Ask veteran gamers whether it’s possible to get too hooked on a game and they might have stories of a World of Warcraft raiding buddy who used to wee in a tin that lived next to his Alienware tower. Or they might confess they got so into their Zelda: Breath of the Wild playthrough that they forgot to shower. But is that sort of thing a diagnosable disorder?
On 26 December, when a draft of the World Health Organization’s 2018 international classification of diseases made the rounds, readers raised an eyebrow at one entry in particular: 6D11, or “gaming disorder.” Classifying gaming as an “addictive behaviour,” the WHO explains that gaming disorder looks like “impaired control over gaming,” “increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities” and “continuation or escalation of gaming despite the occurrence of negative consequences.”
It’s been a burst of electricity through something psychologists and clinicians have hotly debated for years. 2013’s Diagnostic and Statistical Manual, a sort of psychologist’s bible, listed “Internet Gaming Disorder” as a condition for further study. Five years of meditation on it still has experts raising basic questions, like “What are the warning signs?” Despite wildly conflicting individual studies and expert opinions, efforts from industry leaders have slowly cemented a concept of “gaming disorder.”
The WHO’s bold move might be what solidifies “gaming disorder” as a recognised, diagnosable, and actionable thing. Countries would take that opinion into account when considering what resources to allot to which health care needs. A lot of psychologists are not happy about that.
“I have considerable concerns about this proposed diagnosis,” said Dr Chris Ferguson, a psychologist who studies the effects of consistent game-playing. Ferguson is one voice in the sizeable backlash against the WHO’s draft. He explained that, early in psychologists’ debates about gaming addiction, some compared apparent victims’ compulsive behaviors to substance abusers’. Ferguson thinks that was their first mistake.
The push to pathologise gaming, he believes, is based off misguided comparisons to heroin or cocaine addiction: “There are many myths such as that games involve dopamine and brain regions similar to substance abuse,” Ferguson said. “There’s a kernel of truth to that but only insofar as any pleasurable activity activates these regions. How gaming involves them is more similar to other fun activities like eating chocolate, having sex, getting a good grade, etc., not heroin or cocaine.”
University of Oxford psychologist Andrew Przybylski echoed Ferguson’s concerns, adding that “It’s a very bad idea.” He’s concerned that most studies done on gaming addiction are low quality. Codifying gaming addiction as a tried and true disorder could risk “stigmatising millions of players and may divert limited mental health resources from core psychiatric problems such as depression or anxiety which might be at the heart of problematic play,” he said over e-mail.
Both Ferguson and Przybylski acknowledge that some people overdo gaming at the expense of their health and sanity. What’s worth focusing on, they say, is less the “gaming” aspect of that behavior, but the “overdoing” aspect. The impetus to approach something compulsively might matter more than what that “something” is. Research they’ve done and read suggests that what looks like gaming disorder, a lot of the time, is a symptom of depression, anxiety or attention deficit disorder. The WHO’s definition of gaming disorder could inspire an inaccurate diagnosis when, in fact, gaming could just be a coping mechanism for something already known.
“It doesn’t appear to be a stable construct,” Ferguson explained.
Last year, dozens of psychologists, including Ferguson, penned a grave article in response to the WHO’s proposal to list gaming disorder. Declaring that the proposal had “fundamental issues” like poor research quality and a lack of consensus, the paper warned that a rushed decision could have bad consequences. It could contribute to a stigma around gaming that affects healthy gamers. It could also waste public health resources spurred by an echo of the ‘90s moral panic around games.
Even if gaming disorder isn’t the next attention deficit hyperactivity disorder (ADHD), gamers with problematic habits still need help. Publicly recognising their struggle to find balance could make a big difference for them. Cosette Rae, who co-founded ReSTART, a facility for treating internet and gaming addiction, sees 32 patients a day. The facility is full until April, 2018. She is supportive of the WHO draft. Noting that while gambling and gaming disorder are “close relatives,” Rae says that the people who come to her facility have difficulty getting good treatment alongside alcoholics or drug addicts. Playing Guild Wars 2 in complete solitude for a year isn’t a lot like getting blackout drunk at a bar every single night of that same year.
“It’s difficult for the two groups of people to understand what each other is going through,” she said.
Rae acknowledges that lots of gamers don’t have a problematic relationship to their favorite media, but referenced a patient whose teeth rotted out of his mouth while he couldn’t stop himself from going at it. The WHO’s designation could help get folks in similar situations insurance benefits or convince professors to teach coping methods for gaming disorder to in-training psychologists, she said. “Because people don’t understand it, they haven’t regarded it as a real problem,” she explained. “They dismiss what this person is experiencing.”
There’s no debate that video game addiction destroys lives. But is it worth codifying “gaming disorder” into something that could cast a shadow over normal game use—or distract from treating well-known disorders that might inspire over-eager gaming in the first place?