When does enjoying video games turn from enthusiasm to addiction?
The World Health Organization (WHO) is taking steps to answer that question by defining “gaming disorder” in its 11th International Classification of Diseases (ICD) this year.
Gaming disorder falls under the umbrella of addictive behaviors by the WHO and is characterized by three major components.
The first is impaired control over gaming. For example, the frequency and duration of time played.
The second is giving increased priority to gaming over other interests and responsibilities.
Finally, the behavior must continue or escalate despite negative consequences, including harm to social, occupational, or family life.
WHO officials say symptoms must be long term — at least 12 months — before the diagnosis of gaming disorder can be given.
“We are talking about a very small proportion of regular gamers who for different reasons, including biological vulnerability, may develop this kind of condition,” Dr. Vladimir Poznyak, coordinator of the WHO Management of Substance Abuse, told Healthline.
“It’s not at all about millions of people who are enjoying video games, so it’s absolutely wrong to equate gaming behavior, even intensive gaming behavior, and gaming disorder. It’s very different,” he said.
Video gaming under microscope
The announcement comes at a curious time for the video game industry as both consumers and governments pay increased attention to its practices.
A major fiasco last year surrounding “loot boxes” — in-game goodies often purchased through micro-transactions — drew the ire of gamers and politicians likened the practice to gambling.
The distinction between traditional gambling and “loot box” systems has come up frequently over the past year. A commission in the United Kingdom determined last year that “loot boxes” didn’t fall under their current gambling laws, but they were “keeping this matter under review and will continue to monitor developments.”
Poznyak agreed that there’s overlap between gambling — which already has a well-established psychological disorder described in the ICD — and gaming.
“They are often interrelated. Often gambling has elements of gaming and gaming has elements of gambling,” he said.
But, at the same time, Poznyak explained that gaming has significant differences as well. It presents its own unique behaviors, rewards, and problems.
That is to say, even if gambling elements such as “loot boxes” were absent from games, the potential for gaming disorder would still persist.
The importance of the classification
The WHO’s classification of gaming disorder is a big move.
It potentially opens up treatment options and services for those experiencing the ailment. It also signals to national and local governments that it’s being considered seriously by a major health organization.
The question of video game addiction has invariably been brought up by parents over the past 30 years.
Although rare, people do die playing video games — often during binges of extended play, sometimes lasting days on end.
In 2015, a Taiwanese man died of cardiac arrest after a three-day gaming session at an internet cafe.
Last February, a popular American video game streamer died while attempting a 24-hour livestream of the game “World of Tanks.”
Sensational incidents like these may or may not be indicative of video game addiction or gaming disorder, but they have nonetheless raised the profile of gaming as a risky activity when undertaken for prolonged periods of time.
In 2013, the American Psychiatric Association (APA) classified “internet gaming disorder” in their DSM-5 as a “condition for further study.” Such a classification means that the disorder isn’t officially recognized by the APA but does warrant more research.
“At that time it was not strong enough to make a final decision,” said Poznyak. “We have considered all the evidence which already existed by 2013 but also the new evidence... Our experts came to the conclusion that currently we already have sufficient evidence to include gaming disorder under the umbrella of disorders due to addictive behaviors,” he said.
Since the WHO’s announcement, reactions to “gaming disorder” have been mixed.
The Entertainment Software Association, a video game trade association in the United States, released a statement this week saying:
“The World Health Organization knows that common sense and objective research prove video games are not addictive. And, putting that official label on them recklessly trivializes real mental health issues like depression and social anxiety disorder, which deserve treatment and the full attention of the medical community. We strongly encourage the World Health Organization to reverse direction on its proposed action.”
In an article in The BBC this week, Dr. Richard Graham, a technology addiction specialist, welcomed recognition of gaming disorder. However, he also warned that “it could lead to confused parents whose children are just enthusiastic gamers.”
Poznyak is aware of the backlash against WHO’s announcement but believes that it stems from a misunderstanding of what gaming disorder really is.
“Gaming now is regular behavior for millions,” he said. “Even very intense [gaming] behavior,” he explained, doesn’t mean an individual has gaming disorder.
“Everybody experiences depressed mood from time to time, right? But we are not saying that everybody who experiences depressed mood suffers from depressive disorder. The same applies to gaming behavior,” said Poznyak.