The Need to Develop a Strategy With an Evidence-Based Guideline for the Prevention of Gaming Disorder

To the Editor:

The World Health Organization identified “gaming disorder, predominantly online” as a mental disorder in the 11th revision of the International Classification of Diseases (ICD-11). ¹ Essentially, gaming disorder is characterized by (1) impaired control over gaming; (2) increasing priority given to gaming over other interests and activities; (3) the continuation or escalation of gaming despite the occurrence of negative consequences; and (4) the behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning that have been evident for at least 12 months. ¹ As online games have spread among smartphone users, especially school children, adolescents, and young adults, worldwide attention has focused on the risks of excessive online gaming.

In Japan, over 98% of adolescents (aged 13 to 19 years) use the Internet, and >79% of these adolescents access the Internet via smartphones. ² Cross-sectional studies of elementary and middle school students in Japan^3-5 have shown the risks of gaming addiction, Internet addiction, and smartphone addiction for the development of sleep disturbance and the deterioration of both physical and mental states. However, more than 90% of middle and high school students in Japan also use their smartphones for studying. ⁶ These circumstances pose a risk of many children and adolescents becoming addicted to the Internet and Internet-based games. An evidence-based guideline is clearly necessary for the prevention of gaming disorder, and a sufficient number of medical facilities for treatment and the close cooperation of the medical facilities and the relevant parties are also needed.

Gaming disorder is a condition that influences an individual’s sleep and health and causes disruption of his or her daily life. Educational talks and campaigns (eg, public service notices and events) that inform young people how to appropriately play Internet-based games, especially regarding the appropriate lengths of game-playing time, appear to be effective for preventing gaming disorder. Similar to the diagnostic criteria for alcohol dependence, the ICD11 does not include a quantitative criterion, such as game-playing time, for gaming disorder. Nevertheless, the amount of time spent on games online appears to be a critical factor for the prevention of the disorder, since prolonged game-playing time obviously reduces the time available for physiological activities in daily life, including sleeping and eating. For the prevention of gaming disorder, a guideline should stipulate a permissible range of game-playing time that is based on clinical and basic evidence. Such evidence is lacking at the present time. Studies conducted on clinical and experimental bases are clearly warranted to determine the threshold of the amount of gaming time for the development of gaming disorder.

Psychiatrists and pediatricians are likely to encounter individuals with a gaming disorder, but in Japan there is a very limited number of psychiatrists and pediatricians who specialize in treating gaming disorder. Accordingly, medical facilities, school representatives, the local community, families, and government agencies must, when necessary, work together to prevent gaming disorder in children and adolescents.