High involvement versus pathological involvement in video games: A crucial distinction for ensuring the validity and utility of gaming disorder

Purpose of review. The year 2018 was marked by the official recognition of Gaming Disorder (GD) as a mental condition with its inclusion in the proposed eleventh edition of the International Classification of Diseases (ICD-11). Recently, a group of scholars has repeatedly criticized the notion of GD proposed by the World Health Organization (WHO), arguing that its inclusion in ICD-11 will pathologize highly involved but healthy gamers. It is therefore of crucial importance to clarify the characteristics of high involvement versus pathological involvement in video games, the boundaries between these constructs, and the implementation of screening and diagnostic GD tools that distinguish the two.
Recent findings. Increasing evidence supports the view that intense video game playing may involve patterns of gaming that are characterized by high involvement but that are non-pathological. Furthermore, some criteria for addictive and related disorders may reflect peripheral features that are not necessarily indicative of pathology, whereas others may reflect core features that are more likely to adequately identify pathological behavior and so have diagnostic validity. Finally, it is key to assess functional impairment associated with gaming, so that a GD diagnosis has clinical utility.
Summary. Available evidence supports the crucial need to distinguish between high and pathological involvement in videogames, in order to avoid over-diagnosis and pathologization of normal behavior. The definition of GD adopted in ICD-11 has clinical utility and diagnostic validity since it explicitly mentions the functional impairment caused by problem gaming and its diagnostic guidelines refer to core addiction features, reflecting pathological involvement.