By Justin Hsieh & Karen Phan, Staff Writers
Earlier this week, the World Health Organization (WHO)’s World Health Assembly concluded their 72nd annual session in Geneva, where one of their tasks was to approve updates and additions for the 11th revision of the WHO’s International Classification of Diseases handbook (ICD-11). Two of those changes involved relatively new inclusions in the handbook: burn-out and “gaming disorder.”
Burn-out
Occupational burn-out, coined in the 1970s by American psychologist Herbert Freudenberg, originally described feelings of stress and pressure from people in “helping” professions, such as doctors and nurses.
The WHO now includes an updated definition of burn-out in the IDC-11. It is defined as an “occupational phenomenon” caused by “chronic workplace stress that has not been successfully managed.” Burn-out is not classified as a medical condition.
Burn-out is characterized by the following symptoms in the ICD-11:
- “feelings of energy depletion or exhaustion”
- “increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job”
- “reduced professional efficacy”
The syndrome is specific to a work environment and “should not be applied to describe experiences in other areas of life,” states the WHO.
Anxiety, depression, mood disorders and other stress-related disorders must be ruled out before medical professionals can issue a diagnosis of burn-out for a patient who experiences the three symptoms.
Burn-out is listed in the “Factors influencing health status or contact with health services” chapter of the ICD-11. The syndrome was previously included in the ICD-10 under the same chapter, but it was simply defined as a “state of vital exhaustion,” WHO spokesman Tarik Jasarevic told NPR.
The new definition is more detailed, and the WHO says it plans to begin “development of evidence-based guidelines on mental well-being in the workplace.”
Burnout has recently become a significant phenomenon in the United States. In a survey of 7500 full-time employees, global analytics and advice firm Gallup found that 23% of workers said they were very often or always burned out, and 44% said they were sometimes burned out – a total two-thirds of the population. According to Gallup, employees that are consistently burned out are 63% more likely to take a sick day, have 13% lower self-confidence, are two times more likely to say their job makes family responsibilities difficult, and 23% more likely to visit the emergency room.
“Gaming disorder”
The ICD-11 now also includes an entry for “gaming disorder,” which the WHO defines as “a pattern of persistent or recurrent gaming behaviour” characterized by:
- “impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context)”
- “increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities”
- “continuation or escalation of gaming despite the occurrence of negative consequences.”
To qualify as “gaming disorder,” the WHO says a person’s behavior must be severe enough to impair important areas of their normal life, such as family and occupation, for at least a year.
Gaming disorder is listed in the “Disorders due to Addictive Behaviors” category, which also includes gambling disorder and consists of “recognizable and clinically significant syndromes” that result from rewarding repetitive behaviors (not including substance abuse) and interfere with normal functions.
The Pew Research center found in 2018 that 97% of teen boys and 83% of teen girls in the United States play video games, and that 26% of teens believe they spend too much time playing video games. Sixty-five percent of teen boys and 50% of teen girls said they have cut back on their game time.
While the WHO says that “gaming disorder affects only a small proportion of people who engage in digital- or video-gaming activities,” it warns that people who game should beware of excessive time spending, exclusion of normal activities, and changes to normal functioning or behavior caused by gaming.
Implications
The inclusion of burn-out and gaming disorder in the ICD-11 has significant implications for how the conditions are perceived and treated around the world. The ICD is the international standard for researchers and medical practitioners to identify, categorize, report and diagnose conditions, and governments consider ICD inclusions “when planning public health strategies and monitoring trends of disorders,” says the WHO. The ICD-11 will go into effect on Jan. 1, 2022.
Given the weight of an ICD inclusion, many professionals believe that the updated ICD-11 will help to legitimize burn-out and gaming disorder in both medical and social circles, making it easier for people suffering from either to get help and facilitate more targeted research into the causes and treatments of the conditions.
German sociologist Torsten Voigt, who has previously authored a review of existing medical literature on burn-out, told NPR that “people who feel burnout are finally fully recognized as having a severe issue.”
Likewise, Dr. John Jiao, an emergency medical doctor, tweeted that the inclusion of gaming disorder in the IDC-11 was “sorely needed diagnosis.” He stated people who have real video-game addiction can be appropriately diagnosed and receive therapy with insurance coverage.
While these benefits may be seen in some European countries, where many medical professionals rely on the ICD, these changes may be more difficult to achieve in the United States. In the US, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is the authoritative guide in diagnosing psychological disorders. The latest edition of this manual (DSM-5), published in 2013, does not include burn-out and categorizes gaming addiction “not as an official diagnosis.”
The absence of burn-out and gaming addiction disorder in the DSM-5 makes it difficult for medical providers to diagnose patients. Furthermore, people seeking treatment for burn-out and gaming addiction may have issues with insurance coverage, given that medical providers will have a harder time billing insurers for treatments of a condition that lacks an official DSM code.
