Is gaming disorder a mental health condition? Experts say fears are overblown

  1. Gaming disorder serious issue but numbers of people affected minimal: experts
  2. Fears that the popular game Fortnite may be addictive for children overblown

Fortnite

This month’s decision by the World Health Organization (WHO) to classify (CNN) gaming disorder as a mental health condition has highlighted the scale and severity of the growing issue.

The WHO’s guidance on gaming disorder states: “Studies suggest that gaming disorder affects only a small proportion of people who engage in digital- or video-gaming activities.

“However, people who partake in gaming should be alert to the amount of time they spend on gaming activities, particularly when it is to the exclusion of other daily activities, as well as to any changes in their physical or psychological health and social functioning that could be attributed to their pattern of gaming behavior.”

Experts remain dubious of WHO decision; fear overdiagnosis

Experts contacted by WikiTribune, were, however, skeptical of the WHO decision and said it lacked evidence.

Dr Mark Griffiths, the director of the International Gaming Research Unit at Nottingham Trent University, has been studying gaming disorders for thirty years. He says parents see their children spending a lot of time playing games and assume gaming disorder.

In fact, according to Griffiths, gamers who play even many hours every day rarely exhibit symptoms of gaming disorder. “Parents pathologise this behavior. They’re basically saying an activity that’s taking up to three hours a day is something negative, when in fact there’s no evidence for that whatsoever.”

“People are mixing up general gaming, and excessive gaming, with gaming disorder. There is hardly any crossover between those two things whatsoever.”

WikiTribune community member Frank Salvatini, a retired addiction counselor and college professor, points three symptoms must exist before gaming can be considered addictive or a disorder: “Compulsive use or behaviour, loss of control, and continued use despite adverse consequences”.

Stephen Kaar, a psychiatrist who contributes to the Royal College of Psychiatrists’ Gaming the Mind blog, says that only in very rare cases will video game use be considered severe enough to meet the criteria for gaming disorder.

According to the dopamine theory of addiction – where the brain releases the compound dopamine in reaction to certain stimuli to register pleasure – video games are comparable to food and sex, Kaar says. “If you look at things like crystal meth or cocaine, they are multiple times higher in terms of the amount of dopamine they release than gaming.”

Data from the National Institute on Drug Abuse, reproduced below, illustrates the relatively modest effect on the brain of playing video games when compared with other addictive substances.

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The risk, according to both experts, is of overdiagnosis of gaming disorder among children. “There can be a real desire to give something a label and put something into a box. We want to simplify things. We want to give things labels,” says Kaar.

Issue serious but not widespread, say experts

Griffiths says that though gaming disorder is a serious issue, it affects relatively few people. Many people may play video games unhealthily, sometimes to the point that it negatively affects their relationships with friends and partners, but only in a very few cases will their excessive gaming be indicative of gaming disorder, he suggests.

According to Griffiths, the number of people who are affected by their use of video games to the point of becoming “pathological and addicted,” is “very small”.

“Does gaming disorder exist? Yes, it does. Is gaming disorder a big problem? The answer is there’s no evidence that it’s a big problem.”

It is still unclear exactly how many people are affected by gaming disorder, but figures  (Guardian) among young people in some Asian countries are estimated to be as high as 10-15%, as opposed to 1-10% in the West.

The inclusion of so-called “loot boxes,” which present gamers with the chance to receive a reward, from customization options to valuable equipment and weapons, has also been widely criticized. Rewards are randomized, leading critics to compare their functioning to slot machines. Players are typically able to exchange real world money for more loot boxes.

Critics liken (Eurogamer) the functionality of loot boxes to that of gambling machines.

“If you can pay real-world money for an item, or you can gain an item through playing a game a lot, and there’s a chance that that item may turn into something extremely valuable, even if it’s just within the game, and there’s a randomness to that variable … then I think those kind of elements do have the potential to be addictive,” Kaar said.

Several countries regulate the use of loot boxes, including Belgium, where they were banned (The Verge) this year.

Kaar argues that because the gaming industry is so competitive, there is little incentive for developers to self-regulate and remove mechanisms like loot boxes from their games. “All these huge companies are competing over game players’ attention.”

Fortnite: addictive or harmless fun?

One popular game, Epic Games’ Fortnite, has been praised for forgoing revenue add-ons like loot boxes. Fortnite “seems to have taken a simpler tack [than using loot boxes]: build a fun game, monetize it smartly and hope to make more profit from 100 million happy players than a million exploited ones,” the Guardian writes approvingly.

Fortnite’s Battle Royale mode sees up to 100 players parachuted onto a deserted island where every player is tasked with killing anyone they encounter, until a single victor remains. The free-to-play game’s bright colors and lack of gore appeal to young children and parents alike (Guardian).

But even without loot boxes, the methods it uses to keep users playing have been labeled “a compulsion” or even “addiction.”

With stories (Mirror) of children as young as nine addicted to the game, fears are growing of the game’s effects. Dr Jon Godin, also of the Royal College of Psychiatrists, told Britain’s Channel 4 that he sees “patients who find it hard to go to school because they want to be on their Playstation; they want to be gaming.”

“They feel like they’re letting down their colleagues, their teammates, if they’re not available, at all hours, to play on this game.”

Yet fears that Fortnite addiction is widespread among children were dismissed by Griffiths when he spoke to WikiTribune. “There’s very little evidence that many people have become genuinely addicted to [Fortnite],” he says.

Nicola Muir’s son Daniel plays Fortnite about two hours a day after school. “It is violent but cartoony, so while I wouldn’t let him play Call of Duty or Grand Theft Auto, I’m okay with Fortnite,” she says.

Daniel says he isn’t addicted to the game. “It’s just a game like all the others. It’s fine if you do other fun stuff too.”

In a statement, organizations representing the gaming industry, including the Association for UK Interactive Entertainment, said: “Video games across all kinds of genres, devices and platforms are enjoyed safely and sensibly by more than 2 billion people worldwide, with the educational, therapeutic, and recreational value of games being well-founded and widely recognised.

“We are therefore concerned to see ‘gaming disorder’ still contained in the latest version of the WHO’s ICD-11 despite significant opposition from the medical and scientific community. The evidence for its inclusion remains highly contested and inconclusive.

“We hope that the WHO will reconsider the mounting evidence put before them before proposing inclusion of ‘gaming disorder’ in the final version of ICD-11 to be endorsed next year.”

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