The World Health Organization has added "gaming disorder" to the list of mental health conditions.
The addition will appear in the new version the International Classification of Diseases (ICD), the WHO's standardized list of diseases and other medical conditions used by countries around the world, which was released on Monday.
The addition is meant to help clinical professionals define the point at which a pastime or hobby of playing video games becomes problematic. That could also help individuals who feel they are struggling with gaming get treatment.
The ICD now lists gaming behavior as disordered if it meets three conditions: if a person loses control over their gaming habits, if they start to prioritize gaming over many other life interests or daily activities, and if they continue playing despite clear negative consequences. This pattern should be clear for a one-year period before a diagnosis is made, according to the definition.
This adds gaming to a list of behaviors that can become problematic if people lose control over them, including gambling and disorders related to the use of substances like alcohol, marijuana, caffeine, or nicotine.
However, defining behaviors like gaming as addictive or as mental health conditions is still controversial. Some researchers argue that problematic gaming behavior is often a symptom of mental health struggles, rather than a mental health condition by itself.
Severe enough to harm personal relationships
The term "gaming," of course, covers a wide range of activities that can be solo or social pursuits. It includes playing a quick puzzle game on your iPhone while riding the subway, meeting up with friends to play "Minecraft," and sitting down at a custom-built PC for a multi-hour "Destiny 2" raid session.
The WHO's definition is not meant to imply that any one sort of gaming is addictive or to say that a specific amount of it leads to a disorder. Playing video games only would qualify as a mental health condition if the behavior is severe enough to result in "marked distress or significant impairment in personal, family, social, educational or occupational functioning," according to the WHO.
In other words, it has to be harming personal relationships or interfering with school or work.
"Gaming disorders are uncommon, but still very important," Dr. Shekhar Saxena, director of the WHO's department for mental health and substance abuse, said in a YouTube video discussing changes made to the ICD. "ICD has to keep pace with evolving disorders and diseases, and this is one of them."
The psychology of games
The psychological community has been debating whether gaming is addictive enough to be described as a disorder for some time. So far, the American Psychiatric Association has declined to classify gaming addiction as a disorder but has said it merits further research.
Before the WHO's decision, the Society for Media Psychology and Technology Division of the American Psychology Association released a statement expressing concern about the idea of "gaming disorder," due to insufficient research on the topic:
"[R]esearch has not provided clarity on how to define video game addiction (VGA), what symptoms best diagnose it, how prevalent it is, or whether it truly exists as an independent disorder, or, when it occurs is merely symptomatic of other, underlying mental health diagnoses."
Part of the problem is how to distinguish between simply spending a lot of time playing games and actual addictive behavior.
Scientists need to "establish a clear-cut distinction between someone who may use games excessively but non-problematically and someone who is experiencing significant impairment in their daily lives as a consequence of their excessive gaming," a group of researchers from Nottingham Trent University in the UK wrote in a paper published last summer in the Journal of Addictive Behavior.
There are plenty of stories about individuals whose gaming behavior has become problematic — people have gotten so caught up in online games that they've ruined relationships and lost jobs. Games are often designed to compel people to keep playing and in some cases, to keep spending money. Compulsive gaming and problematic substance use can also go hand in hand.
But problematic gaming may also serve as a dysfunctional coping mechanism for some, according to the Nottingham Trent researchers. Someone who is struggling with depression or anxiety may turn to gaming or abuse substances like alcohol as a way to relieve those symptoms.
Benefits, harms, and "gaming disorder" going forward
Figuring out the degree to which playing games is harmful (or helpful) is all about context, according to Bruce Lee, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health. Lee wrote in a column for Forbes that gaming habits can also be psychologically beneficial.
On the positive side, research has shown that game playing can relieve stress, improve problem-solving abilities, and enhance traits like eye-hand coordination. Technologies that we think of as built for gaming, like virtual reality, can also be used in psychological therapy.
Yet people can struggle to find a healthy balance with gaming.
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Researchers are still trying to understand the activity's risks and effects, since it has only recently become such a common pastime — 63% of US households contain at least one "frequent gamer," a trait that didn't exist a couple of generations ago.
The WHO creates the ICD list so that every country can use a standardized system for classifying diseases. That allows for a unified way of identifying illnesses and keeping track of how common certain diagnoses are.
But it'll take some time before the ICD actually gets implemented by countries around the world. Each health care system decides when to start using the updated list, which requires changing various forms of medical record-keeping. The US didn't adopt the last version of the ICD until 2015, despite it being finished in 1992 and first adopted by some members in 1994. As member countries adopt the new system, they'll decide how these diagnoses should be treated by healthcare systems and insurance companies.
In the meantime, research into the effects of gaming will continue.