La dipendenza dal gioco è descritta nel Manuale diagnostico e statistico dei disturbi mentali (DSM-5) dell’American Psychiatric Association, che viene utilizzato dai professionisti della salute mentale per diagnosticare i disturbi mentali. Non ci sono prove sufficienti per determinare se la condizione sia un disturbo mentale unico o quali siano i migliori criteri per classificarlo al momento della pubblicazione del DSM-5 nel 2013. Tuttavia l’APA ha riconosciuto il disturbo del gioco su Internet nella sezione che raccomanda le condizioni per ulteriori ricerche, insieme con il disturbo da uso di caffeina e altre condizioni.
Il disturbo da gioco su Internet è inserito nella sezione “Condizione per ulteriori studi” nel DSM-5 (APA 2013). Ciò significa che non è un disturbo “ufficiale” nel DSM (Manuale diagnostico e statistico dei disturbi mentali), ma uno su cui l’American Psychiatric Association richiede ulteriori ricerche. A seguito di ulteriori ricerche, l’APA può decidere o meno di rendere il disturbo “ufficiale” nelle future edizioni del DSM.
Con il nome di Gaming Disorder l’Assemblea Generale dell’OMS ha proposto di inserire la dipendenza da videogioco nella lista ICD-11, nella sezione relativa ai disturbi del comportamento legati alle dipendenze. La proposta sarà presentata nella prossima riunione dell’Assemblea Generale a maggio 2019.
Il gioco d’azzardo basato su Internet non è incluso nei criteri diagnostici per il disturbo da gioco su Internet. Questo perché il gioco d’azzardo basato su Internet è già incluso nei criteri diagnostici del Disturbo d’azzardo.
Secondo quanto indicato dall’OMS, un individuo affetto da tale patologia risulterebbe talmente assuefatto dai videogiochi (sia online che offline) da compromettere significativamente la sua vita sotto ogni aspetto sia esso sociale, lavorativo od affettivo.
I soggetti affetti da tale patologia restano perciò incollati allo schermo di TV, PC o Smartphone non curandosi di tutto ciò che li circonda, con effetti negativi non solo sulla salute psicologica, ma anche su quella fisica, visto che molto spesso non dormono e/o non mangiano per continuare una partita.
È importantissimo sottolineare che questa patologia colpisce solamente una piccola percentuale di giocatori, che ricordiamo essere oltre 2 miliardi e che il videogioco in sé non debba per questo essere demonizzato o vietato.
Gaming disorder is defined in the 11th Revision of the International Classification of Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.
For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.
What is the International Classification of Diseases?
The International Classification of Diseases (ICD) is the basis for identification of health trends and statistics globally and the international standard for reporting diseases and health conditions. It is used by medical practitioners around the world to diagnose conditions and by researchers to categorize conditions.
The inclusion of a disorder in ICD is a consideration which countries take into account when planning public health strategies and monitoring trends of disorders.
WHO released the 11th revision of the International Classification of Diseases (ICD-11) in mid-2018.
Why is gaming disorder being included in ICD-11?
A decision on inclusion of gaming disorder in ICD-11 is based on reviews of available evidence and reflects a consensus of experts from different disciplines and geographical regions that were involved in the process of technical consultations undertaken by WHO in the process of ICD-11 development.
The inclusion of gaming disorder in ICD-11 follows the development of treatment programmes for people with health conditions identical to those characteristic of gaming disorder in many parts of the world, and will result in the increased attention of health professionals to the risks of development of this disorder and, accordingly, to relevant prevention and treatment measures.
Should all people who engage in gaming be concerned about developing gaming disorder?
Studies suggest that gaming disorder affects only a small proportion of people who engage in digital- or video-gaming activities. However, people who partake in gaming should be alert to the amount of time they spend on gaming activities, particularly when it is to the exclusion of other daily activities, as well as to any changes in their physical or psychological health and social functioning that could be attributed to their pattern of gaming behaviour.
Online games are very popular, at least one person plays video games in two-thirds of American households, according to the Entertainment Software Association. Roughly 160 million American adults play internet-based games, one recent study estimates. The games can be very entertaining, and it may be easy to get absorbed in the competition, but can they be addictive? That is a question still being debated among researchers and health professionals.
Internet Gaming in DSM-5
Addiction to gaming is described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by mental health professionals to diagnose mental disorders. There was not sufficient evidence to determine whether the condition is a unique mental disorder or the best criteria to classify it at the time the DSM-5 was published in 2013. However, it recognized internet gaming disorder in the section recommending conditions for further research, along with caffeine use disorder and other conditions.
The DSM-5 includes substance-related addictive disorders, such as alcohol, tobacco, stimulants, marijuana and opioids. Gambling disorder is the only behavioral addiction (as opposed to substance use) identified in DSM-5.
If you are concerned for yourself or a loved one about preoccupation with gaming and related problems, contact your health care provider or a mental health professional.
The DSM-5 notes that gaming must cause “significant impairment or distress” in several aspects of a person’s life. This proposed condition is limited to gaming and does not include problems with general use of the internet, online gambling, or use of social media or smartphones. The proposed symptoms of internet gaming disorder include:
Preoccupation with gaming
Withdrawal symptoms when gaming is taken away or not possible (sadness, anxiety, irritability)
Tolerance, the need to spend more time gaming to satisfy the urge
Inability to reduce playing, unsuccessful attempts to quit gaming
Giving up other activities, loss of interest in previously enjoyed activities due to gaming
Continuing to game despite problems
Deceiving family members or others about the amount of time spent on gaming
The use of gaming to relieve negative moods, such as guilt or hopelessness
Risk, having jeopardized or lost a job or relationship due to gaming
Under the proposed criteria, a diagnosis of internet gaming disorder would require experiencing five or more of these symptoms within a year. The condition can include gaming on the internet, or on any electronic device, although most people who develop clinically significant gaming problems play primarily on the internet.
In late 2017, the World Health Organization (WHO) announced that in the upcoming edition (11th Revision) of the International Classification of Diseases* (ICD), gaming disorder will be identified as a new disorder. In some countries, including South Korea and China, video gaming has been recognized as a disorder and treatment programs have been established.
Research is Ongoing
Whether internet gaming should be classified as an addiction/mental disorder is the subject of much debate and a growing body of research. There is neurological research showing similarities in changes in the brain between video gaming and addictive substances.
A study published in American Journal of Psychiatry in March 2017 sought to examine the validity and reliability of the criteria for internet gaming disorder, compare it to research on gambling addiction and problem gaming, and estimate its impact on physical, social and mental health. The study found that among those who played games, most did not report any symptoms of internet gaming disorder and the percentage of people that might qualify for internet gaming disorder is extremely small.
The research involved several studies of adults in the U.S., United Kingdom, Canada and Germany. They found more than 86 percent of young adults ages 18 to 24 and more than 65 percent of all adults had recently played online games. The percentages of men and women who recently played was roughly equal. However, the research is mixed on whether those who met the criteria for internet gaming disorder had poorer emotional, physical and mental health than those who did not meet the criteria.
The researchers found that 0.3 to 1.0 percent of the general population might qualify for a potential diagnosis of internet gaming disorder. The authors suggest there is an important distinction between passionate engagement (someone enthusiastic and focused on gaming) and pathology (someone with an illness/addiction). Whether the person is distressed with his/her gaming may be the key factor distinguishing the two.
Writing in a commentary about the study in the American Journal of Psychiatry, Patrick M. Markey, Ph.D., and Christopher J. Ferguson, Ph.D., concluded that the study suggests “video game addiction might be a real thing, but it is not the epidemic that some have made it out to be.”
The research and the debate are ongoing. Some argue, for example, that gaming could be a symptom of an underlying problem, such as depression or anxiety, and not a disorder or addiction itself.
Even while professionals debate, individual stories point to struggles and devastation from the phenomenon. An example was highlighted in a recent Washington Post article, which can be read here.
The Proceedings of the National Academy of Sciences summarizes the current debate: “Adding video gaming to the list of recognized behavioral addictions could help millions in need. It could also pathologize a normal behavior and create a new stigma.”
If you are concerned about yourself or a loved one, talk with your health care provider or a mental health professional.
Stockdale l, Coyne SM. Video game addiction in emerging adulthood: Cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls. Journal of Affective Disorders, 2018, 225:265-272.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 2013. Washington: American Psychiatric Publishing.
*International Classification of Diseases (ICD) is the basis for identification of health trends and statistics globally and the international standard for reporting diseases and health conditions. It is used by medical practitioners around the world to diagnose conditions and by researchers to categorize conditions. WHO is working on updating of the ICD. The 11th revision of the International Classification of Diseases (ICD-11) is scheduled for publication in mid-2018.
Il Centro Nazionale di Documentazione e Ricerca Educativa sul Cyberbullismo (CE.N.D.R.E.CY) ha compiti di ricerca, monitoraggio, documentazione, sperimentazione e formazione in campo psicoeducativo riguardo ai temi del bullismo online, della violazione della privacy e della tutela dei dati personali, stimolando lo scambio e la collaborazione tra studiosi ed enti che condividono la mission.