Friend 1: Up for a game?
Friend 2: Yeah
Friend 3: Letsss
Friend 4: Football?
Friend 1: Ground or FIFA?
Friend 2, 3 & 4: Of course, FIFA!!
I’m sure that leaving your house for game night or shouting
excitedly at the screen while carrying out virtual loots plonked on your home
couch might have earned you a dismayed shaking of head from your parents at
least once—“Gone are those days when you
actually went out to play on field.”
Sure, there is a lot of moral panic surrounding the
issue of gaming already and amidst this when the International Classification of Diseases (ICD) declared Gaming
Disorder (GD) as a clinical diagnosis in its latest 11th edition; it
raged a controversy amongst professionals and laymen alike. ICD, as published by World Health Organization (WHO), helps in identification, research and
report of health trends and statistics globally. It defines the universe of
diseases, disorders, injuries and other related health conditions including
diagnosis pertaining to mental health. Walking in step with it is the Diagnostic and Statistical Manual of Mental
Disorders (DSM) published by the American
Psychiatric Association (APA) which in its 5th edition has
enlisted Internet Gaming Disorder (IGD) as an area requiring further study.
What do these authoritative texts mean by GD/ IGD?
According
to ICD, GD is characterized by a pattern of persistent gaming behavior (either
continuous or recurrently episodic), which may be online or offline, manifested
by:
- impaired control over gaming
- increasing priority given to
gaming to the extent that it takes precedence over other life interests
and daily activities
- continuation or escalation of
gaming despite the occurrence of negative consequences.
This
behavior pattern needs to be severe enough to result in impaired functioning in
personal, family, social, educational, occupational or other important areas. For
diagnosis, symptoms must be evident over a period of at least 12 months,
although the required duration may be shortened if all criteria are met and
symptoms are severe.
On the other hand, DSM-5 has hinted at complementary
yet more detailed symptoms of diagnosis. Under the proposed criteria, IGD would be detected if
five or more of these symptoms are present for a year:
1. Preoccupation with gaming (on internet
or any electronic device)
- Withdrawal
symptoms(sadness, anxiety, irritability) when gaming is taken away or not
possible
- Tolerance:
the need to spend more time gaming to satisfy the urge
- Unsuccessful
attempts to reduce/ quit gaming
- Loss
of interest in other activities due to gaming
- Continuing
to game despite problems
- Deceiving
family members or others about the amount of time spent on gaming
- The
use of gaming to relieve negative moods, such as guilt or hopelessness
- Risk:
having jeopardized or lost a job or relationship due to gaming
The Controversy
To begin with, there is a debate surrounding the
“goodness or badness” of games itself. Although the negative impact of gaming
which is so widely reported (for instance: the recent death of a 16 year old in Madhya Pradesh, India after playing PUBG for 6 hours straight) can’t be denied;
there is also equally researched but not very well accepted set of data
pertaining to the positive contributions of gaming (e.g. increased experience
of positive emotions, valuing of cooperation in team games, stress release,
sharpening of cognitive abilities and so on). Thus, since the research body
dealing with value judgment of the gaming phenomena is not yet conclusive, the
move to pathologize gaming behavior has come under crossfire.
A very obvious area that is found under scrutiny is
the vagueness of the criteria used for diagnosis. For instance, a scholar has
pointed out that the ICD definition doesn’t distinguish between mild, moderate
or severe cases; which means that clinicians — many inexperienced with video
game addiction and oblivious to the gaming culture — have to decide this for
themselves. Also, the DSM criteria requires the individual to exhibit only 5/9
symptoms to be diagnosed with IGD. While few indicators clearly point that
something is wrong viz. experiencing withdrawal symptoms, the desire to stop
but not being able to and losses on occupational and interpersonal fronts;
checking off any 5 symptoms to the exclusion of these 4 important ones for
receiving a diagnosis is quite easy. However, the remaining 5 symptoms are
questioned for their credibility in indicating abnormality. For instance, any
activity that you are extremely passionate about is likely to keep your mind
and schedule preoccupied. If being preoccupied with artistic ideas isn’t
considered abnormal then why is being preoccupied with gaming till the point of
picking it over engagement in other activities considered problematic? Or, one
could argue that tolerance applies
to almost any hobby because with increased ability one needs to increase the
level of challenge to get the same thrill that one got before from that
activity. Hence, it is only normal for a gamer to seek increased stimulation
from games as his/her level of proficiency increases.
Thus, more research is required to narrow down on
what exactly can be considered as signs indicating the presence of problematic
gaming behavior. This is cited as one of the reasons for inclusion of this
diagnosis in ICD—the presence of such a diagnosis would accelerate more
research in the area. However, a concern raised is that the presence of such a
diagnostic category might promote confirmatory rather than exploratory
research. So, instead of trying to find out what more can be indicative of this
condition, clinicians may get caught up in confirming whether or not the
prescribed criteria are displayed by the potential cases.
One last area of heated disagreement is where
research has time and again pointed out gaming behavior as being accompanied by
(comorbid to) other mental health conditions like depression and anxiety. It is
often said that excessive gaming is used as a coping mechanism against the
disturbing feelings invited by depression and anxiety and so the focus should
be on treatment of these underlying conditions thereby rendering the separate notation
of GD/IGD diagnosis redundant. However, a parallel that is often used to argue
against this position is that of substance abuse disorders. They exist as a
separate category despite of being associated with depression and anxiety
because they in themselves pose sufficient risk that needs to be addressed
first hand. Furthermore, in some cases, substance abuse has been found to lead
to the latter conditions and so is GD found to independently exist. Hence, the
symptoms presented by GD/IGD deserve to be treated independently of their
comorbid conditions.
Will classifying abnormal gaming patterns as a
disorder lead to abuse of diagnosis? Will it create a moral panic that was
referred to at the beginning of this post? Will it stigmatize the gaming
community even more than it is currently? The answer is not quite certain.
However, is it a good idea to miss out on a diagnosis based on ICD’s statement that
it is backed by a global consensus of scientists? Is it in the best interest of
all to leave out this diagnosis because only a small minority of gamers might
be suffering from disordered behavior? Will this even help to avoid the
supposed moral panic and stigmatization? The answer is again quite uncertain.
All one can say is that cautioning the public prematurely about a sensitive
topic may involve more harm than gain and so the focus should be on INFORMING
than WARNING.