Behavioral Addictions

Behavioral addictions are receiving more and more attention among doctors, researchers, and the general population, as they're on the rise.

Written and verified by la psicóloga Paula Villasante.

Last update: 23 May, 2023

Addictions are one of the biggest health problems in Western countries. Although it’s true that the most well-known are those that correspond to substances, behavioral addictions are receiving more attention among doctors, researchers, and the general population.

This is because more and more people are experiencing symptoms related to loss of impulse control. Within behavioral addictions, there are several disorders, some of which are more common than others. Among the compulsive activities that lead to these disorders, we can find eating, gambling, sex, shopping, exercising, and working.

There’s great controversy regarding diagnosis and treatment, as many of these behaviors are fundamental daily rituals. Historically, the phrase “impulse control disorders” described these conditions, but researchers and clinicians also use other terms to describe behavioral addictions, such as impulsive-compulsive behaviors.

In any case, there seem to be several behaviors that, like the consumption of psychoactive substances, produce short-term rewards that generate a persistent behavior, despite the knowledge of its bad consequences.

Addiction

Before, the term addiction could be described as a set of mental disorders characterized by a compulsive need to consume substances. However, the essential element of all addictive disorders has been found to be, specifically, lack of control.

This is what addictions have in common and what those who are affected suffer: First of all, a lack of control over a certain behavior, which at first, is pleasant, but then it gains ground until this behavior even manages their lives.

Behavioral addictions

Addictions aren’t limited to behaviors that appear because of the uncontrollable consumption of substances (such as nicotine, caffeine, cocaine, opiates, cannabis, alcohol, or amphetamines). Rather, there are behavioral habits that seem harmless but can become addictive. These seriously interfere with daily life.

As in addictions to chemical substances, people addicted to a certain behavior expertience a withdrawal syndrome when they can’t carry it out. This is characterized by profound emotional distress, dysphoric mood, irritability, sleep disorders, and psychomotor restlessness.

Specifically, in behavioral addictions, the nuclear aspect lies in the type of relationship that the subject establishes with the behavior. In fact, according to researchers on the subject, any normal activity that’s pleasurable to an individual can become addictive behavior.

What characterizes behavioral addictions is that those who suffer from them lose control over the chosen activity. Despite this, they continue with it regardless of the consequences.

How do behavioral addictions appear?

The behavior appears to be triggered by an emotion that can range from intense desire or craving to obsession. This can lead to withdrawal syndrome when the activity is stopped. People with this type of addiction tend to have a lack of interest in free time activities that they previously considered pleasurable.

From a behavioral perspective, all addictive behaviors are activated when the positive reinforcement mechanism begins, such as euphoria or pleasure experienced. However, as the behavior is perpetuated, the reinforcer becomes negative and responds to the need not to experience discomfort or withdrawal.

For example, a person without any type of behavioral addiction can write a message or connect to the internet for pleasure or for the functionality of that behavior. On the contrary, a person who suffers from a behavioral addiction would do it to relieve their dysphoria or emotional discomfort (loneliness, anger, excitement, or boredom).

In summary, some behaviors that are considered normal or even healthy can become toxic depending on the intensity, frequency, money, or time invested. Therefore, a behavioral addiction refers to all that repetitive behavior that produces pleasure and stress relief in its early stages and that leads to a loss of control over it.

Therefore, we can say that if a person loses control over a pleasant behavior that later stands out from the rest of the activities in their life, they’ve become a behavioral addict.

Symptoms of behavioral addictions

The main symptoms of behavioral addictions are the following:

• An intense desire, need, or unstoppable desire to carry out the pleasurable activity
• A progressive loss of control over a pleasurable activity until it becomes uncontrolled
• The neglect of activities that the individual used to carry out regularly, both family and academic, free time or work-related

These negative consequences are usually noticed by people close to the addicted person. Despite warnings, addicts don’t stop the activity and may even become defensive, denying the problem they’re experiencing.

There’s a progressive focus on activities, interests, and relationships around the addiction, with abandonment or neglect of previous interests and relationships, unrelated to addictive behavior. Discomfort and irritability are also recorded due to the impossibility of specifying the addictive pattern or sequence.

Factors that increase predisposition and vulnerability

For a subject to develop an addiction, specifically a behavioral one, there are some factors that can increase predisposition and vulnerability, such as low self-esteem or impulsivity. Also, the lack of tolerance to unpleasant physical or psychological stimuli, such as pain or sadness.

Depressive or dysphoric moods increase susceptibility. In addition, personalities who always seek strong sensations are more predisposed.

What are the most common behavioral addictions?

Within many behavioral addictions, the following seem to be the most well-known or frequent:

• Gambling disorders (pathological gambling)
• Addiction to the internet and new virtual technologies
• Compulsive purchases (oniomania)
• Sex addiction
• Work addiction

In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a new category called addictive and substance-related disorders has been proposed. This chapter includes disorders not related to substances, which include only gambling disorder.

Two relevant behavioral addictions

The two addictions specified below are the most relevant and well-known. These are gambling disorder and internet gaming. Let’s look at their features in detail.

Gambling disorder

Games of chance have taken center stage in society, especially in recent years. This is because they’re so easy to access, plus the immediacy of the reward they offer, as well as the false sense of control they give players. This makes the game easily become an addictive behavior.

This loss of control in the player generates feelings of depression and anxiety due to suicidal thoughts and behaviors in the phase of hopelessness and despair in advanced stages of compulsive gambling.

For an accurate diagnosis of the problem, there must be recurrent and persistent problem gambling behavior leading to disability, such as when the individual exhibits four or more of the following symptoms during a 12-month period:

1. A need to bet higher amounts of money to achieve the desired excitement.
2. Repeated unsuccessful efforts to control, stop, or interrupt the play.
3. Irritability or restlessness upon attempting to interrupt or stop the game.
4. Frequent preoccupation with gambling.
5. After losing money gambling, they frequently return another day to try and win it back.
6. Playing when they feel distressed (hopeless, guilty, anxious, or depressed).
7. The person has jeopardized or lost significant relationships or educational, work, or professional opportunities due to gambling.
8. They lie to hide their degree of involvement in gambling.
9. They trust that others will provide them with money to alleviate their financial situation caused by gambling.

Internet gaming disorder

The criteria proposed for the diagnosis of this disorder are the following:

1. Preoccupation regarding internet games that become the dominant activity.
2. Tolerance: Larger amounts of time are needed to practice them.
3. Withdrawal symptoms when prevented from playing (irritability, anxiety, or sadness).
4. Unsuccessful attempts to control participation in internet games.
5. Loss of interest in other hobbies and other forms of entertainment.
6. The use of internet games to alleviate or escape a negative mood.
7. Continuous use despite knowing the psychosocial problems they generate.
8. Neglect or loss of significant relationships, employment, or educational or employment opportunities because of their involvement.
9. The person misleads family members, therapists, and others regarding the amount of internet gaming they carry out.

Disorders that are still in need of clinical acceptance

In summary, the addition of the section on non-substance-related addictions in the DSM-5 has marked a remarkable advance for science. It’s assumed that behavioral addictions will gradually be incorporated into the classifications.

Given its importance, this inclusion will mark a milestone for global mental health to give behavioral addictions the importance they deserve. This will facilitate the development of new resources and multidisciplinary techniques for a better diagnosis and comprehensive treatment.