What are Behavioral Addictions? Symptoms, Diagnosis, and Treatment

Behavioral addictions can inflict the same damage on your life as addictions to substances. Dysfunctional behaviors can lead to loss of control, relationships, financial and physical harm. But recovery is possible through comprehensive treatment.

This article defines behavioral addictions and factors that contribute to their development and explains what to watch for. You’ll discover how behavioral addictions are diagnosed and treated. Most importantly, how you can find any treatment you need for a brighter future.

Overview of Behavioral (Process) Addictions

What Counts as A Behavioral Addiction?

A behavioral addiction refers to a persistent and compulsive engagement in a rewarding non-substance activity despite harm. The feeling of reward leads to a cycle of loss of control and cravings that require continued use to relieve negative moods or stress.

Behavioral vs Substance Addictions: Key Differences

Both behavioral and substance addictions impact the brain and dopamine levels, the brains feel good neurotransmitters.

Unlike substance addictions, behavioral addictions usually have less pronounced physical withdrawal symptoms. However, behavioral addictions carry the same psychological distress and relapse risks as substance dependencies when attempting to stop.

Why “Process,” “ Non Substance,” and “Compulsive” Mean the Same Thing

Depending on the field of study, when describing addiction, the words process, non substance and compulsive relate to behavioral patterns that lead to dysregulation and negative consequences caused by actions.

Process relates to what a person does. No substance relates to a lack of drugs or alcohol that comprises the addiction. Compulsive relates to how the behaviors make a person feel, even when the behaviors have negative consequences.

These terms describe identical clinical phenomena but can be described differently within DSM-5 and ICD-11.

The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is published by the American Psychiatric Association (APA) and is a guide used by mental health professionals to identify characteristics of mental health and brain related disorders.

The International Classification of Diseases, or ICD, is published by the World Health Organization (WHO). It’s used more broadly among medical professionals and serves as a global categorization system for physical and mental illnesses.

Most Common Types of Behavioral Addictions

Gambling Disorder

A gambling disorder refers to an uncontrollable urge to keep gambling despite the negative consequences in one’s life for doing so. It’s the first and, thus far, the only behavioral addiction formally recognized in the DSM-5.

For individuals with gambling disorders, the action of gambling or betting stimulates the same parts of the brain that alcohol and drugs impact. Over time, it takes more bets to produce the emotional effect as before.

Symptoms of gambling addiction may include continual gambling to try to win your money back, betting more money and at more frequent intervals and thinking about gambling constantly.

Gaming & Internet Use Disorder

According to the WHO, gaming and internet use disorder is characterized by impaired control over the use of the internet or the amount of time spent playing online games. Prioritizing being online or playing over other interests indicates a person may have developed a gaming or internet use addiction.

Social Media & Smartphone Addiction

Social media and smartphone addictions refer to a lack of control over smartphone or social media usage despite their negative consequences on physical, psychological, financial or social wellbeing.

In the digital age, many people have smartphones or participate in social media. While most people can manage their use without issues, individuals who’ve developed addictions chase the dopamine spikes from likes and shares, spend endless amounts of time scrolling and have a persistent fear of missing out.

Shopping/ Compulsive Buying (Oniomania)

Shopping or compulsive buying refers to a lack of control over purchasing items. This repetitive behavior produces “buyer’s highs” from dopamine spikes in the brain.

Individuals with this type of addiction find themselves spending increasing amounts of money to achieve their “high,” hide receipts and items so others are unaware and feel guilty or empty when not actively participating in this activity.

Food, Binge Eating and Sugar Addiction

For individuals with addictions related to food, binge eating or sugar, consuming hyper palatable food produces surges in dopamine levels in the brain. Just as with other addictions, individuals need more and more to feel satisfied.

While we must ingest food to survive, consuming high amounts of calories or items high in sugar increases an individual’s risk of obesity and the development of other conditions such as diabetes or heart disease.

Notably, binge eating disorder is a distinct and formally recognized diagnosis in the DSM-5. It is classified as an eating disorder rather than an addiction.

Sex & Pornography Addiction (Hypersexual Disorder)

Sex addiction refers to excessive sexual thoughts, desires, urges or behaviors that can’t be controlled and lead to negative consequences. Pornography addiction refers to an inability to control the consumption of sexually explicit material.

Much like substance use disorder, individuals with sex or porn addiction need to consume more explicit or novel content over time to get their rush of dopamine. These behaviors are often kept secret and carry a high level of shame.

Exercise & Fitness Addiction

People with exercise and fitness addictions have an unhealthy obsession with exercise or physical fitness. They engage in excessive exercise, spend too much time working out, or exercising despite physical injury.

Over-exercising leads to negative consequences to their health, including hormonal imbalances or injury and personal relationships. As time progresses, they need to engage in more activity to get that “high” because without it, they feel symptoms of withdrawal such as irritability and restlessness.

Work (Workaholism)

Individuals with workaholism engage in excessive hours of work driven by perfectionism and identity. This harms one’s physical and mental health and leads to relationship neglect and burnout.

Emerging/Controversial Behaviors

Behaviors such as uncontrollable obsessions with cosmetic surgery, tanning, thrill seeking, crypto trading, hoarding and love addictions detrimentally impact your physical and mental health, relationships, and finances.

While these behaviors are gaining more attention, the criteria for a diagnosis of these addictions are still being debated by mental health professionals.

How Behavioral Addictions Develop

Brain Reward Circuitry & Dopamine Mechanics

Behavioral addictions activate the same brain reward system that substance addictions do. This includes the ventral tegmental area (VTA), which produces dopamine; the nucleus accumbens (NAc) that processes rewards and reinforcement; and the brain’s prefrontal cortex (PFC) that regulates decision making.

Tolerance, Withdrawal Like Symptoms & Craving Cycles

Behavioral addictions differ from substance addictions in that instead of ingesting something to get “high,” individuals with behavioral addiction must engage in activities to get “high”. However, over time, both forms of addictions require more participation to achieve the desired outcome.

Without the source, individuals have withdrawal symptoms including irritability, restlessness, or dysphoria (negative reinforcement).

Genetic, Psychological & Environmental Risk Factors

The genes modulating DRD2 receptors are implicated in the development of behavioral addictions. A history of trauma, impulsivity or ADHD can increase the risk of developing a behavioral addiction. Ease and access to activities are also cited as risk factors.

Recognizing the Signs of Behavioral Addiction

Cognitive & Emotional Red Flags (Preoccupation, Mood Regulation)

• Ruminating about the next opportunity to engage in the behavior
• Using the activity to escape stress or numb emotions
• Guilt or shame when unable to engage

Behavioral & Social Indicators (Escalation, Secrecy, Conflict)

• Increasing the amount of time or money in the behavior
• Failed cutbacks
• Lying to loved ones
• Neglect of work, school or relationships

Physical, Financial & Legal Consequences

• Debt
• Weight changes
• Repetitive strain injuries
• DUIs
• Legal suits tied to the activity
• Deteriorating sleep or overall health

Screening & Diagnosis

Self Assessment Tools (PGSI, IGDS-SF, YFAS, SABAS and Bergen Scale)

There are several self assessment tools that individuals can complete to evaluate if they have behavioral addictions.

These include the PGSI, IGDS-SF9, YFAS, SABAS and Bergen Scale. While these self assessment tools are useful, they rely on candid answers to the questions. A failure to provide honest answers can distort the severity of the addiction and the assessment.

Clinical Criteria (DSM-5, ICD-11, WHO Gaming Disorder)

Classification systems like DSM-5 and ICD-11 use evidenced based data to develop diagnostic criteria and categorization for behavioral addictions. While gambling addiction is the only recognized behavioral addiction in DSM-5, professionals are developing guidelines to diagnose other behavioral addictions.

Substance or behavioral addictions share similar characteristics across the spectrum, such as impaired control, cravings or urges, tolerance, withdrawal, continued use or engagement regardless of the negative consequences, preoccupation, loss of interest in other activities and secrecy or deception.

Diagnoses are typically made after 12 months of the behavior.

When & How to Seek Professional Evaluation

Taking a self assessment is a good first step, but should be followed up with a formal evaluation by a primary care provider or a mental health professional.

It’s helpful to have the results of any self evaluations, financial records and a support person when going for the assessment. These professional assessments are another step toward developing an individual treatment plan and getting on the road to recovery.

Evidenced Based Treatment Pathways

Psychotherapies: CBT, ACT, DBT, Motivational Interviewing

Psychotherapies such as cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT) and motivational interviewing (MI) are beneficial for individuals with behavioral addictions because they focus on the underlying thought patterns, traumas and dysfunctional behavior that encourage compulsive behaviors.

By using these modalities, an individual can identify triggers, learn positive coping skills and healthy responses to stress.

Group & 12 Step Programs (GA, SA, OA, Smart Recovery)

Many 12 Step groups such as Gambling Anonymous, Sex Addicts Anonymous or Overeaters Anonymous and Smart Recovery provide places where individuals with behavioral addictions can find peer support and accountability.

They can safely share their experiences and connect with other people who’ve experienced the same battles without feeling shame.

Most 12 Steps are usually held in person, but increased access is available through online meetings for those who lack access to meetings or fear attending them in person.

Medication Assisted & Neuromodulation Approaches

The use of medication is often useful for individuals with gambling disorders or sexual urges. SSRIs are used to treat comorbid conditions such as depression or OCD that compound the effects of behavioral addictions.

Treatments such as rTMS and tDCS have shown early promise in modulating the dorsolateral prefrontal cortex in the brain. These noninvasive treatments help individuals with behavioral addictions reduce cravings, improve impulse control and normalize brain function.

Digital Therapies, Apps, & Harm Reduction Strategies

Digital help such as telehealth, apps that limit screen time use or financial blocking software are useful tools for those with behavioral addiction. Ecological momentary assessment (EMA) helps by nudging real time coping skills.

Inpatient, Outpatient & Aftercare Planning

Depending on the severity of the addiction and other factors such as suicidality or other comorbidities, mental health professionals can determine the appropriate level of service an individual with behavioral addiction needs.

Along with choosing the appropriate level of service, relapse prevention planning may include continued support through therapy or the 12 Steps. Continued community support is critical to any successful individualized treatment plan that focuses on long term recovery.

Frequently Asked Questions

Find Treatment Near You

Online resources such as Rehab.com can help you find a treatment center that meets your unique needs. You can search by location, level of care, insurance, special programs and see top rated centers in your area.

Call the number below, and talk to someone about treatment options and see if your insurance will cover rehab. It’s a call that’ll change your life. Recovery is possible!

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