Gaming disorder - the gaming-related disorder in ICD-11

What gaming disorder is

Gaming disorder is a diagnostic entity described in ICD-11, the eleventh revision of the International Classification of Diseases prepared by the World Health Organization. In the classification it is designated by the code 6C51. It belongs to the group of disorders due to addictive behaviours, that is, states in which the loss of control concerns not a substance but a repeated activity.

The essence of this disorder does not lie in playing digital games as such, nor in the amount of time spent at a screen. It lies in the loss of control over gaming and in the fact that gaming becomes more important to the person than other pursuits and obligations, with the activity continuing despite clear negative consequences for the person's life.

The classification covers games played online (over the internet) and offline (without a network connection). ICD-11 provides a distinction here in the form of subcategories: gaming disorder, predominantly online (code 6C51.0) and predominantly offline (code 6C51.1). The mechanism of the disorder, however, is similar in both cases.

It is worth marking the boundary from the outset: playing games is for millions of people a normal, enjoyable and harmless form of recreation. The introduction of a diagnostic entity does not mean that gaming in itself is an illness. It means only that there exists a narrowly defined pattern of behaviour which in some people takes on a harmful form and calls for help.

Why ICD-11 set this entity apart

The previous version of the classification, ICD-10, did not have a separate entity for problematic gaming. In clinical practice, however, there were people whose pattern of gaming led to serious harm, and clinicians needed a shared, agreed way of describing this state. The absence of a name and a code hampered diagnosis, the planning of help, and scientific research alike.

ICD-11 placed gaming disorder next to gambling disorder (code 6C50) within a single group of disorders due to addictive behaviours. This proximity is not accidental. The two states share a similar mechanism: a repeated activity which over time slips out of control and is continued despite harm.

The decision to set this entity apart was preceded by many years of discussion among experts and by analysis of clinical observations from various countries. The aim was to provide a precise definition that makes it possible to recognise a real problem while not pathologising ordinary, intense use of games.

ICD-11 diagnosis in this area therefore has two tasks at once: to make it possible to recognise and help people who genuinely need it, and to mark a clear boundary that protects a popular hobby from being over-medicalised.

Characteristic features according to ICD-11

ICD-11 describes gaming disorder through a set of essential features. The first is impaired control over gaming. It concerns various aspects: the onset of gaming, its frequency, its intensity, its duration and its termination. The person experiences difficulty in limiting gaming even when they want or decide to do so.

The second feature is giving gaming increasing priority. Gaming begins to take a place more important than other interests and everyday obligations. Other activities, once significant, fade into the background, and the person's life becomes increasingly organised around the game.

The third feature is the continuation or escalation of gaming despite the occurrence of negative consequences. These consequences may include deterioration of family relationships, difficulties in study or work, and neglect of health, sleep or hygiene. Despite awareness of this harm, gaming is sustained and sometimes even escalated.

The fourth and very important condition is a significant impact on functioning. The pattern of gaming must lead to significant impairment in personal, family, social, educational, occupational or other important areas of life. Without this element a diagnosis usually cannot be made - the mere presence of intense gaming is not enough.

The duration criterion and its purpose

ICD-11 requires that the described pattern of behaviour persist for a sufficiently long period, usually defined as at least twelve months. The time threshold is meant to guard against a hasty diagnosis based on a transient, intense period of gaming.

Many people pass temporarily through phases of very intense gaming - after the release of an anticipated game, during holidays, in a period of low mood or heightened stress. Such an episode, if it passes on its own and leaves no lasting harm, is not a disorder. The duration threshold helps to separate momentary engagement from an entrenched, harmful pattern.

The classification allows for some flexibility. If all the features of the disorder are present and their intensity is particularly high, the duration needed for a diagnosis may be shorter than twelve months. In such a situation the final assessment rests with the clinician's judgement.

The purpose of this requirement is the same as in other disorders described in ICD-11 diagnosis: a diagnosis should reflect a lasting and stable picture, not a momentary fluctuation in behaviour linked to a specific life situation.

The boundary between passion and disorder

The most common misunderstanding around this entity is the belief that a lot of gaming equals a disorder. ICD-11 clearly contradicts this. The sheer number of hours spent in games is not a diagnostic criterion and is never sufficient for a diagnosis.

A person may play many hours a week, treat it as their main hobby, belong to a community of gamers, and even game professionally, and at the same time have no disorder. What is decisive is whether gaming remains under control and whether it does not cause significant harm in the other areas of life.

The boundary is marked by the convergence of three questions. Does the person retain control over when and how long they game? Does gaming coexist with healthy functioning in relationships, study or work, or does it displace it? Is gaming sustained despite clear negative effects? A disorder appears only when the answers point to a loss of control and real harm.

An intense passion may look similar to a disorder from the outside, but it differs in essence. An enthusiast plays because they want to, derives satisfaction from it, and is able to set the game aside when life requires it. In a disorder, gaming becomes a compulsion, a source of tension and a means of escape, and attempts to limit it end in failure.

Gambling-like elements in games versus gaming disorder

Some contemporary games contain mechanisms similar to gambling, for example random rewards bought with real money. Their presence is sometimes a source of confusion, so it is worth distinguishing two separate entities in the classification.

If the problem concerns above all betting, risking money and chasing a win, the appropriate point of reference is gambling disorder (code 6C50). If, on the other hand, the loss of control concerns gaming itself as an activity, rather than an element of a chance wager, gaming disorder (6C51) is considered.

In practice the boundary is sometimes indistinct, and both patterns may co-occur in a single person. This is one of the situations in which a specialist's assessment is essential - only a clinician is able to establish which mechanism is dominant and whether more than one diagnosis is justified.

Regardless of the entity, the same principle applies: it is the clinical picture that decides, that is, the behaviour as a whole and its consequences, and not a single feature of the game or the name of the platform.

Health and social consequences

Gaming disorder rarely confines itself to gaming alone. An entrenched, uncontrolled pattern usually brings with it a range of consequences affecting different areas of life. They often concern sleep - gaming into the late hours leads to its shortening, an irregular rhythm and chronic fatigue.

In the physical area there may be complaints linked to a prolonged, immobile posture, neglect of physical activity and irregular eating. In the social area, a typical course is gradual withdrawal from contacts outside the game, growing tension within the family and a decline in performance at study or work.

Gaming is also sometimes a way of coping with difficult emotions - with anxiety, low mood, loneliness or stress. Seen in this way it is not the source of the problem but its symptom or a mechanism of escape. This is an important reason why a clinical assessment cannot confine itself to gaming alone.

It must be stressed that the presence of these consequences does not automatically determine a diagnosis. It does indicate, however, that it is worth looking at the situation more closely and considering contact with a specialist, especially when the difficulties become entrenched.

Differential diagnosis and co-occurrence

Before a clinician regards a diagnosis as certain, they carry out a differential diagnosis, that is, they consider other states that could explain the same picture. Intense gaming is sometimes secondary to another disorder, in which case it is that disorder, rather than the gaming itself, that requires primary attention.

Excessive gaming may, for example, accompany mood disorders, including depressive disorder (codes 6A70 and 6A71), when the game becomes an escape from suffering. It may co-occur with disorders specifically associated with anxiety, such as generalised anxiety disorder (6B00), when the game brings momentary relief of tension. It is also sometimes linked to attention deficit hyperactivity disorder (6A05) or to the autism spectrum (6A02).

The clinician considers whether the gaming is best explained by a separate disorder or whether it is a symptom or coping mechanism in the course of another condition. Where to direct help depends on this assessment. Treating the depression itself may, in some cases, also reduce the excessive gaming.

ICD-11 permits co-occurrence, that is, the presence of more than one disorder in the same person. Gaming disorder may therefore be diagnosed alongside another disorder if the overall clinical picture requires it. This is decided solely by a specialist after a full assessment.

Harmful gaming versus the full disorder

ICD-11 also contains a category describing a harmful pattern of gaming, that is, a situation in which gaming causes clear harm to physical or mental health but the full features of gaming disorder are not yet met.

This distinction has practical significance. It makes it possible to notice a problem at an earlier stage, before the pattern becomes entrenched as a full disorder. It also indicates that gaming-related harm forms a kind of continuum, rather than being only a rigid division into health and illness.

From the perspective of the person gaming and those close to them, this means that worrying signals are worth taking seriously even when the picture does not yet meet all the conditions for a diagnosis. An early response and a conversation with a specialist are often more effective than waiting for the problem to deepen.

Here too, the assessment of whether we are dealing with a harmful pattern, with a full disorder, or with an intense but harmless hobby rests with a qualified clinician, who relates the patient's picture to the ICD-11 guidelines.

When to seek help

The signal prompting consideration of a consultation is not the number of hours spent in games, but the loss of control and the appearance of harm. Concern is warranted by unsuccessful attempts to limit gaming, neglect of obligations, sleep and relationships, and continuing to game despite awareness of its negative effects.

It is also worth paying attention to the role gaming plays in emotional life. If it becomes the main way of coping with anxiety, sadness or loneliness, and limiting it provokes strong tension or irritability, this is a reason to talk to a specialist.

Help in this area is provided by mental health specialists: psychiatrists, psychologists and psychotherapists, and in the case of children and adolescents also specialist clinics. A first step may be a conversation with a family doctor, who can help with a referral to the appropriate form of support.

If the difficulties related to gaming co-occur with thoughts of giving up, a marked deterioration of mood or other symptoms that threaten health and life, help should be sought without delay, as a matter of urgency. In such a situation one should not hesitate or wait for a scheduled appointment.

ICD-11 diagnosis versus self-assessment

This site describes gaming disorder in line with the logic of ICD-11 and is educational in nature. It makes it possible to understand what gaming disorder is, what features it has and where the boundary with an intense but healthy hobby lies. It is not, however, a diagnostic tool.

A diagnosis of gaming disorder is always made by a qualified clinician on the basis of a full assessment - the interview, analysis of the life context, the course over time and the exclusion of other explanations. Reading a description does not replace this assessment, and assigning a diagnosis to oneself or to a close person tends to be unreliable.

Knowledge of the disorder's features does, however, have real value. It helps in observing one's own behaviour or that of a close person with awareness, in describing the difficulties better and in starting a conversation with a specialist when worrying signals appear.

Sound ICD-11 diagnosis combines ordered knowledge from the classification with clinical experience. The classification provides a shared language and a map of disorders, while the responsibility for the diagnosis and further management rests with the specialist.

Frequently asked questions