Full disclosure I am an avid video gamer. Since the release of Pong in 1972, I have avidly played video games up to and including the most recent virtual reality games. Playing video games has always been one of my many recreational pursuits, always in moderation, and has never dominated my life. Okay, there was this one period in 1994 after the release of Doom in which I played the game excessively, and I had to delete it from my computer. However, video games have been a harmless and enjoyable pastime.
However, video games do consume the lives of some individuals. In light of this, the World Health Organization (WHO) has recently added Gaming Disorder to the International Classification of Diseases (ICD) (ICD-11). Many refer to the disorder as gaming addiction, although the term addiction should likely be reserved for substance dependence. Instead, gaming disorder is a pure compulsive behavior.
Therefore, what is gaming disorder?
The draft 11th Revision of the International Classification of Diseases (ICD-11) defines gaming disorder as a pattern of gaming behavior (digital-gaming or video-gaming) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite negative consequences.
For a gaming disorder to be diagnosed, the pattern of behavior must be severe enough to cause significant impairment in personal, family, social, educational, occupational, or other important areas of functioning and must have been present for at least a year.
This is a fairly typical structure for psychologically-based diagnoses. A disorder is defined as a persistently impaired ability or function, a negative symptom, or a behavior that causes demonstrable harm. Therefore, there is no disease, as there is not necessarily any pathology. That does not imply that mental disorders are not real.
The brain is the organ responsible for emotion, thought, and behavior. The function of the brain depends not only on the health of the various types of brain cells, but also on the pattern, strength, and function of the connections between them. Consequently, there are numerous potential types of mental disorders that involve only the pattern of connections and no conventional cellular pathology.
In addition to biological and environmental factors, the brain’s function is dependent on environmental factors. It is complicated, as is identifying the cause(s) of any identified problem behavior. Because of this, mental disorders are primarily characterized by their clinical features, which include the characteristic pattern of mood, thoughts, and behaviors. Human behavior is so complex and chaotic that it defies any attempt at unambiguous categorization; as a result, there is a great deal of overlap and fuzzy boundaries, but it is still possible to identify distinct types of disorders.
The new WHO classification aims to achieve this. The other document pertinent to this question is the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The American Psychiatric Association (APA) has added Internet Gaming Disorder to the DSM-V as a condition requiring further study. Therefore, it is not yet an official diagnosis, but clinicians are encouraged to give it a try and provide feedback. Is it a valuable diagnosis, and should it be included in the DSM?
This is their operational definition:
Repetitive use of Internet-based games, frequently with other players, that causes significant functioning issues. Within one year, five of the following criteria must be met:
1 Obsession or preoccupation with Internet games
Two symptoms of withdrawal when not playing Internet games.
3 To develop tolerance, additional time must be spent playing the games.
4 The individual has attempted to stop playing Internet games but has been unsuccessful.
5 The individual has lost interest in additional life activities, such as hobbies.
Six individuals have continued to play excessive amounts of Internet games despite being aware of the negative effects they have on their lives.
The individual lied to others about his or her Internet gaming habits.
8 The individual uses Internet games as an escape from anxiety or guilt.
The individual has lost or jeopardized an opportunity or relationship due to Internet gaming.
I have no idea why they chose to restrict the diagnosis to internet-based games. The same phenomenon can occur when playing offline games. I suspect that the participants were not gamers. In spite of this nitpick, it is clear that there is a reasonable operational definition that encompasses all the characteristics of a disorder: being persistent, negative, and causing demonstrable harm.
As a compulsive-type disorder, a loss of control is also present. Those with alleged gaming disorder persist in their behavior despite knowing it is harmful, even to the point of destroying their health and lives. They engage in behavior that is inconsistent with their personality, such as the addiction-related lying and manipulation.
Obviously, not all avid gamers suffer from a disorder. Compulsive behavior is a common human characteristic that can be highly adaptive. It enables musicians and artists to master their craft and enables athletes to excel. Even if art and sports are purely recreational (and not a person’s primary occupation), we rarely criticize passionate artists and athletes. However, there is a bit of an unfair stigma associated with being an avid gamer. However, this is not what makes it a disorder. Again, it must be demonstrably detrimental to your life; it must cause harm.
As with all behavior-based disorders, there is a continuum and no distinct boundary. At one end of the spectrum, however, there is a clear problem that may be amenable to intervention. Therefore, it makes sense to label this harmful pattern of behavior so that we can discuss and study it. ICD codes are primarily used for billing because professionals must be reimbursed for their time and insurance companies must understand what they are paying for.
I conclude that gaming disorder exists and that the WHO and APA’s working definitions are reasonable. It is a type of compulsive behavior, similar to gambling, and is a harmless pastime in moderation, but can be destructive if it gains a life of its own. This may occur if an underlying disorder, such as anxiety or depression, is being self-treated by the compulsive behavior. Some individuals might possess a compulsive personality type. Others may develop a pattern of compulsive behavior for a variety of unspecific reasons.
Possibly, gaming disorder or other harmful compulsive behavior is more frequently a symptom of a person’s underlying problems. It is still a useful entry point for addressing these more fundamental issues, but it has become a problem in and of itself that must be addressed.
As with all behavior disorders at one end of a spectrum, it is essential to adhere to strict diagnostic criteria and avoid diagnosis creep. This is inevitable, but it does not negate the reality of gaming disorder.
In conclusion, I do not believe that gaming disorder is a singular or entirely novel phenomenon. It is merely a cultural manifestation of a more general disorder of compulsive behavior. In some ways, humans and rats are remarkably similar. Our reward system is hardwired into our brains. When we pull that lever and receive a reward, something that gives us a pleasant dopamine rush, we will continue to pull that lever. It is integral to the system. Simply, we must determine when to stop pulling that lever. For some individuals, this may be easier said than done, and they may need assistance removing their hand from the lever.
AUTHOR Founder and Executive Editor of Science-Based Medicine at present. Steven Novella, MD is a clinical academic neurologist at the Yale School of Medicine. He is also the host and producer of the popular weekly science podcast The Skeptics Guide to the Universe and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, as well as general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science, media, and society. Dr. Novella has also developed two courses for The Great Courses and written a book on critical thinking titled The Skeptics Guide to the Universe.
View all of Steven Novella’s posts.
Conclusion
The WHO has added gaming disorder as an official ICD diagnosis, and the APA is considering adding gaming disorder to the DSM. What is gaming disorder and how should it be diagnosed?
