Behavioural Addiction

Behavioural addiction is a chronic condition where a person compulsively engages in rewarding activities despite harmful consequences to their physical health, mental wellbeing, relationships, and finances—creating a cycle that can be just as challenging as substance addiction.

Table of contents

• What Is Behavioural Addiction?
• Types of Behavioural Addictions
• Why Do Behavioural Addictions Happen?
• Recognizing the Warning Signs
• Medical Classification and Diagnosis
• Treatment Approaches
• Prevention Strategies

What Is Behavioural Addiction?

process addiction, non-substance-related disorder, impulse control disorder

Behavioural addiction, also known as process addiction, is a form of addiction that involves a compulsion to repeatedly engage in a rewarding activity despite negative consequences to a person’s physical, mental, social, or financial wellbeing.^[1] Unlike substance addictions such as drug or alcohol dependence, behavioural addictions do not involve ingesting substances. Instead, the person becomes addicted to performing certain behaviours and the reward these behaviours provide to the brain.^[2]

Behavioural addiction is recognized as a chronic medical condition. The American Society of Addiction Medicine defines addiction as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.^[3] Several behaviours can produce short-term reward that may lead to persistent behaviour despite knowledge of adverse consequences—this diminished control over the behaviour is a core defining concept that connects behavioural addictions to substance addictions.^[1]

In the brain’s reward system, performing certain activities triggers the release of dopamine, a chemical that produces feelings of pleasure. When a person repeatedly engages in an activity to chase this pleasurable feeling, changes occur in brain chemistry. The brain begins to connect the behaviour with survival, taking control away from the area responsible for rational thinking and judgment.^[5] This means that individuals with behavioural addictions cannot simply stop, because their brains have been altered to believe the behaviour is necessary for survival.

Types of Behavioural Addictions

Many different types of behavioural addictions exist. The most common include gambling, eating, shopping, sex, pornography viewing, internet use, video gaming, exercise, and work.^[4] In theory, it is possible for a person to become addicted to any type of activity. What transforms a behaviour into an addiction is the associated dysfunction of the brain’s reward centre linked to repetition of the behaviour.^[16]

Gambling addiction, also called pathological gambling, is one of the most well-studied behavioural addictions. A person with gambling addiction continues to gamble despite serious financial consequences, relationship problems, and other harmful effects on their life.^[3]

Internet addiction involves compulsive use of the internet, including social media, that interferes with daily functioning. People may spend excessive time online to the detriment of work, school, or personal relationships.^[3]

Video game addiction is characterized by compulsive engagement in gaming activities. The person spends excessive amounts of time playing video games, often neglecting other responsibilities and relationships.^[3]

Exercise addiction involves performing excessive amounts of physical exercise to the detriment of physical health, spending too much time exercising instead of maintaining relationships or fulfilling other responsibilities.^[3]

Shopping addiction is the compulsion to continually shop and purchase items, often resulting in significant debt and financial problems. Packages may pile up, credit card debt accumulates, yet the person cannot stop the behaviour.^[5]

Other behavioural addictions include sexual behaviours, pornography use, eating disorders, and work addiction. While these activities are part of normal life for many people, they become addictions when a person finds them impossible to stop despite awareness of the psychological and physical harm they cause.^[16]

Why Do Behavioural Addictions Happen?

The exact causes of behavioural addiction are not fully known, and the way addiction affects each person varies. However, certain factors usually contribute to and worsen the development of a behavioural addiction, including genetic, mental health, and environmental elements.^[16]

A behavioural addiction often traces back to a traumatic experience. When a person experiences a death, divorce, or other trauma in the family, they long for an escape from the pain. They perform an activity—going shopping, playing a slot machine, or testing a video game—and receive pleasure from the behaviour. This behaviour gradually becomes a coping mechanism for dealing with difficult emotions.^[5]

At the heart of an addiction is an emotional or spiritual need. This could be the need to feel powerful and in control, to feel valued, to feel less lonely, or to escape pain. Over time, persistent engagement in the addictive behaviour causes changes in the brain’s reward system. The person needs to continuously repeat the behaviour to trigger the release of dopamine. When the behaviour doesn’t occur, dopamine levels fall, creating a strong urge to engage in the behaviour again so the brain’s reward system can return to what it now considers normal.^[5]

Research suggests that common mental health conditions such as post-traumatic stress disorder, bipolar disorder, and major depressive disorder can make a person more likely to develop a behavioural addiction. The relationship between mental health conditions and behavioural addictions is complicated, with significant overlap between the two.^[16]

Studies suggest that men have higher rates of addiction than women, but women fall into the cycle of addiction more quickly than men. Women appear to be more naturally susceptible to psychological stress, anxiety disorders, and mood problems, which can all fuel addictive behaviour.^[16]

People with low self-esteem generally have a pessimistic view of their life and future. This makes them more inclined to indulge in high-risk behaviours to help them manage and feel in control, especially when faced with difficult situations.^[16] Living in a solitary environment with little social interaction may also lead people to engage in compulsive behaviour for long periods to prevent feelings of loneliness.^[16]

Recognizing the Warning Signs

There is an important difference between enjoying an activity and being addicted to it. If you feel like you need to do something rather than want to do something, that’s a warning sign. When an activity becomes all-consuming and begins to replace other life activities, upsetting your general life balance, it may have crossed the line into addiction.^[10]

Common signs that a behaviour has become an addiction include:

• Spending more time engaging in the behaviour than you intended^[10]
• Feeling that the behaviour has gotten out of control and being unable to stop^[10]
• Needing to increase the amount of time, money, or energy invested in the behaviour to feel satisfied^[10]
• Continuing the behaviour despite negative consequences^[10]
• Failing to meet expectations at work, home, or school because of the behaviour^[10]
• The behaviour becomes your automatic response when trying to relax or take your mind off stressful situations^[10]
• Experiencing intense discomfort when unable to engage in the behaviour^[10]
• Spending less time in other enjoyable activities and healthy relationships because of the behaviour^[10]
• The behaviour interferes with regular daily functioning or causes significant distress^[10]
• Feeling guilt or shame about the behaviour, or feeling the need to hide it from others^[10]

Many people continue engaging in these behaviours after making promises to themselves or others that they will stop. They may notice a profound impact on other areas of their lives, including trouble at work, financial difficulties, or problems in relationships.^[10]

Behavioural addictions are often less obvious to outsiders than substance addictions. If a person performs poorly at work because they are intoxicated, others immediately recognize the problem. However, if someone performs poorly because they stayed up all night on the internet, the root cause is rarely detected, and the person often continues to suffer silently.^[10]

Medical Classification and Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognized behavioural addictions for the first time in its fifth edition, with gambling disorder (formerly called pathological gambling) as the only non-substance-related disorder classified under “Substance-Related and Addictive Disorders.”^[3] Internet gaming addiction was included in the appendix as a condition requiring further study.^[3]

The DSM-5 recommends using the neutral term “disorder” instead of “addiction” in clinical settings to avoid uncertain definitions and potentially negative associations.^[3] Similarly, the eleventh revision of the International Classification of Diseases (ICD-11) introduced the category “Disorders due to substance use or addictive behaviours,” based on a diagnostic framework of impaired control, repetitive harmful behaviour, and continuation or escalation despite negative consequences.^[3]

Growing evidence suggests that behavioural addictions resemble substance addictions in many areas, including natural history, symptoms, tolerance (needing more to achieve the same effect), co-occurring conditions, overlapping genetic contributions, brain mechanisms, and response to treatment.^[1] Current data suggest this combined classification may be appropriate for pathological gambling and a few other better-studied behavioural addictions such as internet addiction.^[1]

Other addictive behaviours that have received research attention but with insufficient evidence for formal classification include pornography use disorder, compulsive buying disorder, social network use disorder, work addiction, exercise addiction, compulsive sexual behaviour disorder, and food addiction.^[3]

Diagnosis of behavioural addiction begins with an initial assessment. Mental health experts use various diagnostic and screening tools, such as the workaholism battery, compulsive buying scale, sexual addiction screening test, exercise dependence questionnaire, and internet addiction test.^[13] As research continues, new tests and surveys are regularly developed.

Treatment Approaches

Addiction is treatable, and it is crucial to seek help as soon as possible.^[4] Treatment for behavioural addictions focuses on addressing compulsive behaviours that disrupt daily functioning and lead to emotional or physical harm.^[13]

Unlike treatment for substance abuse addictions, behavioural addictions usually do not require total abstinence, as people must still engage in activities such as eating, working, and shopping. The exception is pathological gambling, which is often treated similarly to substance addiction, with recovery closely tied to abstinence.^[13] In other cases, a period of temporary abstinence might be required until the person can resume the activity in a healthy manner. The primary goal of most treatment plans is the formation of healthy behaviours and habits.^[13]

Cognitive-behavioural therapy (CBT) is the most common treatment approach for behavioural addictions. CBT emphasizes modifying thought patterns that drive addictive behaviours.^[13] This therapy helps people identify the emotional or spiritual need at the heart of their addiction and find healthier ways of meeting that need.^[5]

Treatment plans may incorporate individual therapy, couples therapy, or group therapy, along with medication when necessary.^[13] Alternative therapies can complement traditional approaches, providing creative outlets and stress relief. Self-help resources and support groups may also be beneficial, especially for those motivated to engage in their recovery process.^[13]

Successful treatment depends on the person’s willingness to participate and embrace change.^[13] Talking to a doctor, mental health professional, counselor, or drug and alcohol service about the decision to seek help is an important first step. Being honest about the situation is essential. Support from friends or family members can also help throughout the recovery process.^[17]

Addiction is often associated with depression and anxiety. When mental health conditions co-occur with behavioural addictions, both conditions may be treated at the same time in what is called dual diagnosis treatment.^[17] In these cases, addressing underlying mental health issues is essential for successful recovery from the behavioural addiction.

Prevention Strategies

Prevention strategies for behavioural addiction include promoting mental health, providing family support, and addressing risks early. Understanding the factors that contribute to addiction can help people recognize warning signs before behaviours become deeply entrenched.^[17]

Proper categorization and understanding of behavioural addictions have substantial implications for developing improved prevention and treatment strategies.^[1] Awareness that any behaviour can potentially become addictive is an important first step in prevention. Recognizing when an activity shifts from a hobby to a compulsion allows for earlier intervention.

Building healthy coping mechanisms for stress, trauma, and difficult emotions can help prevent the development of behavioural addictions. Learning to meet emotional and spiritual needs in constructive ways reduces the risk of turning to addictive behaviours for relief.^[5]

Addressing mental health conditions such as depression, anxiety, and trauma through appropriate treatment can also reduce the risk of developing behavioural addictions. Maintaining strong social connections and avoiding isolation are protective factors that support mental wellbeing and reduce vulnerability to addiction.^[16]