Contributed by Lisa Pont, MSW, RSW, educator and therapist on the Gambling, Gaming & Technology Use team (formerly the Problem Gambling Institute of Ontario) at the Centre for Addiction and Mental Health
The decision by the World Health Organization (WHO) to include video gaming as a disorder in the International Classification of Diseases 11 (ICD-11) has generated a lot of discussion. As a clinician and educator in this area, this pleases me but I am also aware of some of the controversy and criticisms surrounding the decision. A few of the commonly held concerns are that it will:
- stigmatize video game players
- increase anxiety in parents
- dilute the meaning of the word addiction
- only affects a very small percentage of the population
Stigma and video gaming
Any time you label something, there is a risk of stigma and this needs to be weighed carefully. Having clearly defined criteria will make it easier to determine if someone has a diagnosable problem and hopefully, increase the likelihood they receive appropriate treatment. If having an official diagnosis leads to greater public awareness, informed prevention and treatment approaches, then the benefits may outweigh the potential harms. Addressing stigma in regards to mental health is ongoing work, but allowing the fear of stigma to prevent identifying a serious problem is shortsighted. For example, alcohol use disorder is an official diagnosis and, in my experience, has not resulted in falsely labelling social drinkers as having an addiction and/or being stigmatized by society.
Another criticism I have heard is that making gaming disorder an official diagnosis will cause parents to worry needlessly that their child who loves games is addicted or will become addicted. Parents are already worried. They see the impact that gaming and technology have on their kids and they don’t know what to do. If more and better research comes out of having official diagnostic criteria and this helps to clarify symptoms, parents will now know when they should be worried. The decision by WHO to include gaming was intended to increase awareness about this issue in order to promote prevention and early identification of the problem.
Is it really an "addiction"?
The idea that we will dilute the term "addiction" by including video gaming as a disorder due to addictive behaviours is contrary to what we know about behavioural addictions such as gambling. For years, skeptics maintained that gambling could not be addictive because it was not a psychoactive substance, but rigorous gambling research supported its inclusion as an official diagnosis. We know that gaming and gambling have structural similarities and that many video games contain elements of gambling. Research, along with clinical observation and first-person accounts of being addicted to video games, support the belief that video game disorder contains all of the hallmarks of addiction such as craving, loss of control and continuing the behaviour in spite of negative consequences.
What's the big deal?
Some argue that since video gaming disorder only affects a small percentage of the population, it should not be included as an official diagnosis and yet rare diseases that affect very few people are given an official diagnosis. How many people need to be impacted before labelling something as a disorder or a disease? My understanding is that one of the purposes of the ICD-11 is to record medical phenomena so that it can be identified and monitored for health management. Adolescence is a time when people are most at risk of developing video game disorder and mental health disorders. If problems go undetected and untreated during this time when youth are laying the foundation for their future, the negative effects can be far-reaching. In addition, for people experiencing problems with gambling, video gaming or technology use, there is a large percentage who also experience co-occurring mental illness.
Gambling, Gaming & Technology Use has just launched a Community of Interest on EENET Connect for addiction and mental health service providers to stay on top this emerging trend and share knowledge. I encourage you to join the community and share your thoughts there!