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Gaming behavior can be authentic health concern: medical experts

Since the dawn of the internet age, debate has continued over excessive time and energy spent consuming digital content and the difficulties in exercising control. 

In May, gaming disorder became one such contemporary health plight to be included in the World Health Organization’s disease classification.

Less than a month after the adoption of gaming disorder into the International Classification of Diseases, the issue became a subject of heated contention. The most vocal opposition naturally came from the game industry, which fears the newly classified disorder problematizes all gaming.

At the Culture Ministry-sponsored Game Science Forum in April, game researchers and media scholars voiced concerns over the WHO decision, calling it a pathologization of an otherwise healthy culture.

But medical professionals say such concerns stem from a misunderstanding.


The WHO says gaming disorder is characterized by the continuation or escalation of gaming despite negative consequences -- defined as significant impairment in social, educational, occupational and other areas of life -- for at least 12 months.

Not all gaming behaviors are problematic. But depending on where you fall on the spectrum, your gaming behavior can be an authentic health concern, said Koo Ja-hyun, a psychiatrist at a mental health center in Bucheon, Gyeonggi Province.

Koo said that in his clinical experience, he has observed problematic gaming behavior to be common, especially among teenagers.

One of Koo’s recent patients is a high school student who stopped going to school for more than eight months so that he could play games. Koo said the 16-year-old would play games for 10 to 11 hours a day and buy about 500,000 won ($425) worth of in-game items in a single purchase. He also got into legal trouble for scamming strangers online to fund his gaming activities.

Koo said in the absence of the gaming disorder classification, the young patient would have been diagnosed with other mood disorders.

Just as with other mental illnesses, problematic gaming behavior can be diagnosed alongside other conditions, Koo said. “However, coexistence of other conditions doesn’t mean it isn’t a legitimate mental health problem independently.”

Lee Hae-kook, a psychiatrist who served as a consultant on a WHO task force for mental health, said the gaming disorder classification followed a “thorough review of its public health implications.”

He added that “for those not in the health and medical sectors to object (to the classification), especially out of other conflicting interests, is not only puzzling but also irrelevant from where WHO stands.”

Lee said while he “understand(s) the concerns of the game industry,” there were no considerations -- political or economic -- involved in the decision other than protection of public health.

In a gaming disorder discussion forum held Thursday at the National Assembly library, Ahn Woo-young, a psychology professor at Seoul National University, addressed doubts about the impact of problematic gaming on health. He said the behavioral problem could cause neurological changes in the brain, similar to those seen in other addictions.

“Addiction is a brain disorder. By which I mean, addiction is not only psychological but also neurological,” Ahn said. “All addiction activates the dopamine reward circuits in the brain -- including the addictive usage of games.”

“Increasingly more research reveals that video gaming and other (forms of) gaming disorder -- while less researched than substance addiction -- involve neurological changes in brain structure,” he said.

The forum, sponsored by the Korean Psychological Association, was paneled by Korea Addiction Psychological Association member psychologists and other professionals in related fields.

Among the panelists was Bang Seung-ho, who runs a “gaming detox” therapy session for children and adolescents. Bang said that “medical intervention was not necessary in helping kids cut down on gaming in (his) experience,” questioning gaming disorder’s authenticity as a medical condition.

In response, Ahn explained that gaming disorder’s designation as a disease does not delegitimize existing treatment services offered by non-medical practitioners. “There is plenty of evidence that psychosocial treatments, most notably counseling, can help suppress the reward system in the brain.”

Lee Deok-jong, an addiction psychiatrist at National Health Insurance Service Hospital in Ilsan, said there are clear indications that new types of addictive behaviors are emerging along with the development of technology. “Medical problems do not exist independently of sociocultural phenomena,” he said.

“The discussions on internet addiction began in the late 1990s in the medical world, on problematic game use in the 2000s, and in the last decade, such behavioral problems on smartphones.”

Lee added that behavioral addiction is a more recently introduced concept than substance addiction and that consequently, there is less accumulated research and clinical experience on the subject.

In comparing the two, Lee said there are differences in diagnostic symptoms. “Behavioral addiction does not necessarily involve biological tolerance or withdrawal symptoms, as with substance addiction, in which chemical substances are directly involved in the development of the disease.”

“Arguing that gaming disorder is less of a health threat because it does not bear the characteristics of say, alcohol addiction, lacks understanding of the fundamental difference between a substance addiction and a behavioral addiction,” he said.

By Kim Arin (