Saul Rosenthal, PhD

“Gaming Disorder:” The Bad, the Ugly, and…?

The World Health Organization recently included Gaming Disorder as a new diagnosis for the upcoming 11th edition of the International Classification of Diseases (ICD-11). The ICD is the diagnostic “bible” used by health care providers around the world. While the exact criteria do not seem available, the WHO 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 the occurrence of negative consequences.

For diagnosis, the behavior must significantly interfere with functioning and exist for at least 12 months.

In the United States, mental health providers also have the Diagnostic and Statistical Manual of Psychiatric Disorders. The most recent, fifth edition (DSM5), includes Internet Gaming Disorder as a possible condition requiring more study. Criteria are more specific, but very similar, to the ICD11. 

Regardless of the source, gaming- and technology-related problems are treated as addictions. The affected person prioritizes gaming over other activities, even when it interferes with or harms health, relationships, work, or school. More and more gaming is necessary to feel the same thrill. The person might lie about or minimize gaming and its negative effects. In short, health care treats problems with technology the same way as it treats alcohol, heroin, gambling, or any other object of addiction.

Overuse of technology is certainly a problem, and people’s lives are absolutely affected (and sometimes ruined) by it. Unfortunately, pigeonholing overuse into an “addiction” may actually make it more difficult for us to really understand the issues or to provide appropriate treatment.

First, unlike heroin, alcohol, gambling, and other more “traditional” objects of addiction, we realistically cannot survive without technology. Yes, games are one category of technology use and it is possible to get them off your devices. However, with increasing “gamification” of many aspects of our lives, it is less and less possible to avoid gaming. Rather than an abstinence model, it is probably more useful to focus on harm reduction along with building a more positive relationship with technology.

Second, there is really very little good evidence that many people meet criteria for gaming addiction. The first major study using DSM criteria found that the vast majority of gamers report no problems. It estimates that less than 1% of the population meets criteria for addiction. That’s not to say there’s no problem, but that we might need to examine the issues from a broader lens. This brings me to my third point.

Problems related to tech overuse may not reflect an addiction. For example, most research studies on internet addiction find that participants show symptoms of other disorders, especially Attention Deficit Hyperactivity Disorder, Depression, and Social Anxiety. It may be that for many people, tech overuse is a relatively new way to express problems we already know a lot about.

Finally, the problem of applying an addiction lens to the issue is it may over-stigmatize individuals who are heavy users but not experiencing problems, and it may wrongly diagnosis other individuals who would benefit from treatment for ADHD, anxiety, depression, or some other condition. In fact, gaming seems to have benefits.

I believe that the explosion of digital media use reflects one of the most powerful influences on our development at multiple levels — species, society, and individual. The challenges are many — Who is overseeing usage? What are the effects? How do we manage a corporate-driven phenomenon that has such impact on our personal lives and health? It’s easy to focus on only the exaggerated bad and ugly. That’s helpful to get our attention, but we need to look at technology in all it’s complexities in order to utilize it as a force for good.

Saul R September 16th, 2018

Posted In: Internet Addiction