As WHO member states begin the transition from using the ICD-10 to the ICD-11 in health care and data reporting systems, it is important for clinicians to gain an understanding of how new diagnostic categories in the ICD-11 Clinical Descriptions and Diagnostic Requirements for Mental, Behavioural, or Neurodevelopmental Disorders have the potential to improve both individual care and public health globally.
In an article published recently in World Psychiatry, an international team of experts and collaborators share insight on the following four new diagnoses in the ICD-11: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. As part of a series of GCP.Network Perspectives articles, key information on gaming disorder is highlighted here.
What is gaming disorder? In the ICD-11, gaming disorder is described as:
- A persistent pattern of gaming behavior (‘digital gaming’ or ‘video-gaming’):
- Impaired control over gaming behaviour.
- Increasing priority given to gaming (gaming takes precedence over other life interests and daily activities).
- Continuation or escalation of gaming behaviour despite negative consequences (e.g., family conflict, poor scholastic performance, negative impact on health).
- The pattern of gaming behavior over an extended period of time (e.g., 12 months)
- Causes significant distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning.
- To view the full version of the diagnostic requirements, the ICD-11 CDDR is available here.
Why was gaming disorder added as a new diagnostic category? Health care and counseling facilities worldwide have encountered growing demands for services related to problem gaming since the mid-2000s. Excessive video-gaming, characterized by loss of control over gaming behaviour, can interfere with social, educational and occupational functioning and have negative consequences on physical health (e.g., sleep, pain, body weight, vision, and physical exercise). Longitudinal studies have also indicated that sustained problematic gaming behaviours are associated with neurobiological changes and psychopathological symptoms over time (e.g., anxiety and depressive symptoms). With problem gaming having been recognized in most American, European, and Asian countries, this condition is an international public health issue that is likely not primarily driven by cultural or region-specific factors. To avoid pathologizing intensive but healthy gaming behaviors, ICD-11 sets a high threshold for classifying gaming and emphasizes the core characteristics of loss of control over gaming, persistence despite negative consequences, and significant functional impairment due to gaming. Experts agree that criteria that are generally used for substance use disorders such as tolerance, deception, and mood regulation should not be used to diagnose gaming disorder, and more research is needed to determine whether characteristics such as withdrawal or preoccupation should be evaluated in the diagnostic process for gaming disorder.
How does this new diagnosis improve care provision and advance public health? Previously, lack of a formal diagnosis for gaming disorder and the practice of providing individuals a range of alternative diagnoses (e.g., mood disorders, gambling disorder, or impulse control disorder) created inconsistencies in the type of care that individuals and families received. The inclusion of this diagnosis in the ICD-11 not only provides a standardized way for clinicians to diagnose but also allows for evidence-based treatment methods to be developed and tested specifically to reduce persistent patterns and symptoms of gaming disorder. As WHO member states transition to using the ICD-11 diagnostic categories in national health systems, more accurate data on the global and national prevalence rates for gaming disorder can be obtained, and better data can support calls for additional research and public health initiatives that support individuals who may be vulnerable to developing gaming disorder.
To read more about the history, research evidence, and controversies around the inclusion of gaming disorder in the ICD-11, the full article is available online here. GCP.Network members can log in and download a PDF of the article on the Scholarly Output page.
Citation: Reed, G.M., First, M.B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C.R., King, D.L., Kraus, S.W. and Bryant, R.A. (2022). Emerging experience with selected new categories in the ICD-11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry, 21: 189-213. https://doi.org/10.1002/wps.20960