We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the
majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people
whose play of video games is related to life problems. We believe that understanding this population and the nature
and severity of the problems they experience should be a focus area for future research. However, moving from
research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of
evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We
provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better
demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general
behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical
approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge
there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their
commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the
gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side
of caution for now and postpone the formalization.