Introduction to Behavioral Addiction

There are many types of behavioral addiction – from gambling and gaming, to shopping and social media. People with behavioral addiction seek out more and more opportunities to engage in the activity, resulting in a destructive cycle of addiction that can make life a constant struggle.

This blog examines the signs, symptoms, causes and types of behavioral addiction.

What is behavioral addiction?

Behavioral addiction is a type of addictive behavior that does not involve a substance (alcohol, nicotine, drugs or prescription medication). However, the need to experience a ‘high’ from the behavior becomes so strong that the sufferer continues to persistently engage in the activity despite negative consequences.

Researchers describe excessive engagement in behaviors such as shopping, gambling, internet use, exercise, overeating, pornography, television viewing and sexual activity as behavioral or process addictions (Alavi et al. 2012¹), but the exact criteria that unite them are still highly debated.

Some emphasize the role of the brain, for example dopamine deficiency and reward, while others focus on concepts such as maladaptive choices, overwhelming urges or withdrawal symptoms. Each of these concepts has proved to be hard to pin down on closer examination and may not have external validity (Perales et al, 2019²). For example, from a neuro-biological basis, tasty food and sexual experiences create the same dopamine changes in the brain seen in drug addicts, yet we cannot reasonably consider eating a meal or having sex as an addiction (Giordano et al. 2019³).

Some definitions focus on the compulsive aspect of a behavior to define an addiction, so that “whenever a habit changes into an obligation, it can be considered as an addiction” (Alavi et al. 2012⁴). Other early models of behavioral addiction included criteria such as mood modification: whether the activity was done to get a ‘high’ or escape from negative feelings. This is called the compensation model of addiction, and other criteria included relapse – whether the person engaged in the behavior after a period of recovery (Goodman, 1990⁵, cited in Alavi et al, 2012⁶). These criteria were largely coming from substance abuse theories, as researchers tried to fit the criteria for drug abuse to define other excessive behaviors.

At INTENTA, we define behavioral addiction as a behavior in which the person shows impaired control and experiences significant negative consequences in any area of their life – mental health, relationships, financial, legal, career, education and physical health. (Sanders and Williams, 2016⁷).

Behavioral addiction vs. process addiction

The terms ‘behavioral addiction’ and ‘process addiction’ are interchangeable. They both refer to the same type of behavior: feeling compelled to engage in an activity despite potentially harmful consequences for the individual and/or those close to them.

The term ‘behavioral addiction’ is used because the condition describes addiction to a type of behavior rather than to a substance. Engagement in the addictive behavior can be considered a ‘process’ which is where the term ‘process addiction’ derives from.

Signs and symptoms of behavioral addiction

It is important to understand the common symptoms of behavioral addiction in order to tell the difference between addictive behavior, problematic behavior that is not an addiction, and healthy behavior. Here are some warning signs:

• Spending the majority of time engaging in, thinking about or planning to engage in the behavior
• Continuing the behavior despite physical harm, mental distress and/or financial difficulties
• Struggling to control the behavior, despite wanting to cut down or stop
• Becoming dependent on the behavior as a way of coping with emotions
• Experiencing withdrawal symptoms – depression, anxiety or irritability – when trying to stop
• Neglecting work, school, social activities or family commitments to engage in the behavior
• No longer enjoying the behavior, but feeling the need to do it
• Hiding the extent of the problem from others.

Causes of behavioral addiction

There are certain biological, social and psychological factors that can make some people more vulnerable to behavioral addiction than others. These include:

• Family history of addiction or mental health issues
• Childhood trauma, abuse or neglect
• Co-existing mental health and/or addictive disorders – those with existing substance use addictions are more likely to develop behavioral addictions
• Lifestyle – people who repeatedly engage in the behavior are more likely to develop a problem
• Personality traits – those who are more impulsive and prone to risk taking are more likely to experience problematic behaviors and addiction.

Types of behavioral addiction

Experts disagree about whether behavioral (or process) addictions are ‘real’ addictions. However, in 2013 the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) released by the American Psychiatric Association included behaviors in the addictions category.

Officially-recognized behavioral addictions

Gambling disorder⁸ is the only officially-recognized behavioral addiction in the DSM-5 at present but the manual includes a proposed criteria for internet gaming disorder and suggests that more research is needed in order to classify gaming as an independent disorder.

In the meantime, the World Health Organization (WHO) will include gaming disorder⁹ in its eleventh iteration of the International Classification of Diseases (ICD-11) which comes into effect in 2022. It defines gaming disorder 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.”

Other types of behavioral addiction

Other common types of behavioral addiction (not yet officially recognized) include:

• Internet / mobile phone addiction
• Social media addiction
• Exercise addiction
• Food addiction
• Love addiction
• Porn addiction
• Sex addiction
• Shopping addiction
• Plastic surgery addiction
• Risky behavior addiction
• Work addiction.

Treatment for behavioral addiction

Although behavioral addictions can be highly destructive, they are also very treatable. Cognitive-behavioral therapy (CBT) is one of the most effective addiction treatments because it focuses on changing thought patterns, which can help eliminate problem behaviors.

Treatment is widely available for people with common types of behavioral addiction and co-occurring mental health disorders. However, support for those with gaming disorder is not so readily available. An increasing number of problem gamers and concerned families are seeking support but many clinicians lack the skills and knowledge to help them.

At INTENTA, we have developed internationally-accredited Gaming Disorder Training to bridge the clinical skills gap around gaming disorder. It is designed to equip helping professionals with practical strategies, tools and skills to treat clients with problematic and disordered gaming. Get in touch to find out more.