Sunday 26 May 2019

Gaming - psychiatric disorder or bad habit?

‘Fortnite’ is a very popular game with Irish children as young as six years old
‘Fortnite’ is a very popular game with Irish children as young as six years old

Many parents find that their children would happily do nothing apart from playing computer games. They seem to be magnetically attached to their console and they vigorously resist attempts at encouraging what they deem to be healthier pursuits such as reading, playing outdoors or meeting friends face-to-face. The global games audience is estimated to lie between 2.2 and 2.6 billion people at present and the revenue it generates is forecast to grow from ¤118.5bn in 2018 to an estimated ¤155bn in 2021.

The size of the industry, coupled with concerns about the behaviour that is driving this, is one reason for the attention directed to it by mental health professionals. Gaming behaviour, when it reaches a certain level of severity, has just been declared to be a psychiatric disorder by the authors of the International Classification of Diseases (ICD). A question that hangs over this is: what degree of gaming activity should be regarded as constituting a disorder?

The ICD forms the basis for making both physical and psychiatric diagnoses. It achieves this by specifying the symptoms, duration and outcome of these various diagnoses so as to be regarded as a disorder, disease or syndrome. The 11th edition of the ICD is due for publication later this year.

The American equivalent for mental health is the Diagnostic and Statistical Manual (DSM) 5th edition, which was published in 2013 and does not include gaming disorder in its listing. However, the ICD, as a product of the World Health Organisation (WHO), is considered to supersede the former. By specifying in detail what are the features of each disorder, high levels of agreement can be reached between various professionals making each diagnosis. These classifications can then be used to determine the prevalence of various conditions both within and between countries, and treatment services can be planned.

Gaming disorder is defined in the draft ICD revision as "a pattern of gaming behaviour ('digital-gaming' or 'video-gaming') characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences".

For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.

This new psychiatric disorder may be born with the blessing of the WHO, but there is by no means consensus about this development. It is agreed that gaming behaviours that create personal, interpersonal and social difficulties are deserving of our full attention. Whether proclaiming these behaviours to be psychiatric disorders that require treatment may be extending the tentacles of disorder too far. Perhaps they are simply bad habits.

A number of experts have produced a paper outlining their concerns about 'gaming disorder' and whether it should be considered a psychiatric disorder similar to addiction. This opinion piece was published in the Journal of Behavioural Addiction in 2016. The first author, Espen Aarseth, from Copenhagen University, is joined by 25 others working in public health, psychology, communications, psychiatry and sociology.

Their concerns about the medicalisation of gaming behaviour are valid and should be heard. These include the poor methods used in many studies, and this boundary dispute could lead to a bad habit being deemed to require treatment.

They point out that formalising this behaviour as disorder, in the throes of moral panic, will stigmatise many young people who game more than parents approve of, simply because it is new. They say that this might unwittingly drive parents to seek treatment for their children while distracting from simple measures like parental education that might be sufficient to ease parent concerns and reduce gaming behaviour.

They highlight the fact that in some countries, particularly in Asia, 'boot camp', militaristic-type treatments are used to curb gaming deemed to be problematic. Above all, they say there are no long-term studies to indicate that the problems experienced by youth relating to excessive gaming persist, let alone that they need or benefit from an intervention. They go so far as to claim that the consequences of this might violate the UN Convention on the Rights of the Child, which the WHO as a UN agency is obliged to uphold.

It is likely that because of the ubiquity of gaming, the debate started by the ICD about whether the behaviour can become a disorder, entangled possibly with concerns about children's rights, will be played out, not just in learned journals, but in the media, traditional and social. We do indeed live in strange times.

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