Do gaming disorder and hazardous gaming belong in the ICD-11? Considerations regarding the death of a hospitalized patient that was reported to have occurred while a care provider was gaming.

There has been much debate regarding the extent to which different types and patterns of gaming may be considered harmful from individual and public health perspectives. A recent event in which a hospitalized patient was reported to have died while a care provider was gaming is worth considering as an example as to how gaming may distract individuals from work-related tasks or other activities, with potential negative consequences. As the 11th edition of the International Classification of Diseases is being developed, events like these are important to remember when considering entities like, and generating criteria for, disordered or hazardous gaming.

There has been considerable debate regarding how gaming behaviors might best be considered from a psychiatric perspective. Recent events involving the death of a hospitalized patient while a nurse’s aide was reportedly playing a video game highlight the importance of considering different patterns and types of gaming behaviors (Estes, 2017). Over the past decade, psychiatrists and other mental health care providers have been encountering individuals seeking help for problems relating to video gaming. Raised concerns related to video gaming led to the inclusion in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for Internet gaming disorder (IGD; American Psychiatric Association, 2013). The decision to focus on Internet gaming, over other behaviors, was based in part on the data existing at the time of DSM-5 deliberations that Internet gaming had been most well-studied and associated with significant harms (Petry & O’Brien, 2013). The inclusion has led to the generation of more precise research of the condition and hopefully will lead to improved prevention and treatment strategies.

In the setting of the inclusion of IGD in Section III of DSM-5, there has been ongoing debate regarding the appropriateness of a diagnostic entity relating to gaming behaviors (Kiraly & Demetrovics, 2017; van den Brink, 2017), with some scholars proposing that it is premature to have a formal entity for IGD (Aarseth et al., 2017; Dullur & Starcevic, 2018) and others advocating for its inclusion in the forthcoming 11th edition of the International Classification of Diseases (ICD-11; Billieux et al., 2017; King et al., 2018; Saunders et al., 2017). At present, beta draft versions of criteria for gaming disorder (https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1448597234; accessed on: November 10, 2017) and hazardous gaming (https://icd.who.int/dev11/l-m/en#/https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1586542716; accessed on: November 10, 2017) exist on the ICD-11 website. As it is unclear whether the incident involving the patient’s death was or was not related to IGD or subsyndromal levels of gaming, it appears important from a public health perspective to include both diagnostic and hazardous designations as currently being proposed for ICD-11 and is analogous to designations for other addictive behaviors (e.g., alcohol-use disorders and hazardous alcohol use as currently exist in the ICD-10). I believe that having these gaming-related entities defined and included in the ICD-11 is important and that it will hopefully help prevent occurrences like the reported video game-playing-associated death of a hospitalized patient and facilitate the development of prevention and treatment efforts. Furthermore, the consideration of hazardous use of digital technologies more broadly appears important to consider given accidents related to distracted operation of cars and other vehicles (Wilson & Stimpson, 2010). It is important to gather data on these behaviors to guide the development of frameworks and interventions at individual and policy levels to promote public health (King et al., 2017; Kiraly et al., in press). Such efforts will require governments and public health agencies to prioritize systematic research into different types and patterns of gaming and the effects that they may have on individuals (Potenza, Higuchi, & Brand, 2018).