Purpose of review The year 2018 was marked by the official recognition of Gaming Disorder (GD) as a mental condition with its
inclusion in the proposed eleventh edition of the International Classification of Diseases (ICD-11). Recently, a group of scholars
has repeatedly criticized the notion of GD proposed by theWorld Health Organization (WHO), arguing that its inclusion in ICD-
11 would pathologize highly involved but healthy gamers. It is therefore of crucial importance to clarify the characteristics of high
involvement versus pathological involvement in video games, the boundaries between these constructs, and the implementation
of screening and diagnostic GD tools that distinguish the two.
Recent findings Increasing evidence supports the view that intense video game playing may involve patterns of gaming that are
characterized by high involvement but that are non-pathological. Furthermore, some criteria for addictive and related disorders
may reflect peripheral features that are not necessarily indicative of pathology, whereas others may reflect core features that are
more likely to adequately identify pathological behavior and so have diagnostic validity. Finally, it is key to assess functional
impairment associated with gaming, so that a GD diagnosis has clinical utility.
Summary Available evidence supports the crucial need to distinguish between high and pathological involvement in video
games, in order to avoid overdiagnosis and pathologization of normal behavior. The definition of GD adopted in ICD-11 has
clinical utility and diagnostic validity since it explicitly mentions the functional impairment caused by problem gaming and its
diagnostic guidelines refer to core addiction features, reflecting pathological involvement.