Logical fallacies in justifying problematic gaming as a mental disorder

In their recent response to a debate paper addressing the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), Internet gaming disorder (IGD) diagnosis and its counterpart in International Classification of Diseases (ICD-11), gaming disorder (GD) (Dullur and Starcevic, 2018), King et al. (2018) provided arguments for justifying problematic gaming as a mental disorder. They argued that the diagnosis of GD (1) is based on research evidence and clinical reality, (2) does not pathologise or stigmatise normal gaming, (3) promotes growth in assessment and treatment areas and (4) facilitates access to services for problematic gaming. We contend that this perspective is biased and that it is based on several logical fallacies.

Logical fallacies

Logical fallacies are errors in the construction of an argument. More specifically, they represent errors in applying the rules of logic and thereby undermine the logical validity of an argument (Jevons, 1870). Recent studies show that while logical fallacies mostly occur in the discourse without the knowledge of the arguer, they may also be used to manipulate or deceive the audience or opponent (Pope and Vasquez, 2016). Identifying logical fallacies in psychiatry is critical because they can be invoked to support or discredit theories, psychopathological concepts and treatment procedures.

The question of consensus

The paper by Dullur and Starcevic (2018) stated that ‘no consensus exists on what constitutes problematic online gaming as a clinical syndrome’ (p. 110) and King et al. (2018) responded by asserting that ‘one should not expect a total consensus because this is impossible in any scientific field’ (p. 615). This argumentation by King et al. (2018) is an example of the straw man fallacy, because it distorts the original point and then attacks it. A need for total consensus (which is a contradictio in adjecto) was not suggested by Dullur and Starcevic (2018), yet King et al. (2018) implied that this was the expectation, perhaps to distract and downplay the actual lack of consensus.

Evidence and authority

King et al. (2018) state that the diagnosis of GD is based on research evidence and clinical reality. Yet, they fail to cite any research that demonstrates unequivocally that GD is a stand-alone diagnosis. Furthermore, they state that the criticism of GD as a distinct diagnosis is ‘overlooking the larger body of robust work that supports the validity of the disorder’ and that the diagnosis ‘reflects the majority view of support among researchers as well as practicing psychiatrists and psychologists that recognises (1) the harms associated with gaming excessively and (2) gaming as an addictive disorder’ (p. 615).

Notably, there are several logical fallacies in these assertions. First, there is a petitio principii (begging the question) fallacy, so that what is to be proved (that a large body of robust research supports the diagnosis) is already assumed to be proved, and opponents of the diagnosis are essentially reproached for overlooking the lack of evidence that supports the diagnosis. Second, there is an appeal to authority fallacy, whereby an assertion is deemed true simply because of the position of its endorsers (in this context, the presumed majority view among experts that problematic gaming should qualify as a mental disorder). Third, a cherry picking fallacy of inductive reasoning can also be found, so that data that confirm a particular position are taken into account, while data that do not support it or contradict it are ignored. Although it is true that experts consider excessive gaming patterns potentially harmful, it is not true that the majority of experts regard GD necessarily or exclusively as an addictive disorder. However, King et al. (2018) ignore other perspectives on this issue, which is striking, considering that GD is dually classified in the ICD-11 draft among both disorders due to addictive behaviours and impulse control disorders.

Stigmatisation, reification and validity

King et al. (2018) further underline that the diagnosis of GD does not pathologise or stigmatise normal gaming. Can this diagnosis then stigmatise only ‘abnormal’ gaming? The presumed ability of the GD diagnosis to stigmatise or not stigmatise reflects a reification fallacy, because GD is treated as a concrete entity, not as a construct or abstraction. Moreover, King et al. (2018) make several references to the validity of GD, implying that it is the ‘real thing’, not just a construct. This is premature, especially considering that many well-established psychiatric diagnoses lack validity.

Dichotomising and competence

According to King et al. (2018), an ‘experienced clinician should be quite capable of differentiating between “normal” gaming and IGD’ (p. 616). This reasoning is an example of the fallacy of false choice, which suggests that there are only two mutually exclusive, non-overlapping options: a person is either a normal gamer or has IGD/GD. However, there is research evidence that gaming problems occur on a continuum, that there are overlaps between them and that establishing a clear boundary between normal and pathological gaming is not simple. A suggestion that any quandary in this regard indicates a lack of clinical experience or perhaps incompetence is another instance of an appeal to authority fallacy.

Presumed consequences and a need for diagnosis

Another argument used by King et al. (2018) to justify GD is based on an appeal to consequences fallacy. This fallacy refers to argumentation that invokes hypothetical negative or positive consequences of some action. Moralistic fallacy is a related reasoning error, whereby presumed consequences are clearly negative and therefore justify (or do not justify) a certain action on moral grounds. In both cases, the argument relies on the depiction of the consequences. So, we read in King et al.’s (2018) paper that opposing GD ‘hinders access to service for problematic gaming’, that the lack of a specific diagnostic code for problematic gaming behaviours ‘would likely result in more confusion, additional barriers to treatment and a hindrance to research efforts’ (p. 616). With these apocalyptic premises, who could disagree with the apparent need to include GD as a formal diagnosis? Yet, such dire consequences of not having a formal diagnosis are highly speculative, and real public health and clinical needs in the realm of problematic gaming are yet to be ascertained. Without such data, it is very difficult to predict objectively the consequences of the lack of the GD diagnosis.

Final remarks

Scholars have questioned the appropriateness of the GD diagnosis and suggested that its formalisation requires both a much stronger evidence base than we currently have and demonstration of its clinical utility (Van Rooij et al., 2018). We believe that the debate on GD as a formal, separate diagnosis might benefit from exposure of the logical fallacies that underlie much discourse in this area. While we agree with King et al. (2018) that problematic gaming patterns exist, the theory and empirical foundation necessary to formalise the GD diagnosis are not fully developed, and the diagnostic threshold for GD remains unclear. Whether problematic gaming patterns are to be conceptualised as a specific diagnosis, as secondary to other disorders, as maladaptive coping strategies or in some other way should be based on an articulated theory, sound research and clinical wisdom, not on the rhetoric founded on faulty logic.