After months of blowback from video game lobbying groups and certain psychologists, the International Classification of Diseases (ICD)—the sweeping document about common health issues and causes of death worldwide compiled every couple decades, as needed, by the World Health Organization for the United Nations—has added “gaming disorder” as an official mental health condition, marking the first ever mention of the “internet” in any version of the ICD.
“Gaming disorder” is classified under “disorders due to addictive behaviors,” and the only other member of that category is gambling disorder. According to the ICD’s description, symptoms of gaming addiction include “impaired control over gaming,” “increasing priority given to gaming,” and not being able to stop gaming “despite the occurrence of negative consequences.”
The ICD hasn’t been updated since 1992—a time where video game use was only beginning to proliferate. In 1994, video game sales worldwide added up to less than $7 billion. In 2017, video games sales took in almost $116 billion.
Some lobbyists and psychology specialists have resisted this decision for months. Seven video game lobbying groups spoke out against the decision when news of it broke earlier this year. Back in February, a group of dozens of psychologists around the world self-published an editorial letter to the WHO arguing that existing data and research about gaming addiction is inconsistent.
“If gaming is a coping behavior in some cases,” the authors argue, “it would make more sense to explore the underlying causes for this behavior first and be sensitive to the extent to which treating these first-order challenges might resolve the gaming problems.”
According to the authors, the rush to put gaming disorder in the books is driven by a nearly three-decade long moral panic about how video games affect behavior. (To be clear, this “behavior” has to do with addiction itself, not gaming culture, which, well, is not healthy.) They argue, what makes addictive behavior with video games truly different than, say, food, sex, work, exercise, or tanning addiction?
“A behavioral addiction definition focused purely on video games is on its face arbitrary,” they wrote. “A convincing rationale for focusing on gaming, rather than the myriad of other activities one might overdo, is lacking.”
The authors of the paper also argued that it’s not clear what “clinical benefit” there is to making gaming disorder official. Some psychologists have argued that compared to the Diagnostic and Statistical Manual of Mental Disorders (DSM)—a classification system of mental health conditions— the ICD influences the direction of psychology research more than actual doctor’s office diagnoses.
The ICD is still technically the official diagnosis manual for psychologists operating in the U.S., meaning that its definitions still has some influence in a medical setting. The authors ask, will categorizing gaming disorders this way actually help people get treated?
Existing approaches to gaming addiction treatment have been wildly inconsistent. reSTART, the first “gaming disorder” treatment center in the U.S., treated the condition as an “intimacy disorder,” that it undermines ability to ready body language, social cues, and generally exist as a social being. Plenty of treatment centers treat gaming addiction alongside internet addiction, which is not recognized by the either ICD or DSM, but it’s often described with the same language of addictive behavior as gaming or gambling disorder.
Lumping together treatment styles the two disorders is a controversial idea within the psychological community. Mark Griffiths, a professor of behavioural addiction at Nottingham Trent University in England, told The Outline he believes that the internet is simply a medium for addiction—not a pathway or mechanism behind addiction itself.
“Individuals are no more addicted to the internet than alcoholics are addicted to a bottle,” Griffiths said in an email. “An online gambling addict is addicted to gambling, not the internet. An online gaming addict is addicted to gaming, not the internet.”
Per the ICD’s definition, gaming disorder can be categorized with behavior that happens mostly on the internet, or mostly offline. The ICD doesn’t clarify what makes online or offline gaming intrinsically different from a psychological perspective. Griffiths believes that there’s not enough research, data, and evidence to back up the drawing of these subtypes.
But the interfaces of video games, as well as smartphones and computers, are masterfully designed to suck the user in and reinforce use with dopamine-inducing reactions (for instance, the subtle click and pop of the Twitter “favorite” icon). The problem is so pervasive that companies like Google have begun to reframe and redesign their products with a view toward “digital wellbeing”—or, products with features that help you manage your time on their products (without ever ceasing to use their products entirely).
Although there isn’t medical consensus behind a formalized “gaming disorder” yet, diagnoses are constructed to reflect the medical fears and concerns of the present, meaning the diagnosis will undoubtedly be changed and refined in the future.
“A classification is a way of seeing the world at a point in time,” the previous version of the ICD reads. “There is no doubt that scientific progress and experience with the use of these guidelines will require their revision and updating.”