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Gaming disorder: an issue of public health importance
Shekhar Saxena
Director of the Department of Mental Health and Substance Abuse, World Health Organisation
Last year, in 2018, the WHO revised the International Classification of Diseases (ICD) for the first time since the early 90s. This revision added a newly identified ‘gaming disorder’ to this list, in order to confirm that this issue is of public health importance.
People who episodically play video games will not be identified with a disorder
Research showed that a small minority of people playing video games can develop this disorder, which is diagnosed by several criteria: we can speak of the ‘gaming disorder’ when a person looses control over gaming, and in consequence neglects other activities, such as sleeping, eating, studying, or maintaining personal hygiene. But, we can only speak of a disorder if these symptoms occur during more than 12 months, which is an another criteria of diagnosis. WHO consulted a very large number of experts before adding the gaming disorder to the ICD in 2018. It convinced us that the criteria we used for the classification were valid.
Although often neglected, the ‘gaming disorder’ can have a serious impact on a person’s physical and mental health. It can lead to an important decrease of exercise and food intake, sometimes obesity. Lack of sleep and social contact can provoke anxiety and depression. Finally, observations showed the ‘gaming disorder’ may encourage other addictive behaviors, such as addiction to alcohol or tobacco.
The skeptical approach to the gaming disorder, although understandable, is mostly based on misinformation, as some may consider that there is not enough evidence to recognize it as a disorder. WHO clearly states that only small number of people have the disorder, and the applied criteria are strict: people who episodically play video games will not be identified with a disorder.
Thanks to the recognition of a ‘gaming disorder’, governments can collect data, test possible treatment strategies
In terms of public health policy, it is essential to officially recognize abusive, long term gaming addiction as a disease. Thanks to this, governments become aware of its existence, they can collect data, test possible treatment strategies and develop preventive measures. Today, most countries struggling with the ‘gaming disorder’ are Asian countries, but the official recognition of the disease can boost research in countries which do not yet face this challenge.
In the light of these arguments, recognizing the ‘gaming disorder’ as a serious health condition seems a logical decision, which will give rights to arguments and evidence over opinions.
AGAINST
Gaming disorder is a scientific fairytale
In 2019 the WHO has surprised the scientific community and psychotherapists by announcing that the next version of the International Classification of Diseases will include a ‘gaming disorder’ classified as a behavioral addiction. This decision is problematic for several reasons.
There is no agreement on a definition of a gaming addiction, nor on how to measure it
The video game addiction has been present in the scientific literature since 1995 to designate excessive use of gaming. Therefore, there is no agreement on a definition of what a gaming addiction would be, nor on how to measure it, nor even on the frequency on which this trouble occurs. Researchers and psychotherapists agree on saying that an addiction must, at least, lead to psychosocial difficulties or to an important distress for an individual, and this in a long enough time lapse. But today, research still could not prove that an excessive use of video games is causing important difficulties over time.
Even though the development of a substance abuse is well described, the one of a video game addiction remains still very mysterious after 25 years of research. The underlying mechanisms of this addiction are similarly unknown. The biological model is sometimes put forward – playing video games is sometimes associated with a liberation of dopamine, which is involved in the pleasure circuit. But this model is insufficient because the quantities of dopamine are very different. Video games are associated with 50-100% of the ordinary rate, which is well below rates for cocaine (350%) or methamphetamine (1200%).
Research did not either bring to light the two main components of an addiction. First, the tolerance, which means the need of increasing the substance’s dose to achieve the same effect. Second, the withdrawal syndrome, which is neither diagnosed in players’ behaviors. Research did not succeed either to prove that excessive gaming is detrimental.
‘Gaming disorder’ relies on poor-quality research with no consensus on its symptomatology
The use of the word ‘addiction’ to describe excessive behaviors of some players is not only clinically inappropriate. It is also problematic because it tends to reduce very serious consequences of substance addictions, and to exaggerate risks taken by gamers. Finally, it’s main effect is to stigmatize normal and un-problematic behaviors.
To conclude, a gaming disorder is a problematic notion, as it relies on poor-quality research and there is no consensus on its symptomatology nor its evaluation. This diagnosis stigmatizes gamers and drives the medical care in a wrong direction.
