tag:theconversation.com,2011:/ca/topics/icd-11-55505/articlesICD-11 – The Conversation2022-05-06T15:39:29Ztag:theconversation.com,2011:article/1815122022-05-06T15:39:29Z2022-05-06T15:39:29ZComplex post-traumatic stress disorder explained<p>Stephanie Foo, an award-winning radio producer, suffers from complex post-traumatic stress disorder, a disorder that in her country (the US) “doesn’t officially exist”. In her new book, <a href="http://www.randomhousebooks.com/books/658389/">What My Bones Know</a>, Foo writes movingly about what it’s like to live with complex PTSD and her long journey to getting a diagnosis.</p>
<p>Earlier this year, the American Psychiatric Association released the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM – the so-called psychiatrists’ bible. The manual, first published in 1952, is used worldwide to diagnose, treat and research mental health conditions. But it does not recognise complex PTSD as a distinct diagnosis. Many experts, however, do recognise that complex PTSD is a disorder in its own right. </p>
<p>Before we talk about complex PTSD, let’s look at what “standard” PTSD is.</p>
<p>PTSD is a mental health disorder that is the result of a traumatic event. People often associate it with war veterans – someone flashing back to the Afghan conflict because they were triggered by a car backfiring, for example. But, really, anyone who has suffered trauma is at risk of PTSD. And, according to the World Health Organization, around <a href="https://www.tandfonline.com/doi/full/10.1080/20008198.2017.1353383">70%</a> of people experience at least one traumatic event in their life. Research shows that just under <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/posttraumatic-stress-disorder-in-the-world-mental-health-surveys/7DB941D95BB33FCC18BF52DFB3F78197">6%</a> of those people will develop PTSD. </p>
<p>Everyone’s experience of PTSD is different, but people with the condition may have reoccurring memories or nightmares related to the traumatic event, they may have distressing and intrusive thoughts about it, and they can be jumpy and easily startled. “Avoidance” is part of the condition, too. People with PTSD may avoid people or places that remind them of the trauma. Or they may try to avoid the memory by using drugs or alcohol.</p>
<p>The condition can seriously affect a person’s relationships and is often associated with <a href="https://journals.lww.com/co-psychiatry/Abstract/2019/11000/Eating_disorders_and_posttraumatic_stress_disorder.8.aspx">eating disorders</a>, substance abuse, <a href="https://link.springer.com/article/10.1007/s10880-016-9449-8">depression and suicidal behaviour</a>.</p>
<h2>How complex PTSD is different</h2>
<p>In complex PTSD, the trauma is not a one-off event, but something repeated and sustained, such as torture, domestic violence or childhood abuse.</p>
<p>Complex PTSD includes the same symptoms of PTSD, plus additional symptoms called <a href="https://www.sciencedirect.com/science/article/pii/S0272735817301460?casa_token=XupdJYp_U4AAAAAA:KJUbKMYYvk0dAoCpz-egTJfXgalBty3bIHf_s-PcgXCLkOl3qp3vaqeVPAbrprFe8_qT1ke8vvRL">disturbance in self-organisation</a>. Disturbance in self-organisation refers to problems in regulating emotions (for example, feeling numb or having sudden anger outbursts), feeling distant from others, and having extremely negative views about yourself. </p>
<p>Complex PTSD is not as common as PTSD, but it seems particularly widespread among specific groups of people, such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/acps.12973?casa_token=kBM6npfaVScAAAAA%3A0GL6A6TRiDUPznwi0IAf1LCQgBbWc1xkn4KFeVIlXb-ZM7k0YLzOJfubmpYmPDgEUCfRwo9WJTqo1cdl">refugees</a> and people who <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/acps.13161">experience psychosis</a>.</p>
<p>While the DSM does not recognise complex PTSD as a diagnosis, the term has been around since <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.2490050305?casa_token=fBW8Z1ZD_3sAAAAA:oKtcIZeVakVaxSTLpNJqlHcNxd8NENPFvIAmGDV5scF0hty-r6_3Mkywf625ZvWXzrMlEpO8uySmy_RJ">1992</a>. And in 2019, it was officially recognised as a diagnosis in the World Health Organization’s diagnostic bible, the <a href="https://icd.who.int/browse11/l-m/en#/http%253a%252f%252fid.who.int%252ficd%252fentity%252f585833559">International Classification of Diseases</a> (ICD-11). (Both the DSM and the ICD are officially recognised diagnostic manuals, the main difference being that the DSM is more popular in the US, while the ICD is more commonly adopted in Europe.)</p>
<p>The <a href="https://www.phoenixheroes.co.uk/_webedit/uploaded-files/All%20Files/ITQ%20Overview%20and%20Scoring%20Final%209%20September%202018%20%281%29.pdf">international trauma questionnaire</a> has been developed as a self-report measure specifically designed to capture the additional symptoms of complex PTSD. The difference between PTSD and complex PTSD has been shown in <a href="https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1739873">over 40 studies and across 15 different countries</a>. A <a href="https://www.sciencedirect.com/science/article/pii/S169726001500085X?via%3Dihub#sec0085">study</a> involving nearly 1,700 doctors from 76 countries found that, despite differences in ethnicity and nationality, doctors were able to accurately diagnose and distinguish between PTSD and complex PTSD. </p>
<p>In the UK, complex PTSD is officially recognised by both the <a href="https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex/">NHS</a> and the <a href="https://thepsychologist.bps.org.uk/what-complex-ptsd">British Psychological Society</a>, and popular mental health charities, such as <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/complex-ptsd/#.XIkykij7SUl">Mind</a>, strive to inform people about this new diagnosis.</p>
<p>The National Institute for Health and Care Excellence, which in England is in charge of publishing national guidelines and advice to improve health and social care, has not yet developed recommendations specifically for complex PTSD. But several treatments (still in their early stages) are being developed. </p>
<h2>How it’s treated</h2>
<p>In the meantime, people who experience complex PTSD are being offered the usual treatments for PTSD. While such treatments have shown to be effective to an extent, they need to be offered for a longer period, should be accompanied by more intensive support and supplemented with extra therapies focusing particularly on the disturbance in self-organisation symptoms.</p>
<p>Usual treatments for PTSD that the NHS offers in England include trauma-focused cognitive behavioural therapy (<a href="https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/treatment/">CBT</a>) and eye-movement desensitisation and reprocessing (<a href="https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/treatment/">EMDR</a>). </p>
<figure class="align-center ">
<img alt="Woman having therapy." src="https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461768/original/file-20220506-22-l9yrgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Trauma-focused CBT can help people manage their complex PTSD.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mental-health-patient-psychotherapist-talking-therapy-1611463261">Microgen/Shutterstock</a></span>
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<p>Trauma-focused CBT involves eight to 12 weekly sessions where you learn how trauma can affect your body and which techniques are useful to deal with symptoms, such as flashbacks. EMDR is also offered as a course of eight to 12 sessions, where you will try to think about details of the trauma while making eye movements, usually by following the movement of your therapist’s finger. Both these treatments, while effective, involve thinking about the trauma and so can be quite distressing.</p>
<p>Treatments that have more than one component are the ones that are <a href="https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1866423">more promising</a> for managing complex PTSD symptoms. For example, a <a href="https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1783955">study</a> conducted in the Netherlands found that an intensive eight-day treatment programme combining different techniques including EMDR and physical activity significantly decreased symptoms of both PTSD and complex PTSD.</p>
<p>If you feel you might benefit from trauma-focused therapy, or would like to discuss any symptoms that you might be experiencing, you can talk to your doctor or, in the UK, refer yourself for assessment to an NHS psychological therapies service (<a href="https://www.nhs.uk/service-search/mental-health/find-a-psychological-therapies-service/">IAPT</a>) without a referral from a GP.</p><img src="https://counter.theconversation.com/content/181512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolina Campodonico does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Complex PTSD was left out of the latest version of the ‘psychiatrists’ bible’, but that doesn’t make it any less real for those who live with it.Carolina Campodonico, Lecturer in Clinical Psychology, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1206222019-07-24T13:37:24Z2019-07-24T13:37:24ZWhat exactly is a disease?<figure><img src="https://images.theconversation.com/files/285188/original/file-20190722-11314-1vrn0qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not all disease is easy to spot.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1407569297?src=_V1oZAF_73mzq0rXE74X4w-1-6&studio=1&size=medium_jpg">Yok_onepiece/Shutterstock</a></span></figcaption></figure><p>There is an ongoing <a href="https://www.bmj.com/content/366/bmj.l4258">lively debate</a> among healthcare professionals about whether or not obesity is a disease. Differences between those who argue that it’s a disease and those who argue that it’s just a risk factor for conditions such as type 2 diabetes and heart disease are unlikely to be resolved any time soon. The debate, however, raises other questions, such as, what exactly is a disease and who gets to decide?</p>
<p>A <a href="https://www.medicinenet.com/script/main/art.asp?articlekey=3011">simple definition</a> of disease is an “illness or sickness characterised by specific signs or symptoms”. But it is interesting that some <a href="https://www.collinsdictionary.com/dictionary/english/disease">dictionaries</a> suggest that diseases are caused by “bacteria or infections”, seemingly dismissing psychological and noncommunicable conditions as diseases, which is odd given that <a href="https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death">noncommunicable diseases</a>, such as cardiovascular disease and cancer, make up most ill health in the world today.</p>
<h2>Official catalogue of disease</h2>
<p>On a global level, diseases are catalogued by international groups of experts for the World Health Organisation (WHO). This catalogue, the International Classification of Disease, is now in its tenth revision (<a href="https://icd.who.int/browse10/2016/en">ICD-10</a>). Despite its name, the classification doesn’t stop at diseases but includes related health problems, which may be linked to a particular disease, or may be a symptom as part of a syndrome or even a consequence of a medical procedure. For example, even dehydration appears in ICD-10, where it is also called “volume depletion”. So perhaps there is not even agreement on what is meant by disease. And what <em>is</em> classified as disease is essentially down to expert consensus.</p>
<p>While the WHO doesn’t seem to have a clear definition of disease, it does at least have a definition of health. It is <a href="https://www.who.int/about/who-we-are/constitution">defined as</a> “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. </p>
<p>The definition of health appears to be broad and inclusive, but defining disease appears to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1299105/">more challenging</a> than defining its opposite. Few people would disagree that measles, say, is a disease. But what happens when society decides to classify a certain human behaviour or characteristic, which some groups happen to find disturbing, as a disease. </p>
<h2>Sin as a source of disease</h2>
<p>Examples of classifying characteristics as diseases can be seen throughout human history. Many of these might be grounded in traditional beliefs and views of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/">health, disease and their links to sin</a>. </p>
<p>The development of psychology as a science potentially led some perceived “sins” to be translated into mental health disorders. Perhaps the best example of this is homosexuality. Homosexuality was classified as a mental disorder by the American Psychiatric Association (APA) in 1968. This was later challenged by a vote among APA members in 1973, where <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/">a majority of 58%</a> chose to remove it from the diagnostic manual. Homosexuality was not fully removed from the diagnostic manual for another decade and is now considered to be a normal characteristic within the diversity of human nature.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285379/original/file-20190723-110154-19r5hjq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Being gay was once considered to be an endocrine disorder.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1099936808?src=l_4eaFhdo4Aa_-EWEnGYlQ-1-0&studio=1&size=medium_jpg">lazyllama/Shutterstock</a></span>
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<p>This disturbing episode raises further questions: on what basis and in whose interests are diseases classified? </p>
<p>In 2013, researchers at Bond University in Australia looked at <a href="https://theconversation.com/how-diseases-get-defined-and-what-that-means-for-you-16965">who gets to classify diseases</a>. They found that common diseases often had their definitions widened by expert groups, without considering the <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001500">potential risks</a> or challenges of increasing the number of people living with disease. They also noted that experts who widened definitions of diseases often have conflicts of interests in the form of funding from pharmaceutical companies.</p>
<h2>On the spectrum</h2>
<p>Sometimes, risk factors for a disease – such as high blood pressure – eventually get defined as a disease in their own right. And once these risk factors are reclassified as a disease, their <a href="https://www.health.harvard.edu/heart-health/reading-the-new-blood-pressure-guidelines">targets or ranges</a> tend to shift over time, increasing the number of people who have the disease. For example, high blood pressure used to be anything over 140/90. But in 2017, the US <a href="https://www.health.harvard.edu/blog/new-high-blood-pressure-guidelines-2017111712756">changed the threshold</a> to 120/80.</p>
<p>Distinguishing a disease from a risk factor is not easy, especially when it comes to chronic diseases, which tend to be a spectrum from health to illness. Blood glucose (sugar) is a clear example as levels move from healthy through pre-diabetes into type 2 diabetes. So spotting where health finishes and disease begins is difficult, to the point that the WHO and International Diabetes Federation suggest there is no such thing as a <a href="https://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf">normal level of blood glucose</a>. </p>
<p>Nevertheless, the definition of gestational diabetes (diabetes in pregnancy) changed in 2014, when the blood glucose threshold was lowered. The change increased the incidence of gestational diabetes by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326329/">74% with no improvement in short-term outcomes</a>, such as the mother needing a caesarean section, according to one Australian study.</p>
<p>Many <a href="https://www.bmj.com/content/350/bmj.h2308">clinicians</a> are critical of this trend, calling it <a href="https://www.theguardian.com/commentisfree/2014/jul/19/patients-hospital-care-over-intervention">over-medicalisation</a>.</p>
<h2>Normal ageing or disease?</h2>
<p>Sometimes, conditions previously thought of as being a natural part of getting older have become diseases. For example, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32112-3/fulltext">osteoporosis</a> was considered a normal part of ageing until 1994 when the WHO <a href="https://www.ncbi.nlm.nih.gov/pubmed/7941614">officially recognised it as a disease</a>. Given osteoporosis’s link with an increased risk of fractures and the devastating impact broken bones can have on the elderly, this seems like a change in definition that is justified.</p>
<p>Other physiological changes that occur in older age, such as a fall in testosterone levels in men, may not benefit from disease status. But that hasn’t stopped some healthcare experts trying to create a new condition called “<a href="https://www.nhs.uk/conditions/male-menopause/">the andropause</a>”. So far, though, resistance to recognising this change as a disease has been strong.</p>
<p>All of the above goes to show that deciding what is or isn’t a disease is not easy, but hopefully you’ll be better equipped to ask some critical questions such as, who benefits from this new definition? And do they have my best interests at heart? The answer to the latter question is usually yes – but not always.</p><img src="https://counter.theconversation.com/content/120622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It seems like an easy question, until you take a closer look. Then things get messy.Duane Mellor, Senior Teaching Fellow, Aston Medical School, Aston UniversityShahid Merali, Clinical Senior Lecturer: Lead for Primary Care Education, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1180382019-06-04T20:07:46Z2019-06-04T20:07:46ZHow to know if your child is addicted to video games and what to do about it<figure><img src="https://images.theconversation.com/files/277857/original/file-20190604-69059-1b98r13.jpg?ixlib=rb-1.1.0&rect=82%2C6%2C4518%2C3055&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When gaming interferes with a person’s daily life, it might become a disorder.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/xWkRYoSf8_c">Alex Haney</a></span></figcaption></figure><p>If your child spends long hours playing video games, you might be worried they’re addicted. </p>
<p>“Gaming disorder” is real, and has now been classified as a disease in the World Health Organisation’s <a href="https://www.who.int/features/qa/gaming-disorder/en/">International Classification of Diseases and Related Health Problems</a> (ICD). The new ICD will be adopted in 2022. </p>
<p>If you are worried about your child’s gaming, this new classification will help you identify whether they have a problem and if you need professional help. </p>
<p>Gaming disorder is not just for kids – it can be experienced by gamers of all ages: children, teenagers and adults. </p>
<p>The condition isn’t defined by gaming too much, or the number of hours played, but rather it’s when gaming interferes with a person’s daily life. </p>
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Read more:
<a href="https://theconversation.com/i-want-my-ipad-are-our-kids-getting-addicted-to-technology-46325">I WANT MY iPAD! Are our kids getting addicted to technology?</a>
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<p>To be diagnosed, a person will demonstrate all three of the following symptoms for at least 12 months:</p>
<ul>
<li>losing control over gaming </li>
<li>prioritising gaming to the extent that it takes precedence over other activities and interests </li>
<li>continuing to game despite negative effects on work, school, family life, health, hygiene, relationships, finances or social relationships.</li>
</ul>
<p>The classified disorder focuses on gaming only, it doesn’t include other digital behaviours such as overuse of the internet, online gambling, social media, or smart phones. </p>
<p>It also relates to gaming on any device, although <a href="https://www.psychiatry.org/patients-families/internet-gaming">most people who develop clinically significant gaming problems</a> play primarily on the internet.</p>
<h2>Serious health condition</h2>
<p>While millions of kids and adults around the world play video games, only a small number are expected to meet the WHO criteria. </p>
<p>Like other diagnosable addictions, gaming disorder is an extreme mental health condition expected to affect only 0.003 to 1% of the population who <a href="https://www.psychiatry.org/patients-families/internet-gamin">engage in video-gaming activities</a>. </p>
<p>This small percentage still however incorporates a lot of people. Drawing from a random sample of 1,234 people of all ages, around <a href="https://www.igea.net/wp-content/uploads/2017/07/Digital-Australia-2018-DA18-Final-1.pdf">67% of Australians play video games</a>. This would mean that around 5,000-16,500 Aussies could potentially be diagnosed with the disorder. </p>
<h2>Not everyone agrees this is a disorder</h2>
<p>While it feels like this classification is a <em>fait accompli</em>, the designation of gaming disorder as an addiction remains hotly debated. </p>
<p>The American Psychiatric Association (APA) is still not convinced. Two things are holding it back. </p>
<p>The first is that problem gaming often occurs alongside other factors <a href="https://www.emeraldinsight.com/doi/abs/10.1108/IntR-01-2018-0020">such as loneliness</a>, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/28841491">mental health conditions</a> such as anxiety and depression. The APA argues problematic gaming may be a symptom of these, rather than a unique condition in its own right. </p>
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Read more:
<a href="https://theconversation.com/could-playing-fortnite-lead-to-video-game-addiction-the-world-health-organisation-says-yes-but-others-disagree-98458">Could playing Fortnite lead to video game addiction? The World Health Organisation says yes, but others disagree</a>
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<p>The second issue for the APA is the lack of <a href="https://www.psychiatry.org/patients-families/internet-gaming">strong evidence and research</a> to support gaming disorder as an addiction in its own right. </p>
<p>Other experts have also<a href="https://akademiai.com/doi/full/10.1556/2006.7.2018.19"> weighed into this debate</a> suggesting the classification is simply a response to the huge community concern and moral panic about video games.</p>
<h2>How gaming disorder should be treated</h2>
<p>An important impact of the classification of gaming disorder as an addiction is it lays the path for treatment by health professionals. </p>
<p>But like the classification of the disorder, research-based treatment plans are also in their infancy. </p>
<p>A <a href="https://journals.sagepub.com/doi/abs/10.1177/1039856216684714?journalCode=apya">survey of psychiatrists in Australia and New Zealand</a> found only 16.3% felt confident managing the disorder. </p>
<h2>So what should you expect from professional treatment?</h2>
<p>The are two common forms of treatment: one focuses on understanding the gamer’s situation; the other focuses on learning new behaviours. </p>
<p>Treatment often <a href="https://www.tandfonline.com/doi/full/10.1080/14656566.2019.1612366">includes</a> therapy sessions with an addiction counsellor. The sessions may take the form of individual sessions, group sessions and/or family sessions. Each session dynamic has a different focus. For example, family therapy sessions focus on exploring and addressing issues in the patient’s family that may contribute to the addiction. </p>
<p>The second common treatment is <a href="https://www.ncbi.nlm.nih.gov/pubmed/3034198">cognitive behavioural therapy</a> (CBT). This often takes place in addition to counselling sessions. CBT is based on the premise that thoughts determine feelings and it is used to treat many psychiatric disorders, such as substance use disorders, depression and anxiety. CBT teaches the gamer different ways to think, behave, and <a href="https://thiswayup.org.au/how-we-can-help/cognitive-behavioural-therapy/">respond</a> to stressful situations. </p>
<p>Other medical treatments proving to have some success include art therapy and exercise therapy. </p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/14656566.2019.1612366">Research</a> on suitable medication is also continuing. </p>
<p>Treatment plans are designed according to the needs of the individual. It may involve a series of CBT sessions, for example, plus individual therapy sessions, plus family therapy sessions. Treatment is tailored to the age of the person, their faith, their professional status or other factor important to their treatment. </p>
<p>At this stage, no treatment can claim a 100% success rate and this is reflective of the need for more <a href="https://www.ncbi.nlm.nih.gov/pubmed/3034198">research</a>. </p>
<h2>Tips to manage your child’s gaming</h2>
<p>While most gamers will not be diagnosed with gaming disorder, a child’s gaming habits can cause significant distress for parents. They may be concerned their child is spending too much time on video games, that they resist every time they are asked to get off, or that gaming is leading to an unhealthy or unbalanced lifestyle. </p>
<p>Here are some tips for supporting more healthy approaches to gaming for children include:</p>
<ul>
<li><p>encourage sport and physical activity. This can increase blood levels of serotonin and have a positive effect on mood and symptoms of problematic gaming</p></li>
<li><p>talk to your child about what they enjoy about gaming and why they want to game regularly. Their answer will help you identify if there are others issues they may be experiencing and using gaming as an escape</p></li>
<li><p>when you call your child off their game, ensure they have an activity to shift to, such as a family outing or dinner. This will create a reason to get off </p></li>
<li><p>when calling your child off a game, give them time to finish the game. Continuously being asked to get off mid-game can be frustrating and lead to arguments. Ask them how much longer they will need to finish the game and then ensure they get off when the game is over. </p></li>
</ul>
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Read more:
<a href="https://theconversation.com/curious-kids-why-do-adults-think-video-games-are-bad-76699">Curious Kids: Why do adults think video games are bad?</a>
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<p>With video games such a significant aspect of young people’s lives, it’s important to guide healthy, balanced approaches as young as possible. </p>
<p>Central to this is ensuring you include gaming and any other technology activities in family discussions. This will help keep the lines of communication open and will help identify any problem behaviour early on.</p><img src="https://counter.theconversation.com/content/118038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanne Orlando does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The World Health Organisation has classified gaming disorder as an addiction. But it involves more than just playing videogames for hours on end. Here’s how to spot it and what you can do about it.Joanne Orlando, Researcher: Technology and Learning, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/984952018-06-21T15:12:55Z2018-06-21T15:12:55ZGaming addiction: what we can learn from smoking cessation programmes<figure><img src="https://images.theconversation.com/files/224075/original/file-20180620-137738-1xlw31w.jpg?ixlib=rb-1.1.0&rect=23%2C148%2C974%2C540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/278969585?src=XP8Eyi7TmKcFXR-8wPRPiA-1-15&size=medium_jpg">rangizzz/Shutterstock.com</a></span></figcaption></figure><p>Between <a href="https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.16020224">0.3 and 1%</a> of the UK’s <a href="https://newzoo.com/insights/infographics/the-u-k-gamer-2017/">32.4m</a> gamers are living with a gaming addiction. At last, their condition is officially recognised. This week, the World Health Organisation (WHO) added “<a href="http://www.who.int/features/qa/gaming-disorder/en/">gaming disorder</a>” to the 11th version of its International Classification of Diseases (ICD-11). </p>
<p>People suffering from gaming disorder are likely to prioritise game play over every other part of their life. Some <a href="https://www.theguardian.com/technology/2011/mar/11/i-was-games-addict">self-confessed games addicts</a> have admitted playing up to 16 hours a day. </p>
<p>As with other addictions, people with gaming disorder allow their habit to take precedence over their other interests. These factors influenced the WHO to take action against an emerging and worrying global trend. </p>
<p>In the same way that tobacco companies made cigarettes more addictive by <a href="https://www.tobaccofreekids.org/press-releases/2014_06_23_report">tweaking the ingredients</a>, games developers have added features to their games to keep players addicted. Strategies have included using behavioural science to entice users to play for longer periods of time and to play more often. In fact, the data that developers collect from users allows them to enhance the features of the game that users enjoy the most.</p>
<p>Developers have also started incorporating social elements into game play. Some encourage users to form teams with others. As a result it becomes increasingly difficult to leave a game. Doing so may impact the other members of the team.</p>
<p>In-game purchases make games even more appealing by offering users the opportunity to enhance their own experience. They are able to personalise characters and access different gaming worlds, giving them a sense of ownership of the game.</p>
<p>For most gamers, the strategies created by developers make the games more fun to play, but for others these strategies can have severe health consequences. It was recently reported that a nine-year-old girl had to be <a href="https://www.indy100.com/article/fortnite-addiction-rehab-young-girl-video-game-8394716">admitted to rehab</a> for an addiction to Fortnite, a multiplayer online shooter game.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224078/original/file-20180620-137734-1bsfwl7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Lots of parallels.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/187473707?src=VXyBXffAvLLpYmU9npakdw-1-17&size=medium_jpg">NeydtStock/Shutterstock.com</a></span>
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<h2>Treat it like tobacco</h2>
<p>Having identified that gaming disorders are a real health problem, governments must look to the success of other public health campaigns, such as smoking cessation programmes, to resolve this issue.</p>
<p>In the UK, huge success was achieved in reducing smoking rates by taking a multi-pronged approach. This included targeting cigarette manufacturers by banning tobacco advertising, changing product packaging and increasing tobacco taxes. A similar approach may be needed with games developers. </p>
<p>Strategies may include incorporating enforced breaks in play if a user is engaged for a prolonged length of time, limiting advertising to certain age groups, running awareness campaigns about the signs of gaming disorders and adding prompts within games that give advice on where users can get support for problems.</p>
<p>Of course, overcoming gaming disorders is also a parental and user responsibility. Parents should consider where their children are playing computer games and remove computers from bedrooms if needed. Parents also need to be conscious about their own use of technology and act as a positive role model for their children.</p>
<p>It is hoped that by classifying gaming disorder in the ICD-11 it will encourage gamers who feel that they are developing a problem to seek help. The advice from the WHO is to be conscious about the amount of time spent on gaming activities, particularly if this interferes with day-to-day activities.</p><img src="https://counter.theconversation.com/content/98495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Crilly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Now that gaming addiction is officially recognised, we need to develop strategies to counteract it.Philip Crilly, Pharmacy Teaching Fellow and PhD student (Digital health), Kingston UniversityLicensed as Creative Commons – attribution, no derivatives.