A Focus on: Behavioural Addiction

What constitutes addiction? The past few years have seen online fantasy sports and gaming addiction cases garner high-profile coverage in the media, and dedicated camps and residential programs for treating Internet addiction have proliferated worldwide.  Children now spend more time developing and maintaining relationships online or via texting rather than in person. The US and many other countries throughout the world are suffering from an epidemic of obesity. Despite clear health warnings, tanning salons maintain regular customers. Can people become addicted to tanning, foods, or online activities?  Are such behaviors addictions that can be compared to more commonly recognized substance addictions, or merely bad habits?

For the first time, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) opened the door to recognizing behavioral addictions. The Substance-Related and Addictive Disorders chapter now contains Gambling Disorder, and Internet Gaming Disorder is included in section 3, “Conditions for Further Study.” Although this inclusion does not recognize Internet Gaming Disorder as a distinct diagnosis per se, the mention certainly lends support for its recognition as a formal diagnosis in future editions of the DSM.  

Research and clinical experience have long suggested that behaviors that occur in extremes can lead to substantial problems. People can smoke cigarettes, drink alcohol, take drugs, gamble, play video games, use the Internet, engage in sexual activities, shop, exercise, eat, or tan in moderation or in excess. Growing evidence indicates that extensive and problematic engagement in these activities does share some similarities with substance use disorders. One may develop tolerance to their use and can develop psychological or even physiological consequences from engaging in them extensively. But at what point between moderation and excess can a behavior be considered an “addiction”?  
In preparing for the DSM-5, researchers and clinicians considered many putative non-substance addictions. They also examined changes in society and technology use, including smartphones and the omnipresence of the Internet, providing rapid and instantaneous gratification for social connections and information. Several resources, such as those below, review the available research on these conditions, and the extent to which they align or not with mental disorders. 
Nancy M. Petry, PhD, is Professor of Medicine at the University of Connecticut School of Medicine in Farmington, CT. Dr. Petry is the Editor of the journal Psychology of Addictive Behaviors; her most recent book is “Behavioral Addictions: DSM-5® and Beyond” from Oxford University Press.
Avena, N. (2015). Hedonic Eating: How the Pleasure of Food Affects Our Brains and Behavior. Oxford University Press. 
Kang, Jay Kaspian. “How the Daily Fantasy Sports Industry Turns Fans into Suckers.” The New York Times: http://www.nytimes.com/2016/01/06/magazine/how-the-daily-fantasy-sports-industry-turns-fans-into-suckers.html?_r=0
Petry, N. M. d. Petry, N.M. (2015). Behavioral Addictions: DSM-5 and Beyond. Oxford University Press.
Petry, N. M., Rehbein, F., Gentile, D. A., Lemmens, J. S., Rumpf, H., Mößle, T., . . . Borges, G. (2014). An international consensus for assessing Internet Gaming Disorder using the new DSM‐5 approach. Addiction, 109(9), 1399-1406.
Petry, N. M., Rehbein, F., Ko, C. H., & O'Brien, C. P. (2015). Internet Gaming Disorder in the DSM-5. Current Psychiatry Reports, 17, 72.