Gambling was the first behavioural addiction – that is, one not related to use of substances —to be officially classified as such. It was included in the diagnostic manual DSM 5 under Addictive Disorders. This set an important precedent that led to Internet Gaming Disorder being included under the “Emerging Measures and Models” section; effectively the waiting room for conditions requiring further study before endorsement by the American Psychiatric Association (APA). Meanwhile the World Health Organisation (WHO), in assessing the impact of computers, smart phones and the internet, had singled out Gaming Disorder as deserving of diagnostic recognition and added it to its classifications within ICD 11 under mental health conditions.
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The loss of control
As with other addictions, Gaming Disorder is characterised by the diminished ability to control gaming activity as demonstrated by ever greater priority and importance being given to gaming at the expense of other everyday activities and interests. Furthermore, the tendency is for it not only to continue compulsively but also to escalate despite a variety of negative consequences. For a diagnosis to be justified, the severity of the pattern must include a significant impairment in personal, family, social, educational and occupational functioning, which will, under normal circumstances, have been in evidence for a minimum of 12 months. Many clinicians use this time frame as a guideline rather than as a hard and fast rule.
Five out of nine signs indicates disorder
It is important to note that gaming behaviour must be causing significant impairment and/or distress to warrant a diagnosis. If five or more of the following symptoms are experienced within a year, Gaming Disorder may be identified:
- Preoccupation – a great deal of time is given to thinking about gaming even when not playing
- Withdrawal symptoms – emotional and even physical discomfort and agitation is experienced when not gaming
- Tolerance – needing to increase the amount of gaming to achieve the same level of stimulation or reward
- Attempts to reduce gaming fail – will power is undermined and motivation overridden
- Loss or neglect of other interests, even of self-care – evidence that priorities have changed
- Continues despite awareness of the negative impact – ignores or plays down the effects identified by self and others
- Deceit – lying to cover up the amount of time spent gaming
- Used for relief or escape – a way to deal with uncomfortable realities and feelings
- Risked losing a significant opportunity or a relationship
More research needed
Debate about the diagnostic validity of Gaming Disorder will continue until research provides a clearer indication to support the classification. As with other addictions, one avenue to be explored is how much the behaviour may be a symptom of underlying psycho-social problems. Some clinicians and academics have warned of the danger of pathologising and therefore potentially stigmatising what may be for some people “normal” behaviour, which may even have some benefits to the user. While it is essential to take note of this caveat, significant numbers of distressed people are coming forward seeking help.