Toward resolving normality-disorder boundary issues in gaming disorder research

A longstanding challenge in the behavioral addictions field has been determining the point at which gaming involvement becomes clinically significant problematic use. Gaming disorder (GD) and hazardous gaming as recent ICD-11 diagnoses have attracted polarized perspectives due in part to the global popularity of recreational gaming and gaming culture. The broad continuum of gaming can often be perceived differently by different parties, including gamers themselves; what might be seen as regular, harmless, and normative to some, may be considered risky and problematic by others. The ICD-11 guidelines provide some clarity by advising that gaming disorder should not be diagnosed based on persistent gaming alone; that gaming as part of a routine, developing skills, changing mood or relieving boredom, or facilitating social interaction is not sufficient for a diagnosis; and that cultural and peer group norms should be considered in diagnosis. In this paper, we examine gaming normality-disorder boundary issues in the areas of conceptualization, assessment, and interventions. Some examples of the complex personal, social, and cultural considerations that arise in gaming diagnoses are provided. We call for researchers in the addiction and health disciplines to grapple with conceptual controversy and conduct the empirical and clinical research needed to ensure that normal recreational gaming is always clearly distinguished from harm and disorder.