This year the World Health Organization (WHO) controversially decided to include the diagnoses of gaming disorder and hazardous gaming in the upcoming eleventh version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). Take This wrote about the controversy both before and after the official inclusion, but the official inclusion has not stopped the debate or media fascination. Stories about sensational personal experiences of “video game addiction” continue to make headlines, but what do we actually know about gaming disorder?
What is Gaming Disorder?
Part of the problem in identifying gaming disorder is we’re not entirely sure what it is yet. There are still active debates about the best way to conceptualize and assess it (see here, here, and here). To further complicate it, different diagnostic manuals have widely different standards proposed or implemented. In the most recent publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Internet Gaming Disorder was identified as a possible psychiatric condition. It has nine different criteria. This contrasts with the WHO’s gaming disorder which only has three criteria. For the purposes of this article, we will use “gaming disorder” to generally indicate these diagnoses as a whole, unless otherwise noted.
Whilst the wording may vary slightly across studies, the assessment of gaming disorder has consistently focused on six key areas:
- salience – video game play begins to dominate the player’s thoughts, emotions, and behavior
- mood modification – the player experiences a change in mood because of video game play
- conflict – the player begins to suffer negative interpersonal, occupational, and psychological consequences due to game play
- tolerance – the player needs increasing amounts of play time to achieve the mood-modifying effects
- withdrawal – when the player is unable to play, they become frustrated and irritable
- relapse – players repeatedly fail to reduce their video game use
If these seem a bit vague, then you’re paying attention. There has been a lot of debate within the academic community about the vagueness of this diagnostic criteria (in fact, this is one of the primary concerns from the scientific community). For example, if you replace the word “games” with another enjoyable activity that you often participate in – for example, dancing – you will likely find that you also meet the criteria for being “addicted” to that activity. The vagueness of diagnosis criteria also makes establishing prevalence rates in the general populations a challenge, which make it difficult to determine the severity of the problem, though one study suggested an average prevalence rate of 3.1%.
What Causes Gaming Disorder?
One of the key debates regarding gaming disorder is understanding its underlying cause. This is something that is still being debated. However, it is generally understood that gaming disorder likely is, at least partially, driven by external factors such as diminished control over decision making or a lack of autonomy.
Part of the reason for this ongoing debate is that there are many other reasons that a person might engage in repetitive behaviors that have nothing to do with addiction, as the term is used in scientific circles. What’s interesting is that there is no conclusive, agreed-upon scientific evidence indicating that games alone are the motivating force behind any kind of dysregulated gaming behavior, even though games are often specifically created to keep players engaged. The common argument draws on neuroscience to suggest that compulsive game play and addictive drugs alter the brain’s reward circuits in similar ways. However, this is an overgeneralization, as discussed by researchers Christopher Ferguson and Patrick Markey:
“Playing a video game or watching an amusing video on the internet causes roughly about as much dopamine to be released in your brain as eating a slice of pizza. By contrast, using a drug like methamphetamine can cause a level of dopamine release 10 times that or more. On its own, the fact that a pleasurable activity involves dopamine release tells us nothing about it.”
Additionally, video games activate much more than just pleasure pathways of the brain. Palaus and colleagues found that games not only activate many areas in the brain (such as those involved in visual acuity, attention, and spatial memory), but can contribute to long-term growth in some of these areas. In this sense, games can exercise your brain “muscles” and alter them in positive ways.
Gaming Disorder and Well-Being
One of the primary reasons that some have pushed for a diagnosis of gaming disorder is due to concern that it may undermine physical, social, and mental health. The work examining the effects of gaming disorder on well-being has been limited, as there have only been two studies that follow the same people over time; see here and here) exploring the precursors and consequences of gaming disorder.
To account for this gap, researchers draw inferences on the potential effects of gaming disorder from studies examining the effects of both disordered and non-disordered online game playing on psychological well-being. This is problematic for several reasons. First, it is not prudent to generalize findings about typical game playing populations to disordered game playing populations as they are likely to vary widely in a variety of ways (e.g., game playing history, current use, and various other demographic factors). This is like saying someone who is an occasional craft beer enthusiast will behave the same as someone with alcohol addiction. Second, Internet Addiction and things like the DSM-5’s Internet Gaming Disorder are distinctly different concepts.
The lack of studies examining the relationship between gaming, disordered gaming, and well-being outcomes grossly limits our understanding of gaming disorder as a psychiatric condition. There is still a ways to go before gaming disorder is fully understood in terms of its underlying causes and potential consequences.
There will always be anecdotal stories about individuals who used games in ways that impair their lives. However, putting the blame on the games without looking at other potential root causes does a disservice to that individual and the scientific community at large. We know that too much of anything can lead to negative consequences, that does not mean that the action itself is to blame. For example, we know that drinking too much water can lead to death, but no one is clamoring for formal regulations on water consumption. The same is true for video games.
However, if we are ever going to generate a clear understanding of the impact of digital media on our well-being we need more data, better science, and to leave the moral panic narrative behind. As so eloquently stated by James Ivory of Virginia Tech University, “Saying someone plays video games is like saying someone wears shoes”.
Video game play is ubiquitous.
Demonizing the activity itself hinders scientific progress.
Moving forward, we need to shift the narrative away from the assumption of “games as the root problem” and towards understanding why some individuals may use games in disordered ways. Only then can we better understand these patterns of disordered use currently subsumed by the label “gaming disorder.”