Behavioural Addiction

Behavioural addiction refers to several mental health conditions in which a person engages in a particular behavior repeatedly; even if the behavior causes them harm—it may seem as if they simply cannot resist engaging in it. Common behavioural addictions—also known as process addictions—include gambling addiction, shopping addiction, hoarding, and kleptomania (impulsive stealing). While the compulsivity associated with behavioural addictions may seem uncontrollable, treatment options are available to those who suffer from them.

ARTICLE SUMMARY

1. What Factors Contribute to Having One?
2. Typical Signs and Symptoms
3. Common Behavioural Disorders
4. Types of Treatment Programs

What Factors Contribute to Having One?

A number of factors contribute to the development of behavioural addictions, including personality, substance abuse, and genetics. For example, you may have heard the term “addictive personality” in the context of addiction, treatment, and recovery. While no clinical criteria define an addictive personality, research has shown that people who suffer from substance abuse or behavioural addictions tend to share common personality traits.¹ For instance, people who score high on personality and behaviour assessments for impulsivity and sensation-seeking are more likely to suffer from a process addiction.¹ Similarly, people who score low on harm-avoidance are also more likely to suffer from a behavioural addiction.¹

Individual behavioural addictions are more common in people with a specific set of personality traits. For instance, a person who scores high in harm-avoidance and shows traits of psychoticism, interpersonal conflict, and self-directedness may be more likely to suffer from internet addiction. ¹ People who score high on impulsivity (an inhibition of motor activity) are more likely to suffer from active behavioural addictions, such as skin-picking or hair-pulling (trichotillomania).¹

Another factor that may contribute to a behavioural addiction is substance abuse. Researchers have studied in depth the relationship between substance abuse and gambling disorder, showing that addictive gamblers are approximately 3.8 times more likely to have an alcohol use disorder.¹ However, it is unclear whether a gambling addiction makes someone more likely to engage in substance abuse, if substance abuse increases the risk of developing a gambling addiction, or if the two conditions are caused by some other, unknown factor.

Genetics is another important factor that influences whether or not someone will develop a behavioural addiction. If you have a first-degree relative (such as a parent or sibling) who suffers from a process addiction, you are at increased risk of suffering from either a behavioural or substance addiction yourself.¹ A study of identical and fraternal twins revealed that genes are responsible for 12–20% of the risk of gambling addiction, and environmental factors account for 3–8% of the risk.¹ Further research has shown that 64% of the risk of developing both a gambling addiction and an alcohol use disorder is attributable to genetics. ¹ More research is required to identify whether genes play a role in the risk of other behavioural addictions.

Research has shown that urge-driven disorders, such as gambling addiction and kleptomania, trigger the release of extra dopamine, which causes feelings of pleasure.The factors that contribute to the onset of a behavioural addiction are unique to each person, which makes predicting behavioural addiction nearly impossible. However, what is clear is that when you continue to engage in the maladaptive behaviours associated with behavioural addiction, your brain is rewarded each time, which makes the addiction increasingly more difficult to overcome.

Research has shown that urge-driven disorders, such as gambling addiction and kleptomania, trigger the release of extra dopamine, which causes feelings of pleasure.¹ Therefore, every time you engage in that behaviour, your brain receives a pleasurable jolt of dopamine.¹ Unfortunately, the brain becomes reliant on the behaviour in order to feel that heightened sense of reward.¹ A relative decline in these dopamine surges can leave you with feelings that resemble depression, which might further compel you to engage in the addictive behaviour once again to feel good, further reinforcing the cycle of addiction.

Typical Signs & Symptoms

• Preoccupation with the behaviour.
• Diminished ability to control the behaviour.
• Building up a tolerance to the behaviour so the behaviour is needed more often or in greater intensity to get the desired gratification.
• Experiencing withdrawal if the behaviour is avoided or resisted.
• Experiencing adverse psychological consequences, such as depression or anxiety symptoms, when the behaviour is avoided or resisted.

Mental health professionals and addiction experts continue to debate the existence of and diagnostic criteria for other behavioural addictions such as sex, gaming, internet, and porn addiction, but evidence is mounting to support their validity as a diagnosable addiction.

Common Behavioural Disorders

According to the DSM-5, gambling disorder is characterised by a persistent and recurrent gambling behaviour that leads to personal distress and problems in social, occupational, or other areas of functioning.² You may be suffering from a gambling disorder if you meet four or more of the following criteria during a 12-month period:²

• A need to gamble with increasing amounts of money to feel excited
• Restlessness or irritability when trying to restrict or cut back on gambling
• Repeated unsuccessful attempts to control, stop, or reduce gambling behaviours
• A mental preoccupation with gambling, such as thinking of ways to get gambling money or reliving past gambling experiences
• Gambling to relieve stress
• Returning to gambling after significant monetary losses, especially with the intention of gaining back losses
• Lying to conceal gambling activity, involvement, or debts
• Jeopardising relationships, jobs, or education for the sake of gambling
• Relying on others to get out of desperate financial situations caused by gambling

Hoarding disorder and trichotillomania are behavioural addictions that are classified in the DSM-5 as obsessive-compulsive disorders. Hoarding is a persistent difficulty in parting with physical possessions, regardless of its value, the space one has, the need for money, a safe living environment, or other resources.²  Hoarding is sometimes associated with a shopping addiction, though there is no official diagnosis for shopping addiction in the DSM-5.

Trichotillomania is another process addiction that is labelled as an obsessive-compulsive disorder.²  Trichotillomania is the compulsion to pull out your own hair, which often results in hair loss and significant social or occupational functioning.² Similarly, excoriation is a skin-picking disorder in which you compulsively pick at your skin until lesions form.² Excoriation causes significant impairment in day-to-day functioning because you are unable to stop the behaviour. ²

Kleptomania—the impulse to steal items—is classified in the DSM-5 as an impulse-control disorder and is defined as the recurrent failure to resist stealing objects, especially objects that are not necessary for use or monetary gain.² If you suffer from kleptomania, you will experience tension right before stealing, followed by relief and pleasure immediate afterwards ²

While gaming, internet, porn, sex, food, and shopping addictions are not officially APA-verified conditions, many experts believe that they should be included in the DSM. Researchers are continuing to work on developing standard criteria for identifying these other behavioural addictions. And, although these addictions are not included in the DSM-5, many reputable inpatient, outpatient, individual, and group treatment options for these behavioural addictions are available.

Types of Treatment Programs

• Behavioural addiction residential treatment programs address the underlying psychological issues that led you to develop the process addiction. These programs often follow the same structure as substance abuse treatment programs, including 12-step programs, motivational enhancement, and cognitive behavioural therapies that have proven successful at treating behavioural addictions.¹ These treatment programs focus on helping you develop healthier ways of dealing with life and daily stressors.
• In addition to residential programs, outpatient behavioural addiction treatment is another option for those struggling with these conditions. Outpatient therapy involves visiting a treatment facility or medical professional on a daily or weekly basis during the beginning stages of treatment. As you begin to feel more control over your behavioural addiction, treatment may become less frequent. Outpatient treatment usually involves a maintenance period in which you visit twice monthly or once per month to receive supportive ongoing care.
• During individual or one-on-one counselling, you meet privately with a behavioural health counsellor who is trained in behavioural addiction therapy. Sessions focus on identifying the emotional issues and underlying causes of the behavioural addiction, which can include trauma therapy, if applicable. One-on-one counselings offers you a chance to privately voice concerns that may otherwise be uncomfortable to talk about with others in a group setting.
• In many behavioural addiction treatment programs, therapy is based on the cognitive behavioural therapy (CBT) model. CBT focuses on eliminating unhealthy or negative behaviours by replacing them with positive, healthier options. This form of treatment teaches new behavioural patterns as well, but the focus is usually on the motivations behind the behaviour rather than the physical actions themselves. One of the main goals of CBT is to change or modify the thought processes that led to the behavioural addiction.
• Another treatment option is group therapy in which you attend a session that at least two other patients and one behavioural health counsellor are present. Group therapy allows you to share common experiences and understand that you are not alone in the addiction and recovery process. During group therapy sessions, the therapist may lead your group in a focused topic or leave the topic of discussion up to the group members. Common topics in group sessions include denial, legal problems, relationship problems, work problems, health issues, financial struggles, identity crises, and stress.
• Similar to group therapy, 12-step recovery programs provide a structured framework for working through behavioural addiction problems while having the support of others who have gone through similar experiences. Some 12-step programs have religious undertones and require participants to admit that they do not have control over their addictions. Non-12-step programs follow a similar structured framework, but exclude any religious affiliation and emphasise taking personal accountability for one’s addiction. Non-12-step, 12-step, and group therapy programs are excellent options for long-term recovery because they offer built-in support from people who understand how hard overcoming addiction can be.
• The type of behavioural addiction treatment program you need will depend on your specific addiction. For example, a gambling addiction requires abstinence as part of the treatment program, while overeating requires relearning behaviours so that you can modify negative patterns and engage in healthy eating. The staff at the facility you choose will assess your situation and your addiction, and then determine the most effective behavioural addiction treatment for your unique circumstances.

Several different types of behavioural addiction treatment facilities are available, including state-funded, nonprofit, and privately owned rehabilitation facilities. All facilities, no matter how they are funded, must comply with patient privacy rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).³

The decision about which type of treatment facility to choose depends on whether you plan to use health insurance, where you are located, where you want to complete your treatment, and what sort of addiction you are working to overcome. Some treatment facilities specialise in one particular kind of addiction (such as gambling addiction), while others offer various programs or an all-inclusive program to treat people with a variety of different addiction struggles. You can also choose from inpatient and outpatient programs, or a sequential combination of both.

Ideally, people suffering from behavioural addiction will receive multiple forms of treatment. For example, in an inpatient setting, you participate in one-on-one therapy sessions, group therapy, skills building activities, and coping skills development. This diverse therapeutic approach offers the greatest chance of success in beating a behavioural addiction.

Sources

1. Grant, J. E., Potenza, M. N., Weinstein, A. & Gorelick, D. A. (2010). Introduction to Behavioural Addictions. American Journal of Drug and Alcohol Abuse, 36(5), 233–241.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association.
3. United States Department of Health and Human Services. (2016). Summary of the HIPAA Privacy Rule.