Experts Have A New Reason To Debate Whether 'Gaming Disorder' Is Real

Ask veteran gamers whether it's possible to get too hooked on a game and they might have stories of a World of Warcraft raiding buddy who used to pee in a can that lived next to his Alienware tower. Or they might confess they got so into their Zelda: Breath of the Wild playthrough that they forgot to shower. But is that sort of thing a diagnosable disorder?

Following WHO's move today to classify "gaming disorder" as a mental health condition, this story has been republished. It first appeared in December 2017.

Yesterday, when a draft of the World Health Organisation's 2018 international classification of diseases made the rounds, readers raised an eyebrow at one entry in particular: 6D11, or "gaming disorder."

Classifying gaming as an "addictive behaviour," the WHO explains that gaming disorder looks like "impaired control over gaming," "increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities" and "continuation or escalation of gaming despite the occurrence of negative consequences."

It's been a burst of electricity through something psychologists and clinicians have hotly debated for years. 2013's Diagnostic and Statistical Manual, a sort of psychologist's bible, listed "Internet Gaming Disorder" as a condition for further study. Five years of meditation on it still has experts raising basic questions, like "What are the warning signs?" Despite wildly conflicting individual studies and expert opinions, efforts from industry leaders have slowly cemented a concept of "gaming disorder."

The World Health Organisation's bold move might be what solidifies "gaming disorder" as a recognised, diagnosable, and actionable thing. Countries would take that opinion into account when considering what resources to allot to which health care needs. A lot of psychologists are not happy about that.

Himouto! Umaru-chan

"I have considerable concerns about this proposed diagnosis," said Dr. Chris Ferguson, a psychologist who studies the effects of consistent game-playing. Ferguson is one voice in the sizable backlash against the WHO's draft. He explained that, early in psychologists' debates about gaming addiction, some compared apparent victims' compulsive behaviours to substance abusers'. Ferguson thinks that was their first mistake.

The push to pathologise gaming, he believes, is based off misguided comparisons to heroin or cocaine addiction: "There are many myths such as that games involve dopamine and brain regions similar to substance abuse," Ferguson said.

"There's a kernel of truth to that but only insofar as any pleasurable activity activates these regions. How gaming involves them is more similar to other fun activities like eating chocolate, having sex, getting a good grade, etc., not heroin or cocaine."

University of Oxford psychologist Andrew Przybylski echoed Ferguson's concerns, adding that "It's a very bad idea." He's concerned that most studies done on gaming addiction are low quality.

Codifying gaming addiction as a tried and true disorder could risk "stigmatising millions of players and may divert limited mental health resources from core psychiatric problems such as depression or anxiety which might be at the heart of problematic play," he said over email.

Both Ferguson and Przybylski acknowledge that some people overdo gaming at the expense of their health and sanity. What's worth focusing on, they say, is less the "gaming" aspect of that behaviour, but the "overdoing" aspect.

The impetus to approach something compulsively might matter more than what that "something" is. Research they have done and read suggests that what looks like gaming disorder, a lot of the time, is a symptom of depression, anxiety or attention deficit disorder.

The WHO's definition of gaming disorder could inspire an inaccurate diagnosis when, in fact, gaming could just be a coping mechanism for something already known.

"It doesn't appear to be a stable construct," Ferguson explained.

Gamers!

Last year, dozens of psychologists, including Ferguson, penned a grave article in response to the WHO's proposal to list gaming disorder. Declaring that the proposal had "fundamental issues" like poor research quality and a lack of consensus, the paper warned that a rushed decision could have bad consequences.

It could contribute to a stigma around gaming that affects healthy gamers. It could also waste public health resources spurred by an echo of the '90s moral panic around games.

Even if gaming disorder isn't the next attention deficit hyperactivity disorder (ADHD), gamers with problematic habits still need help. Publicly recognising their struggle to find balance could make a big difference for them.

Cosette Rae, who co-founded ReSTART, a facility for treating internet and gaming addiction, sees 32 patients a day. The facility is full until April, 2018. She is supportive of the WHO draft. Noting that while gambling and gaming disorder are "close relatives," Rae says that the people who come to her facility have difficulty getting good treatment alongside alcoholics or drug addicts.

Playing Guild Wars 2 in complete solitude for a year isn't a lot like getting blackout drunk at a bar every single night of that same year.

"It's difficult for the two groups of people to understand what each other is going through," she said.

Rae acknowledges that lots of gamers don't have a problematic relationship to their favourite media, but referenced a patient whose teeth rotted out of his mouth while he couldn't stop himself from going at it.

The WHO's designation could help get folks in similar situations insurance benefits or convince professors to teach coping methods for gaming disorder to in-training psychologists, she said.

"Because people don't understand it, they haven't regarded it as a real problem," she explained. "They dismiss what this person is experiencing."

There's no debate that video game addiction destroys lives. But is it worth codifying "gaming disorder" into something that could cast a shadow over normal game use — or distract from treating well-known disorders that might inspire over-eager gaming in the first place?


Comments

    Thankyou Ive been saying it dor years and finally there are experts saying it. "What appears to be gaming addiction is more likely to be a coping mechanism for something else."

    Its like people aren't asking why instead just blaming x technology for the problem. And lets not ignore the fact that everybody gets a temporary compulsion to play a new game obsessively for a short while, which would class every gamer as an addict under this so called definition.

    I'm with the doctor on this one. If there is a thing as video game addiction then you want to make fucking sure its not a symptom of a bigger problem first. Otherwise you aren't helping the person, you're just being an arsehole and potentially shifting them along to a potentially more dangerous addiction to cope.

    If that was all that indicated a disorder, you might as well just add everything else in life.

    Like most of the bullshit in the Diagnostic Manuals such as the DSM5... real disorders are underclassified to make it easier for the insurance industry to underpay for chronic health conditions, and then they make up new disorders that they can charge and arm and a leg for cause Mummy and Daddy thinks their child behaviour in any shape or form is a mental condition and labelling their child with an alphabet is just an an excuse for their basically bad parenting.

    Fun ones...
    Caffeine Addiction is a disorder... but Caffeine Withdrawal is also a disorder
    Cannabis Addiction is a disorder... but Cannabis Withdrawal is also a disorder.

    So...
    Gaming Addiction is a disorder... then Gaming Withdrawal should also be a disorder.
    Which means they won't know what is really wrong with you, but know your playing too many or not enough games to supress your underlying issues.

      Caffeine and cannabis addictions are both substance addictions though. Surely it'd be more comparable to other behavioural addictions like gambling disorder, for which the addiction exists in the DSM but the withdrawal doesn't.

      I'm curious since medicine isn't an area I have much expertise in, can you give an example of a disorder the DSM 'underclassifies', and what makes it underclassified? My impression of the DSM was that it describes diagnostic criteria rather than making a statement about relative importance of a disorder.

      Dude, what? There's a reason that addition and withdrawal are disorders, if you've ever seen someone suffering from drug withdrawal you'd understand why they list it. The normal state is not to be addicted nor to suffer withdrawals from a substance, hence why both are disorders. Gaming hasn't got a withdrawal disorder yet probably because there's no physiological dependence identified, and any psychological one is probably non-specific and would amount to "I didn't get what I want so I'm going to throw a tantrum".

      It may well be masking something else, but that doesn't mean it isn't a disorder - it just means it's another disorder that occurs concurrently with something else, just the same as a person can suffer from cannabis addiction secondary to depression or PTSD because they use it as a coping mechanism.

      PS I initially downvoted you for the entire 'insurance industry underpay' comment but on reflection I decided not to.

      DSM5 went through a lot of changes... caffeine was a notable addition as coming out of the blue cause the pyschological treatment industry saw a market for their treatments.
      Coffee addiction and withdrawel came out of the blue followed by

      My complaint is how varying degrees of an Autism are lumped together as a spectrum, and making care more difficult when there are so many subsets.

      but they added more alphabet kid behaviour disorders that are only minor different to ADHD or Agressive Mood behaviours... and more addictions not based on the patients psychology but by the cause of the behaviour.

      Like how is gaming addiction different to internet addiction? with internet addiction (which covered online gaming) was removed from DSM4 as it was consider a medium for displaying behaviour issue not an addiction onto itself and further study was needed.

    This. Nicely done bringing some balance to the issue. I spend a lot of time educating parents about video games and the motivation behind why we love them so much. I also run some programs for gamers and their families where we shine a spotlight on why they are playing excessively and In my experience there is never a simple answer, but there are definitely recurring patterns behind escapism. It's true that game designers do have the ability to exploit some gambling mechanics to keep people playing longer than they otherwise might, but its also true that the obsession to be good at something is enoigh to drive thr hours up, but when it becomes a problem it is usually a coping mechanism. I think the time displacement issue is the one parents worry about most, which is why I'm more interested in self regulation because ripping the xbox away or turning off WiFi starts to cause more harm than good... and once a gamer moves out of home, how are you going to put on the brakes for them then? But i digress. Thanks for the balanced POV.

    I find Mr. Ferguson’s argument that this is a “push to pathologize gaming” extremely misguided. They are not pathologizing gaming; however, they are asking and exploring how a gaming disorder can affect people, and how does that disorder develop and overwhelm.

    For example, when the father of a 12-year-old cuts off his son’s gaming and that child goes to such a dark psychological place that he begins threatening suicide; that’s a problem. When a 16 year old is so focused on World of Warcraft that he stays up all night, night after night, and that he stops brushing his teeth, bathing, and is failing school, that’s a problem.

    And they physically grow up, but as a 22-year-old they have the emotional intelligence of a 12-year-old because they’ve spent their growing up years cocooned in a virtual world. They struggle to relate to real girls, real social relationships and to take on the responsibilities of an adult.

    Older compulsives risk their jobs, relationships and health as they obsess and spend countless hours gaming while ignoring all the other aspects and responsibilities of life.

    Mr. Przybylski, yes, “problematic play”, that seems so nice and clinical…problematic. What else may be core to the dysfunction besides depression or anxiety? Try poor self-esteem, social problems and isolation, home-life dysfunction and stress, ADHD/ADD, and other mental, emotional and environmental issues.

    I also think we should backtrack on codifying gambling as an addiction and “true disorder” because it could stigmatize millions of those that gamble. We don’t want to divert resources to those who are destroying their lives through their “problematic play.”

    Also, what an inept and empty statement, “could inspire an inaccurate diagnosis when, in fact, gaming could just be a coping mechanism for something already known.” Duh! The drug addict who just OD’d; the gambler who lost the family home; or the gamer holed up gaming his life away. They are all the result of some underlying mental, physical, emotional and/or environmental issue. Geez…

    And Mr. Przybylski, what does “It doesn't appear to be a stable construct," even mean? Can you be any more abstract? You want a more reliably designed study with a methodology and analysis providing greater detail and accuracy over a longer span and larger data set, do something…create and implement your research study and analysis. I would love to see it. There are those who do and those who simply criticize Mr. Przybylski. You seem unable to do either well or at all.

    And I love this summary, “But is it worth codifying "gaming disorder" into something that could cast a shadow over normal game use.” Gaming cannot cast a shadow! A building can cast a shadow, or a tree when it gets between the light source and destination. Hmmm…maybe like a dark, malignant cloud shadowing the casual gamer in overwhelming shame and guilt. Yeah, that’s far more melodramatic.

      It must be said that Dr Przybylski has authored multiple psychometrically rigorous studies on not just the effects of video game play (and varying levels of it, from low to moderate to high), but also comparing between what is termed as "harmonious" game play (aka playing to relieve stress, regulate emotions, etc.) and "obsessive" game play (aka playing because there is a need to play, even when there are more important priorities at hand).
      http://www.andrewprzybylski.me/Publications/ This link hasn't been updated for a few years but contains a nice selection.

    Can "Proper parenting and interacting with this child (that I probably shouldn't have had, but hey, benefits amirite?) is hard and cuts into my social life/Facebook/reality TV time. So lets put the Little Angel in front of a screen and OH MY GOD MY CHILD HAS GROWN INTO A TOXIC, SPOILED TEENAGER WHO CANT BE TOLD 'NO' WTF DO I DO?" be classified as a disorder now too? You (non assumed gender) guys in this comments section are spot on too.

    Even the non gaming side of things, in voice chat, in places like reddit, there are very clear behavioural problems around the whole of gaming culture. that seem to be just constantly getting worse.

    I know from myself there are many games I have been addicted to when i was off work injured for a long time. And some nights even now I know I should be doing constructive things, with real goals, diversity and giving me opportunities to broaden my mind. But I just get in the 'just one more turn' and whole nights go by.

    This has impacted my concentration outside games, in terms of relaxing and reading books and general losing interest in learning new things.

    but ultimately it isnt the games, or the playing itself, or me as a person. It is the perfect storm of all of them.

    It's an interesting point and one that I honestly never considered. Instead of blaming the video games as the source of addiction, looking into why these people are retreating into video games is probably more important, and it makes total sense.

    When I was a teenager, I didn't have many friends, and whatever friends I did have were very quick to back stab me, and I was frequently bullied both physically and emotionally. I had suicidal thoughts and I'm pretty sure I was depressed with anxiety. I was so scared of going to school to face my bullies that I would often fake being sick. I was overweight and did pretty much zero exercise or sports because my self-esteem and self-confidence was so low and I also had poor social skills.

    I played a lot of video games... A LOT. That's pretty much all I did in my free time. N64, Game Cube, Game Boy, Game Boy Advanced, PC... I was a huge gamer. I have two older brothers so growing up, we shared a lot of stuff like consoles, games, the PC etc.

    When I think about it, I had a lot of fun playing video games and I would often forget about the people in reality who were trying to hurt me and put me down. For me, video games was an escape. I could play as an awesome character or person and do some pretty incredible things or go on amazing adventures.

    It's funny, I know video games in the past for me was escapism, but at the same time, I never thought to think about my previous gaming addiction as I used to say "I played a shit load of games" and never really thought about WHY I played "a shit load of games".

    Classifying gaming as an "addictive behaviour," the WHO explains that gaming disorder looks like "impaired control over gaming," "increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities" and "continuation or escalation of gaming despite the occurrence of negative consequences."

    That is literally the general term for addiction, not to gaming in particular but for everything. Put another word to replace gaming that it will still make sense.

    The only reason why gaming get classified as an disorder is because it is something that people are publicly exposed and always been a target for blame for any violence in kids. Not saying it does not but gaming became the scapegoat in search of a reason to blame.

    I know kids in america is going so overboard with their games that they end up SWATing and sending death threats just because they cannot play their games, but if it was not games but something else, it will be the same and another disorder would have be added instead of gaming.

    Rather than finding reasons and wasting time in making new scapegoat disorders, I would rather them spend more time and fund in researching how to assist people in those situation.

      To play devil's advocate for a second; if video games represent a very common catalyst and vehicle for an addictive behavior disorder, isn't there some value in classifying it individually so that it so that it can be treated in a way that can be specialized for gaming?

      They already have different classifications for various substances (6C40 is alcohol, 6C41 is cannabis, etc) and gambling addiction also has its own classification. Because gaming is extremely prolific and has its own somewhat unique mechanisms for addiction, doesn't it make some level of sense to classify it separately? Even if there's a lot of commonality between all addictive behaviors that aren't substance-related, there's also a lot of room for specialized treatment of cases related to gaming behavior.

        The problem with addictive personality traits is that when you treat the symptom and not the cause people more on to other things.
        Though there are no single psychological traits that relate to every addiction, studies show there are common elements to all addictions.

          There are definitely common elements, but there are common elements between many conditions, even outside the realm of addiction and psychology in general. The question is whether there are enough distinct elements, whether they're symptoms or causes, to justify a distinct classification. I think there's a reasonable argument for gaming addiction to fall into that category.

            I think there is enough to justify its own classification I'm not disputing that. I'm more against the way we try to hard to look at the addiction it's self as opposed to the underlying causes of.

    I dunno, I chose to not shower when playing BOTW, I didn't forget.

    See this baffles me. if you approach it with a little Cognitive Behavioral therapy, IE

    [Thought <-> impulse] -> Action -> Behavior. its a little obvious that gaming can greatly be associated with coping just like alcohol or a drug, or eating, or working out. blaming the action is sometimes fixing a symptom and not the cause.
    So i think it would be so silly at any point to say, hey its gamings/ alcohols, drugs fault instead of recognizing a problem psychologically, which a lot of society does. THEM PESKY PHONES
    as a gamer i know i personally struggled with mental health until i was forced to get help, can you guys too? i think that given our generation suffers alot from depression and anxiety, this was to be expected, especially when its generally stigmatized that getting help is somehow weak or gay.
    i wish this a trend we could break together, because its gonna kill a lot of people

    Last edited 19/06/18 6:07 pm

    So last week I had to negoiate a 12 year old boy from stabbing his neck with a kitchen knife because his parents took away his Fortnite priviledges. He constantly told me he just needed to play a bit of Fortnite and he'll be fine. Kid wants for nothing, family is stable and well off. If gaming disorder isn't a thing then what the hell was his problem?

      Yep. I get that people are resistant to the idea of a formal diagnostic being assigned for gaming disorder, but *something* is going on.

      I don't see how it's any different to Gambling. I've heard stories of gamblers wracking up huge debts, stealing from their families and employers, completely destroying their lives. It's a compulsion, which frankly I personally believe is biological in origin.

      As someone who's never been remotely interested in gambling, I find it utterly alien to think of a compulsion so strong, I'd rob my own family to fund it, but obviously it's there.

      There are people who are "addicted" to video games in every sense of the word and we need to provide better tools for them and their loves ones to treat their condition.

      Last edited 20/06/18 7:58 am

      The family being stable and well-off doesn't mean there aren't underlying mental health issues there. Video games didn't cause the kid to make a scene, don't be absurd. Would you be crying lolly addiction if he did the same over not getting some candy?

      You've spectacularly missed the point of what the TRAINED PSYCHOLOGISTS are saying in this article. There is no physical addiction present, these behaviours are caused by underlying issues and would be present no matter what they choose as their form of escapism, by placing the blame on video games, you muddy the waters and make it near impossible to find the real reason someone is experiencing issues.

      That kid could be depressed. Maybe he's bullied, maybe it's just the chemicals in his brain, but it's not the video game, don't be thick. By blaming the video game, you're blatantly ignoring that this kid is pretty clearly mentally ill. I don't want to play armchair psychologist but I had a Borderline Personality Disorder housemate who acted exactly like that, and had never played a video game in her life. She would threaten to kill herself over not being able to go to the restaurant she wanted to go to. When she was off her meds, she was an absolute monster if something didn't go her way. If she did play video games, and the people around her just blamed it on those, she would not have gotten the meds she obviously needs to keep her BPD mood swings in check.

    This is the same WHO that *just* delisted transgender as a mental disorder, so how seriously am I supposed to take this?

Join the discussion!

Trending Stories Right Now