1. まとめトップ

この記事は私がまとめました

アメリカDSM-5では、インターネットゲーム障害としてゲーム依存を障害として認定していたが(CFS区分)、WHOはこれをインターネットに限らない「ゲーム障害」として、対象をさらに拡大してゲーム依存の障害としての病理化を決定した。

What is gaming disorder?
Gaming disorder is defined in the draft 11th Revision of the International Classification of Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.
For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.

ESA Responds to WHO’s Proposed Disorder Classification

ESA issued the below statement in response to the World Health Organization (WHO) announcing its intention to recognize obsessive video game playing as “gaming disorder.”

“Just like avid sports fans and consumers of all forms of entertainment, gamers are passionate and dedicated with their time. Having captivated gamers for more than four decades, more than 2 billion people around the world enjoy video games. The World Health Organization knows that common sense and objective research prove video games are not addictive. And, putting that official label on them recklessly trivializes real mental health issues like depression and social anxiety disorder, which deserve treatment and the full attention of the medical community. We strongly encourage the WHO to reverse direction on its proposed action.”

大スポンサーとしてのスマホゲーム会社との狭間で

現在、TV業界は、地上波放送テレビを見ている人口は激減してきているとはいえ、まだまだ広告メディアとしての地位は高い。そのTVのCMの大黒柱の1柱となっているのがスマホゲームCMや据え置きゲーム機CMだ。そのため、各メディアは、このような大スポンサーの基幹業務を揺るがしかねないゲーム障害についての報道にはかなり慎重な姿勢だ。

アメリカCDC疾病対策予防センターの見解

Among the sample of 15,624 adolescents, 51.3% were male and 48.7% were female. One in 5 adolescents spent 5 hours or more per day playing video or computer games or used a computer for something unrelated to school work.

ゲームを1時間未満しかしない群に比べて、5時間以上ゲームをする群のうつ病の発症・増悪の割合は2.5倍以上に達しており、それ以外の精神疾患の発症・増悪の割合も押しなべて2倍以上になるとの研究結果が発表されている。

日本政府の見解

これに対し、日本政府見解として、菅官房長官はつぎのように述べて、ゲーム障害に対する医療的介入への明言を避けている。

WHOがゲーム障害を疾病と位置づける国際疾病分類の案を公表し、来年5月の総会で議論するというふうに報告を受けています。
 一方、ゲーム産業はクールジャパン戦略において重要な産業の一つと位置づけられており、我が国産業の成長分野であるこのように認識してます。こうした産業が成長していくためには、様々な問題に対し適切に対応していることが大事だと思ってます。ゲーム障害は睡眠や学業などの様々な日常生活と関係があるこのようにも指摘されています。これまでも精神保健福祉センターで相談・支援、これを行って来てるところです。
 今後、まずはその実態等について調査、研究を行って、その結果を踏まえ対応をしっかりしてまいりたいというふうに思います。

日本政府のいう「調査・研究」とは?

ここでいう「調査・研究」とは「実態等について」とは、いまどれだけのゲーム障害と思われるひとがどれくらいいるかをメインとした、公衆衛生学的・社会学的調査のことを指しており、日本政府と医学界がゲーム障害の実態を知らないと言っているにひとしい。これまで長時間のネットゲームに没頭する引きこもりやエコノミー症候群による死亡例も出ている障害に対する認識としてはあまりに不充分であり、無様というしかない。多くの先進国では、調査・研究の段階はとうに過ぎ、すでに治療と介入の実践の段階に入っている。

各国のゲーム障害(VGA)に対する先行研究の例

Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention
J Behav Addict. 2017 Sep; 6(3): 271–279. Published online 2017 Jul 26. doi: 10.1556/2006.6.2017.039

Video gaming and gaming addiction in transgender people: An exploratory study
J Behav Addict. 2017 Mar; 6(1): 21–29. Published online 2017 Feb 13. doi: 10.1556/2006.6.2017.002

Psychometric validation of the Persian nine-item Internet Gaming Disorder Scale – Short Form: Does gender and hours spent online gaming affect the interpretations of item descriptions?
J Behav Addict. 2017 Jun; 6(2): 256–263. Published online 2017 May 12. doi: 10.1556/2006.6.2017.025

DSM-5 diagnosis of Internet Gaming Disorder: Some ways forward in overcoming issues and concerns in the gaming studies field: Response to the commentaries
J Behav Addict. 2017 Jun; 6(2): 133–141. Published online 2017 Jun 20. doi: 10.1556/2006.6.2017.032

Neurobiological Correlates in Internet Gaming Disorder: A Systematic Literature Review
Front Psychiatry. 2018; 9: 166. Published online 2018 May 8. doi: 10.3389/fpsyt.2018.00166

ゲーム障害診療拠点病院 関東(千葉)・関西(神戸)・九州(福岡)

このようななか、関東・関西・九州の3つの地域に、2018年からゲーム障害専門外来が相次いで開設された(千葉 久里浜医療センター/神戸 神戸大附属病院/福岡 九州ベテルクリニック福岡)。いずれの病院も、思春期外来・発達障害外来・依存症外来などを以前から有する医療機関で、ゲーム依存がゲーム障害として定義される以前から発達障害とゲーム依存に取組んでいた病院だ。特に、ゲーム依存とゲーム障害には、その基礎疾患として、コミュニケーションの苦手や感覚知覚異常・過集中・睡眠障害といった症状を有する発達障害が基礎にあると考えられている。そのため、単にゲームに依存癖があるというだけでなく、その基礎疾患として存在しているかもしれない発達障害を発見・鑑別できることが、ゲーム専門外来には求められている。

関東 久里浜医療センター
〒239-0841神奈川県横須賀市野比5-3-1
電話  046-848-1550/FAX  046-849-7743
http://www.kurihama-med.jp
http://www.kurihama-med.jp/outpatient/clinic/cl_seishinka.html
http://www.kurihama-med.jp/access/index.html
http://www.kurihama-med.jp/hospital/index.html
http://www.kurihama-med.jp/english.html(英語サイト)

関西 神戸大学医学部附属病院
〒650-0017 神戸市中央区楠町7丁目5-2 (代表)Tel. 078-382-5111
http://www.hosp.kobe-u.ac.jp/
http://www.hosp.kobe-u.ac.jp/medical-institution/department-list.html
http://www.hosp.kobe-u.ac.jp/medical-institution/index.html#kanjacenter
http://www.hosp.kobe-u.ac.jp/access.html
http://www.hosp.kobe-u.ac.jp/e/index.html(英語サイト)
http://www.hosp.kobe-u.ac.jp/topic/welfare.html(地域医療福祉窓口)
http://www.med.kobe-u.ac.jp/kikiso/index.html(研究基盤整備)

九州 九州ベテルクリニック福岡発達障害専門外来併設ゲーム障害専門外来
〒812-0038 福岡県福岡市博多区祇園4-3
https://bethelclinic.wixsite.com/gamingdisordericd11
http://xn--pckah3evb7hzc7g533zs41a7ecosfl38jv84d.bethel.clinic
発達障害専門外来
http://asd.bethel.clinic
https://asd-adhd-pdd.wixsite.com/asd-adhd-oxytocin
http://xn--kckg4aa8ftmo69pfkwg2b20eb24akkgl3dzy8ddxjzh1ewxva80z.co-ltd.be
http://gid.bethel.clinic

その他のゲーム問題を取り扱う子どもの発達障害専門外来
東大病院こころの発達診療部
http://kokoro.umin.jp/(特設サイト)
http://www.h.u-tokyo.ac.jp/patient/depts/hattatsu/index.html(発達ポータル)
http://neurosci.umin.jp/j/child_neuropsychiatry.html(総合)
東京大学医学部附属病院 〒113-8655 東京都文京区本郷7-3-1 電話03-3815-5411(代表)/03-5800-8630(受診予約)

ゲーム障害を専門とする海外の医療センター

"Gaming disorder is now an official mental health diagnosis under the World Health Organization’s new International Classification of Disease (ICD-11), released this week. Although many health professionals have recognized addictive gaming behavior for years as a serious problem, the WHO’s new classification helps legitimize the diagnosis, experts say—and is an important step in making sure patients in need get the necessary treatment.

The ICD-11 is a database of around 55,000 unique codes for injuries, diseases, and causes of death that help health professionals around the world speak a common language. With this new update, gaming disorder—which includes unhealthy behaviors involving both Internet and traditional video games—has been added to the ICD’s section on addictive disorders.

But what exactly is gaming disorder, and who is it most likely to affect? We spoke with Doug Gentile, PhD, professor of psychology at Iowa State University, to learn more."

"What counts as a gaming disorder?

According to the WHO, gaming disorder is characterized by impaired control over gaming behavior; in other words, says Gentile, gamers know they should stop—to do their homework, to meet social obligations, or to get a good night’s sleep, for example—but they feel unable to.

Troublesome behavior also reaches disorder levels when gaming begins to take precedence over other interests and daily activities. With gaming disorder, this pattern continues and escalates, despite the negative consequences that occur because of it.

Another symptom of gaming disorder is lying about how much you’re gaming, Gentile says, which can damage trust with friends and family members. “These are ripples that look, at the time, like they’re small issues, but in fact, can have very serious long-term repercussions.”

The ICD-11’s new designation involves both online and offline forms of gaming. “It can include gaming on any platform—cell phones, tablets, or traditional console games,” Gentile says.

Games with an online component may have the potential to be especially addictive, he adds. In 2013, the American Psychiatric Association mentioned "Internet Gaming Disorder" in its own database of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but stopped short of giving it its own entry.

Finally, for gaming disorder to be diagnosed, a person’s behavior has to be significantly impairing his or her personal, family, school, or work life. Normally, this pattern has been evident for at least 12 months.

"Research also suggests that boys and young men are much more likely than girls and young women to exhibit disordered gaming behavior. In a 2017 German study of 12- to 25-year-olds, the estimated prevalence of gaming disorder was 8.4% in males versus 2.9% in females. Because the disorder has been identified in so few girls and women, Gentile says, it’s not known whether it manifests differently than in boys and men.

Experts have wondered whether children or adults who are already depressed or anxious may be more likely to develop a gaming addiction, as a means of coping or hiding from real life. But research shows that disordered gaming behavior isn’t simply a symptom of these conditions, Gentile says.

“In fact, when kids become addicted to games, their depression increases and their anxiety increases,” he says. “And if they stop being addicted, we see the opposite pattern; their depression gets better. So it looks like the gaming can definitely feed some of these other problems.”

"What to do if you or a loved one needs help

As with most mental health issues, gaming disorder affects only a small percentage of the total population. “We’re not talking about people who play games when they’re bored, or who enjoy playing games but are managing their lives just fine,” Gentile says. “As long as it’s not affecting your mental or physical health, go ahead and play.”

"It's about trying to understand that there is a boundary at which behavior becomes too dysfunctional," he continues. "It's like depression: Everyone gets sad, but there is a point at which it becomes too much and you need treatment."

"It’s also important to remember that excessive gaming can have other consequences, besides those directly related to mental health. It’s been associated with sleep disturbances, low fitness levels, and poor nutrition, for example, which can all have long-term physical effects.

If you do feel that you or a loved one could use some help treating a gaming addiction, Gentile recommends finding a mental health professional with experience in impulse-control disorders—especially since it may be difficult to find someone who specializes specifically in Internet or video games.

Gentile says the WHO’s new classification will likely help health care providers become better versed in treating this disorder and pave the way for more health insurance companies to provide coverage for care. “The first step toward getting people the help we need is recognizing the problem is real,” he says."

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