The World Health Organization lists "hazardous gaming" and "gaming disorder" as potential problems "due to substance use or addictive behavior" in a newly proposed draft update of its widely used International Compendium of Diseases. The listings, set to be finalized this year, renew a debate about if and when playing video games can cross the line from casual pastime to a harmful addiction.

The draft language suggests a patient with gaming disorder is one who lets playing video games "take precedence over other life interests and daily activities," resulting in "negative consequences" such as "significant impairment in personal, family, social, educational, occupational or other important areas of functioning." Such symptoms would "normally" need to be present for at least 12 months for a diagnosis, under the listing, but could be indicated even sooner.

Hazardous gaming, as defined in the draft document, more generally encompasses game playing that "increases the risk of harmful physical or mental health consequences to the individual or to others around this individual."

The argument over whether a certain amount of game playing should be classified as an "addiction" has been raging for decades. In 2013, the American Psychiaric Association stopped short of listing "Internet Gaming Disorder" as a formal diagnosis in the fifth edition of its widely cited Diagnostic and Statistical Manual of Mental Disorders. But it did list it as a potential disorder in "Section III," calling such "preoccupation" with online games "a new phenomenon" that merits "more clinical research" to determine whether it deserves a full place in the manual.

The state of the debate

Many point to heavily publicized deaths during marathon gaming sessions as obvious evidence that some players can take their relationship with games to unhealthy extremes.

Others argue that this kind of "problem gaming" is an outgrowth of other mental health issues and that patients might simply be using gaming as a coping mechanism for other undiagnosed problems. There are studies that show playing games could actually reduce addictive tendencies elsewhere in life

"Quite possibly, labelling excessive screen use as an addiction may just be a proxy for expressing concerns about the impact disagreements about screen time are having on family dynamics," as a recent UNICEF report about children's access to digital technology put it. "Careless use of addiction terminology downplays the very real consequences of the behavior for those who are seriously affected, while overstating the risk of harm for those who at times engage in somewhat excessive, but ultimately not harmful, use of digital technology."

In calling the WHO's proposed definition a "junk diagnosis," Stetson University Psychology Professor Christopher Ferguson argues in a Huffington Post piece that "of course, any fun activity can be overdone... but there’s little evidence to suggest video games are more addictive than other behaviors... 'gaming disorder' is indicative of a larger trend to increasingly pathologize normative behaviors, whether for moral reasons (because older adults would prefer kids look at trees or play canasta than play video games) or financial (because there’s money to be made) or political (to regulate behavior or speech)."

Similar concerns led a group of 28 experts in the field, including Ferguson, to write an open letter to the WHO in 2016 urging them not to let a "moral panic [surrounding] the harm of video gaming" lead to "the treatment of abundant false-positive cases." Citing the low quality of current research and lack of consensus on symptoms, the group worried that listing the disorder would "cause significant stigma to the millions of children and adolescents who play video games as part of a normal, healthy life."

On the other side, a group of researchers led by Nottingham Trent University's Mark Griffiths recently noted that even critics of a clinical listing for gaming disorder note that "some gamers do experience serious problems as a consequence of the time spent playing video games." If that's the case, they argue, "how can such an activity be seriously problematic yet not disordered?"

Griffiths and his colleagues also point to a growing body of epidemiological and neuroimaging studies on large populations that suggest some similarity between the effects of problem gaming and "substance-related addictions" on the molecular and neurocircuitry level. While Griffiths and his colleagues have acknowledged that there is little consensus on the issue, they argue that listing the disorder would help add some consistency to the diagnosis and provide clarity for further research.

The game industry, as represented in the US by the Entertainment Software Association, doesn't agree. "Just like avid sports fans and consumers of all forms of engaging entertainment, gamers are passionate and dedicated with their time," the ESA said in a statement. "The World Health Organization knows that common sense and objective research prove video games are not addictive. And, putting that official label on them recklessly trivializes real mental health issues like depression and social anxiety disorder, which deserve treatment and the full attention of the medical community. We strongly encourage the WHO to reverse direction on its proposed action."

A finalized WHO listing for these two gaming disorders probably won't settle the long-running debate over the issue. But it could represent a major step forward for those who see overuse of gaming as a risky behavior for a small portion of the population and for those seeking treatment of these kinds of symptoms in themselves or loved ones.