Ian Betteridge, A British Technology journalist is well known for his law of headlines, an adage which states “Any headline that ends in a question mark can be answered by the word no.”
That is the same here. You are probably not.
The recent addition of video gaming addiction to the International Classification of Diseases has garnered some interest. While many people have welcomed the decision which will allow the development of more specialised services, others have slammed the idea of an individual disorder, claiming the classification suffers from fundamental issues and formalising the disorder will do more harm than good.
So here I am, with a BSc in Psychology and an MSc in Occupational Psychology (humble brag) here to break down what exactly classifies as having a video gaming disorder, what could be wrong with classifying them as disorders and other thoughts I have on this new medical phenomena.
Now video game addiction is not a new idea in the social sphere. Plenty of people have either invested in games far too much for any reasonable person to consider it healthy or have even reached the point of dying.
What has changed now then, if it has existed for such time anyway?
Well it now has definition. In Psychology identifying whether a person is suffering from a recognised mental disorder requires the meeting of certain criteria. The most commonly used set of criteria? The Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD.) The ICD is published by the World Health Organisation, directly co-ordinating with the United Nations, aiming to create a worldwide standard for UN countries to classify diseases and differs from the DSM in its broader classification of illnesses, with the DSM limited to covering only psychiatric disorders.
So what does this definition say? Well here is the link for the source material but I’ll paste it down here for you:
Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline, manifested by: 1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context); 2) increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and 3) continuation or escalation of gaming despite the occurrence of negative consequences. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern of gaming behaviour may be continuous or episodic and recurrent. The gaming behaviour and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.
Plenty to sink your teeth into. Now lets look at the important points:
1) Impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context) In layman terms, the person is incapable of imposing self-limits on their gaming. This is distinct from the idea of just binging a game or just filling a gap in time by playing games, we have all done that at some point.
2) Increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities. This is ranging more into what we socially consider an addiction to gaming. While gaming taking priority over washing the dishes and changing a lightbulb is not really a problem; it is when prioritisation is given over tasks which give a heavy negative impact, such as not socialising in real life, maintaining romantic relationships, or going to work. This leads nicely into the third manifestation…
3) Continuation or escalation of gaming despite the occurrence of negative consequences. Here is the clincher of classification of an addiction. Think of any classical addiction: Smoking, drinking, drug use. If we focus on smoking, the negative consequences are quite quick: nicotine dependency, mood swings, breathing problems, and plenty other health issues. Yet despite this the smoker continues and this is the distinct point of an addiction and the main point which needs to be reached. If you continues gaming unchanged when you lose your job and relationships that is when it is an addiction.
So all in all that seems like a pretty robust categorisation. It covers everything we know about an addiction and focuses upon a gaming scenario. What could be there to dispute?
Well quite a lot. In the paper Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal, 24 separate scientists specialising in video gaming, mental health, and addiction wrote to the WHO claiming that: ‘The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues.’
So what are these fundamental issues? Well they’re all laid out nicely for us, so let us take a quick look through them:
- The Quality of the research base is low. Psychology prides itself on having a large research base for any disorder, covering its psychological manifestations, biological effects and nuances and differences in the disorder. The research just is not there, and there are still fundamental errors which more research needs to iron out: Extreme participants inflating the prevalence of an issue in smaller samples, and less speculative hypotheses about the condition need to be measured.
- The current operationalisation of the construct leans too heavily on substance use and gambling criteria. Despite the fact that EA seems hell-bent on becoming a digital casino, the reliance on using other criteria can cause gamers to believe that normal everyday behaviour is problematic. Especially when we consider gaming against substance abuse, there are significant differences between behaviour and substance-driven behaviour, particularly in withdrawal effects or tolerance to use.
With the comparison to gambling, this almost verbatim use of its classification with the word gambling replaced to gaming (I’m not kidding, here is gambling just so you can check) means that the criteria used, which are very broad and lack specificity, could misclassify gamers as addicts when in reality they are just hardcore gamers and experience none of the other manifestations to a dangerous degree.
- There is no consensus on the symptomatology and assessment of problematic gaming. Now here they are pretty much correct. Claims regarding symptoms are normally based on flawed data and a reliance on psychometric measures when a disorder like this would require interviews to distinguish normal behaviour from clinically significant symptoms and signs of addiction. In fact research so far sees problematic gaming as more of a coping mechanism against difficult life events, something which many gamers have used gaming for.
Here we reach the crux of the problem. Classification of a disorder without a proper research base can have positive and negative effects, and correctly weighing up whether this is worth the risk is important. The authors consider that it will do more harm than good, but others consider that benefits will appear. So what might happen?
Well firstly, how we view gaming could change. This could happen in two directions; positively people who are presenting addictive behaviours may conduct self-treatment and cut down on their gaming; however negatively moral panic around harms of video games could result in premature application of diagnoses and an abundance of false-positive cases. While video games are not unfamiliar with controversy, being blamed for pretty much everything since their inception including the loss of limbs (it’s true, look it up) and classification as an addiction could create more issues for an art form that is still developing. Consider as well various social breakdowns of gaming. Gamers are primarily younger, and the risk of parents false-diagnosing their own child as a gaming addict increases when they are given such ambiguous criteria. In a worst case scenario, we could begin a path to considering other forms of entertainment diagnosable such as sports, dancing, eating, sex, work, exercise, and even gardening.
As a hard negative having a poor diagnosis does not help the minority of addicted gamers, instead affecting the majority of gamers who play games as part of a normal and healthy lifestyle. Raising concerns that video games may be dangerous is known to add tension to the parent-child relationship. A disorder may be used to control and restrict children, which has already begun to happen in the way of ‘gaming-addiction camps’ where military regimens are used to treat children with no evidence of effectiveness and creating long lasting psychological and physical damage to the child. These pseudo-treatments can draw attention away from better methods of addiction management, such as literacy of the medium and education which would provide far more resolution to the issue.
As a hard positive, a formal classification for the disorder can provide treatment demands and funding for treatment. There is already demand worldwide for treatment for gaming addiction in Asia and Europe and the disorder may provide a funnelling of medical funding towards development of treatments. It would also mean that in countries such as the UK, where healthcare is nationalised, that the treatment would be free allowing anyone who wishes for treatment to get it.
So where do I fall on this? Well while I do believe that gaming can become an addictive behaviour giving such a thin criteria is not worth the risk. Gaming is far more nuanced that other forms of addiction due to the sheer spectrum gaming has, from mobile games to RPG’s and its use as a competitive sport and a coping mechanism; classifying it alongside gambling is a major negative. More research is needed for sure, particularly to distinguish reasons for gaming addiction, rather than simply what it constitutes. If the current classification is used, I feel like it would create nothing but trouble, and planet Earth is full of enough trouble as it is.