Behavioral Addictions

What Is A Behavioral Addiction?

Behavioral addiction is characterized by a compulsion to perform rewarding, non-substance-related behavior that eventually leads to adverse disruptions in a person’s daily activities.

Behavioral addictions are controversial and still being debated among professionals. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) recognizes gambling disorder as a standalone mental health disorder. It classifies internet gaming disorder as an impulse control disorder. Porn, sex, shopping, and social media addictions continue to be studied to determine how or if they should be classified.

Behavioral addictions cause feelings of euphoria, calm, and relaxation, much like drugs and alcohol. The difference is that behavioral addictions produce a natural high versus a high caused by substances. Behavioral addictions are recognizable due to specific components, like the following:

• Addictive behavior becomes the top priority in someone’s life over healthy thoughts, feelings, and actions.
• Addictive behavior greatly influences mood and may lead to emotional consequences.
• Tolerance may build, requiring someone to intensify the behavior to achieve desirable results.
• Someone may experience emotional and physical withdrawal symptoms when they cannot engage in their addictive behavior.
• Conflicts often arise at home, work, and socially because addictive behavior interferes with someone’s ability to fulfill responsibilities.
• A person is unable to stop engaging in addictive behavior despite adverse consequences.

Additional components of behavioral addiction may include cravings, feelings of loss of control over behaviors, and guilt or shame after engaging in behaviors. To cope, people with addiction may continue to engage in addictive behavior to achieve the initial feelings of euphoria and relaxation, often finding themselves in an unhealthy cycle.

Who Can Develop A Behavioral Addiction?

Behavioral addictions, like substance use disorders (SUDs), can happen to anyone. There are risk factors that make developing an addiction more likely. Risk factors do not guarantee a behavioral addiction, however. Common risk factors of behavioral addiction may include:

• Having a mental health disorder
• Externalizing behaviors as a method of coping
• Drug or alcohol misuse
• Genetics or having close family members with addiction
• Family and friends who enable or support addiction
• Lack of parental involvement or supervision
• Previous traumatic experiences that go untreated
• Brain malfunctioning due to biology or injury

Researchers continue their search for more details on why some people with risk factors develop an addiction and others do not. One reason may be the number and type of coping skills a person knows and uses. If so, there may be a need to increase education about behavior addiction and treatments.

Are Behavioral Addictions Real?

Behavioral addictions are real, but because they are not all listed in the DSM-5 as a mental health disorder, it becomes easier for stigma to exist.

Stigma regarding behavioral addictions refers to the negative attitudes people have about themselves or others who suffer from gambling, internet, or other addictions. They may see themselves as inadequate or experience discrimination, their loved ones may experience discrimination, or they may fear future mistreatment. Stigma can interfere with someone seeking help, as it affects people in multiple areas, including:

Individual Shame And Guilt

People with behavioral addictions may be afraid of how others will perceive them if they find out they have a disorder. This fear can prevent them from seeking treatment and prolong dealing with unhealthy behaviors, which will prolong improvements in other areas of their life.

Interpersonal Judgement

How one person treats another, based on their irrational thoughts about addiction, can prevent someone from seeking help. People may experience disrespect, dehumanization, and discrimination.

Structural Support

There is a lack of opportunities at the professional and institutional levels in society for people with behavioral addictions to get the care they need. For example, workplaces may not have policies in place to help those with behavioral addictions as they do with substance abuse or other mental health disorders.

When a behavioral addiction is listed in the DSM-5 as a mental health disorder, it reduces stigma. Society recognizes that if it is defined as a disorder, it is real, and people are encouraged to seek support. When a behavioral addiction is not listed in the DSM-5, people tend to think they should be able to overcome their behaviors or that they are making a choice, even when they cannot control their behaviors.

What Are The Most Common Types Of Behavioral Addictions?

Behaviors, specifically those not involving substance misuse, are addictive when the results of the behaviors produce euphoria or a pleasurable high. Behaviors known to do this include gambling, sex, porn, internet gaming, social media, and shopping or shoplifting.

Gambling Addiction

Gambling addiction is the only standalone behavioral addiction disorder recognized in the DSM-5. This means it is recognized as a mental health disorder rather than being listed under another disorder, such as impulse control disorder. Someone with a gambling disorder lacks control over their gambling behavior. As a result, they experience significant consequences, like financial distress, legal problems, and loss of relationships.

Gambling includes activities such as:

• Casino gaming
• Online gambling
• Sports betting
• Lottery tickets and scratch-offs
• Other activities in which someone risks losing money in hopes of winning a larger amount

The criteria for diagnosing gambling addiction requires that someone exhibits at least four of the following:

• Increases the amount of money spent to achieve feelings of pleasure
• Becomes irritable or agitated when trying to quit or being unable to gamble
• Tries to quit or cut back gambling behaviors but can’t
• Spends much of their time preoccupied with thoughts of gambling
• Gambles when feeling negative emotions
• Feels compelled to continue gambling after a loss to redeem themselves
• Lies about their gambling behaviors
• Loses relationships, jobs, or school opportunities due to gambling
• Relies on other people for financial help because they can’t pay bills or expenses

Someone who meets four or five of the criteria has a mild gambling addiction. Meeting six or seven criteria is moderate, and eight or nine is severe.

According to the National Council on Problem Gambling, 2.5 million American adults meet the criteria for severe gambling addiction, and 5 to 8 million have mild or moderate symptoms.

Sex Addiction

Sexual addiction may be known as hypersexuality or compulsive sexual behaviors. It occurs when someone cannot control their engagement in sexual activities even though it causes them negative consequences. Examples of sexual activities include voyeurism, exhibitionism, frotteurism, fantasies, pornography, sexual promiscuity, and compulsive masturbation.

It is estimated that between 3% and 6% of Americans have a sex addiction.

While there are no official DSM-5 criteria for sex addiction, professionals will use the following as a guide to determine if someone may need treatment:

• They seem obsessed with sexual activities
• They masturbate multiple times a day
• They frequently engage in sexual activities, like viewing pornography
• They spend a lot of time planning a sexual encounter
• They engage in activities that go against what is personally or socially acceptable
• They cannot stop engaging in sexual behaviors even when they try and despite adverse consequences

Many people with a sex addiction feel shame and guilt after performing an act. Addiction can interfere with work or school performance, getting quality sleep, and personal relationships.

Porn Addiction

In a study shared by the National Institute of Health on a nationally represented sample, results showed an estimate that 11% of men and 3% of women have a diagnosable porn addiction. The study also reports an estimate of 70% of men and 40% of women viewed pornography in the previous year.⁹

Pornography addiction occurs when someone depends on porn to meet their emotional and physical needs. Many professionals debate as to whether it is an actual disorder, but there are specific signs to suggest it is, like seeking porn, even though doing so causes significant problems.

Experiencing any of the following is a sign to seek treatment for porn addiction:

• Sex life with a partner becomes less satisfying due to porn use
• Engage in risky behavior to view porn, like viewing it while at work
• Spend a lot of money to view porn
• Cannot resist viewing porn even though it causes problems
• Inability to perform sexually with a partner
• Feels guilt or shame about viewing porn but cannot stop

Today, accessing pornography is very easy. Someone can find it in magazines they purchase at the local store, on the internet, and with pictures sent through text messages. This easy access only adds to the problems porn addiction creates in personal, professional, and social relationships.

Internet Gaming Disorder

Internet gaming disorder (IGD) is recognized by the DSM-5, which states a person has an addiction when they excessively and compulsively engage in video games that leads to significant impairment within 12 months. Gaming behaviors can lead to poor academic performance, physical problems, and social isolation. The criteria for diagnosis of IGD include the following:

• Preoccupation with gaming
• Withdrawal symptoms when not gaming
• Tolerance or requiring more gaming time or intensity to achieve desired results
• Gaming activities take control over their life
• Lack of interest in other hobbies or interests
• Continuing to game even though it leads to psychosocial issues
• Lying or being secretive about the amount of time spent gaming
• Gaming to relieve negative moods or emotions
• Gaming leads to significant impairment or distress

Someone must meet five or more of the above criteria within a year to be diagnosed with an internet gaming addiction. Internet gaming is highly entertaining and triggers the same reward circuits in the brain as drugs and alcohol, supporting the theory that excessive gaming can be addictive and harmful.

Social Media Addiction

Social media refers to Facebook, Snapchat, Instagram, Twitter, TikTok, YouTube, Reddit, and many other platforms that allow people to connect online. Social media addiction is the inability to stop using online platforms despite the negative consequences it produces.

Currently, there are nearly 4 billion active social media users. Some spend an hour or less online daily, while others spend most of their day and may have a social media addiction.

Many reports suggest social media impacts users negatively, especially teens and young adults, who spend three or more hours online daily. Because they tend to compare their lives to those online, they can develop anxiety, eating disorders, depression, and other mental health symptoms.

Social media addiction can lead to many of the following symptoms:

• Low self-esteem
• Social isolation
• Mental illness
• Sleep disturbances
• Poor performance at work or school
• Doomscrolling
• Relationship problems

Someone with an addiction may experience similar symptoms to other addictions, including withdrawals, preoccupation, and increasing distress. Although social media addiction is not listed in the DSM-5 yet, many professionals recognize it as a disorder and offer effective treatment.

Shopping And Shoplifting Addiction

Shopping or compulsive buying addiction has likely increased due to the ability to make online purchases with the click of a button. Shopping addiction refers to ongoing, excessive, impulsive purchasing of products that take control over someone’s life, even when they experience severe financial, mental, professional, and social consequences.

Shopping produces a brief high, making someone feel good. It can alleviate tensions, stressors, or negative emotions for a short while. When those feelings subside, someone begins to experience the harmful effects of shopping addiction, including shame, guilt, depression, and anxiety.

Shoplifting addiction or kleptomania refers to the inability to control impulses when stealing items that belong to others. Stealing, like other addictions, leads to worsening mental health symptoms, relationships, and performance at work and school.

Shopping and shoplifting addiction symptoms may include the following:

• Spur of the moment buying or stealing
• Obsessive thoughts about buying or stealing
• Being unable to resist urges to shop or steal
• Lying about where or how they got new products
• Financial problems
• Purchasing or stealing items they do not need
• Relying on shopping or stealing to feel better emotionally
• Experiencing a high after compulsive shopping or shoplifting

Shopping and shoplifting addictions are treatable with the help of a mental health professional. Some people discover they have a co-occurring disorder, such as depression, anxiety, substance abuse, obsessive-compulsive disorder, or eating disorders. Professionals will treat all disorders simultaneously for the best outcomes.

Signs Of A Behavioral Addiction

The signs of a behavioral addiction are comparable to SUDs, except they do not involve the use of drugs or alcohol. The signs will differ for every person, depending on their unique situations. However, common signs include the following behaviors.

Secretive Behaviors

People who go missing for a time without explaining their whereabouts, get defensive or lie when asked about their behaviors, or isolate themselves from others and exhibit secretive behaviors could be making an intentional effort to hide their addictive behaviors.

Preoccupation With Behaviors

People preoccupied with behaviors spend most of their time thinking about or planning to engage in them. They may seem obsessed with the behavior, prioritizing it before other obligations. They find it hard to focus on more important things and use it to obtain pleasure and alleviate emotional distress.

Increase Time Engaged In Behaviors

Behavioral addictions worsen over time, starting with someone spending a short time engaging in activities. The more they engage, the more time they need to spend in the activity to achieve the same high or euphoria they initially experienced. This refers to tolerance, which increases the longer someone engages in the behavior.

Interference With Responsibilities

Someone with a behavioral addiction struggles to meet their responsibilities at work, school, and home. They may miss work or school, lose their job, fail academically, miss family events, or lose relationships due to neglecting their responsibilities.

Withdrawal Symptoms

Withdrawal symptoms are primarily associated with substance abuse but can also apply to behavioral addictions. When someone can’t engage in a behavior or is trying to quit a behavior, they can exhibit noticeable changes in their physical and mental states. They may have cravings, feel anxious, be easily agitated, and seem restless. They may also have trouble sleeping, concentrating, or finding motivation.

Self-Medication

Some people do not have the coping skills to deal with negative emotions or situations properly. They often turn to behaviors such as gambling, sex, or the internet to help them cope. They are said to be self-medicating their underlying symptoms or illness. Other reasons for self-medication include fighting stress, making social connections, and avoiding negative emotions.

Anyone with a behavioral addiction will continue to have these symptoms, thinking they are improving their situation when, in reality, they are worsening every aspect of their life. The addiction takes over control of their lives, making it hard for them to envision a life without the behavior.

Behavioral Versus Physical Addiction

Physical addictions occur when someone misuses substances such as alcohol, opioids, sedatives, or other prescription and illicit drugs. The substances produce physical dependence in some people who use them over long periods and in large amounts. The brain convinces a person that it needs the substance to survive, causing withdrawal symptoms each time they try to quit using it. Withdrawal symptoms can be mild, moderate, or severe and include:

• Nausea
• Chills
• Fever
• Shaking
• Vomiting
• Muscle spasms

While physical addiction is based on substances, behavioral addictions are based on the feelings of pleasure someone experiences when engaging in a behavior. A person feels they depend on those behaviors to achieve happiness or rewards. They may have mental withdrawal symptoms when trying to quit or cut back on the behaviors. Symptoms may include:

• Anxiety
• Depression
• Cravings
• Urges
• Agitation
• Irritability
• Obsessions

Behavioral and physical addictions can be overwhelming and interfere with how someone functions in all areas of their life. They require specialized treatment to learn new coping skills and behaviors to stop the unhealthy behaviors and maintain long-term recovery.

How Are Behavioral Addictions Treated?

There are multiple mental health treatment options for people with behavioral addictions. The first step in determining the best treatment path is to complete a comprehensive assessment with a licensed mental health professional. A treatment plan is created based on the information you provide. Treatment plans typically involve a combination of treatment methods, like the following.

Medications

There aren’t medications that stop a behavior, but there are mental health medications that can address underlying symptoms like anxiety or depression. For some, behavioral addictions are a way of alleviating symptoms caused by other disorders. Medications can ease symptoms, reducing the need to seek behaviors for relief.

Medications often include antidepressants and antianxiety medicines. If an assessment reveals you have a co-occurring mental health disorder, like bipolar disorder, mood stabilizers may be prescribed.

Outpatient Therapy

Outpatient therapies include individual and group programs where you can learn appropriate skills to help you cope with life stressors, unhealthy emotions, and recovery from addiction. Outpatient therapies may include:

• Cognitive behavioral therapy (CBT) is a form of psychotherapy that helps you recognize the connection between your thoughts, feelings, and behaviors. Improving thought patterns, learning coping strategies, and building self-esteem are benefits of CBT.
• Motivational interviewing (MI) empowers and motivates you to make necessary changes to overcome a behavioral addiction. MI helps you overcome insecurities, build confidence, and inspire you to make positive changes.
• Mindfulness-based CBT (MBCBT) teaches you how to be aware of your present surroundings and feelings and take time to meet your needs. MBCBT helps you avoid returning to addictive behaviors once you are in recovery and avoid placing negative judgments on yourself by changing how you react to emotions.

You and your treatment team will choose the combination of therapies that will address your behavioral addiction best. You can have input into your treatment, the methods you want to explore, and the steps to help you maintain long-term recovery.

Group Support

Groups led by peers and professionals are highly effective in treating behavioral addictions. Fortunately, there are many options for in-person and online groups, some with a broad reach that covers general recovery topics and others geared to address only one behavior. The most common groups include the following:

• 12-step facilitation groups, where you can meet with peers struggling with the same behavioral addictions, share your story, and receive feedback from peers. One example is Gambler’s Anonymous.
• Support groups specific to your behavioral addiction can be found in person and online. Some groups are led by peers, and others by licensed mental health professionals. You can learn specific methods for overcoming addictive behaviors. An example is SMART™ recovery.

Additional recommendations may include alternative or holistic therapies like equine, music, and art. You may also explore acupuncture, fitness, meditation, or biofeedback.

Working with your treatment team, you can create a treatment plan to address your needs. It can also include your family and loved ones who support your recovery from a behavioral addiction.

Take The First Step Toward Overcoming A Behavioral Addiction

Behavioral addictions are treatable, and you do not have to try to overcome your symptoms alone. Many treatment professionals have the experience and knowledge to help you obtain success in recovery. The first step in seeking help is to contact a mental health professional to assess your needs. It’s imperative to ask for a therapist who specializes in your behavioral addiction.

If you are not ready for an assessment, attend a local support group. Talk to others with the same symptoms and ask them for a therapist referral. Make treatment a priority so you can take back control over your life.