World Health Organisation Publishes ICD-11 – “Gaming Disorder” and “Hazardous Gaming” Recognised as Mental Health Conditions.

Wednesday 20th June 2018

The World Health Organisation have published the latest version of their International Classification of Diseases (ICD-11), and among the confirmed changes is the inclusion of two health disorders related to digital gaming; gaming disorder and hazardous gaming.

This has highlighted addiction to video games as a public health issue, coming in the wake of the popularity of free-to-play action game Fortnite Battle Royale and the controversies surrounding video games, “loot boxes” and the connection to gambling. There has been a flurry of misinformation as to what gaming addiction is according to this medical description, brought about as part of a more general moral panic about the medium, and as such, it is prudent to explore what is meant by these new definitions.

Gaming disorder is part of a section of addictive behaviour disorders, which include gambling. The diagnosis even borrows a lot of the text from the gambling disorder section. It is made up of three main aspects. The first is an “impaired control” with gaming, which means the player isn’t consciously in control of when they play, how often, how intensive a session is, how long they play for or when they stop. The next is that gaming is more important a priority than other parts of their life. Finally, the player continues to play at the level they do or higher despite bad things happening.

Hazardous gaming, on the other hand, is gaming behaviours that pose a risk to a person’s physical and/or mental health. This can be difficult to visualise but health concerns related to stressful activities engaged in for long periods of time can cause acute health complications and death. In 2011, a 20-year-old man died from deep vein thrombosis after a 12-hour session of first-person shooter Halo, and there are a few rare but notable examples of people dying in-game cafes after sessions that have lasted 20 hours or more.

With the definitions added amidst a moral panic, there are some important clarifications to make regarding the news. The first, and probably clearest point to make is that both are extreme conditions, and a diagnosis for either requires either a long period of addictive behaviour, extremely abnormal behaviour or a combination of the two in order to receive either diagnosis. A child who is really into a game of Fortnite Battle Royale and plays a little longer than they should would not, in fact, be diagnosed.

The diagnosis is given to people for whom video games of some form or another are causing tangible harm. People who neglect taking care of their hygiene, health, diet, employment, finances, physical exercise, social life, hobbies and everything else that is part of a healthy life balance in favour of gaming are the people that would qualify, and only over long periods of time or for serious cases where there is a tangible and significant risk of harm.

There are examples where game design may cause addictive behaviour, with certain business practices that encourage either a long period of constant play or the purchase of in-game items or currency with real money. As with gambling, if a game encourages spending extra money or spending an inordinate amount of time, follow the advice of “if the fun stops, stop”.