Dependence on video games as a diagnosis: it means changes in the International Classification of Diseases

Recently, the World Health Organization publishedWHO releases new International Classification of Diseases (ICD 11) eleventh edition of the International Classification of Diseases (ICD-11). It describes the 55,000 diseases, injuries and disorders, including mental and behavioral.

A number of known disorders ICD-11, the authors have proposed viewed differently than before, and even in medical practice will be introduced a new type of dependence - on computer games. Learn more about what the ICD and as the next edition of the publication changes our understanding of mental norm, says clinical psychologist Giorgi Natsvlishvili.

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Creating a common language in which to communicate the researchers from different countries, it is necessary for the development of any science. Medicine is no exception. It does not even have to talk about dealing with colleagues from different countries. To understand each other, and doctors must be at the level of a single city. To this end, and were invented nomenclature of diseases and their classification.

International Classification of Diseases is the world's standard procedure to collect data on mortality and morbidity data. It allows you to organize and encode the health information to be used for statistics and epidemiology, management health, resource allocation, monitoring and evaluation, research, primary health care, prevention and treatment. It helps to get an idea about the general situation in the field of health in the countries and population groups.

International Classification of Diseases is updated regularly, and is currently preparing for the introduction of the eleventh revisionICD-11 (International Classification of Diseases 11th revision). Each revision takes into account the latest medical advances and the implementation of new approaches in the administrative Registered patients and in the treatment and analysis of various diseases. ICD is not only doctors, but also by nurses, researchers, various administrative staff of medical institutions, insurance companies and various suppliers medical care.

ICD-11 will be presented to the World Health Assembly in May 2019, and will come into force from January 1, 2022. During the remaining time in the classification can be made a number of revisions that would change the course of the development of medical diagnostics, and related to certain diseases. ICD-11 is the first revision, changes in which can make not only the WHO committee of experts, but also other interested parties. To do this, they need to be up WHO on a special web portal.

It should be remembered that the ICD, with all its weight and importance, is not the only and the last word on which guided doctors all over the world. There is the national medical association, so the diagnosis of certain disorders and the criteria for the award from one country to another may vary. This concerns, including mental disorders, which will be discussed in our article.

For example, previous revision, ICD-10International Classification of Diseases 10th revision (ICD-10), Adopted in 1990, extended the boundaries of mental normality, excluded from the list of diseases homosexuality. And although in the professional debate on this subject is still going on, and egosyntonic and egodystonic homosexuality as a diagnosis continued in ICD-10, it was an important step in slowing down the stigmatization of people with a homosexual orientation in around the world.

Can we say that the change in the class of mental and behavioral disorders that ICD-11 introducedThe process of developing the head of the ICD-11. Mental and behavioral disorders compared with the previous version, are also expanding the boundaries of the norm? Let us consider this an example of schizophrenia, personality disorders, and gambling addiction - that may be a new stigmatizatsionnym factor.

Schizophrenia

Schizophrenia - a mental disorder with a very rich history. Until now, when people talk about madness, they have in mind is schizophrenia. This is one of the most popular psychiatric disorders that appear in popular culture. Respectively, related to schizophrenia, as well as to any element of mass culture radically different both in the community and among the experts.

The term "schizophrenia" was introduced Eugen Bleuler in 1908. The disease is characterized by both endogenous and polymorphic symptomatology was not united in its qualitative content, the outcome of the development of the disease forecasting was difficult. In connection with this were disputes about how much it is advisable to allocate schizophrenia as a single disorder. Later, the majority of experts agreed on the allocation of schizophrenia as a single disease, but the discussion did not end there.

Throughout the twentieth century it has been much debate about how to analyze the symptoms of schizophrenia - like a single process, an indivisible whole (Kronfeld) or divide it into negative (inhibition of any brain function, such as memory impairment) and positive (when there is something new as a product of our psyche, such as hallucinations) symptoms (Kraepelin).

And argued about how to treat schizophrenia - based on the understanding of its nature. If we consider it as an endogenous disorder is schizophrenia - a brain disease that is treated only with medicines. If we are talking about exogenous disorder is schizophrenia - a family illness or the public, and to cure the patient should change the situation. You can also use a multidisciplinary approach that combines the first two.

Ultimately, the diagnosis has won, so to speak, the structuralist approach, taking into account the division between negative and positive symptoms. If we talk about the treatment, the individual experts hold a multidisciplinary approach, others look at schizophrenia as exclusively endogenous disorder.

Until recently, schizophrenia was proposed to differentiate the type of flow and form. Thus, the ICD-10 stand out, among others, such forms:

• Paranoid schizophreniaIn which the clinical picture is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory and perceptual disturbances. Disorders of emotions, will, speech, and catatonic symptoms (excessive muscle tone, in which the patient or many moves and speaks, or vice versa falls into a stupor and freezes) are absent or relatively weak expressed.
• Disorganized form of schizophreniaAt which dominate the affective (emotional) changes. Delusions and hallucinations are superficial and fragmented, unpredictable and absurd behavior, mannerisms. The mood is variable and inadequate, disorganized thinking, speech incoherent. There is a tendency to social isolation. Prognosis is usually unfavorable due to the rapid growth of "negative" symptoms, especially affective flattening (the patient ceases to feel and show emotions) and the loss of faith.
• Catatonic form of schizophrenia, The clinical picture is dominated by alternating psychomotor impairment polar character, such as fluctuations between hyperkinesis (involuntary movements of the limbs) and stupor (frozen) or automatic submission (excessive obedience) and negativity (the patient or acts contrary to the doctor, or does nothing and does not respond to instructions doctor).

The new version of the ICD division on various forms of schizophrenia, we no longer find. ICD-11 offers professionals evaluate the manifestations of symptoms in the patient, paying more attention to the descriptors that expand understanding of the patient's condition with specific diagnosis, such as "negative symptoms of primary psychotic disorders," "depressive symptoms in primary psychotic disorders" and so Further. The very same schizophrenia is now divided only by the number of episodes and their duration.

Apparently, the descriptors entered for a thin and flexible diagnostic more fully describe the existing symptoms. The fact that, according to many experts, with the current diagnosis of 'schizophrenia' can disappear completely different content, and not always patient with the same diagnosis show a similar picture disease. The new approach will build a more individual approach to patients that are likely to expand the boundaries of "normality".

Firstly, people with schizophrenia, and now can no longer be accurate terminology to combine the word "schizophrenic". Secondly, it will change the ratio to a process treatment and care on the part of doctors and medical personnel.

Nevertheless, given the active development of neuroscience in the coming years we can expect further changes in view of schizophrenia, as well as the perspective of psychiatry in relation to this disease.

personality disorders

Personality disorder or psychopathy, often shown in popular culture. We will not go into diagnostic differences of Western and domestic approaches that exist and are very important for dialogue between experts from different countries. Instead, pay attention to how to change the perception of personality disorders in the new edition of the ICD.

At the moment, the term "psychopathy" has long been used as a diagnosis: he is now replaced by the term "personality disorder." Nevertheless, in this section we will refer and the term "personality disorder" and the term "psychopathy" in view of the fact that in the academic and professional circles, it is still used. To further the narrative, however, we must understand that they are in some way identical.

These disorders cover several areas of the personality, and are almost always closely linked to the expression of personal suffering and social disintegration.

These disorders usually occur (but not always found) in childhood or adolescence and continuing throughout later life.

The doctrine of psychopathy developed domestic psychiatrist Pyotr Gannushkin. He called the disorder "constitutional psychopath" and singled out a number of different types of psychopathy, such as schizoid, unstable, hysterical, and so on. Each type had been described in detail, but the complexity of the diagnosis was that Gannushkina cited extreme variants of the severity of the disorder, occurring less frequently.

In the West, a similar approach developed by Emil Kraepelin, whose concept (as Gannushkina concept) is used in modern practice.

Nevertheless, the division of psychopathy on certain types did not cause corresponding confidence Professionals in force that are often encountered patients showing symptoms, which is suitable for multiple disorders personality.

The ICD-11 approach has been changed: the authors refused allocation of types of personality disorders. Now the diagnosis of psychopathy is a constructor. The first step is to make sure that psychopathy as a whole takes place. The ICD-11 availablePersonality disorders in ICD-11 the following criteria:

1. The presence of a progressive disorder in the way a person thinks and how feels, and other the world, which is manifested in inadequate ways of cognition, behavior, and emotional experiences reactions.
2. Maladaptive patterns revealed a relatively rigidity and are associated with significant problems in psychosocial functioning, what is most evident in interpersonal relationships.
3. Violation is shown in various interpersonal and social situations (ie not limited to the specific relationships or situations).
4. Violation is relatively stable over time and has a long duration. Most often, a personality disorder first appears in childhood and explicitly manifests itself in adolescence.

It should be noted that these criteria are very similar to the criteria offered by P. B. Gannushkina, compliance with which confirmed the presence of psychopathy:

• Totality - certain personality traits affect the entire mental and social life of man;
• stability - during the life symptoms are not leveled;
• social exclusion caused by personal characteristics.

In the future, ICD-11 proposes to determine the severity of the course and then - some personality traits in each individual patient.

Thus, one can speak of displacement of the focus from the diagnosis a particular disorder with description of the corresponding behavior on disorders mechanism and its structure. At first glance, this is done to help the doctor to establish a more accurate diagnosis. However, this is changing the very concept of personality disorders from which, in particular, depends on the method of treatment. It turns out that innovations in the ICD-11 call into question the therapy of patients with personality disorders. What is offered in exchange and whether these changes are for the better, it is not yet clear.

Games dependence

Depending, in the broadest sense, there are two types associated with the use of psychoactive and related substances addiktivnym (prone to occurrence of various non-chemical dependencies) behavior. Games dependence included in ICD-11 belongs to the second type and assumes video game addiction.

The ICD-11, this disorder is referred to as "gaming disorder» (gaming disorder). Note that this is not the same thing as Gamblers, or gambling - pathological gambling addiction. However, gambling description, according to ICD-11, fully identical description gaming disorder. They are allocated the same criteria:

1. Violation of the game process control (e.g., the beginning, the frequency, intensity, duration, the termination, context).
2. Gambling / computer games is given more preference. They are more important than any other activity.
3. Continuation or even greater involvement in the gambling / computer games.
4. Such a relationship should be observed for at least 12 months.

Despite the apparent simplicity in the description of the diagnostic criteria in the diagnosis of disorders of the game may have many difficulties. The fact that computer games - is a very broad scope. To understand the principles of its operation the physician must familiarize himself with some number of games or, as would be funny as it may sound, pass educational course, to understand that the game can be different and not all of them can really be a trigger for a dependent behavior.

ICD-11 is really draws attention to the existing problem - the dependence on games as a form of addictive behavior. Often the mere presence of a non-chemical based suggests that the likelihood of developing chemical dependency increases. This is something that is really worth paying attention to. However, the introduction of such a diagnosis causes concern, and here's why.

For starters, you can ask a reasonable question: Why multiply the symptoms? At the heart of gaming addiction may underlie a variety of problems: conflicts with parents, the tendency to escape from their own failures, insecurities, and so on. Any problem of this kind can stand for many non-chemical dependencies (which belongs to the game). Whether it is necessary to allocate a separate gambling addiction disorder?

There seems more appropriate diagnostic approach, implemented in a situation with personality disorders. Indeed, at first it was possible to highlight the presence of addiction, then move to its generalized characteristic (For example, satisfied with it at home, or on the street, or in the extreme conditions and the etc.). Further it is possible to approach a particular characteristic.

Another problem is that the "gambling" can be and it is the usual story about the search for contact with peers or desire to play in the game with a good story - it's akin to the desire to read interesting book.

Do not forget about e-sports, which might also be the cause of many hours of "hang" the computer (The question of the personal features of those who prefer this kind of sport, will leave for backstage discussions).

It should be taken into account (and this is also stated in the ICD-11), in which the game - online or offline - the children play. Various investigators (Andrew Przybylski, Daphne Bavelier) have shown that games can bring both harm and benefit. Are the benefits of a challenging game with a complex control system and / or an interesting plot.

As for online games, everything here is a bit more complicated. Many online games have a system of rewards of various kinds, and, if the gameplay turns into constant pursuit of these achievements, indeed non-adaptive switching may occur in the game process. Only then we can talk about non-chemical dependent behavior.

The criterion on the observation of similar symptoms and more also in doubt throughout the year. Most likely, a potential "game-dependent" child to the doctor-psychiatrist will come to parents who do not know anything about the computer games market. As does the psychiatrist. As a result, the children will receive unfounded diagnosis, which causes the most confidence in this approach.

In addition, hardly the whole year will be a child. Most likely, we will get a picture with a lot of families in which the children after school to themselves: they are preparing their own meals, do their homework and decide to rest at the computer. This is where there is their a meeting with parents. As far as the objective is similar history?

But there is another important question. Do not privedo new treatment of disorders in ICD-11 to the stigmatization of the gaming community? People playing computer games, and so are under attack from the older generation, the computer considers a toy, to select the time and money (which is not always true, though it happens).

Of course, video game addiction as a coping strategies may exist and are likely to exist. But if we're talking about practice, it is found it is rare, much rarer than cases of parents worry about their "dependent games" child.

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So, can we say that the introduction of ICD-11 extends the normal range? I think no. But the rate is likely to change.

Changes to the ICD-11, aimed at simplifying the diagnostic process. And it can affect not only the experts, but also on the attitude to the disease the patients themselves.

Definitely we can talk about a new look at a variety of disorders. In the future, this should help their treatment. Modern science is familiar with situations in which there is no need to invent new complex solutions, sometimes enough to change the concept, the approach to the problem.