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WHO classifies gaming disorder as illness

Playing video games to excess at the expense of work, school or relationships can be medically diagnosed if it lasts more than a year, WHO agreed.

GENEVA (AN) — Playing video games to excess at the expense of work, school or relationships can now be diagnosed as a medical condition if it lasts more than a year, the World Health Organization agreed in a formal vote on Saturday.

Delegates to the World Health Assembly, the decision-making body of the U.N. health agency, approved the inclusion of a newly defined "gaming disorder" in the eleventh edition of WHO's diagnostic manual for classifying diseases, the first such update in nearly three decades.

The many parents who have trouble prying mobile devices or gaming controllers from their children's hands should not necessarily be alarmed. Likewise, children who see their parents glued to mobile phones day and night need not jump to conclusions. There are no set amount of hours specified for the disorder, and just being a fan of video games is not enough for someone to be considered a gaming addict.

What is meant is someone who has been unable to stop playing video games despite "significant impairment" involving work, school, sleep, family, relationships or other aspects of daily life for at least a year or more.

"Studies suggest that gaming disorder affects only a small proportion of people who engage in digital or video gaming activities," WHO said in a statement.

What matters is how much time those people spend gaming "to the exclusion of other daily activities," the U.N. health agency said, and whether there are "any changes in their physical or psychological health and social functioning that could be attributed to their pattern of gaming behavior."

The manual, known as the International Classification of Diseases, or ICD-11, provides standards for classifying diseases, underpinning the global collection of mortality and morbidity statistics.

The latest proposed revisions to the manual, notably including gaming disorder, were publicly released almost a year ago, but have been awaiting approval from the World Health Assembly at its meeting this month from the 20th to the 28th. Now that those revisions have been approved, the ICD-11 manual will take effect at the start of 2022, WHO said.

WHO released a 34-page background document on all the changes to the manual. Those also notably include a shift in how "gender incongruence" should be viewed, reducing the stigma among transgender people. It is now listed as a condition of traditional medicine and sexual health, rather than as a mental health condition, meaning that transgender health issues are no longer classified as mental and behavioral disorders.

Workplace "burnout," characterized by fatigue, negativity towards a job and reduced professional efficacy, is defined in more detail in the manual's eleventh revision. It is considered an occupational phenomenon, not a medical condition, and a legitimate reason for someone to seek health services. But it is limited to what WHO called "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed."

WHO said the newly approved manual serves as the "foundation for the identification of health trends and statistics globally, and the international standard for reporting diseases and health conditions. It is the diagnostic classification standard for all clinical and research purposes. ICD defines the universe of diseases, disorders, injuries and other related health conditions."

Understanding what makes people sick, and what eventually kills them, is at the core of mapping disease trends and epidemics, deciding how to program health services, allocate healthcare spending and invest in improving therapies and prevention," WHO said. "ICD-11 is now fit for many uses, including clinical recording, primary care, patient safety, antimicrobial resistance, resource allocation, reimbursement, case mix, in addition to mortality and morbidity statistics."

The manual is important because it has 55,000 unique codes for injuries, diseases and causes of death, providing a uniform language for health professionals to share information worldwide. Health insurers, national program managers and data collection specialists also rely on it.

Academic and industry pushback

The updated manual is intended to reflect 21st century advances in science, medicine and digital information.

"It can be well integrated with electronic health applications and information systems," WHO said in a statement. "This new version is fully electronic, allows more detail to be recorded and is significantly easier to use and to implement, which will lead to fewer mistakes and lower costs, and make the tool much more accessible, particularly for low-resource settings."

But a forthcoming article in the medical journal The Lancet in June takes issue with how the ICD-11 deals with personality disorders.

The manual "includes a reconceptualization of the categorization of personality disorders with an explicitly expansionist objective," author Jay Watts, a British clinical psychologist, wrote. "The ICD working group assumes this is a positive step, yet the grounds for this assumption are unclear."

Gaming disorder is listed as similar to a gambling disorder, under the category of mental, behavioral or neurodevelopmental disorders. It is defined as a "pattern of persistent or recurrent gaming behavior" that may be online or offline, among people who may exhibit "impaired control over gaming" which increasingly "takes precedence over other life interests and daily activities."

Computers, mobile phones and digitalization, including video games and social media, are inescapable aspects of modern life. Most students need to learn to use computers and to accumulate digital tech skills to be able to navigate the 21st century workplace. In so doing, many inherently grapple with issues around focus, distraction, divided attention and procrastination.

WHO's gaming disorder classification is "unjustified," said the Brussels-based Interactive Software Federation of Europe, which has a mission of ensuring that "the voice of a responsible games ecosystem is heard and understood" on behalf of Europe's video games industry.

"The WHO is a highly esteemed organization and its guidance needs to be based on robust, regular, inclusive and transparent reviews backed by independent experts," ISFE's CEO Simon Little said in a statement.

"We are concerned that 'gaming disorder' is not based on sufficiently robust evidence to justify inclusion in one of the WHO's most important norm-setting tools," he said. "Once set in stone, conditions can be left on this list for many years inappropriately."

WHO’s Director-General Tedros Adhanom Ghebreyesus, however, said last June that the new manual "enables us to understand so much about what makes people get sick and die and to take action to prevent suffering and save lives."

The previous version of the manual, which is used in at least 43 languages and more than 120 countries, was published in 1990. With the latest changes, WHO officials referred to it as “a modern electronic tool” that fills a global need for accurately recording diseases and causes of death.