The scientific controversy over whether gaming addiction is a disease—or a symptom

Too much at stake
Too much at stake
Image: REUTERS / Wolfgang Rattay
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Like a good book, the best compliment anyone can give a new video game is that they just can’t put it down. But taken to an extreme, excessive gaming can tilt into unhealthy territory. This week, the World Health Organization lent credence to the seriousness of the issue by adding “gaming disorder” to its manual of disease classifications.

In the latest revision of the manual, ICD-11, WHO classifies compulsively playing video games as a mental health condition, similar to gambling addiction. Under the new guidelines, symptoms of gaming disorder include being unable to control how often you play video games; giving the activity priority over everything else in your life; and persisting in this behavior despite negative consequences. In order for doctors to diagnose patients with gaming disorder, WHO says the symptoms must have been present for at least a year, and that the effects have to be severe enough to “result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

The addition to the disease manual turns out to be pretty controversial. At the heart of the debate among medical professionals is the question of whether excessive gaming is itself a disease—or the symptom of other mental health problems.

The science of gaming addiction

Scholars from around the world are already debating WHO’s move. In a letter of concern published on November 9, 2016, a dozen academics write that “the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life.” They warn that a “moral panic” over gaming might lead kids with normal gaming habits to be diagnosed as having a disorder, which could stigmatize them and set them on a course of treatment they don’t need.

Joan Harvey, a psychologist and spokeswoman for the British Psychological Society, agrees with this concern. “People need to understand this doesn’t mean every child who spends hours in their room playing games is an addict, otherwise medics are going to be flooded with requests for help,” she told CBS News.

Beyond the potential issue of over-diagnosing kids with the disorder, some medical professionals argue that addiction to gaming is actually symptom of an underlying condition like depression or ADHD. In the open-access debate on the WHO decision, scholars write that problematic gaming might be “better viewed as a coping mechanism associated with underlying problems of a different nature.” Existing research on gambling disorder, arguably the closest behavioral addiction to gaming disorder, shows that gambling addiction is frequently accompanied by other psychiatric disorders. And so “misclassifying such problems as Gaming Disorder could lead to worse treatment outcomes for patients,” according to the researchers.

Was the WHO right in recognizing gaming disorder?

That said, there are definite upsides to the new WHO classification. For one thing, classifying the disorder means it might become easier for patients with gaming problems to get their insurance companies to reimburse treatment programs. So far, that’s been almost impossible, despite the fact that intensive gaming rehabilitation programs like reSTART cost $25,000, a price that is prohibitive for many American families.

“It’s going to untie our hands in terms of treatment, in that we’ll be able to treat patients and get reimbursed,” Petros Levounis, the chairman of the psychiatry department at Rutgers New Jersey Medical School, told The New York Times.

The new classification will give also give children, parents, and health-care providers reason to take problematic gaming behaviors more seriously. The ICD-11 is currently used by more than 100 countries, meaning that the official diagnosis can now be used by health care workers, including doctors, around the world.

How big of a problem is gaming addiction?

The US video games industry made $36 billion last year, according to the Entertainment Software Association (ESA), and more than 2.6 billion people play video games around the world. The ESA’s 2017 survey (pdf) of 4,000 US households found that 65% had at least one person who plays video games regularly, defined as playing three or more hours of video games per week.

But estimates of how many of those people are actually addicted to gaming are harder to come by. A 2009 survey by Harris Polls, the results of which were published in the journal Psychological Science, found that 8% of American video game players between eight and 18 years old “exhibited pathological patterns of play.” But a March 2017 study published in the American Journal of Psychiatry found that only between 0.3%-1.0% of Americans who play video games might qualify for a potential acute diagnosis of Internet gaming disorder. And the WHO’s own experts claim that gaming disorder affects no more than 3% of gamers, according to the Associated Press.

Meanwhile, the video game industry has a vested interest in making sure that people play as many video games as possible. That’s why, in its 2017 annual report, the Entertainment Software Association directly called out the WHO, writing that ones its goals was to build “stronger relationships with our colleagues around the world in 2017 is helping us in 2018 to present a united front against the World Health Organization’s unnecessary plan to classify playing video games too much as a disorder.”

It’s hard to identify the precise point at which gaming tips from a favorite pastime into a problem. But research shows that at a certain point, too much time playing video games is  associated with negative consequences. A 2012 study, for example, showed that gaming addicts had lower cognitive functioning. For that reason alone, holding gaming behaviors up to closer scrutiny can only be a good thing.