Are Video Games Addicting?

Announced this week The World Health Organization classified “gaming disorder” as a mental health problem in its 2018 update of the International Classification of Diseases (ICD).

The disorder, which experts say affects no more than 3 percent of all gamers, diagnosed if a person’s video game habit “is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning,” according a tentative draft of WHO’s 11th update to the ICD.

“Gaming disorder is characterized by a pattern of persistent or recurrent gaming behavior (‘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 behavior 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 behavior may be continuous or episodic and recurrent. The gaming behavior 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.”

Official designating “gaming disorder” as a disease serves a number of purposes, according to Dr. Shekhar Saxena, director of WHO’s Department of Mental Health and Substance Abuse. The agency accepted the proposal that gaming disorder should be listed as a new problem based on scientific evidence, citing “the need and the demand for treatment in many parts of the world.” It may help gamers to be aware that they have a problem, encourage psychiatrists and therapists to provide treatment and increase the chances that insurance companies would cover the cost of that treatment.

The Society for Media Psychology and Technology, a division of the American Psychological Association said it’s “concerned that the current research base is not sufficient” to label gaming addiction as a disorder, which “may be more a product of moral panic than good science.” It’s a position supported by the video game industry.

Also Dr. Joan Harvey, a spokeswoman for the British Psychological Society, warned that the new designation might cause unnecessary concern among parents. “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 said.

Psychologist Michael Fraser says he’s seen an increase in the number of patients in his practice seeking help for compulsive gaming. “There’s a lot of arguing sometimes it escalates and gets physical where the parents have to pull the controller out of their kids’ hands,” he said.

“The studies suggest that when these individuals are engrossed in Internet games, certain pathways in their brains are triggered in the same direct and intense way that a drug addict’s brain is affected by a particular substance,” The American Psychiatric Association said in a statement. “The gaming prompts a neurological response that influences feelings of pleasure and reward, and the result, in the extreme, is manifested as addictive behavior.”

In 2013 The American Psychiatric Association released a report from the Diagnostic and Statistical Manual of Mental Disorders (DSM). “Internet gaming disorder” is listed in DSM-5, but only as a “condition for further study” — not a clinical diagnosis.

Dr. Mark Griffiths, who has been researching the concept of video gaming disorder for 30 years, said the new classification would help legitimize the problem and strengthen treatment strategies. “Video gaming is like a non-financial kind of gambling from a psychological point of view,” said Griffiths, a distinguished Professor of Behavioral Addiction at Nottingham Trent University. “Gamblers use money as a way of keeping score whereas gamers use points.”

Robert Figone plays in video game tournaments. He says video gaming can be a healthy form of entertainment. “I join tournaments for competitive video games,” he said. “It’s mentally stimulating, but doesn’t hold me back from my workout everyday.”

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 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.

According to the American Psychological Association, an estimated 160 million American adults play video games, but the percentage of people that could qualify for the disorder is extremely small. Players’ ages range from under 18 to over 50, and the male-to-female ratio is almost equal.

The new WHO classification hopes to bring more patients for the intensive gaming rehabilitation programs like reSTART cost $25,000, a price that is prohibitive for many American families. The program, reSTART, offers residential treatment for problematic Internet and video game use. The treatment approach first takes the gamer through the equivalent of detox: A digital “de-tech” period. They work to address mental health issues — depression, anxiety, and attention deficit disorder (ADD), while coming to grips with factors that might lead to increased virtual connection and developing an individualized plan for how to engage with digital media in a healthy way.

Child and adolescent psychiatrist Victor Fornari, MD, sees many families who struggle to control the amount of time their children spend in front of a screen. People who do seek help right now likely find it difficult. Fornari says that there are few treatment programs around because mental health professionals really don’t know how to treat the disorder yet. Rehab centers and wilderness camps exist, but there is little proof of how well they work, and they are often expensive. He says it is unclear if gaming disorder will require treatment similar to other mental disorders or addictions. Fornari says the WHO action will bring about research on diagnosed cases that will help doctors understand more about the condition.

“I think any time changes like this occur, an initial period of time will be needed to test it out,” he says. “How often the diagnosis is made and the range of clinical cases, like in any other mental disorder, will have to be studied. When a new disorder is proposed, we need to see if it will survive the test of time.”

The draft will be presented at the World Health Assembly in May 2019, and is scheduled to go into effect Jan. 1, 2022. The WHO released it as an “advance preview” to give countries time to prepare and train people for its implementation, the organization said in a news release.