Geneva, Switzerland · 18 June 2018
The World Health Organization (WHO) released the 11th revision of the International Classification of Diseases (ICD-11) on 18 June 2018, marking the first major overhaul of the global health classification system in nearly three decades. Among the most widely discussed additions was the formal inclusion of gaming disorder as a recognizable mental health condition — a decision that ignited debate among health professionals, researchers, and the video game industry worldwide.
The ICD is the foundation for identifying health trends and statistics globally, and is used by medical practitioners, researchers, health insurers, and policymakers in more than 100 countries. The previous revision, ICD-10, had been in use since 1990. ICD-11 incorporated approximately 55,000 unique codes for injuries, diseases, and causes of death — a significant expansion from the roughly 14,000 codes in ICD-10.
Defining Gaming Disorder
The WHO defined gaming disorder as a pattern of persistent or recurrent 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 it takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.
For a diagnosis to be made, the behavior pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. The WHO specified that the pattern must typically be evident over a period of at least 12 months for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.
The Path to Recognition
The decision to include gaming disorder in ICD-11 was not sudden. The WHO had been studying the issue for several years, with technical consultations held as early as 2014. A 2017 meeting of experts in Tokyo, organized by the WHO Department of Mental Health and Substance Abuse, reviewed the evidence and concluded that the condition met the threshold for inclusion in the classification system.
The WHO outlined three main reasons for the inclusion:
- Clinical evidence: A growing number of treatment services had emerged in countries around the world for people who sought help for excessive gaming patterns that they could not control.
- Public health significance: The behavior pattern was associated with distress and impairment in important areas of functioning, meeting the criteria for a public health concern.
- Diagnostic need: Health professionals needed a standardized definition to identify the condition, develop treatment protocols, and monitor prevalence.
Controversy and Opposition
The classification faced significant pushback from segments of the video game industry and some researchers. A coalition of industry groups, including the Entertainment Software Association, Interactive Software Federation of Europe, and others, issued a statement arguing that the evidence base was insufficient and that the classification risked "stigmatizing a popular hobby."
Some mental health researchers echoed these concerns. Critics argued that the diagnostic criteria were too vague, that more research was needed to distinguish gaming disorder from other underlying conditions such as depression or anxiety, and that the diagnosis could lead to mislabeling healthy behavior as pathological.
| Position | Arguments |
|---|---|
| WHO and supporters | Growing clinical evidence; need for standardized diagnosis; treatment services already emerging worldwide |
| Industry and some researchers | Insufficient evidence base; risk of pathologizing normal behavior; may mask underlying conditions |
Timeline of Adoption
While ICD-11 was released in June 2018, the formal adoption process extended over several years. The classification was officially endorsed by member states at the 72nd World Health Assembly in May 2019. The new system came into effect on 1 January 2022, giving countries time to prepare for implementation, train health professionals, and update reporting systems.
The transition from ICD-10 to ICD-11 represented one of the most significant changes in global health classification in a generation. Beyond gaming disorder, ICD-11 introduced updates across virtually every medical domain, including new chapters on traditional medicine, sexual health, and digital health interventions.
Broader Implications
The inclusion of gaming disorder in ICD-11 has had practical consequences beyond the clinical setting. Health systems in countries that adopt ICD-11 are expected to develop treatment protocols and reimbursement mechanisms for the condition. Insurance companies in some jurisdictions have begun to consider coverage for gaming disorder treatment. Researchers have intensified studies on prevalence, risk factors, and effective interventions.
The classification also raised broader questions about the relationship between technology use and mental health — questions that have become increasingly relevant as digital devices and online platforms occupy growing portions of daily life. The WHO has separately expressed concern about excessive screen time and digital addiction across age groups, framing gaming disorder as part of a wider conversation about healthy technology use.
Image: WHO ICD-11 release. Credit: World Health Organization
Sources
- WHO ICD-11 release (18 June 2018):
- WHO gaming disorder Q&A:
- ICD-11 classification page:
- 72nd World Health Assembly (May 2019):
FIRAT Editorial Board
Institutional Research Desk · Foresight Institute of Research and Translation
The collective editorial and research translation board of FIRAT, synthesising peer-reviewed evidence, policy briefs, and division milestones across our seven foundational research pillars.
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