The World Health Organization has added “gaming disorder” to its diagnostic handbook, but experts argue that we still don’t know enough to claim that gaming disorder exists. The evidence is inconsistent, they say, and the criteria are too broad.
According to the WHO, the following criteria indicate gaming disorder: gaming is strongly preferred over other activities, the patient does not stop even when there are negative consequences like doing badly at work, compulsive gaming strains the patient’s life or relationships, and all this has been happening for at least a year.
But nothing in this criteria has anything to do with gaming specifically, says Andrew Przybylski, a psychologist at the Oxford Internet Institute who has extensively studied video games and mental health. “You could easily take out the word ‘gaming’ and put in ‘sex’ or ‘food’ or ‘watching the World Cup,’” he says. We know how opiates and nicotine work and what makes them addictive, but we don’t know the same for games. The gaming disorder definition says nothing about what kinds of games or what features of games might be addicting, and so it’s too broad to be helpful. It’s just stating that sometimes people who play games play them too much. This could be true about any activity and such an attitude, Przybylski says, “could lead to a kind of pathologization of every aspect of life.”
It’s undeniable that there are people who suffer because they play too many video games, says Michelle Colder Carras, a public health researcher at Johns Hopkins University focused on the problematic use of technology. But she argues that these people usually can get psychiatric treatment under a more general diagnosis like depression or anxiety. Both Carras and Przybylski were part of a group of researchers who wrote a letter to the WHO in 2016 recommending against adding “gaming disorder” to the diagnostic handbook because there’s no consensus and most studies in the area are low-quality.
So what’s wrong with the studies? First, we don’t even know how many people might have gaming disorder. Most papers collect data from self-help or gaming forums where people post about being addicted to gaming. “It’s like asking, ‘what is the prevalence of heroin?’ and then going to a clean needle exchange and running your survey there,” Przybylski says. As a result, some numbers say that gaming disorder afflicts less than 1 percent of gamers, but other studies suggest rates up to 100 times higher.
Some people studying gaming disorder will ask people about “internet addiction” or “computer addiction,” according to Carras, but it’s not the same thing. And there are more general problems, too: Often, scientists don’t share their data and don’t say what they were testing before they gathered it, which makes it easier for scientists to look at the data and report findings they already expected.
This broad, fuzzy diagnosis could stigmatize gamers and lead to more misconceptions. Carras points to a recent Observer article that suggested that the diagnosis could help prevent school shootings, insinuating that video games cause mass violence. “There’s a danger of a moral panic with people who don’t understand video games making these statements and causing family conflict, and kids being brought to treatment who don’t need to be there,” she says. And it can lead to more of the unfounded fear that screen time is “digital heroin.”
Still, there could be potential upsides to the diagnosis being added. Because the stakes are higher, it might push researchers to do more open and more rigorous science, says Przybylski. Plus, it might encourage gaming companies to be proactive and share their data. “I’m genuinely worried about the mechanics of games taking advantage of vulnerable people,” he says, “but there’s a fundamental asymmetry between the kinds of data I can collect and the data that video game companies — like the ones that create Fortnite or League of Legends — collect every day.”
Finally, it’s worth noting that although plenty of headlines claim that the WHO has decided “gaming addiction” is real, the agency has been careful not to cry “addiction.” Instead, the classification is labeled under “disorders due to addictive behavior.” “If they were going to say ‘addiction,’ it would really require much higher evidence that doesn’t exist yet,” says Przybylski. “I think it’s very intentional that they’ve avoided the term addiction and used an ambiguous term like ‘disorder.’”
If there really are people who suffer, why not just call it an addiction? “I think that dilutes the term ‘addiction,’” says Przybylski. In theory, he adds, “if you had an infinite number of therapists and an infinite number of dollars and medications, it’s fine to medicalize everything because then you can therapy and drug your way out of the problem.” But we don’t live in a world like that and so triage is necessary: “If we start creating all of these ‘addictions’ that are mostly normal behaviors, it may distract resources away from those that we know cause human suffering.”