Behavioral addiction

While ancient history tells of compulsive behaviors involving activities like sex or gambling, the term behavioral addiction has only recently come into use. Behavioral addiction refers to a persistent, compulsive dependence on a behavior. Addictions are chronic conditions that affect the brain's reward and motivational systems. In the case of behavioral addictions, the reward is the result of experience rather than related to a chemical substance. When a behavior produces a potential reward in spite of threatened negative consequences and it is frequently repeated, it has likely become a behavioral addiction. In 2013, a form of behavioral addiction was included in the DSM-5 although it is in a category denoted as in need of additional research.

TYPE OF PSYCHOLOGY: Addiction; Clinical; Counseling; Psychopathology

Introduction

The terms behavioral addiction and process addiction are often used interchangeably. The criteria for behavioral addiction were published in the American Journal of Preventive Psychiatry & Neurology in 1989. A behavioral or process addiction is said to exist when a person repeatedly engages in a behavior to a significantly greater extent than they had intended. When such an addiction exists, the behavior occurs repeatedly in spite of the person's attempts to control it. A person with a behavioral addiction tends to be preoccupied with the behavior and spends enormous amounts of time in activities dedicated to the behavior. This will often interfere with the ability to perform other activities and fulfill obligations. The addictive behavior tends to persist in spite of the fact that it may have adverse effects on life and may cause social, financial, psychological, or physical problems for the person involved. The individual will often find that they must spend increasing amounts of time devoted to the behavior in order to receive the desired effect. In the twenty-five years since these criteria were established, many different types of behavioral addictions have been researched. However, not all have been recognized by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As research of these process addictions continues, the category of behavioral addictions will continue to grow.

Types of behavioral addiction

While the field of behavioral addiction still is amid much ongoing research, many types of activities have been tentatively categorized as behavioral addictions. If an individual engages in an activity or behavior to such a great extent that it tends to not leave time for other activities or relationships, that behavior is considered to be a behavioral addiction. In most cases, these behaviors adversely affect the individual and cause social, financial, psychological, or physical problems for the individual. Generally behavioral addiction involves behavior that is repeated persistently while seeking reward in spite of the fact that those rewards often do not materialize.

While not all of the behavioral addictions are included in the DSM-5, many addiction researchers consider there to be a wide range of problematic, addictive behaviors that warrant clinical treatment. These other behaviors are also persistently repeated by individuals to their detriment and to the exclusion of other activities and social interactions. These behaviors generally fit the criteria for behavioral addiction established in 1989 and are currently being researched as types of behavioral addiction. Examples of such behavior that involve technology include television watching, video game playing, or using the computer. As is evident from these examples, a behavioral addiction can be active like playing video games or passive like watching television.

Moreover, addictive behavior may include various types of physical exercise. Exercise addiction, for example, may be seen in someone who spends an increasing number of hours at the gym or running or bicycling increasingly longer distances, leaving little time for other activities. People with exercise addictions often also demonstrate some type of eating disorder. Another common behavioral addiction is sex addiction, which again may involve being an active participant (including exhibitionism or voyeurism) or an observer. Such an observer may have a pornography addiction, in which case they spend excessive amounts of time and money collecting pornographic pictures or magazines or accessing pornography on the Internet. Another commonly investigated form of behavioral addiction is a shopping addiction (compulsive buying disorder). A person who is a compulsive shopper will spend money repeatedly and unnecessarily on virtually anything. Making purchases provides these individuals with pleasure so they tend to do it repeatedly, often spending money that they do not have or should be devoting to other aspects of life. Finally, a person who is commonly dubbed a workaholic may actually have a work addiction. People who have a work addiction are unable to stop themselves from engaging in work to the extent that it interferes with the rest of their lives. Such behavior often starts out as a desire to succeed or get ahead and is often found in people who are viewed as perfectionists. While these are the behaviors that are routinely considered to turn into addictive behaviors, any activity or behavior that seemingly takes over one's life can become a behavioral addiction.

Biological basis of behavioral addiction

While substance use disorders or substance addictions have been recognized for much longer than behavioral addictions have, all addictions seem to have the underlying common denominator of reward seeking. The human brain seems to respond to rewards as equivalent whether they occur in response to a chemical substance or as a result of a particular behavior. It is felt that behavioral addiction can affect the release of neurotransmitters in the brain and that these neurotransmitters will then affect the brain as directly as chemical substances that are ingested by the individual. This may then help explain why individuals with behavioral addictions actually exhibit cravings and develop a tolerance requiring them to engage in ever increasing amounts of that behavior in order to feel the same effect. Neurotransmitters that are involved in addiction are most likely to include serotonin, dopamine, and noradrenalin. Studies done with functional magnetic resonance imaging (fMRI) indicate that the same areas of the brain seem to be involved in both chemical addiction and behavioral addiction. The ventral tegmental area, ventral striatum, and amygdala seem to play parts in both types of addiction. It has also been found that families whose members exhibit substance addictions often also exhibit behavioral addictions. Research is currently ongoing to investigate whether there may be a genetic link to any or all types of addiction.

Diagnosis and treatment of behavioral addiction

There are currently a large number of scales and inventories available to help diagnose those forms of behavioral addiction that are not recognized in DSM-5. There currently are recognized scales available to help diagnose addictions to work, exercise, video game playing, Internet use, compulsive buying, problem gambling, sex, and binge eating. In 2010, the Behavioral Addiction Scale was developed as a means to screen for behavioral addiction in general, rather than trying to screen for each individually.

Many of the above mentioned behaviors that are being researched as forms of behavioral addiction respond to the same treatments as substance use disorders. These treatments range from self-help groups to behavior modification and cognitive behavioral therapies. Medications have also been used to treat various forms of behavioral addiction. Some of these medications are again the same drugs that have been used in treating chemical addictions. Potential for relapse is also something that all forms of addiction share. Relapse prevention and harm reduction models are commonly used with all forms of addiction.

Similarities between substance addictions and behavioral addiction

Much of the current evidence indicates that there are many similarities between substance use disorders and behavioral addiction. These similarities exist in terms of the onset and progression of the condition up to and including family history, the biological functioning of the brain and systems of neurotransmitters involved, types of symptoms displayed, existence of cravings, development of a tolerance, and types of treatment that appear effective in dealing with these disorders. The main distinguishing factor between substance addiction and behavioral addiction is that the various forms of behavioral addiction involve only a psychological need while substance addiction involves both a physical and psychological need. In spite of the fact that many forms of behavioral addiction are not yet officially recognized as such, it is believed that the category of behavioral addiction is much broader than currently recognized and in most ways is equivalent to substance addiction.

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