The World Health Organisation has adopted version 11 of their International Classification of Diseases, a statistical coding tool used by health care professionals and systems around the world for recording, reporting and monitoring health issues in a common way. 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 an implementation period of time (which can be a long time), including translating ICD into their national languages.
ICD-11 was submitted to the 144th Executive Board Meeting in January 2019 and the Seventy-second World Health Assembly in May 2019. ICD-11 will now come into effect in January 2022 subject to transitional arrangements which allow for at least five years and extending to as long as necessary for Member States to compile and report statistics using previous versions.
What is the ICD-11 list?
The World Health Organisation's (WHO) list on classification of diseases (ICD) is widely used as a statistical coding tool by practitioners in healthcare and importantly is implemented by many countries in their health services (state provided or insurance based).
The ICD is important because it provides a common language or coding for reporting and monitoring diseases. This allows the world to compare and share data in a consistent and standard way – between hospitals, regions and countries and over periods of time. It allows the collection and storage of data for analysis, reporting and evidence-based decision-making on different health conditions.
Why and how has the WHO arrived at a "gaming disorder" definition?
The WHO have been conducting activities related to the public health implications of excessive use of the internet, computers, smartphones and similar electronic devices since 2014. This was in response to concerns expressed by professional groups, WHO collaborating centers, academics and clinicians about the public health relevance of conditions associated with excessive use of the internet and other communication and "gaming" platforms.
There is no official report available from the mental health expert group within the WHO explaining what led to the decision to include or even single out "gaming disorder".
The WHO’s reasoning for introducing this disorder and "codifying it" is therefore unclear, especially considering other respected expert-medical bodies in the field of mental health, such as the American Psychiatric Association, declined to codify gaming disorder and are calling for additional research into this.
Does this mean that video games are addictive now?
No: a critical point in understanding the ICD is that inclusion or exclusion is not a judgement on the validity of a condition or the efficacy of treatment. ICD is designed to enable healthcare systems to compare and share data in a consistent, coded and standard way.
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 for some time.
The argument is that the WHO’s action has not been guided by an appropriate level of robust research, data and analysis. Numerous internationally-renowned mental health experts, social scientists and academics from research centres and universities, including Oxford University, Johns Hopkins University, Stockholm University, and the University of Sydney, have published peer reviewed journal articles calling into question the WHO’s plan to create a new “gaming disorder” at this stage.
The American Psychiatric Association has declined to include the concept of video game addiction in the most recent edition of its Diagnostic and Statistical Manual of Mental Disorders, citing insufficient evidence. In addition, the American Medical Association voted specifically against creating this new diagnosis.
What is the harm in having "gaming disorder" on ICD-11?
The act of codifying this as a disorder under an addiction category could have a number of negative impacts across the medical and player communities. The medical community believes there is still a lack of objective and robust evidence to define and diagnose "gaming disorder", which would indicate inclusion at this point is premature.
Some scientific experts state that this may result in misdiagnoses, putting those in need at risk of further harm, adding further pressure to already stretched public health resources.
There is additional cause for concern from the potential for this to adversely affect the vast majority of the game playing community by stigmatising something they enjoy as part of a healthy and helpful range of activities.
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 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.
Studies show that games have beneficial effects on cognitive, motivational, emotional and social development including benefits to children’s vision and their ability to learn.
In the UK one in three people play games for all the above-mentioned purposes as well as for pure fun. Globally, the average age of a player is mid-30s, with a growing population of over-50s and adult women enjoying games as part of their cultural diet. Across games and platforms globally, the gender split is almost 50/50.
What does the industry do to promote sensible balanced play?
The safety of our players is our primary concern and the video games industry takes this responsibility incredibly seriously. In addition to clear age rating symbols and descriptor icons, all of today's consoles and mobile devices offer smart and simple parental controls which can be used to restrict the amount of time spent playing games, limit internet access and they allow control of access to age appropriate content.
askaboutgames.com contains information on all of these tools as well as up to date information on the latest titles, advice on how to play games safely and responsibly, and it offers families, educators and carers helpful tips to ensure they get the most out of the games they can enjoy together.
We encourage the use of parental controls combined with talking as a family to promote balanced and fulfilling game play. Globally, there are regular awareness campaigns and we want parents, carers and educators to be able to have the conversations together about setting household rules and then sticking to them.
We recognise that players who experience mental or behavioral health issues may be coping with issues that have nothing to do with games – so we encourage policy makers at all levels to boost public investments in mental and behavioral health.
So what happens now?
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 was 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.
In a resolution discussed at the World Health Assembly it was agreed that transitional arrangements would be introduced which allow for at least five years and extending to as long as necessary for Member States to compile and report statistics using previous versions.
Some other useful reports
2016 Open Debate paper opposing inclusion of gaming disorder by 36 internationally renowned mental health experts
2018 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.
Studies show that video games have beneficial effects on cognitive, motivational, emotional and social development including benefits to children’s vision and their ability to learn.
Video games are helping cancer patients combat treatment-related side effects.
Source: I, Hope
Brain training video games improve memory, help older people manage daily tasks and can help manage the onset and assist in treatment of Alzheimers disease.
Source: Alzheimer’s Society UK
Source: Dementia Australia
NASA uses Video games with astronaut training.
Girls who play video games are three times more likely to study STEM degrees
Source: “Girls’ video gaming behaviour and undergraduate degree selection: A secondary data analysis approach”, University of Surrey, Dr Anesa Hosein, pub- lication in “Computer in Human Behaviour” February 2019, Volume 91, pages 226-235