Gaming disorder

Gaming disorder is a disease officially included in the World Health Organization’s International Classification of Diseases in January 2022.

Background

Let’s briefly look at the history, jumping back and forth in time a little.

The WHO’s International Classification of Diseases

The International Classification of Diseases (ICD) is a kind of dictionary comprehensively describing all diseases and causes of death. It is maintained by the World Health Organization.

The previous version, ICD-10, was finalized in 1990 and took effect in 1993. When the ICD is revised, South Korea, as a WHO member state, must reflect the changes in a new edition of its Korean Standard Classification of Diseases (KCD).

2019: “Gaming disorder” added

In 2019, formal adoption of ICD-11, the revision of ICD-10, was on the World Health Assembly agenda (WHA 72). ICD-11 added a new disease, “gaming disorder.” All participating countries, including South Korea, voted unanimously to adopt it, confirming that ICD-11 would take effect on January 1, 2022.¹

Several participating countries voiced concerns at the assembly, but none explicitly proposed amendments.²

The United States said more research was needed to determine whether gaming disorder is a disease in its own right or a symptom of other diseases.
South Korea welcomed its inclusion as a way to encourage healthy gaming, while suggesting a more cautious approach to diagnostic criteria for gaming disorder severe enough to require medical intervention.

2022: Takes effect

Following the WHA 72 resolution, ICD-11 took effect in 2022. South Korea, however, did not announce KCD-9, reflecting ICD-10, until July 2025. KCD-10, intended to reflect ICD-11 including gaming disorder, is scheduled for implementation in 2031, so there is still some time.

Nevertheless, wasteful debates about gaming disorder have continued at every major milestone (the 2019 assembly, its taking effect in 2022, implementation of KCD-9 in 2025, and so on).

2007: Discussions begin

Given that serious discussion of the ICD-11 revision actually began in 2007, that member states and outside organizations were consulted repeatedly over the years,³ and that the content itself was finalized in 2018,⁴ it is very strange to make a fuss as though gaming disorder were suddenly rammed through at the 2019 assembly.

2013: “Internet gaming disorder” in DSM-V

In 2013, the American APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) added a behavioral addiction category, while recommending more research into whether a disease called “internet gaming disorder” should be included in it. But even in 2013, it explicitly recognized that gaming can cause serious problems in people’s lives.⁵

Responses from different fields

People working in clinical psychology and public health generally seem to support the WHO’s decision, while those in psychology, sociology, education, and the games industry seem opposed.⁶ Academic criticism rests mainly on insufficient scientific evidence and the need for more research, and on concerns that assigning a disease code could stigmatize gaming.⁷

Nevertheless, I support the argument that the precautionary principle should take priority in public health policy. Where there is a risk of serious harm to ecosystems or human health, scientific uncertainty should not be used to delay preventive action.⁸

Shortly after the 2019 assembly, the Game Developers Guild of Korea released its official position,⁹ and the Korea Association of Game Industry also issued a statement.¹⁰

Thoughts on the Game Developers Guild of Korea’s official position

First, I support the guild’s acknowledgment of problematic practices in the games industry, such as encouraging overspending through randomized items and repeated logins to secure retention.⁹

However, I think several points could lead to misunderstandings.

First, reading the guild’s statement alone could leave the impression that two diseases—“hazardous gaming” and “gaming disorder”—were added. But the only gaming-related mental disorder added to ICD-11 was gaming disorder. Hazardous gaming was proposed as a factor that can affect health or contact with health services, rather than as a disease itself. Other such factors include “lack of exercise,” “unhealthy eating habits,” and “low income.”

The statement’s “interpretation” says that hazardous gaming includes “swearing at others while playing, self-harming out of self-reproach for one’s mistakes, or swearing at others and damaging property after losing.” This seems somewhat exaggerated, and I could not find the source on which it was based.

Second, I do not think it is appropriate to explain the misunderstanding as arising from translating “gaming disorder” simply as “addiction” instead of behavioral addiction or disorder, thereby making it sound equivalent to drug addiction. Arguments for avoiding “addiction” because it is derogatory or overly broad, and for distinguishing substance misuse, dependence, and behavioral addiction because their causes, symptoms, and treatments differ, are valid.¹¹ But there seems to be little reason to attribute the misunderstanding to rendering a term that should be translated as behavioral addiction or disorder simply as addiction. Both the DSM-V proposal for internet gaming disorder and the ICD-11 inclusion of gaming disorder aim to encourage systematic collection of data and research into gaming-related problems.⁵ In other words, whatever the wording, an attempt really is being made to treat gaming on a par with substances such as alcohol or tobacco.

I consider it desirable to treat games on a par with addictive substances. This view comes from observing the IT and games industries. Compared with the industry’s professional, relentless efforts to exert lasting and profound influence on human behavior, what individual users can do to resist seems all too feeble. Some references:

Still, “gaming disorder” feels like an odd category—something like “beer addiction.” If beer addiction were a disease, makgeolli addiction, soju addiction, and wine addiction would all need separate entries. “Alcohol addiction” (more precisely, alcohol dependence) is more useful. I strongly agree with an article pointing out that although severe depression can lead people to spend long periods in bed, calling this “bed addiction” would be strange.

Even so, I think we need to start, however imperfectly.

Thoughts on the Korea Association of Game Industry’s statement

The association argues in its statement¹⁰ that because the WHO is enormously influential, it should register diseases only on the basis of clear scientific evidence. I do not particularly agree, since this conflicts with the WHO’s precautionary principle discussed above.⁸

For the statement to be persuasive, it would need to show that scientific evidence for gaming disorder is so weak that even the precautionary principle cannot apply, or that the harm caused by gaming is minor. Merely declaring that the evidence is unclear does nothing to advance the discussion.

It also claims that political pressure from certain countries led to games being “unilaterally singled out as a cause of mental illness without even a proper opportunity for evaluation.” Yet this document alone³ shows countless discussions since 2007, with procedural transparency far greater than that of DSM-V, at least. If there truly was no proper opportunity for evaluation, doesn’t that merely amount to admitting that the relevant organizations, including the association, had failed to respond adequately all that time?

Third, it asks whether professional gamers are “severely mentally ill,” and, if they are exempt as the WHO says, whether aspiring professionals are indeed “patients suffering from gaming disorder.” This seems problematic in two ways. First, the association seems unfamiliar with the definition of mental illness: neither DSM nor ICD treats spending a long time or working hard at something as a mental illness in itself. Second, the statement appears to exploit society’s widespread stigma against people with mental illness. I wish the association would refrain from strengthening that stigma with phrases such as “professional gamers qualify as severely mentally ill” and “become patients suffering from gaming disorder.”

Finally, it calls gaming “a leading form of content enjoyed by 70% of our population” and says the issue “requires consideration of the individual’s surrounding environment and relationships, rather than games themselves.” These claims do not follow from one another. Whether 10% or 70% of the population enjoys games is not the point. Many adults drink alcohol, but that does not remove alcohol dependence from disease classifications.

Drinking is cultural. Alcohol is also a substance that can cause addiction. These two facts are compatible. The same goes for games.