Behavioural Addiction Explained
Behavioural addiction – sometimes also referred to as impulse control disorder – is a type of addiction which sees an afflicted person seized by the compulsion to take part in specific behaviour or behaviours, on a repeated basis, regardless of any potential negative consequences to that person’s well-being (physical, emotional, financial or otherwise).
Unlike a drug addiction or alcoholism, in the case of behavioural addiction, there is no external chemical substance upon which a person becomes physically dependent. Nevertheless, regardless of this lack of substance dependence, the internal chemical effects (especially in relation to the brain’s reward system) are very similar to those caused by a psychological addiction to drink or drugs, and the impact upon the addict can be similarly destructive.
Why Certain Behaviours Are Regarded As Addictions
Behavioural addiction as a separate area of study is a relatively new phenomenon, though its effects have been felt and observed for centuries: gambling addiction in particular (a subset of behavioural addiction) has been recognised as a socially destructive force for many years, and as medical and psychiatric science (and psychiatric and medical classifications) has evolved over recent decades, the importance of behavioural addiction is increasingly being recognised, and greater efforts have been made to understand and to treat the problem.
While full diagnostic models have not yet emerged to give a comprehensive description of each type of behavioural addiction, it is recognised that there are many different activities which can result in the development of addiction, ranging from extremely common and supposedly harmless habits (such as shopping and exercise) to activities which have long been associated with negative behaviour and dangerous ramifications (such as gambling and types of sex).
It is theoretically possible for some people to become addicted to any kind of activity, while others may engage in potentially addictive behaviour over and over again without becoming addicted; again, the precise mechanisms associated with behavioural addiction are not yet fully understood in many cases, but generally speaking it is a result of dysfunction in the brain’s reward circuitry (which may pre-exist, or develop during the course of repeated engagement in addictive behaviour). Any repeated behaviour which is damaging or has the potential to be damaging to you, and which you find difficult or impossible to stop even whilst being aware of that damaging potential, may be considered an addiction.
Are Behavioural Addictions Real Addictions?
Although, as noted above, our current understanding of behavioural addiction still has some way to go, and full diagnostic models are still lacking, there is little doubt that behavioural addictions are “real” addictions in terms of having a genuine and identifiable cause in the brain: the American Society of Addiction Medicine (one of the leading bodies internationally dealing with addiction of all forms) states that “addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction”.
As a result, it is possible to talk about a coherent approach to the treatment of behavioural addiction as a disorder in itself, rather than a manifestation of other, broader mental disorders. In other words, behavioural addiction should be seen as just as “real” like drug addiction regardless of the fact that there is no external physical substance causing a dependence.
Factors that Contribute to having a Behavioural Addiction
Although every case of behavioural addiction (as with any other type of addiction) is unique, and every addict is an individual with his or her own particular life story and circumstances, there are certainly some factors which are especially likely to contribute to the development of an addiction of this type – quite apart from pre-existing neurological factors.
A person suffering from low self-esteem is much more likely to engage in destructive behaviours, which can become addictive. This is as a result of a variety of potential factors, including a lack of self-worth (making the risk of damage to oneself less of a concern), and a prioritisation of the opinions and gratification of others over one’s own well-being and happiness. For example, you might repeatedly engage in risky, extreme and/or promiscuous sex – which can quickly develop into an addiction – because of a lack of self-regard and a feeling of obligation to satisfy others.
If you have low self-esteem you are also more likely to continue to engage in behaviour which inhibits the likelihood of self-improvement or which makes it more likely that you will suffer negative consequences – for example, a person addicted to video games may continue to indulge in their addiction for many hours at a time, day after day, at a cost to their fitness and health, rather than exercising or, perhaps, putting time into improving their education and/or future job prospects, because they may not see themselves worthy of the “investment” which such activities might represent.
Trauma, Loss, and Guilt
If you have gone through a traumatic experience, have lost someone dear to you, or have feelings of intense guilt (justified or otherwise) you are more likely than the average to engage in and display addictive behaviour, as a way of escaping painful memories or difficult circumstances. Activities such as gambling, sex, shopping sprees and others can be exciting and can distract a person – often for prolonged periods – from a reality which is proving difficult to bear.
Of course, such behaviours do not address the underlying factor/s which are distressing you, and participating in them can often make life circumstances much more difficult; however, in the short term this escapism can feel extremely stimulating, and repeatedly engaging in it can become habitual and, eventually (potentially very quickly) can result in addiction.
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Poor Social and Communication Skills
If you have poor social and/or communication skills you may be more likely than average to participate in certain activities – such as types of video gaming – which can create a feeling of community without the normal emphasis on such skills.
Alternatively, you may also be more likely to participate in activities which can provide stimulus and reward without requiring you to engage with other people: gaming, gambling (especially electronic/digital), browsing the internet, pornography and other things can all be done whilst solitary, potentially over a very long time (simply requiring a place to be alone and an internet connection and/or a computer or gaming console).
The advent of online shopping and food delivery has made it possible for some people to become extremely inclusive, engaging in compulsive behaviour for long periods every day without interacting with their fellow human beings in any meaningful sense.
Types of Behavioural Addictions
As noted above, it is theoretically possible for any activity engaged in repeatedly to become addictive, if it has the necessary impact upon brain chemistry. However, certain activities have become identified as being comparatively widespread examples of addictive behaviour, and indeed, many people participating in one or more of these activities on a regular basis have sought treatment for their addictions.
It is important to recognise that merely engaging in these activities, even frequently and regularly, does not automatically lead to addiction in everyone; simply that these activities, in particular, have been associated with the development of addiction in certain individuals.
In mainstream society, gambling has been recognised as “addictive” for centuries, and in recent decades this has been increasingly understood clinically – indeed, gambling addiction is included as a separate category (the only behavioural addiction thus classified) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the leading authority for psychiatric diagnosis in the United States and in much of the rest of the world.
Gambling addiction can be one of the most destructive of all addictions in terms of its ability to ruin a person financially (with obvious consequences for life circumstances and relationships) extremely quickly; even the very wealthiest person can become destitute if they allow their problem gambling to become a gambling addiction and then to run unrestrained.
The intense physical (and possibly emotional) pleasure of sex makes it an experience enjoyed by, and an important aspect of the lives of, most people, and a desire to have sex regularly should not be considered healthy. However, some people feel compelled to seek out sex on a constant basis in order to achieve sexual gratification over and over again – any satisfaction or fulfilment felt fading relatively quickly – and sex addiction is increasingly recognised by the medical community worldwide.
Highly promiscuous and/or risky and/or taboo sex also provides an additional excitement above and beyond the physical pleasure with which sex (either in or outside a relationship) is associated, and for many people that thrill becomes something to be sought out increasingly frequently, resulting in the emergence of addiction. As noted above, sex can also be a compensatory mechanism for people with low self-esteem or those seeking escapism, and used in this way also frequently results in sexual addiction.
Understandably, internet addiction is a comparatively recent phenomenon, and our understanding of it is developing rapidly from an initially very low level. Many medical authorities do not yet recognise internet addiction as a distinct disorder (though this may in part be simply because of a lack of data at present).
However, many doctors believe that prolonged, regular use of the internet in place of participating in other activities, especially social ones, have pronounced effects upon a person’s well-being (physical and mental), and while precisely diagnosing internet addiction disorder may currently be comparatively subjective, compulsive use of the internet to the exclusion of other activities has caused many thousands of people worldwide to reach out to help (and has even been associated with numerous deaths, in cases where individuals have allowed their internet usage to dominate their lives to such an extent that they have gone without sleep and/or nutrition to a fatal degree).
Shopping is an inescapable part of modern life – but for some people the thrill of acquiring new objects (of whatever type) becomes compulsive. Meanwhile, spending money – sometimes large quantities – can create excitement in itself (especially if there is a risk involved – for example, if the sums are more than you can afford, or if the money is not yours).
However, in such cases the feeling of gratification which results from making purchases is often very short-lived, and you are driven to make more and more purchases in order to recreate that feeling, even if you do not need the items you are buying (indeed, shopping addiction and “incidental hoarding” may be closely related). Shopping addiction – also known as compulsive buying disorder – can be extremely financially destructive, potentially creating large and unsustainable quantities of debt.
Video Game Addiction
As with internet addiction (see above) and related computer addiction, video gaming can be an extremely addictive and damaging activity, resulting in social isolation, emotional atrophy, and a range of negative physical effects (especially related to a lack of fitness and sleep deprivation). The regular excitement and repeated rewards associated with gaming of various types, along with the lack of requirement for social interaction, mean that some people feel compelled to play video games for extremely long periods of time, to the detriment of education and professional prospects and, as noted, physical and mental health.
Video game creators have become extremely proficient at designing their games to make them as captivating as possible, maximising their effect upon gamers’ brains’ reward centres, and in recent years this has also included an increasing emphasis on ongoing financial commitments (in-game purchases, micro-transactions et cetera) which have made some cases of gaming addiction extremely financially destructive for the individuals concerned.
Plastic Surgery Addiction
There may be many reasons why a person seeks out cosmetic surgery, but in many cases, it is a result of fundamental unhappiness with themselves, which they feel altering their appearance will improve. In such cases, the pleasure resulting from a successful procedure may be only temporary, as it has not affected the underlying lack of contentment they feel; as a result, they are driven to engage in further surgery in order to recapture that lost pleasure, and this can become habitual, with eventually devastating effects upon their physical appearance (and serious financial consequences). In certain cases, an individual may become obsessed with resembling an ideal (another person or a fictional character) and will engage in many surgeries in their quest to look as much like that ideal as possible.
Risky Behaviour Addiction
The lure of risky behaviour has been known since ancient times (see the legend of Icarus) and is increasingly well understood on a clinical basis today. Risks can be thrilling – the experience of engaging in behaviour which has the potential to damage or indeed end one’s life can create a feeling of intensity which everyday life cannot replicate – and normality can feel incredibly mundane comparison, driving some people to engage in risky behaviour more and more frequently, and/or to take ever greater risks.
Different kinds of risks appeal to different people: for some, activities such as BASE jumping or dangerous sex, which combine obvious physical thrills with high risks, can become addictive, while for others the risks of choice can be less obviously immediately gratifying (gambling unaffordable amounts, intentionally placing oneself in dangerous situations, or acting in ways which if discovered would have devastating consequences for relationships, jobs et cetera). In all such cases, however, it is the feeling of risk and danger itself to which the person becomes addicted and which needs to be addressed: it is important to recognise that engaging in risky activity is not automatically addictive.
There are a great many eating disorders, by no means all which involve addiction to food. However, for some people, the instant gratification of eating becomes compulsive, and they become more and more focused on the consumption of food. Binge eating (which may or may not be followed by purging), and/or constant “grazing”, especially of high sugar or high-fat foods, creates strong chemical reactions in the brain, and the after-effects can include feelings of intense dysphoria and depression which can drive a person to further eating in order to dispel such feelings.
Food addiction is often associated with obesity and other related conditions which can prove fatal if not addressed; it can also have serious financial ramifications (if the food being consumed is too expensive for the individual to afford, or if their addiction negatively impacts upon their ability to work).
Exercise can result in extremely pleasant feelings of euphoria, and carried out sensibly and regularly is an essential aspect of staying healthy. In some people, however, the desire to feel this euphoria can become compulsive, and physical exercise can become an addictive behaviour. Moreover, for some people, the quest to attain a certain idealised body image can also become increasingly obsessive, and feelings of guilt can develop if those individuals go without exercising even for a short time.
In all such cases, there is a risk of doing serious harm, as excessive exercise can cause a very broad range of physical conditions and is associated with a greatly increased incidence of injury. Exercise deprivation on the part of a person suffering from exercise addiction can also result in various withdrawal symptoms, which can include appetite disorders, anxiety, insomnia and headaches and which can lead to engagement in other destructive behaviours including substance abuse.
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Although something which has been observed in art and literature throughout history, love addiction is a comparatively little-understood phenomenon and medical authorities differ on how to describe it, or even on whether to recognise it at all. The extremely pleasurable and satisfying emotions associated with the experience of falling in love can for some people prove overwhelmingly attractive, driving them to engage in the process over and over (with obvious consequences for existing relationships and the stability of life circumstances).
For others, meanwhile, love provides an ostensible purpose for life and/or validation of their own existence, but while they strive to achieve their ideal of “love” the reality does not meet expectations, and they are driven constantly to search for new companions and new experiences of love.
The very widespread availability of pornography – especially internet pornography – today has resulted in very high levels of its consumption in many parts of the world, and in a large number of cases this consumption has had negative effects upon individuals’ self-esteem, relationships, approaches to sexual activity and other factors. It has also seen the emergence of pornography addiction: the compulsive consumption of pornography (often, but not exclusively, extremely hardcore porn) to the detriment of a person’s well-being.
Merely viewing pornography is not by itself necessarily problematic, but some individuals can develop the need to watch porn as much as possible regardless of the consequences for their social lives, careers and relationships, to the extent that they can only feel content whilst viewing porn and their lives increasingly revolve around doing so.
The pleasure of watching porn (usually, though not always, combined with masturbation) can quickly fade after a climax (an actual orgasm and/or a feeling of extreme psychological intensity) and can often be followed by feelings of profound guilt and even disgust; the desire both to recreate the pleasure and to drive off such negative feelings can lead to immediate resumption of porn viewing, sometimes resulting in very long-term binges which can have negative health impacts.
Living with a Behavioural Addiction
It may initially be possible to develop a behavioural addiction with relatively few consequences for your daily life and to conceal it from loved ones. However as addiction progresses and intensifies it becomes increasingly hard to sustain a normal life – possibly because of the time being devoted to the behaviour in question, because of its financial impact, or for a range of other reasons. Engaging in the behaviour becomes your primary focus of the addict, and you will pursue opportunities to engage in it to the exclusion of other activities, possibly including socialising, spending time with family, work, side projects and hobbies, exercise and others.
As with other addictions, you may become deceitful about the extent of the problem, or possibly be unable to recognise it as a problem at all, even as the situation deteriorates. You may need to find new (potentially illegal and/or risky) sources of income to fund your behaviour, with obvious potential risks involved. Meanwhile, you may begin to experience a welter of negative emotions and potentially a range of mental health disorders as you feel yourself losing control, becoming increasingly trapped by your addiction.
The Dangers of Behavioural Addictions
Because each person is unique, and because of the broad range of activities which can result in behavioural addictions, the impact of such addiction on your life can range from comparatively negligible to utterly catastrophic and indeed fatal. Most behavioural addictions result in at least some deterioration of life circumstances – the costs in financial terms as well as to your health and relationships can be severe – while others pose the risk of death (either instantly, as with some risky behaviours, or gradually as a result of health complications such as obesity or AIDS).
As with other types of addiction, and similar to the phenomenon of drug tolerance, the desire to seek out ever-greater thrills can lead to, for example, increased risks; greater quantities of consumption of pornography, internet viewing or gaming; increased promiscuity and/or more extreme sex; and other intensifications which can accelerate the rate of damage to your life circumstances and prospects.
Participating in the behaviour to which you have become addicted can leave you increasingly isolated, destroying relationships with family and friends, and can lead to a perpetual cycle of gratification and guilt which can result in depression and a range of other mental disorders. Life can feel increasingly meaningless, while life without the behaviour in question can feel intolerably drab.
Even for those people for whom their addictions have not had catastrophic permanent consequences (for example death, life-changing injury or illness, destitution, permanent estrangement from loved ones et cetera), a great deal of treatment (such as therapy) may be required before they can once again find happiness and contentment in “normal” everyday life.
Signs and Symptoms of Behavioural Addictions
For obvious reasons, the symptoms of one behavioural addiction may vary greatly from those of another: the injuries sustained by someone with an exercise addiction will be very different from the obesity which a video game addict may develop. However, in general terms, behavioural addiction is likely to be evident in the form of an increasing focus upon that behaviour at the expense of other elements of your life: in other words, if you are an addict you are likely to withdraw from previously enjoyed activities and from loved ones and friends, in favour of participating in the activity to which you’ve become addicted. Many behavioural addictions involve significant financial cost,
Behavioural Addictions Vs Drug Addictions: Differences and Similarities
Although behavioural addiction is a relatively new area of study compared with substance addiction, they may be considered very similar conditions, with the main difference being the absence of physical dependence in the case of behavioural addiction – though not all substances are physically addictive.
In both cases, regularly participating in an activity (whether it is drug consumption or another behaviour) can lead to addiction (though this is not inevitably the case in every individual); the mechanisms in the brain driving addiction appear to be very similar for both behavioural and substance addictions.
Both types of addiction can have devastating effects upon an addict’s life, and in some cases can lead to physical harm or even death. Both behavioural and substance addictions can be treated therapeutically: there is no “miracle cure” for either.
Neurological Characteristics of Behavioural and Substance Use Disorders
While some substances are physically addictive and have particular chemical effects of their own upon the brain and body, the foundation of most substance addictions and, presumably, behavioural addictions is to be found in your brain’s reward centre. Amongst other biomolecular mechanisms, the brain produces the chemical dopamine which stimulates certain receptors (especially in the parts of the brain known as the amygdala and the ventral tegmental area) and creates a feeling of desire to repeat a given behaviour (as opposed simply to creating feelings of pleasure, as previously thought and as commonly understood by most laypersons).
When the brain has “learnt” to anticipate and experience them, dopamine production can be stimulated by engaging in specific behaviours, including the consumption of addictive substances as well as activities such as those described above. This reward system leads to pleasurable sensations when a behaviour is engaged in, as well as to unpleasant sensations if you go too long without repeating the behaviour in question due to the absence of dopamine and other chemicals.
Over time, the brain can develop a tolerance to certain levels of dopamine, meaning that you will need to consume greater quantities of a substance or engage in increasingly intense behaviour in order to experience the same “high”. On the other hand, a prolonged period of time without engaging in these behaviours can normalise the brain, suppressing – potentially permanently – the addiction.
Mental Health, Dual-Diagnosis, & Behavioural Addictions
A person with certain pre-existing mental health conditions may be much more likely to develop behavioural addictions, though that is not to say that this is an inevitability. On the other hand, as with any addiction behavioural addiction increases the likelihood that a person will develop other mental health disorders, especially depression and potentially psychosis.
Some behavioural addictions – for instance, sex addiction – are associated (partly as a result of the phenomenon of cross-sensitisation) with an increased likelihood of developing a substance abuse disorder which in turn also increases the likelihood of further mental health disorders. Dual diagnosis – experiencing a behavioural addiction alongside another mental health disorder, which may be pre-existing or consequential – requires a specific approach to treatment as both conditions impact upon each other and may be impossible to treat successfully in isolation.
When Behavioural Addiction is Out of Control and Help is Needed
There is no hard and fast rule for when any addiction becomes “too much”; however, it is safe to say that the earlier a problem can be recognised, and the sooner treatment can be sought, the less likely it is that serious permanent damage will be done; and that if you want to stop a certain behaviour, and find it difficult or impossible to do so, you are already likely to be addicted. Moreover, if you find that your behaviour is having negative consequences for your relationships, finances, employment, and life circumstances generally, and/or is causing you mental or physical harm, it is time to change and seek help.
Treatment for Behavioural Addictions
Behavioural addiction is treatable, by therapy and possibly with the help of certain medication (though it is important to note that no medicine currently exists to treat specific behavioural addictions). The capability of addiction professionals to treat behavioural addiction is increasing year by year, and many thousands of people have already been able to turn their lives around with help.
Diagnosis and Evaluation
Prior to commencing any treatment, getting a full psychiatric diagnosis and evaluation of your condition is imperative – and this is not something which you can do yourself, regardless of how serious you may consider your situation to be. Your first stop should be your GP, who will be able to give a preliminary assessment and if necessary, refer you on to a specialist. You might also contact an addiction specialist independently. As mentioned above, there are no unanimously agreed diagnostic criteria for some behavioural addictions; however, in most cases, if the situation is sufficiently serious to warrant treatment, this will be evident to medical professionals.
If your assessment suggests that treatment is necessary, the service or facility you go to will draw up a comprehensive treatment plan outlining how your condition will be treated, including the kind of therapy you will receive, any medication prescribed, the duration and stages of treatment, and other elements potentially including a dietary and fitness regime. Each individual treatment plan will be entirely bespoke, and one person’s plan should not be followed by anyone else.
Detoxification – “detox” – usually refers to the process by which an addict’s system is cleansed of any substances of abuse and during which drug withdrawal may occur. In the case of behavioural addiction, there will be no substances involved (unless the addiction co-occurs with a substance abuse disorder) but withdrawal symptoms may well still manifest during a period following the cessation of the behaviour involved, and therefore a detox period may well still be imposed as part of a treatment plan.
The family can play a crucial role in helping to break an addiction – and at the same time can often be affected profoundly by the addiction of a loved one. Some treatment facilities offer therapy models which involve the family in treatment directly, while others provide treatment to family members alongside that being provided to the addict themselves.
Therapy is the foundation of any addiction treatment, and a wide variety of different therapy models and formats are potentially available. The most commonly deployed model is cognitive behavioural therapy (CBT), which focuses on discovering triggers and compulsive patterns and making fundamental changes in lifestyle and life circumstances to encourage healthy behaviour.
Motivational therapy (MT) is also commonly used, which is based upon encouraging a patient through contemplation and introspection to come to see the negative aspects of their behaviour and as a result to develop a determination to change. The specific therapy model/s you might engage in will vary from one treatment facility to another, and you may need to try out various therapies before settling on one or more, which suits you best.
Alternative Treatment Approaches
Alongside mainstream psychotherapy and medicine, various alternative treatments have become available and may be provided at treatment facilities or independently. Some of these include:
- Meditation: this has proven successful in many cases of addiction, and forms a useful coping mechanism long into the future after the immediate pressures of addiction have receded.
- Prayer: many spiritual people find prayer and communion with their higher powers vital when confronting addiction.
- Art or expressive therapy: the creative process can be extremely cathartic and lead to feelings of increased self-worth and broadened horizons, which can dramatically improve a person’s outlook on life.
- Nature retreats: immersing yourself in the quiet beauty of nature can be hugely psychologically and emotionally nourishing and provide a healthy grounding far from the pressures of modern life, which have contributed to your addiction.
Facts About Behavioural Addiction
Over 400,000 people in the UK are addicted to gambling, with over 2 million at risk.
An estimated one in 10 teenagers who play video games have an addiction.
Up to 6% of women – and 5.5% of men – suffer from shopping addictions.
People suffering from sex addiction are up to five times more likely than the average to develop substance abuse disorders.
In clinical studies related to food addiction, 94% of rats chose sweetened water over cocaine.
In general, when it comes to behavioural addiction, the earlier the diagnosis, the better the prognosis.
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