So hooked on video games it’s a mental disorder
Excessive playing of video games is no longer just annoying to your parents or roommate. As of this year, it can be considered a mental disorder.
The World Health Organization is including “gaming disorder” in its latest International Classification of Diseases, used worldwide to diagnose health problems, provide health care and allocate resources.
But don’t pull yourself away from “Call of Duty” for a trip to the therapist just yet, cautioned a Cal State Fullerton professor who specializes in addiction to video games and social media.
“It’s good to have it on the books; it’s a positive step forward,” said Ofir Turel, professor of information systems and decision sciences. “We do need this increased recognition. But we need many more steps forward to make our society a better place.”
The gaming disorder news hit as Turel was fielding questions from reporters around the world about people who make New Year’s resolutions to cut back or quit their time on social media.
WHO decided to add gaming disorder to its list because in a number of countries, the problem has become a significant public health concern.
“There is increasing and well-documented evidence of clinical relevance of these conditions and increasing demand for treatment in different parts of the world,” said WHO spokesman Tarik Jašarević in Geneva.
The ICD-11 entry on gaming disorder includes only a clinical description and not prevention and treatment options.
WHO’s classification goes a step beyond the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which classifies mental disorders for billing and insurance purposes just in the United States. The latest edition doesn’t classify video game addiction as a formal disorder, but one that merits more research.
But even with WHO’s announcement, nothing will change overnight, Turel pointed out. There’s a time lag to recast all the medical billing and coding that allow health care providers to be paid by insurance companies for the care they provide.
“Once you classify this as a mental disorder, it’s very complicated,” he added. If an employee is caught playing video games at work and is fired for it, for example, the employee could claim a disability, which under the Americans with Disabilities Act prohibits that person from being terminated.
Classifying mental disorders is tricky because there aren’t the clear cut-offs present in other medical fields, Turel said. If someone has a temperature over 100 or a heartbeat that doesn’t follow a certain pattern, it’s easy to diagnose illness. “With mental disease, we just consider what is problematic and requires treatment and what doesn’t,” he said. “It has never been like other medical fields.”
Homosexuality was once considered a mental disorder, he gave as an example. “People keep coming up with classifications and changing them,” he said.
WHO’s description of gaming disorder says it’s characterized by a pattern of persistent or recurrent gaming behavior manifested by:
•Impaired control over gaming
•Increasing priority to the extent that gaming takes precedence over other life interests and daily activities
•Continuation or escalation despite the occurrence of negative consequences
The behavior pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning, says WHO. The pattern must be evident over at least 12 months, though that timeframe can be shortened if symptoms are severe.
What constitutes severe impairment is subjective, pointed out Turel. What’s severe for one person might not be for someone else. Pharmaceutical companies might try to broaden the definition to sell potential medication, while insurance companies might try to narrow it to avoid paying for treatment.
“There is always a struggle,” Turel said.
There is not, of course, an anti-gaming pill that will cure someone glued to a game pad. Turel said medication used in substance abuse treatment to reduce cravings might be tried. Cognitive behavioral therapy, which challenges distorted thinking, might work in many cases, he said. In China, he said, there are “detox camps” where people attempt to break their video game habit by learning to live with nature.
“We don’t want to over-pathologize people,” he said. “I don’t want to see mothers going around saying ‘You have an addiction.’ ”
Other conditions, such as social phobia, attention deficit hyperactivity disorder or weak self-control ability, could also be present, complicating a diagnosis.
“This is why the DSM team didn’t jump,” he said.
“We know there’s a problem. We know some kids play 15-plus hours,” he said. “I don’t know if the term ‘addiction’ is appropriate for this. There will be an ongoing debate for many years over what constitutes treatment.”
That debate will stretch to the insurance industry and perhaps even the state Legislature, said Shana Alex Charles, assistant professor in the CSUF Department of Health Science.
Insurance companies have some leeway in defining categories, said Charles, who was director of the Health Insurance Studies Program at the UCLA Center for Health Policy Research before joining Cal State Fullerton in 2015. Excessive video gaming would likely fall under addiction, which might have coverage limitations. Carriers typically restrict such conditions more than they do physical ones, she explained.
“Insurance companies aren’t usually on the forefront of jumping in to cover experimental therapies,” Charles said. If the company has a therapist in its network treating gambling addiction, it might cover the same kind of therapy to treat video game addiction, for example.
“There might be some pushback. This could be interesting,” she said. If insurance companies don’t step up to cover treatment, she added, the Legislature could compel them to.
Charles is an active member of the California Health Benefits Review Program faculty task force, which analyzes the impact of proposed health insurance benefit mandates for the Legislature. Such mandates are often influenced by what lawmakers see in the news and hear from their constituents.
“The important part is there’s so much press being paid to it,” she said of the WHO announcement. It’s unusual for mental health issues to garner so much attention.
Pressure for insurance companies to cover gaming disorder would increase if the American Psychiatric Association includes it in its DSM. “That’s the next step,” Charles said.