On Monday, June 17th, the World Health Organization (WHO) released a final draft of the 11th revision of the International Classification of Diseases (ICD-11), and in it ‘gaming disorder’ is listed as a ‘disorder due to addictive behaviours’. The draft explicitly describes the disorder as a persistent behaviour pattern that can lead to significant widespread impairment across all ‘important areas of functioning’. The full definition in ICD-11 is:
Gaming disorder is characterised 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.
The announcement, a preview for the official announcement in 2019, in advance of its 2022 official start, seems to have been suggestively timed to coincide with the end of E3, the Electronic Entertainment Expo, the biggest annual event in the online gaming industry, which ran from June 12th to June 14th in Los Angeles, California. E3 is put on by the Entertainment Software Association (ESA), the US gaming industry association.
Unsurprisingly, the ESA has been consistently against this proposed course of action from WHO. It joins other trade and industry associations around the world in arguing that the process through which WHO reached this conclusion is ‘flawed’, ‘lacks transparency’, and ‘lacks objective scientific support’, while also highlighting academic studies and papers that, in no uncertain terms, argue against it, calling it a premature move based on a lack of clear evidence, moral panic, and confusion.
On the other side, WHO argues that this classification will be useful as a first step in opening up new research avenues and will allow medical professionals to describe and diagnose the disorder, now that there is a strong basis for it, once codified.
It is clear why video game enthusiasts and industry groups would be against this official categorisation of disorder, as it can lead not just to stigma among players dealing with other mental health issues, but also to a potential loss of business, and even more, calls for regulations from lawmakers around the world eager to take action. However, the motivations of WHO are less clear, considering the lack of consensus; the broad and vague terms of defining the disorder, without also defining its levels; and an admitted lack of research into the issue.
There are certainly other ways for WHO to support further research and study of something that even those firmly opposing the ICD-11 addition admit is a concern. This move seems hasty, at best, considering the potential negative outcomes: further stigmatising gaming, pushing practitioners and researchers to more often than not diagnose the disorder as such, and most importantly overlooking any underlying disorders of which gaming may be a symptom. Conversely, the potential for more research would be one of the few positive effects of the official determination of gaming disorder. It may be hard to gauge what the loose coalition of industry, gamers, and mental health academics would be in favour of, instead of the new classification, but they seem to be on the same page arguing that this is a step too far.
On a more macro level, gaming will undoubtedly become an even larger part of daily life and of the global economy, so this conversation is not as marginal as it may appear. One facet of gaming that is gaining widespread adoption is Virtual Reality, which has been used to help those suffering from post-traumatic stress disorder (PTSD). For instance, a phenomenon that is only going to get bigger is that of eSports, video-game-based professional competitions featuring large crowds of spectators. While it may not sound incredibly interesting for everybody, the eSports industry is set to gross around $1 billion by the end of next year according to some economists, and is drawing the attention of the Olympic Committee, and legacy sports broadcasters (for instance, US-based sports channel ESPN has already started reporting on eSports tournaments similarly to its coverage of traditional sports).
Beyond eSports, the proliferation of faster Internet speeds, faster processors, and better games means that there is greater likelihood of games being abused, and people turning to games as an escape from daily life that may turn into an addiction. Relatedly, technology in general has been accused of being purposefully addictive, from social media to handheld electronic devices, and it seems like beyond an initial push-back, the companies responsible have responded by taking active steps against their products’ addictive nature. Even without WHO taking this action, gaming will certainly go through at least the same cycle of hype and outrage as information technology.
Dr David Morar, PhD, is a curator for the GIP Digital Watch observatory.