World Health Organization Recognizes Gaming Disorder and Compulsive Sexual Behavior Disorder

The World Health Organization (WHO) released its International Classification of Diseases manual (ICD-11) in June, featuring two new controversial mental disorders. While WHO says gaming disorder and compulsive sexual behavior disorder should be considered “disorders,” many mental health professionals disagree.

Gaming disorder is classified as playing video or computer games persistently over at least 12 months, though the severity of symptoms could shorten the amount of time before diagnosis. Those with the disorder show a lack of control over how much time they spend playing games, prioritizing games over other daily activities and continuing to game despite negative consequences. Gaming must also cause significant impairment in areas of functioning in day-to-day life, according to the ICD-11.

WHO classifies gaming disorder as “disorders due to addictive behaviors,” the same classification it gives gambling disorder. Though WHO has recognized gaming disorder, the American Psychiatric Association (APA) has not. The APA’s Diagnostic Statistical Manual (DSM-5) lists internet gaming disorder as a condition needing more clinical research before any classification.

Chris Ferguson, a psychology professor at Stetson University, previously told The Mighty many people in the mental health field don’t believe it should be classified as a disorder because of the lack of confirming research. Over-gaming could be a symptom of an underlying mental illness instead qualifying as its own diagnosis, he said, adding:

This ‘disorder’ may trivialize mental illness by pathologizing normal behaviors and may be the product of ongoing moral panics regarding video games.  Although some people likely do over-game, in the same sense that some people overdo almost any pleasurable activity, there isn’t good evidence to suggest that gaming is unique and deserving of it’s own diagnosis.

Those who support adding gaming disorder to the ICD-11 say the classification isn’t meant to pathologize the average player, but provide support and treatment for those who have had significant impairment in their lives because of gaming. Supporters also hope that having the disorder officially recognized would help people gain insurance coverage for treatment, according to Take This.

Recognizing “sex addiction” as a disorder has a similar divide in the mental health profession. Compulsive sexual behavior disorder falls under the ICD’s impulse control disorders section and isn’t classified as an addiction. This disorder is characterized as an inability to control intense sexual urges that lead to repetitive sexual behavior. Persistent sexual activities become a central focus in one’s life and interfere with proper personal care and other responsibilities. Someone diagnosed with this disorder would have unsuccessful efforts at limiting their sexual behavior and could continue to engage in it, despite little satisfaction. Symptoms must be present for more than six months and cause significant problems in functioning in day-to-day life.

Dr. David Ley, a clinical psychologist who treats sexuality issues, told The Mighty there isn’t enough scientific research to back up the classification of this as a disorder. Ley said sexual problems are often a symptom of another disorder, such as hypersexuality is a symptom of bipolar disorder. Ninety percent of people who identify as sex addicts actually qualify for a depression or anxiety disorder and may be using sex as a coping mechanism, Ley wrote for Psychology Today.

Ley also said the recognized disorder excludes many people who identify as sex addicts, such as those who think their behavior is immoral.

“The best research at this time indicates that the predictor of identifying as a sex addict is not how much sex you have or want to have, but how religious you are and the religious values you have about sex, so, in other words, there are a lot of people out there who want lots of sex that they feel like they shouldn’t have. And then they perceive that wanting or that desire as an addiction,” Ley said.

People who identify as sex addicts aren’t necessarily having more sex than others, Ley said, but they feel bad about the sex they’re having.

ICD-10, the previous version of the manual, was published in 1992, but wasn’t adopted in the U.S. until 2015. It’s unclear when or if the U.S. will adopt ICD-11, and there’s no way to know if insurance will cover this disorder.

Robert Weiss, a licensed clinical social worker and certified sex addiction therapist, told The Mighty the inclusion of compulsive sexual behavior disorder will help alleviate the shame many people feel. He also said having a diagnosis could help with getting insurance to cover treatment. Most treatment now, which sometimes includes living at a facility, is expensive and unable to be covered.

On his website, Weiss said that sex addicts use addiction to handle emotional and psychological problems they same way other addicts do.

Like other addicts, sex addicts use their addiction not to have a good time, but to ‘numb out’ and escape from stress and emotional (and sometimes physical) discomfort, including the pain of underlying emotional and/or psychological issues like depression, anxiety, unresolved early-life trauma, and the like. In other words, sex addicts don’t use compulsive sexual fantasies and behaviors to feel better, they use them to feel less (to distract themselves from what they are feeling). So, sexual addiction is not about having fun, it’s about controlling what one feels.

Weiss said the name of the disorder (sex addiction vs. compulsive sexual behavior) doesn’t matter to him, as long as it’s recognized as legitimate. Ley said the term “compulsive” is not theoretically accurate because it’s an anxiety term that is commonly used to describe a behavior that is used to make intrusive thoughts go away, which isn’t recognized as a part of this disorder. Compulsions do not make a person feel good, though the compulsive sexual behavior disorder criteria does note that someone diagnosed with the disorder may receive no to little satisfaction.