Me, You, and WHO: Gaming Disorder Breakdown

Gaming addiction. It’s a topic we’ve talked about a few times before, and one we’re going to talk about again. Why?

Well, it’s more like “who,” and by WHO, I mean the World Health Organization.

For those of you who might not know, the World Health Organization (WHO) has recently rolled out a beta definition for the new “gaming disorder” diagnosis that will be included in the new International Classification of Diseases (ICD-11), set to be released this year, if I’m not mistaken.

And if gamers aren’t all atwitter, chips firmly on shoulders.

Some have tentatively spoken about being glad people who truly have a problem being able to seek the help they need, and others, well, didn’t. I noticed that, underneath all of the woe-is-us and everyone-is-out-to-get-gamers and the like was real fear as to what this might mean for our hobby, or for the medium in general.

Fear not, hypothetical person who might be feeling this way. We are going to take a look at some of the hype surrounding this diagnosis, and then take a look at the actual diagnostic criteria and talk about what those words on the page mean, and why you shouldn’t be afraid of them.

Seeing Double

For those of you who read this article about how to not pathologize play, you know that I have an “it’s complicated” relationship with the Diagnostic and Statistical Manual of Mental Disorders (DSM5). But this is where we need to start. In the most recent fifth edition, the DSM5 includes “internet gaming disorder” as a “condition for further study.” What this means is that clinicians technically can’t diagnose people with this disorder, but the American Psychiatric Association thinks it might be a viable diagnosis that needs further research before they can determine whether it is actually “bad enough” to be a diagnosis.

So, it’s open to change, and more research will hopefully inform a diagnosis that doesn’t harm the folks who partake in games healthfully, in the same way that people who are sad for a few days aren’t diagnosed with major depressive disorder.

But what about the WHO’s definition? Well, although the definition itself is in its beta stages, the diagnosis is going to be included in the next ICD as a proper diagnosis that can be used by medical professionals. This is contrary to the DSM, which is basically alerting people that, “hey, guys, this might be a problem so we’re going to research it more.” The DSM seems like it’s leaving room for error, whereas the ICD definition is about to be rolled out. It’s time to face the music, gamers, it seems to say. This is a real issue and we’re not tip-toeing around.

Another consideration is that the DSM is pretty much only a “big deal” in the world of psychology, but the ICD is not only a manual used worldwide, but it is used by both psychology and medical fields. The take-away message from this is that it’s incredibly important that the ICD get their diagnoses right.

But, as usual, it’s not so simple.

Dissention in the Ranks

Perhaps one of the best arguments I can give in favor of even having this diagnosis available is that there are research psychologists like Douglas A. Gentile who started off wanting to disprove the idea that gaming disorders exist, only to be surprised by their studies to find that, yes, gaming can potentially be a problem for some people. Others hope that, by having the diagnosis be “real,” it will start a conversation that people don’t want to have, and spark research that people might not otherwise want to conduct.

While that can be putting the cart before the horse, I wonder if making the diagnosis official will force researcher to try and clean up the conflicting research that already exists.  After all, if research finds that there is no possible way for gaming to be a disorder, the diagnosis will disappear. It has happened before (look up homosexuality in the DSM-II if you don’t believe me).*

Another potential benefit that Gentile suggests is that by making gaming disorder “real” in the ICD, it will not only start conversations and research about it, but will also start the ball rolling on developing treatments for people who might be affected.

On the other hand, the APA has already fumbled the ball a bit when it comes to connecting video games with violence, saying that the connection is clear when in fact anyone who takes the time to read the research (or any of the articles I’ve been posting on the topic) knows that the connection isn’t quite as cleanly cut as that. Another issue that I’ve heard raised is that gamers were not included.

Sorry, guys. The average gamer should not be included in any sort of official capacity here. I took to Reddit with this topic, and, while a few people did mention that if it was a problem for some then there should be research and treatments available, most people did not approach the topic with the type of objectivity that research really requires.* Just because you or I don’t personally know anyone with a gaming problem, doesn’t mean it doesn’t exist. Just like if you or I don’t personally know someone with an alcohol problem, it doesn’t meant that doesn’t exist, either.

This, in my mind, is like saying that because I do not have autism spectrum disorder, I cannot be qualified to research it, or that I can’t tell the difference between a slight deviation from the norm and a deviation that is having a profound/negative impact on a person’s life. I’m going to sound a little salty here, but researchers really aren’t “out to get” the population they’re researching. They want to know more so clinicians can help. If data are there, researchers will find them.

But I digress.

Chris Fergusen, another psychology professor, opines that gaming disorder isn’t any different from any other behavioral addiction, but rather it’s simply a manifestation of a deeper issue. As with any addiction, it’s rare that the behavior/substance use starts by accident (although that can happen). Sometimes people fall into addictive behaviors because they are trying to cope with something else, either a mood disorder, or a stressful life event, or any other reason that pushes them to self-regulate in an extreme way. Of course we need to treat the underlying issue for long-term success, but if the immediate behavior is a problem, that needs to be addressed, too.

And, anyway, a person’s behavior is going to be indicative of these deep issues. If we don’t recognize when a behavior becomes a problem, those deeper issues will go un-diagnosed and untreated.

I don’t know about you, but to me that doesn’t seem very fair to the person who needs help.

What It’s Not

As happens when psychology meets popular culture/the internet, this diagnosis has taken on a number of strange characteristics as its name is whispered like a contagious disease, or shouted as a condemnation of “non-gamers.” So let’s take a few that I’ve seen and work through them.

Gaming disorder is not…

…obsessive-compulsive disorder (OCD). This is one of those diagnoses that people misuse upon themselves and others all the time. Have you heard something like this before? “I made a shopping list organized by food group because I’m so OCD.”

No, no you’re not. That’s called organization.

When a person has OCD, they experience uncontrollable, recurring thoughts and behaviors that they feel compelled to repeat over and over. This is not the same as wanting to play a video game all day and night.* The most “famous” example is an obsession with germs, resulting in hand-washing to a harmful point, like skin turning red and cracking open. The person may feel a brief relief from their obsessive thoughts when they perform the behavior, but get no enjoyment out of the behavior itself, unlike folks who may be addicted to a video game.

Gaming disorder is not…

…emotion regulation disorder. This one is just silly, because emotion regulation is the ability of a person to control (or “regulate”) their emotional responses in response to external or internal stimuli (things happening outside your body or thoughts inside your head). Basically what having an emotion regulation disorder means is that a person reacts in an out-of-proportionate way to whatever is happening. A slight setback at work might result in sobbing or extreme anger, etc.

This one has popped up a few times, so I think people are trying to say that gaming disorder is a symptom of anxiety or depression. But no, gaming disorder is not secretly anxiety or depression, nor a problem with “emotional regulation.”.

Of course, one thing this diagnosis is not, is harmless. Like any diagnoses, there is the potential for overdiagnosis, which gamers who can function just fine, perform their daily lives, and aren’t experiencing any ill effects being dragged to the doctor by concerned family members because they spend 5 hours on Saturday playing a game instead of binge watching Netflix. But over-diagnosis is a prevalent issue nowadays, anyway, especially when it comes to behaviors that people might think are inconvenient to themselves, but that’s not a rant I’m going to start on here.

What It Is

The problem with all of the above thoughts is that psychology is messy and made of shades of grey, and the differentiation is made on the smallest details sometimes. For instance, any addiction could be considered to have some obsessive components, as the person thinks about their addiction of choice when not partaking in it. Likewise, there is an emotional component to addiction, as the addictive substance or behavior helps a person feel better. But these are not OCD or emotion regulation disorder, these are symptoms within a larger – and unique – whole.

Some people don’t believe behavioral addiction is a real thing. I disagree, pretty forcefully, actually, but there’s a certain detail in there that is important. People aren’t addicted to a behavior, they are addicted to the feeling the behavior gives them, which is caused by a chemical… Except the chemical is caused by a behavior, not an external substance, so…

This might seem like a mundane detail, but is actually very important. This is the line between a gamer being a regular ol’ gamer and someone with an addiction problem. It’s the difference between someone who plays the lottery every so often and someone with a gambling problem.

Unfortunately, it can be a fuzzy line. Is someone who drinks everyday, but is functioning, addicted, or is the person who never drinks and then gets blackout-hammered once a month the one with the problem?

Is someone who plays game everyday, to the detriment of a social life, addicted, even if by all other accounts they are functioning and content, or is should we send help to the one who only games on the weekend, during which they lock themselves in their residence, close the blinds, and don’t eat or shower for two days before returning to work on Monday, no worse for the wear? Or, do either of them have a problem at all?

These are not answers that I have.

And this is why the ICD and DSM are trying to pinpoint exactly where the line for The Problem begins. Let’s take a look at what they have to say.

The Criteria

The ICD-11 Beta Draft lists gaming disorder under the parent heading “Disorders due to addictive behaviors,” and reads as such:

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.

Let’s break this down:

Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour
— easy enough to understand

manifested by: 1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context)

— This wording is odd, and was lifted out of the gambling addiction section if the ICD, but the spirit of this is that a person feels compelled to play games. This is the inexorable, driving desire to perform the behavior

2) increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities;

— This is the “it’s taking over your life” bit of addiction

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.

— You keep doing it even though there are clear indicators of the behavior harming your life (bills not paid, eschewing self-care tasks, etc.)

The pattern of gaming behaviour may be continuous or episodic and recurrent.

— This is an attempt to define a fuzzy line with another fuzzy line, but this is the same criteria for gambling. To judge from its use in gambling, this is meant to give “case by case” freedom to the mental health professional.

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

— Like any addiction, it needs to go on for a while, unless it’s really bad in the short-term (e.g., ask yourself if you would suggest a friend seek help if they lost $5000 gambling, but “it’s only been two weeks.”).

The Bottom Line

Some people might say that having a “gaming disorder” puts the blame on the behavior, and not the deeper issues that drive the behavior/addiction. I disagree. While I admit I am not an expert in addiction, from what I know, addiction is “giving” a person something they need; this can be a (misplaced) feeling of control because the substance/behavior starts off as something they can choose to do or not, or it can be a much-needed chemical boost, or it could be pure escapism from something terrible happening in one’s life.

But this is like saying diagnosing someone with depression is putting an emphasis on the symptoms of lethargy, low mood, and low energy, rather than the underlying cause of the depression. We can only understand what is going on in the brain by the behaviors it commands the body to do.

To think that any diagnosis is simply a sum of behaviors is misguided at worst and dangerous at best. I might not know a lot about addiction, but I do know about behavior modification, and while a harmful behavior must be addressed to stop the immediate harm, the behavior must be addressed in conjunction with the reason that is driving the behavior. This is the only way to hope for any sort of long-lasting effect.

So, gamers, don’t be afraid of this new diagnosis. It has a firm foundation, and more research is being conducted. This is just a way for people who need help to understand that they need help, and seek it without being ridiculed for self-diagnosing an imaginary problem. Sure, it’s scary, because gaming is still misunderstood as a hobby, but that doesn’t mean people who need help shouldn’t receive it, just because of our insecurities.

What do you think? Do you have concerns about this new diagnosis? Or are you confident in the mental health professionals handling this? Let me know in the comments!

Thanks for stopping by, and I’ll see you soon,
~ Athena
**This article has some extra content available on Patreon**

(if you can believe that I went on even longer than I already did…)

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