, in most cases, it does so for a period of 12 months or more, resulting in “significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.”

The WHO’s take on gaming disorder is more measured than the APA’s, in the sense that it doesn’t necessarily frame gaming as an intrinsically dangerous, addictive activity akin to substance use. And the WHO has taken some pains to make clear that gaming disorder is not meant to be a condition of gamers as such, but a small percentage of players who take the activity to extremes. As a WHO spokesperson put it to me, “WHO is concerned with negative health consequences of gaming activities and not with gaming activities per se.”

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