Women and behavioral addictions

DEFINITION: Behavioral addictions, also called non-substance or non-drug addictions, are addictions to activities such as gambling, shopping, eating, exercising, sex, working, or using the Internet. In the case of behavioral addictions, what was originally a pleasurable activity manifests as a compulsion and results in excessive use with negative consequences. Women and men have different risk factors, responses, and incidences of behavioral addictions.

Studying Behavioral Addictions in Women

Behavioral addictions can be just as harmful to overall health and well-being as a substance addiction to drugs or alcohol. A behavioral addiction typically begins when the performance of a certain action elicits a feeling of pleasure, decreases depression, eases anxiety, or allows escape from a problem. Eventually, the person feels a loss of control and consistently repeats the behavior.

Similar to substance addiction, behavioral addiction also comes with periods of withdrawal, urges or cravings, and dependence. Later research literature suggests that the resulting feeling of depression from the addiction does not get better as the individual ages. A woman in her thirties or forties, for example, with a predisposition to an addiction, will usually have an increase in her depression.

Certain behavioral addictions occur more frequently in women than in men. Women are more likely to develop shopping, plastic surgery, food, and internet use addictions. A study of college-aged women and men revealed that men are more likely to gamble and to excessively use the Internet and watch television. However, the incidence of these behaviors in women began rising in the late 2010s and continued through the 2020s. Additionally, women tend to develop an addiction to gambling more quickly than men.

Behavioral and substance addictions are not mutually exclusive: A person may have more than one behavioral or substance addiction at any given time. Women and men have gender-specific risk factors for behavioral addiction. It is thought that there are underlying biological genetic predispositions that make women and men more prone to specific addictions. Furthermore, psychological diagnoses besides anxiety and depression are often present in any individual with an addiction.

Women, however, are at risk for unique medical and health-related concerns from certain behavioral addictions. A compulsive sexual addiction places women at increased risk for unintended pregnancies or sexually transmitted diseases.

Spending Addictions

Compulsive shopping affects more women than men, with approximately 6 percent of women having the diagnosis. The negative consequences include financial debt and an excess of unused purchases.

Risk factors for compulsive shopping include episodes of anxiety or depression. An additional risk factor is the widespread availability of the Internet, which allows for purchases to be made at any moment. Although an immediate positive feeling results from shopping, the individual eventually cycles back to the initial feelings of depression and anxiety; feelings of guilt may also arise after the purchases.

Women with a shopping addiction also commonly have other substance or behavioral addictions or both. In particular, concurrent shopping and food addictions are common. For example, obese women who binge eat have greater rates of compulsive shopping than women who are not binge eaters. Research indicates that the prevalence of food addictions, binge eating disorder (BED), and problematic eating patterns among women is likely due in part to hormonal fluctuations and societal pressures.

Although pathological gambling addictions used to be considered a condition only affecting men, the number of women who pathologically gamble is on the rise: Approximately 2.5 percent of American women had gambling addictions in the early 2010s, and in the 2020s, around 2.9 percent of women had a gambling addiction, compared to 4.2 percent of men. Though more women were diagnosed with gambling addictions during this time, men still outnumbered them two to one. Women begin gambling at a later age, but the disorder progresses more rapidly in women. Treatment-seeking for gambling addictions appears to be higher in women.

Casino gambling activities for women typically include playing a slot machine or bingo alone rather than with others at a betting table or other game table. Also, specific websites target female gamblers, thereby increasing their access to solo gambling, and women can gamble in the home, away from casinos. Many women also find it socially acceptable to gamble with friends or colleagues in a sporting pool.

Women also have different psychological and physiological responses to gambling. While men try to attain the high positive feeling of a win, women typically gamble to achieve more of an emotionally deadened feeling and to forget about life’s problems. Women also gamble because winning can help their self-esteem.

Compulsive Sexual Behavior and Internet Addictions

Compulsive sexual behavior, often termed sex addiction or hypersexuality, involves obsessive sexual thoughts, feelings, or behaviors that interfere with routine functions. Initial studies focused on men and sexual predators because of a failure of clinicians to recognize the addiction in women and because of a failure in women to admit a sex addiction themselves. Oftentimes, feelings of guilt, shame, and isolation keep women from sharing their stories of sex addiction, contributing to under-diagnosis of the disorder.

Women also have different symptoms of sex addiction than men. The addiction for men is associated with pornography, masturbation, and meaningless sexual relationships. Women may display these behaviors but much less frequently. Instead, relationship or love addictions are much more common among women.

Women who have compulsive sex addictions frequently have a history of sexual abuse or molestation. This type of trauma can lead to the additional diagnosis of post-traumatic stress disorder (PTSD) or an eating disorder. With sex addiction, women are reliving a painful part of their childhood and searching for the security that these traumas will not recur. Many professionals, however, treat PTSD or eating disorders only and fail to recognize or address the individual's behavioral addiction.

With regard to Internet use, women may use the Internet to create relationships with others and to establish emotional bonds that are not available in their community. They may or may not seek sexual pleasure as part of these relationships. Rather than foster relationships online, men use the Internet as a coping mechanism for stress and to view pornography to avoid intimacy while still gaining sexual pleasure. Women also use the Internet to express a wide range of emotions, such as anger or aggression. These emotions may not be socially acceptable in their home environment or community. Internet use becomes an addiction when it interferes with daily functioning and with interpersonal relationships.

Treatment

It is integral for psychotherapists to address the reason for the behavioral addiction and to provide methods to reduce its frequency. Cognitive-behavioral therapists and dialectical-behavioral therapists have been successful in treating these diagnoses. Some therapies involve the twelve steps modeled by Alcoholics Anonymous, including Sex Addicts Anonymous, Narcotics Anonymous, and other such treatment and recovery programs.

Family therapy is recommended too, especially if the woman is the primary caregiver or is being physically or emotionally abused. Individuals with addictions have a high rate of relapse because of the comorbid diagnosis of additional psychiatric diagnoses and other possible substance addictions.

Although specialty clinics now exist to handle specific behavioral addictions, services specializing in treating women with these disorders are lacking. Another lack is childcare services for recovering individuals. Treatment centers that provide childcare are crucial to allow the individual time to focus on their own recovery. It also may be necessary to combine psychotherapy with pharmacologic treatments for a comorbid psychiatric diagnosis.

A final barrier to treatment is the controversy over whether compulsive behaviors should actually be considered addictions and in the same category as substance addictions. Critics state that behavioral addictions are impulse control issues and not true addictions.

Treating psychologists should acknowledge and recognize these addictions nonetheless and should provide appropriate treatment. Although the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) did not categorize behavioral addictions, these addictions were proposed for the DSM’s revision; ultimately, most were not included. Gambling disorder is in its own chapter on “addictive behavior” in the fifth edition (DSM-5).

Bibliography

Chambers, James. Drug Abuse Sourcebook. 7th ed., Omnigraphics, 2023.

Ferree, Marnie. “Females and Sex Addiction: Myths and Diagnostic Implications.” Sexual Addiction and Compulsivity, vol. 8, 2001, pp. 287–300.

Greenberg, Joshua, et al. “Overlapping Addictions and Self-Esteem among College Men and Women.” Addictive Behaviors, vol. 4, no. 8, 1999, pp. 565–71.

Hoffman, Kent S. "Gambling Addiction Statistics." Addiction Help, 14 June 2024, www.addictionhelp.com/gambling/statistics. Accessed 20 Sept. 2024.

Hollen, Kathryn H. Encyclopedia of Addictions. 2 vols. Greenwood, 2009.

Kalo, Z. “Woman Aspects of Behavior Addiction, Including Gambling.” European Psychiatry, vol. 66, 19 July 2023, doi:10.1192/j.eurpsy.2023.133.

Kuhn, Cynthia M., and George F. Koob, editors. Advances in the Neuroscience of Addiction. CRC, 2010.

McVeigh, Tracy. “Britain’s New Addicts: Women Who Gamble Online, at Home, and in Secret.” Guardian, 16 Jan. 2010, www.theguardian.com/uk/2010/jan/17/women-gamblers-online-addiction. Accessed 20 Sept. 2024.