Rune Kristian Lundedal Nielsen

Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

COPE-ICD: A randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population

BackgroundGrowing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity. It has been suggested that psychological stress can increase the risk of shock and predict death. Small studies have indicated a beneficial effect arising from exercise training and psychological intervention, therefore a large-scale rehabilitation programme was set up.Methods/DesignA mixed methods embedded experimental design was chosen to include both quantitative and qualitative measures. A randomised clinical trial is its primary component. 196 patients (power-calculated) were block randomised to either a control group or intervention group at a single centre. The intervention consists of a 1-year psycho-educational component provided by two nurses and a 12-week exercise training component provided by two physiotherapists. Our hypothesis is that the COPE-ICD programme will reduce avoidance behaviour, sexual dysfunction and increase quality of life, increase physical capability, reduce the number of treatment-demanding arrhythmias, reduce mortality and acute re-hospitalisation, reduce sickness leading to absence from work and be cost-effective. A blinded investigator will perform all physical tests and data collection.DiscussionMost participants are men (79%) with a mean age of 58 (range 20-85). Most ICD implantations are on primary prophylactic indication (66%). 44% is NYHA II. Mean walk capacity (6MWT) is 417 m. Mean perception of General Health (SF-36) is PCS 42.6 and MCS 47.1.A large-scale ICD rehabilitation trial including psycho-educational intervention and exercise training has been initiated and will report findings starting in 2011.Trial RegistrationClinicalTrials.gov: NCT00569478

A weak scientific basis for gaming disorder: Let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

Video game addiction: The push to pathologize video games.

With proposals to include “gaming disorder” in both the Diagnostic and Statistical Manual (DSM) and International Compendium of Diseases (ICD), the concept of video game addiction has gained traction. However, many aspects of this concept remain controversial. At present, little clarity has been achieved regarding diagnostic criteria and appropriate symptoms. It is unclear if symptoms that involve problematic video gaming behavior should be reified as a new disorder, or are the expression of underlying mental conditions. Nonetheless, the recent proposals around gaming disorder from respected bodies such as the World Health Organization and the American Psychiatric Association seem to lock much of the applied research into a confirmatory trajectory. Since the DSM–5 proposal, research is increasingly focused on the application of the proposed criteria, as opposed to broadly testing validity and necessity of the overarching construct. This raises multiple concerns. First, the current approaches to understanding “gaming addiction” are rooted in substance abuse research and approaches do not necessarily translate to media consumption. Second, some research has indicated that “video game addiction” is not a stable construct and clinical impairment might be low. Third, pathologizing gaming behavior has fallout beyond the therapeutic setting. In light of continuing controversies, it is argued that the currently proposed categories of video game addiction disorders are premature.

Helping Parents Make Sense of Video Game Addiction

Digital technologies, including video games, are the cause of much concern and much optimism. Many parents are concerned by reports in the popular press about the concept of video game addiction. This chapter aims to critically examine some of the most prolific concerns surrounding the concept of video game addiction and provide a discussion of the science behind such concerns. Among the concerns discussed in this chapter are (1) the idea that increasing amount of time spent playing is a symptom of addiction, (2) the notion that video games are forms of digital substances akin to cocaine or heroin, (3) the concern that Internet descriptions of symptoms can be used for diagnostic purposes, and 4) the concern that video games necessarily have negative consequences. We argue that the term “addiction” is not well suited to describe children’s involvement with digital media.