In January 2018, in a draft of their new International Classification of Diseases (ICD), the WHO addressed this addiction for the first time in a condition known as “gaming disorder.” In May 2019, the WHO officially voted to update its ICD to include gaming disorder as a behavioral addiction in a section which includes other addictive behavior, such as substance abuse and gambling. Their new guide, ICD-11, takes effect in January of 2022. Bruce Y. Lee, MD, associate professor of international health at the Johns Hopkins Bloomberg School of Public Health ih Baltimore, helps explain what gaming disorder is, and things to consider when you feel that someone is addicted to gaming.
The Negative Impacts of Gaming Disorder
“The real issue is how is gaming affecting a person’s life,” Dr. Lee says. “This can apply to nearly any habit or activity. If an activity is helping you and not really hurting anyone, then there’s not a real reason to consider it a disorder. But if you look at the ICD-11, they really specify that it’s affecting the person’s life in a negative way."
Defining the Problem: What Are the Symptoms of Gaming Disorder?
The WHO defines the condition of gaming disorder as a person exhibiting the following behaviors:
Translation: Gaming Disorder Symptoms in Real-Life Language
“In other words,” Lee says, “for number one, gaming controls you and you don’t control it. For number two, it’s taking you away from other things that you should be doing. And three, you keep doing it even though you know it is hurting your life, or others know that it’s hurting your life. And lastly, it should occur over a period of 12 months, unless there is some kind of emergency situation. Everyone can get absorbed in something for a short period of time. You don’t necessarily want to call something a disorder because a person does an activity a lot. In most cases, people are able to say ‘I no longer want to do this,’ but if it lasts more than 12 months, than that’s when you start to think this may be an issue.”
Determination of a Gaming Problem and Who Is Affected by a Gaming Disorder
“What the WHO does with the ICD-11 is establish whether something is going to be a condition or not, and give some definition to it,” Lee says. “In terms of more specifics, different experts will come in and determine more kinds of diagnostic screening as a result of the classification."
Video Game Addiction: Do You Need Help?
“What we can do now is rely on some of the existing indications of addiction and try to translate some of those things over to gaming,” explains Lee. “I’ve indicated the CAGE questions, which are usually applied to alcohol use. They’re not 100 percent accurate, but they are a good way of identifying if someone may need help.”
Do you feel like you need to cut (C) down?Are you annoyed (A) by people criticizing your gaming?Have you ever felt bad or guilty (G) about your gaming?Are video games usually the first thing you think about in the morning when you wake up — your eye (E) opener?
“These are general signs to look for in addiction, but there are other things as well. Have you had a change in your mood in a negative direction ever since you started picking up this habit? Are you finding yourself having decreased social connections — losing touch with friends, losing touch with family? Is your performance at school or work beginning to suffer without any other explanation?”
Game Changers: Why Gaming Disorder Is an Issue Now
For as long as video games have been part of our culture (nearly five decades), parents have often thought of kids playing games too often for their liking as being “addicted” to games. Why did the WHO feel this was the time to determine gaming disorder as a more official condition? “Many times, when people identify something, it’s not as if it magically appeared one year,” Lee says. “Usually there is a long history of something being around. It becomes a process where there is a formal recognition of something that is being more noticed. In the ’80s, people would go to an arcade and play Pac-Man for hours. When Atari came out, people would be hooked to that. So there’s a combination of things that likely have caused the recognition.” There’s a critical mass; everyone can play. When video games started, a certain percentage of the population played them, but not everyone did. That group has grown considerably, so there have been more and more people playing video games as time goes on. There’s no magical threshold that people pass where they say, “We need to see this many people experiencing it before we formalize a problem or an issue.” But you get a sense that this decade, there are just more people playing them. You start hearing more stories about people losing their job, their marriages, not doing well in school as a result. Gaming has become more professionalized. You have a number of people saying they want to play video games as a profession. That may have existed to some degree in the past, but not to this degree. Not to say that everyone who has that intention has a disorder, but you are just seeing more people dedicating their lives to it. Gaming is complicated. The games are becoming more complex, and as these games get more complex, there are more aspects of the games that draw people in more deeply. A lot of these games can be more interactive — they can talk to people, they can give you a sense of community. These can all be positive things, but it also tends to draw people in deeper and deeper to a game. As the technology advances, the attractions of the game grow stronger. Related issues, such as sedentary behavior and obesity, have become major problems as well. Video games aren’t the only cause of these issues, like obesity, but they are contributing, so it’s part of the overall conversation.
Digital Games Contribute to a Blurred Reality
While gaming has always had an addictive quality to it, how we consume games today has drastically changed, and at times, made it more difficult to disengage. “Technology has certainly advanced to facilitate the use of gaming,” Lee says. “At first, you had to travel to an arcade to play, so there were limits. The arcade closed, so you went home. Then, you had an Atari set at home, but it was still segmented. You had to open up this thing that was designed to play video games and make that choice. But now things have become much more interlaced, where you are doing things on your smartphone in different locations. We are working on computers now more, as well. We have a lot more screen time and things have become more integrated. Game manufacturers are thinking about this: How do I make it easier for you to play?"
Graphics, Interactive Features, and Social Networking Aspects of Modern Games
Games are becoming more interactive now. The game can actually contact you and say, “Hey! Come on back and play the game!” This happens especially when you are linked up to Facebook, instant messaging, or other social media. It begins to blur the boundaries. It makes it seem like there is a person there that wants to interact, rather than it being a game that you just shut off. The graphics continue to get better. With virtual reality, the characters look more and more real. As characters look more real, these boundaries are getting more blurred.
What to Do When Someone May Have Gaming Disorder
To Lee, understanding what gaming disorder is gives a person a better idea on how to properly recognize and deal with it, especially if a parent is trying to address it with their children. “Generally, if you tell kids they can’t do something, they could be motivated to do it more or explore it more because their parents are telling them not to do it,” Lee says. “When a diagnosis like this is created, people worry about labeling. ‘All games are evil or have a negative influence.’ That’s not necessarily the case. Gaming could have a lot of positive influences. It can help with hand-eye coordination, problem solving, it can help people connect with others. Games are even being developed to help with various health conditions. It’s important to help children understand the larger picture, and help them recognize when they are becoming addicted to something. This could apply to a variety of things."
Perspective: What Is Controlling Behavior?
As a parent, it’s important to help them understand that they always want to be in control of whatever activity they are doing. You don’t want to be in a situation where that activity controls you. That’s a sign of addiction. You can’t put something down, even if you wanted to put it down. You don’t want to be in a situation where the game itself is telling you what to do, or other people playing the game are telling you what to do. It requires building up the child’s self-esteem. They are going through a process where they want to be autonomous and don’t want to take orders. You can build upon that — “You don’t want to be told what to do, so you shouldn’t want the video game to tell you what to do either.” Games shouldn’t replace things that are beneficial to them, such as human-to-human interaction. Playing tennis on the Wii isn’t like playing real tennis. Helping put things in perspective is key.
Parameters and Boundaries for Young Gamers
If you are setting time parameters on gaming for kids, it’s important not to make those parameters seem arbitrary and show the reason behind them. You don’t want to seem as if you are setting rules for the sake of it. Many times that’s when kids will rebel and do things secretly or without telling you. If you come up with time parameters, help them understand why. There are 24 hours in a day, you are sleeping for eight hours, you are in school for several hours, you have to eat. How much time does that really leave you?
Symptom vs. Cause: Is There a Bigger Problem at Play?
For Lee, if a person is truly experiencing gaming disorder, the key question is why? “We have to be careful about what the video game is potentially masking. Sometimes its masking another issue. You might say, ‘Well if this person is addicted to a game, if we can separate them from the game, they will be okay.’ But if they have another issue that they are covering up, it’s not such a clear solution. Maybe they don’t have friends, or have trouble making friends, or they can’t perform in school. Gaming addiction can be a warning sign for something else. When treating what you think is a problem, don’t always just look at the problem. Look at the root cause, because if you shift the problem, it may manifest in other ways."
Seek Out Support From a Doctor or Therapist
If your loved one is having more severe levels of addiction and it is significantly impacting their daily life, it is best to seek professional help for individual or family therapy. “If there is any indication that the person can’t handle the issue with a loved one, then there should be a low threshold for seeking professional help,” says Lee. Seek advice from a primary care physician, who can help screen for other issues or help refer to the appropriate mental health professional. Another resource is the website of the American Psychological Association, which offers information on how to chose a therapist, and a searchable database.
