As the World Health Organization prepares to make a final decision on whether to include gaming addiction in its official mental health disorder guidebook, medical experts and industry insiders worldwide remain divided on the scientific evidence and merits of the move.

As debate ensues, medical professionals and industry experts in South Korea -- home to a thriving game industry and some of the world’s most enthusiastic gamers -- have cast concerns and doubts over the WHO’s push to medically label game addiction as a mental disorder.

WHO’s controversial revision

The controversy began in December 2017, when the WHO revealed plans to list “gaming disorder” as a mental health condition its next revision of the International Classification of Diseases scheduled for May.

If finalized, this would place addiction to video games -- both online and offline games -- in the same category as substance abuse and gambling addiction.

A beta draft of the WHO’s 11th ICD describes gaming disorder as a pattern of persistent or recurrent gaming behavior, characterized by impaired control over gaming, increasing priority given to gaming over other life interests, and gaming activities and continued gaming despite negative consequences.

The behavior pattern should be severe enough to cause significant impairment in personal, family, social, educational, occupational areas, or other important areas of functioning. The symptoms should be evident over a period of at least 12 months for a diagnosis, with permitted flexibility.

The descriptions are broad in their definitions and have prompted several questions, with the most prominent being: what separates clinically diagnosed gaming disorder patients from passionate gamers who choose to spend time playing games at their leisure?

It is up to individual countries to decide whether to take the ICD’s changes into account when drafting their own disease classifications. But most countries, including Korea, base their domestic guidelines on the ICD’s.

Too vague vs. necessary step

Medical experts in Korea and elsewhere are divided on the ICD’s definition of gaming disorder. Some argue that the definitions are too vague, blurring the line between what’s normal and problematic behavior, while others call them a necessary first step toward solutions.

The biggest problem is that the ICD defines gaming disorder as a form of addiction, but fails to meet the associated criteria, said Han Doug-hyun, a professor of neuropsychiatry at Chung-Ang University, during a discussion on the issue hosted by the Korea Creative Content Agency in Seoul this month.

Addiction involves elements of craving, tolerance and withdrawal. In gaming, this could roughly mean craving a game, having to play a game longer every time because you have built up a tolerance to shorter playing times, and getting anxious or angry when you stop.

However, it is much more difficult to apply these traditional elements of addiction to gaming behavior, according to the expert.

“The thing is, most people naturally get tired of the same game after playing it for a few years. How do we view such cases? Is it a symptom of withdrawal when a gamer gets angry when someone pulls the plug on a computer?” Han said.

Such questions are the reason why game addiction was excluded from the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the handbook used by mental health professionals worldwide.

The fifth edition of the DSM published in 2013 lists internet gaming disorder as “a condition for further study.”

Other issues with the ICD’s description of gaming disorder include threshold and categorization. It is difficult to determine what amounts to “excessive” gaming and at what point gaming “takes priority” over other life interests, Han said.

Singling out gaming disorder as a condition of its own is also a challenge, given its close association with depression, anxiety disorder, obsessive compulsive disorder or attention deficit hyperactivity disorder.

Among patients displaying symptoms of game addiction, around 75 percent are diagnosed with depression, 57 percent with anxiety disorder, 60 percent with OCD and 100 percent with ADHD, according to Han.

Meanwhile, other psychiatrists have asserted that the ICD’s description of gaming addiction is structured in a way that avoids overpathologizing, and that a diagnostic system sets a structured path addressing harmful behavior triggered by excessive gaming.

Societal concerns

Taking a broader approach, sociocultural experts in Korea caution against a medical labeling of gaming addiction, citing the cultural, and eventually economic, ramifications.

“If formalized, the term ‘gaming disorder’ itself could easily prompt even non-patients to easily diagnose themselves as a patient of gaming disorder, generating unnecessary medical costs,” said Lee Jang-ju, social psychologist and head of Irock Digital Culture Research Institute in Korea, during the KOCCA-hosted discussion in Seoul.

For instance, enthusiastic gamers are more likely to be mistakenly labeled as a gaming disorder patient, especially by Korean parents alarmed by what they believe may be “excessive gaming.”

Moreover, Lee noted that adolescents considered “game addicts” at a younger age typically lose interest in games as they grow older. But if their behavior is labeled as “addiction,” they have to live with the diagnosis for the rest of their lives, as the concept of “full recovery” does not apply to mental conditions.

The social psychologist also highlighted the ironic dilemma that game companies would face if game addiction was recognized as a formal mental disorder to be prevented and treated.

“It would be like asking game companies to develop games that are fun, but not too fun as to get people addicted,” Lee said, pointing to the highly competitive nature of the global game market where only 0.8 percent of the games launched globally generate sales exceeding 1 billion won ($938,000).

Yoon Tae-jin, a professor at Yonsei University’s Graduate School of Communication and Arts, said that the concept of “game phobia” is the result of traditional media attacking “new media” of the youth.

“Today, kids are spending lots of time on not playing games, but watching videos on YouTube. In a few years, the attacks now directed at games will shift to rising media channels like YouTube. Old media always resists new media,” Yoon said.

Korea’s game sector cautious

The WHO’s May decision on the ICD is particularly significant for Korea, home to major game companies like Nexon, Netmarble Games, NCSoft and Smilegate that contribute significantly to the country’s content exports.

According to the 2017 Game Industry White Paper published by KOCCA in December, Korea’s game exports reached $3.27 billion in 2016. Last year, games accounted for 55.8 percent of Korea’s total content export, according to KOCCA’s 2018 content industry projection report.

Last month, Korea’s eight representative game industry bodies, led by the Korea Association of Game Industry, released a statement in Korean denouncing WHO’s plans to include game disorder in the ICD-11.

“We are skeptical on whether the WHO has plausible data and clinical evidence to define game disorder,” the joint statement reads.

“There is a logical need to review whether the WHO’s description and diagnostic criteria that categorize games, a cultural content regularly enjoyed by roughly 2 billion people around the world, as a disease.”

The Korea Association of Game Industry said it plans to formally draw up an English statement of its views, as well as bring its case to related government industries and lawmakers.

“If the WHO decides to incorporate gaming addiction (into its ICD revisions), it will bolster negative perceptions toward online video games,” said an official from the association. “It’s particularly concerning as games are part of a cultural content business that is sensitive to public opinion.”

By Sohn Ji-young (jys@heraldcorp.com)