Antonius J. van Rooij , 1 , * , Christopher J. Ferguson , 2 , * , Michelle Colder Carras , 3 , * , Daniel Kardefelt-Winther , 4 , * , Jing Shi , 5 , 6 , * , Espen Aarseth 7 , Anthony M. Bean 8 , Karin Helmersson Bergmark 9 , Anne Brus 10 , Mark Coulson 11 , Jory Deleuze 12 , Pravin Dullur 13 , Elza Dunkels 14 , Johan Edman 15 , Malte Elson 16 , Peter J. Etchells 17 , Anne Fiskaali 18 , Isabela Granic 19 , Jeroen Jansz 20 , Faltin Karlsen 21 , Linda K. Kaye 22 , Bonnie Kirsh 5 , 23 , 24 , Andreas Lieberoth 25 , Patrick Markey 26 , Kathryn L. Mills 27 , Rune Kristian Lundedal Nielsen 7 , Amy Orben 28 , Arne Poulsen 10 , Nicole Prause 29 , Patrick Prax 30 , Thorsten Quandt 31 , Adriano Schimmenti 32 , Vladan Starcevic 33 , Gabrielle Stutman 34 , Nigel E. Turner 6 , Jan van Looy 35 , Andrew K. Przybylski , 28 , 36 , *
12 March 2018
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.