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WHO: "There is increasing and well-documented evidence of gaming disorder"

Recent listing is "only a clinical description" for diagnoses, not prevention or treatment

The World Health Organisation stands by its definition of the recently-classified 'gaming disorder', describing it as "a clinically recognisable and clinically significant syndrome."

Last week it emerged both 'gaming disorder' and 'hazardous gaming' had been added to the current draft of the next revision for WHO's International Compendium of Diseases (ICD).

The listings are fairly broad in their definitions and prompted several questions from across the industry - most prominently: what separates victims of gaming disorder from passionate consumers who choose to pour a lot of their leisure time into the medium?

GamesIndustry.biz reached out to the organisation, and a spokesperson observed that gaming disorder is one of two diagnostic entries related to addictive behaviour - alongside gambling disorder, which has been included in the ICD for several years.

"There is increasing and well-documented evidence of clinical relevance of these conditions and increasing demand for treatment in different parts of the world," the spokesperson told us.

"Use of the internet, computers, smartphones and other electronic devices has dramatically increased over recent decades. While the increase is associated with clear benefit to users - for example, in real-time information exchange - health problems as a result of excessive use have also been documented. In a number of countries, the problem has become a significant public health concern."

GamesIndustry.biz requested several times for examples of this evidence, or clarification on how WHO defines 'excessive', but we have yet to receive an adequate response.

When pressed for a definition of 'excessive', the WHO spokesperson directed to the listing for hazardous gaming, which doesn't entirely satisfy the question.

The spokesperson did offer further examples of the health concerns that can result from both gaming disorder and hazardous gaming. Negative consequences on the sufferer's physical health include sedentary lifestyle, impaired vision and/or hearing, musculoskeletal problems, injuries and accidents, and infections.

They also listed some of the psychosocial problems that can arise, including cyber-bullying, hindered social development, sleep deprivation, risky sexual behaviour, aggressive behaviour, depression and suicide.

The organisation did stress that the entry on gaming disorder "includes only a clinical description and not prevention and treatment options", reiterating that the purpose of the ICD is to identify global health trends, helping medical practitioners and researchers to categorise conditions.

"Inclusion of a disorder in ICD is a consideration which countries take into account when making decisions on provision of health care and allocation of resources for prevention, treatment and rehabilitation," the spokesperson added.

It's also worth restating that the current beta of ICD-11 is a draft and can change on a daily basis. The final revision won't go live until later this year.

The WHO's decision to classify gaming disorder prompted debate across the games industry, as well as a response from the Entertainment Software Association. The ESA said the listing "recklessly trivialises real mental health issues" and urged the WHO to remove it.

However, WHO's listing is not without merit. There are numerous stories of deaths linked to extensive gaming sessions in Asian internet cafes over the past decade, which are presumably part of the "well-documented evidence" WHO has based this clinical description on.

Meanwhile the rise of free-to-play mechanics and loot boxes are reminiscent enough of gambling systems to have prompted another debate across the industry and even drawn in governments on the matter. It's not difficult to see that such mechanics could exacerbate addictive tendencies in certain individuals.

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Latest comments (12)

Joćo Namorado Project Manager, Portugal Telecom3 months ago
"Use of the internet, computers, smartphones and other electronic devices has dramatically increased over recent decades. While the increase is associated with clear benefit to users - for example, in real-time information exchange - health problems as a result of excessive use have also been documented. In a number of countries, the problem has become a significant public health concern."
This pretty much explains why it should NOT be called "gaming disorder". Excessive use is the problem and it's not necessarily videogames. And most of the times the excessive use is not the cause: it is a symptom. Singling out a "gaming disorder" is an invitation to treat the symptom and not the cause. It is worrying.

Gambling addiction in general and gambling mechanics in videogames do merit attention, though.
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Jessica Hyland Artist, Turbulenz Limited3 months ago
I disagree that excessive use of games is just a symptom and not an issue in itself.

As game developers we go to great lengths to create immersive, rewarding experiences that encourage our players to keep playing, to come back and play again, to value the time they spend playing and the things they achieve in the game. This allure is why we love playing games, and I am perfectly willing to believe that it can lead to genuinely harmful addiction in some cases.

Playing games to excess may not be as immediately physically harmful as chemical addictions like cigarettes, opiates or alcohol but it is extremely dangerous when playing the game becomes more important and psychologically easier to achieve to someone than fulfilling basic needs like eating, sleeping, hygiene or caring for dependents. I can't be the only person who has stories to tell about friends who spent days on end playing their game of choice, forgoing sleep and toilet trips because they were so immersed. Are tales of excessive book or movie use anywhere near as common? Do you know anyone who passed out after three solid days of scrolling through Facebook? I do think games can be uniquely addictive in this sense.

Instead of trying to swat down the WHO's concerns, I think we should all be looking to see what we can do to avoid harming people, even inadvertently, with our products.
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Nicholas Lovell Founder, Gamesbrief3 months ago
I agree with Jessica. We design games to keep people immersed, engaged, and coming back frequently. Those are good commercial AND entertainment goals. Sometimes, the consequences of that is bad for the individual, for many reasons. We must take our share of the responsibility, as must the player. Meanwhile the medical profession needs guidance on how to separate out the symptoms from the causes, and the WHO categorisation seems like a first step.
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Show all comments (12)
Joćo Namorado Project Manager, Portugal Telecom3 months ago
@ Jessica and Nicholas: Please note that I share your concerns. Any game mechanics or characteristics that might trigger addiction should be studied and treated. However, I'll bet that the amount of cases where excessive use of videogames is a symptom far outweighs the cases where it is the cause. The problem, in my view, is that the current classification is not sufficiently clear to allow for a distinction (while also lacking scientific evidence) and can lead to most cases being incorrectly labeled, thus making things worse most of the times.
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Jessica Hyland Artist, Turbulenz Limited3 months ago
Many addictions start out as merely a symptom, a coping mechanism, for an underlying mental health problem. But I think that obsessive gaming, just like alcohol or drugs, can become a monster unto itself. Comorbid with other things, sure, mental health problems rarely stand on their own, but a serious problem that deserves attention, study, treatment and, yes, a WHO classification. Said classification is currently only a draft and will be detailed and improved in time. The important first step that WHO is taking is recognising that this can be a problem.

And I'll add that I am unsurprised but disappointed to see the ESA and IGDA both attempting to dismiss this.

Edited 1 times. Last edit by Jessica Hyland on 9th January 2018 5:17pm

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Todd Weidner Founder, Big Daddy Game Studio3 months ago
the real issue is, treating symptoms is all they will do because the cause is society itself. The way we work, where we work, how we work, how long we work, where we live, how we live, with whom with live, and of course how we socialize, with whom we socialize, and how often, is ALL out of balance. Addiction is not new, the need for escapism and validation is growing as society continues to fail more and more people. The real problem is the few corps that now run society/politics/entertainment, have created it to be exactly as it is, a souless money extraction machine. Living in such a machine is not much fun so we look to escape in any manner that we can which ultimately leads to addiction in many, which to the bottom line of some/many corps is just fine.

So creating definitions of said addictions is fine and dandy, treating the symptoms however will never get to the root of the real problem, but then again, there really isnt much money in curing anything, and isn't it all always about just that ..money.

I just hope they don't ultimately throw gaming under the bus, and act as if its one of society's ill, when in fact it's likely one of the least harmful escapes we have.

Edited 4 times. Last edit by Todd Weidner on 9th January 2018 5:57pm

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Neil Young Programmer, Rebellion Developments3 months ago
Will try to find some links, but most of the criticism I've seen of the WHO stance is from health care professionals. As I recall, a key concern is that this could lead to people with depression, anxiety etc who use games as a coping mechanism being misdiagnosed.
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Adam Campbell Game Production Manager, Azoomee3 months ago
I agree with Jessica. Our industry (online and social casino too) goes to great lengths to make games compulsive. Creating something people are highly engaged with and want to spend time in is great, but with the point we should do everything we can to prevent harming people.

That being said, some of the things that come from the WHO have a habit of scaring people or not presenting information clearly (for whatever reason), so I think its important they properly define what this means.
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Ian Griffiths Game Director, Hutch3 months ago
There's little evidence of harm, the latest studies suggest that while it's an issue for some it probably wouldn't be sufficient for a clinical diagnosis of Internet Gaming Disorder. There's actually a good article on the subject from New Scientist website, by Inga Vesper - https://www.newscientist.com/article/2151515-gaming-addiction-probably-isnt-a-real-condition-study-suggests/
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Klaus Preisinger Freelance Writing 3 months ago
There is the act of doing what others do not want you to do.
The act of doing something that works for you but isn't a best case scenario.
The act of doing something that is killing you in the long run.

To give three examples, the difference between basejumping, having no job ambition and Heroin. In which category would one put playing too much computer really? The WHO definition seems to be designed to be intentionally loose enough to have a tool for control, more than to have a medical tool.
problems that can arise, including cyber-bullying, hindered social development, sleep deprivation, risky sexual behaviour, aggressive behaviour, depression and suicide.
Previously known as growing up, or par for being a human. Is there a pill I can take?
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Jessica Hyland Artist, Turbulenz Limited3 months ago
If you consider that list of behaviours, especially depression and suicide, a normal part of life then yes, there is a variety of pills and other treatments you can try to help you with that.

Mental health problems affect so many people in many different ways and ruin so many lives. Try being a bit more understanding and less flippant.
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Gary Lucero QA Analyst, Advanced 3 months ago
I think sometimes game players and makers are so afraid of being linked to anything untoward, so we reflexively fight against it. We should instead look for ways to help those who are affected through their abuses, or fall victim to game makers that prey on those who can't help themselves, or unwilling to.
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