Where is the evidence of ‘Gaming Disorder’?

Ruben Ferreira with a letter from the May issue.

This year the World Health Organisation (WHO) officially recognised ‘gaming disorder’ as a psychiatric disorder characterised by maladjusted behaviours surrounding video gaming activity, via the 11th Revision of the International Classification of Diseases (ICD-11). I am early in my psychology career and happen to be a big fan of video games, so this should feel like an exciting time to engage in this topic and receive credibility and attention from those outside the field, ranging from the general public to policy makers. However, we should be careful with what we wish for.

Given the lack of strong empirical evidence on causal effects, the WHO’s decision seems too hasty. Professor Andrew Przybylski perfectly described this matter: ‘the burden of evidence around global health policy in this area should be extremely high, because there is a genuine risk of abuse of diagnoses’. Hopefully I am wrong, but I can already foresee video games going through another wave of stigma from the media, politicians and concerned parents who years ago were agitated about video games causing violence (this narrative had little basis in science). This time, instead of violence, it would be depression, suicide, and any other psychological disorder, when we do not fully understand what is going on in the patient’s life.

As Professor Przybylski said, we need to understand how video games work, what is potentially harmful and beneficial about them, otherwise it is like ‘having a debate about addiction to glass bottles, and no one cared what was inside the bottle’. This is reminiscent of social media research in the past, in which plenty of studies tried to establish a link between time spent on social media and wellbeing but the links were either weak or not significant (see Huang’s 2017 meta-analysis in Cyberpsychology, Behavior, and Social Networking). However, when researchers considered the differences in online behaviours, this provided a clearer picture – social media can be good or bad for our mental health, it depends on how we use it (e.g. Verduyn et al.’s 2017 review in Social Issues and Policy Review). Time spent alone is not a reliable indicator.

I believe our interactions with video games also dictate if they are good or bad for us, but we can only safely make such conclusions by analysing those interactions. Another approach to consider is if specific gaming elements/features can influence mental health. I am particularly interested in ‘Games as a Service’ (GaaS), a model in which games receive continuous updates and new monetised content after their initial release (e.g. Fortnite and Clash of Clans). I have noticed the majority of GaaS contain features of extreme psychological interest, such as daily/weekly objectives, login rewards and time-limited events – these are specifically designed to keep people playing and thinking about the game. 

Regardless of what direction this area will pursue, it is inevitable that researchers and therapists will need to collaborate with the gaming community and ideally developers and publishers to have a look at ‘inside the bottle’. This should be a more pressing matter now that the ICD-11 has come into effect.

Ruben Ferreira

Research Assistant, Nottingham Trent University

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