“At what point does an activity transform from an entertainment to a disorder?”

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Gaming Disorder

In 2018, the World Health Organization plans to add “gaming disorder” – characterized by a pattern of persistent or recurrent gaming behavior – to its list of mental health conditions.

According to the beta draft site, the WHO’s 11th International Classification of Diseases (ICD) defines a number of diseases, disorders, injuries and other related health conditions, which are listed in a comprehensive, hierarchical fashion. It enables the sharing of health information between countries and facilitates the analysis of “health information for evidence-based decision-making.” The previous version of the ICD was approved in 1990 by the 43rd World Health Assembly. The current draft that lists “gaming disorder,” is not final, nor does it list prevention or treatment options. The beta draft site, updated daily, is also not approved by the WHO.

The WHO’s impending beta draft for the next ICD classifies gaming disorder as a pattern of behavior with “impaired control over gaming,” in terms of its frequency, intensity, duration, and the capacity to quit. The disorder falls under the parent category of “Disorders due to addictive behaviors,” and is characterized by giving increased priority to gaming over other daily activities.

Applying to both online and offline video gaming, the condition is also defined by the “continuation or escalation of gaming despite the occurrence of negative consequences.” In order to be diagnosed, these behaviors must be evident over a period of at least 12 months, according to the draft.

“The WHO designation is now generally in line with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5)’s description of internet gaming disorder (IGD),” Nancy Petry, a professor of medicine at the University of Connecticut Health Center, told Futurism. The main difference though, Petry said, is that the DSM-5 didn’t consider the data sufficient to classify IGD as a unique mental health condition. Rather, it’s categorized under “conditions for further study.”

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The WHO’s decision highlights a schism among psychologists: some think the new designation is a welcome one, but others don’t see enough evidence to justify it.

Alexander Blaszczynski, a professor of clinical psychology at the University of Sydney, Australia told Futurism he is concerned about “the absence of clear diagnostic criteria determining what constitutes a gaming disorder, and the validity of applying existing addiction criteria to a behavior.” He noted that there is a range of behaviors now being identified as addictions — everything from salsa dancing, to smartphones, to in vitro fertilization. “At what point does an activity transform from an entertainment to a disorder?” he said.

The controversy ultimately reflects some deeper philosophical debates that have dogged most areas of medicine for many years, Ronald Pies, a clinical professor of psychiatry at Tufts University School of Medicine, told Futurism. “What should or should not count as “disease” or “disorder”? Do we require physiological, biochemical, or neurological “markers” of a putative disease entity in order to validate it, or is it sufficient to document substantial impairment and dysfunction in activities of daily living, responsibilities, etc., as the WHO criteria emphasize?”

Chris Ferguson, a professor of psychology at Stetson University in Florida told Futurism that he does not support the WHO’s designation. “Basically I don’t think the research is there yet to support this as a diagnosis and there is considerable risk of harm due to a ‘junk diagnosis,’” he said.

He said research suggests what we’re calling “gaming disorder” isn’t really a solitary diagnosis. Ferguson said some people certainly overdo gaming, as others may “overdo” or develop addictions to myriad other activities like shopping, exercise, and sex, “but the data we have suggests that usually individuals have a preexisting mental health condition like depression or anxiety first, then use these activities as coping mechanisms.”

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Pies said he shared many of Ferguson’s concerns, saying he was “more skeptical than not” of the designation. “While some recent neurophysiological studies suggest that IGD may be a discrete disorder, there is still no scientific consensus on this point. It is unclear whether IGD is truly a “stand alone” condition; whether it is mostly explained by other underlying conditions, such as anxious or depressive disorders; or whether it is merely a subtype of so-called “behavioral addictions”, which are themselves sources of scientific controversy,” Pies said.