The World Health Organisation has issued an updated version of their International Classification of Diseases, a diagnostic manual used by health care professionals throughout the world. ICD-11 includes a proposed definition of "gaming disorder" for the first time.
The latest version, ICD-11, was released on 18 June 2018 to allow Member States to prepare for implementation, including translating ICD into their national languages. ICD-11 will be submitted to the 144th Executive Board Meeting in January 2019 and the Seventy-second World Health Assembly in May 2019 and, following endorsement, Member States will start reporting using ICD-11 on 1 January 2022.
Below outlines the facts about the proposed inclusion, which is yet to be formally adopted.
What is the ICD-11 list?
The World Health Organisation (WHO) is currently reviewing its list on classification of diseases (ICD) that is widely used as a manual by practitioners and importantly is implemented by many countries in their national health policies.
The current draft proposes to add “gaming” under the section that deals with ‘Disorders due to addictive behaviours’ (category 06) which also deals with alcohol, drugs, gambling. The ICD-11 can be consulted here.
Will the ICD-11 list be approved or is it just ‘published’?
A version of ICD-11 was released on 18 June 2018 to allow Member States to prepare for implementation, including translating ICD into their national languages. ICD-11 will be submitted to the 144th Executive Board Meeting in January 2019 and the Seventy-second World Health Assembly in May 2019 and, following endorsement, Member States will start reporting using ICD-11 on 1 January 2022.
Over the next 12 months, there is an opportunity for futher input.
Why is there so much debate around the inclusion of gaming in this list?
There is strong disagreement among experts on the inclusion of video gaming in the ICD-11 list, and the issue has been heavily debated since 2016 when 36 internationally renowned and respected mental health experts, leading social scientists and academics from research centers and universities – including Oxford University, Johns Hopkins University, Stockholm University and The University of Sydney – opposed the inclusion in an Open Debate paper.
Two years later, in March 2018, the same academics reiterated its opposition as there had been little acknowledgement from the WHO of their views in a second open paper published in the Journal of Behavioral Addictions. The paper alerts on the weak evidence base, stressing that the “burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses”. ‘A Weak Scientific Basis for Gaming Disorder: Let us err on the side of caution’.
Views of practitioners: In May 2013, the American Psychiatric Association (APA) proposed criteria for video game addiction in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), but concluded that there was insufficient evidence to include it as an official mental disorder. Proposed criteria for "Internet Gaming Disorder" were included in a section called "Conditions for Further Study". For the time being there is no timetable for a review of the DSM. Subsequently there have been numerous academic papers and research both for and against the formalisation of problematic gaming behaviours.
In March 2018, the Society for Media Psychology & Technology, division 46 of the American Psychological Association called on the WHO not to include video game addiction in the ICD -11 list.
Video games are enjoyed for recreational, educational and therapeutic uses, aren't they?
Video games are enjoyed by people all over the world for recreational, educational and therapeutic purposes. The therapeutic value of games are increasingly important in today’s society and bring innovation to treatments, such as in the field of dementia but there are numerous other areas.
The value of the educational benefits of video games for educational purposes no longer needs to be proved. Games improves strategic thinking and increasingly teachers bring gams into the classroom for an enhanced learning experience, ranging from Minecraft’s Education Edition allowing to create workshops and initiate pupils to work on mathematics, languages and science. Other games such as Assassins Creed Origin's Discovery Tours dedicated to teachers brings the history of Ancient Egypt into the classroom allowing virtual visits to monuments and historical places.
In Europe some 50% of the population play video games for all the above-mentioned purposes. To classify playing games as a disorder under the mental health and addiction category of the ICD-11 list will create moral panic and may lead to abuse of diagnosis as the inclusion is not based on a high level of evidence, as would be required to formalise any other disorder.