Here is a scary story about gaming. A 23-year-old male was engaged for 23 hours straight playing “League of Legends” in a Taiwan Internet cafe in 2012 He had a heart attack and died while playing. Apparently he had a prior heart condition.  But his body sat for nine hours before anyone realized he died. Thirty gamers sat around him yet no one noticed he died! According to the report, his heart attack was brought on by low temperatures, fatigue and lack of movement. He did have a prior heart condition. How do 30 people playing games not know someone has died?

For years I have been writing about my concerns regarding possible digital addiction with gaming. Internet gaming is being studied for possible inclusion into the Diagnostic and Statistical Manual, the standard classification of mental disorders used by mental health professionals in the U.S. It has not been classified as a mental health disorder, but instead has been noted as a disorder in need of more study.

Recently, the International Classification of Disease, a comprehensive manual of disease classification used world wide, came out with their updated diagnostic manual, the ICD 11, and included gaming as a mental health disorder. It is an important manual in that it is used by medical practitioners around the world for reimbursement of disease and other conditions. According to the ICD 11, gaming disorder has 3 characteristics which are similar to substance use:

1. A pattern of gaming behavior that takes precedence over other activities and interferes with completing other things. In other words, it is too much of a priority.
2. Despite negative consequences, the person continues the behavior or escalates playing. It is persistent or recurrent with severity.
3. Game playing leads to distress and impairment in personal, family, social, educational or occupational functioning.  There may also be sleep disturbances, diet problems and a lack of physical activity.

The person has to meet this criteria for at least 12 months unless the symptoms are quite severe. Then it can be diagnosed sooner. The diagnosis can only be made by health professionals and is usually treated with cognitive-behavior therapy. In addition, there are inpatient programs in the US that treat video game addiction and treat it as an addition. Considering an estimated 150 million plus Americans play videos games, we are talking about a lot of people who might need help. Yet, researchers assure us that only a small percentage of people will meet this criteria.

But not everyone agrees with classifying this as a mental health disorder.

Several questions are unanswered. Does it matter which games are played? Which features of gaming behave like a true addiction? Is it the built in unpredictable rewards of the game that keep you coming back for more?

We might all agree that people who play too much have a problem. I am just not ready to label that a mental health problem. In our family, we called it a life balance problem. Anything that is done to excess and interferes with relationships or daily life is a problem.

Some professionals feel gaming is a way to cope with anxiety and depression, not a separate mental health disorder. Others feel it is too subjective and that most clinicians are not informed about gaming since they don’t live in that world. Consequently, it is difficult to know when gaming moves from a favorite pastime to a disorder.

And there are positive benefits that have been noted from playing video games–increased cognitive effort, enhanced motivation for goals, improved memory and hand-eye coordination to name a few. So, are we singling out the gamers and calling them pathological? Does gaming disorder function like other disorders? At this point, the ICD 11 has decided to make it a mental health disorder based on the above. The DSM 5 has yet to include it. More studies are needed. I think the jury is still out.