{{Short description|Compulsion to engage in a non-substance related behavior}} {{Use American English|date=October 2020}} {{Use dmy dates|date=January 2018}}
'''Behavioral addiction''', '''process addiction''',<ref>{{Cite journal |last=Smith |first=David E. |date=2012-01-01 |title=Editor's Note: The Process Addictions and the New ASAM Definition of Addiction |url=https://www.tandfonline.com/doi/full/10.1080/02791072.2012.662105 |journal=Journal of Psychoactive Drugs |language=en |volume=44 |issue=1 |pages=1–4 |doi=10.1080/02791072.2012.662105 |pmid=22641960 |issn=0279-1072|url-access=subscription }}</ref> or '''non-substance-related disorder'''<ref>{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2022-03-18 |publisher=American Psychiatric Association Publishing |isbn=978-0-89042-575-6 |edition=DSM-5-TR |page=661 |language=en |doi=10.1176/appi.books.9780890425787|s2cid=249488050 }}</ref> is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a '''natural reward'''<!--Phrase redirects here; bolded per MOS:BOLD--><ref name="Nestler">{{cite journal|date=November 2011|title=Transcriptional and epigenetic mechanisms of addiction|journal=Nat. Rev. Neurosci.|volume=12|issue=11|pages=623–637|doi=10.1038/nrn3111|pmc=3272277|pmid=21989194|quote=ΔFosB has been linked directly to several substance-related behaviors ... Importantly, genetic or viral overexpression of ΔJunD, a dominant negative mutant of JunD which antagonizes ΔFosB- and other AP-1-mediated transcriptional activity, in the NAc or OFC blocks these key effects of drug exposure14,22–24. This indicates that ΔFosB is both necessary and sufficient for many of the changes wrought in the brain by chronic drug exposure. ΔFosB is also induced in D1-type NAc MSNs by chronic consumption of several natural rewards, including sucrose, high fat food, sex, wheel running, where it promotes that consumption14,26–30. This implicates ΔFosB in the regulation of natural rewards under normal conditions and perhaps during pathological addictive-like states.|vauthors=Robison AJ, Nestler EJ}}</ref><ref name="Natural and drug addictions">{{cite journal|author=Olsen CM|date=December 2011|title=Natural rewards, neuroplasticity, and non-drug addictions|journal=Neuropharmacology|volume=61|issue=7|pages=1109–22|doi=10.1016/j.neuropharm.2011.03.010|pmc=3139704|pmid=21459101}}</ref> – despite any negative consequences to the person's physical, mental, social or financial well-being.<ref name="SteinHollander2009">{{cite book |first1=Dan J. |last1=Stein |first2=Eric |last2=Hollander |first3=Barbara Olasov |last3=Rothbaum |title=Textbook of Anxiety Disorders |url=https://books.google.com/books?id=quQY1R8vsZcC&pg=PA359 |access-date=24 April 2010 |date=31 August 2009 |publisher=American Psychiatric Pub |isbn=978-1-58562-254-2|pages=359–}}</ref> In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.<ref name="Nestler" /><ref name="Natural and drug addictions" /><ref name="ΔFosB reward">{{cite journal|year=2012|title=Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms|journal=Journal of Psychoactive Drugs|volume=44|issue=1|pages=38–55|doi=10.1080/02791072.2012.662112|pmc=4040958|pmid=22641964|quote=It has been found that deltaFosB gene in the NAc is critical for reinforcing effects of sexual reward. Pitchers and colleagues (2010) reported that sexual experience was shown to cause DeltaFosB accumulation in several limbic brain regions including the NAc, medial pre-frontal cortex, VTA, caudate, and putamen, but not the medial preoptic nucleus. Next, the induction of c-Fos, a downstream (repressed) target of DeltaFosB, was measured in sexually experienced and naive animals. The number of mating-induced c-Fos-IR cells was significantly decreased in sexually experienced animals compared to sexually naive controls. Finally, DeltaFosB levels and its activity in the NAc were manipulated using viral-mediated gene transfer to study its potential role in mediating sexual experience and experience-induced facilitation of sexual performance. Animals with DeltaFosB overexpression displayed enhanced facilitation of sexual performance with sexual experience relative to controls. In contrast, the expression of DeltaJunD, a dominant-negative binding partner of DeltaFosB, attenuated sexual experience-induced facilitation of sexual performance, and stunted long-term maintenance of facilitation compared to DeltaFosB overexpressing group. Together, these findings support a critical role for DeltaFosB expression in the NAc in the reinforcing effects of sexual behavior and sexual experience-induced facilitation of sexual performance. ... both drug addiction and sexual addiction represent pathological forms of neuroplasticity along with the emergence of aberrant behaviors involving a cascade of neurochemical changes mainly in the brain's rewarding circuitry.|vauthors=Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar-Berman M, Gold M}}</ref>
Addiction canonically refers to substance abuse; however, the term's connotation has been expanded to include behaviors that may lead to a reward (such as gambling, eating, or shopping)<ref>{{Cite journal |last=Holden |first=Constance |date=2001-11-02 |title='Behavioral' Addictions: Do They Exist? |journal=Science |language=en |volume=294 |issue=5544 |pages=980–982 |doi=10.1126/science.294.5544.980 |issn=0036-8075 |pmid=11691967 |s2cid=27235598}}</ref> since the 1990s. In addition, modern brain scan technologies have suggested that chemical and experience rewards have virtually identical reactions on the organ. Through this reward system, the brain becomes vulnerable to the possible risk of being trapped in compulsions.<ref>{{Cite journal |last=Holden |first=Constance |date=2001 |title='Behavioral' Addictions: Do They Exist? |url=https://www.jstor.org/stable/3084922 |journal=Science |volume=294 |issue=5544 |pages=980–982 |issn=0036-8075}}</ref> Such findings imply that addiction may be partially based on behavior rather than solely on chemical processes, given the fact that some behaviors can also have negative impacts on an individual’s brain. Still, the framework to diagnose and categorize behavioral addiction is a controversial topic in the psychopathology field.<ref>{{Cite journal |last=Starcevic |first=Vladan |date=August 2016 |title=Behavioural addictions: A challenge for psychopathology and psychiatric nosology |journal=The Australian and New Zealand Journal of Psychiatry |volume=50 |issue=8 |pages=721–725 |doi=10.1177/0004867416654009 |issn=1440-1614 |pmid=27357713|s2cid=22843151 }}</ref><ref>{{Cite journal |last1=Pinna |first1=F. |last2=Dell'Osso |first2=B. |last3=Di Nicola |first3=M. |last4=Janiri |first4=L. |last5=Altamura |first5=A.C. |last6=Carpiniello |first6=B. |last7=Hollander |first7=E. |date=1 Dec 2015 |title=Behavioural addictions and the transition from DSM-IV-TR to DSM-5 |url=http://www.paolocianconi.it/documenti/articoli/Journal%20of%20P.%20SOPSI.pdf#page=76 |journal=Journal of Psychopathology |volume=21 |issue=4 |pages=380–389 |archive-date=12 October 2023 |access-date=5 October 2023 |archive-url=https://web.archive.org/web/20231012202430/http://www.paolocianconi.it/documenti/articoli/Journal%20of%20P.%20SOPSI.pdf#page=76 }}</ref>
==Psychiatric and medical classifications== ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM) recognized behavioral addictions for the first time in DSM-5 with gambling disorder, formerly pathological gambling, as the only non-substance-related disorder classified under the chapter of "Substance-Related and Addictive Disorders".<ref>{{Cite book |last=Petry |first=Nancy |title=Behavioral Addictions: DSM-5 and Beyond |publisher=Oxford University Press |year=2015 |isbn=978-0-19-939155-4 |pages=1–5 |language=en}}</ref> Internet gaming addiction was included in the appendix as a condition for further study.<ref>{{cite journal |last1=Kuss |first1=Daria |year=2013 |title=Internet gaming addiction: current perspectives |journal=Psychology Research and Behavior Management |volume=6 |issue=6 |pages=125–137 |doi=10.2147/PRBM.S39476 |pmc=3832462 |pmid=24255603 |doi-access=free}}</ref> Although "addiction" is commonly used to describe repetitive harmful behavior in nonmedical settings,<ref>{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2022-03-18 |publisher=American Psychiatric Association Publishing |isbn=978-0-89042-575-6 |edition=DSM-5-TR |page=914 |language=en |doi=10.1176/appi.books.9780890425787|s2cid=249488050 }}</ref> DSM-5 recommended the neutral term "disorder" instead of "addiction" under the clinical settings to avoid uncertain definition and potentially negative connotation.<ref name=":0">{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2022-03-18 |publisher=American Psychiatric Association Publishing |isbn=978-0-89042-575-6 |edition=DSM-5-TR |page=543 |language=en |doi=10.1176/appi.books.9780890425787|s2cid=249488050 }}</ref> Previous proposed revisions for the DSM-5 have included the removal of “binge eating disorder” from the DSM-4 appendix and creating a diagnosis in the eating disorders category. The possible implementation of a near equivalent to “sex addiction” in the form of the new diagnosis of “hypersexual disorder” being added to the sexual disorder section was also proposed. As well as considerations for the gray area that is presented when defining “addiction” and “compulsion” as terms. Along with discussions to limit the term “addiction” to substances as they are more identifiable than behaviors, and the classifying of all drinking problems into “alcohol use disorder” as there are possible subcategories that may necessitate individual treatment and analysis.<ref>{{Cite journal |last=Holden |first=Constance |date=2010 |title=Behavioral Addictions Debut in Proposed DSM-V |url=https://www.jstor.org/stable/40509930 |journal=Science |volume=327 |issue=5968 |pages=935–935 |issn=0036-8075}}</ref>
Similar to the changes in DSM-5'','' the eleventh revision of the International Classification of Diseases (ICD-11) introduced the category "Disorders due to substance use or addictive behaviours", based on the diagnostic framework of impaired control, repetitive harmful behavior, and continuation or escalation despite negative consequences.<ref name=":1">{{Cite journal |last1=Stein |first1=Dan J. |last2=Szatmari |first2=Peter |last3=Gaebel |first3=Wolfgang |last4=Berk |first4=Michael |last5=Vieta |first5=Eduard |last6=Maj |first6=Mario |last7=de Vries |first7=Ymkje Anna |last8=Roest |first8=Annelieke M. |last9=de Jonge |first9=Peter |last10=Maercker |first10=Andreas |last11=Brewin |first11=Chris R. |last12=Pike |first12=Kathleen M. |last13=Grilo |first13=Carlos M. |last14=Fineberg |first14=Naomi A. |last15=Briken |first15=Peer |date=27 January 2020 |title=Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies |journal=BMC Medicine |language=en |volume=18 |issue=1 |page=21 |doi=10.1186/s12916-020-1495-2 |issn=1741-7015 |pmc=6983973 |pmid=31983345 |doi-access=free }}</ref> The new sub-category "Disorders due to addictive behaviours" included gambling disorder (formerly under the habit and impulse disorders), gaming disorder (a new diagnosis), and two residual categories (other specified and unspecified) to raise attention among clinicians and the public and to facilitate further research.<ref name=":1" /><ref>{{Cite web |date=2022 |title=International Classification of Diseases Eleventh Revision (ICD-11) |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/499894965 |access-date=2023-10-05 |website=World Health Organization |language=en |publication-place=Geneva}}</ref>
In 2019, the American Society of Addiction Medicine (ASAM) revised its definition of addiction including substance use and compulsive behaviors, stating: "addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences."<ref>{{Cite web |date=15 September 2019 |title=What is the Definition of Addiction? |url=https://www.asam.org/quality-care/definition-of-addiction |archive-url=https://web.archive.org/web/20231001163603/https://www.asam.org/quality-care/definition-of-addiction |archive-date=1 October 2023 |access-date=2023-10-05 |website=American Society of Addiction Medicine |language=en |url-status=bot: unknown }}</ref> Other addictive behaviors which have received research attention but with insufficient or inconclusive evidence include pornography use disorder, compulsive buying disorder, social network use disorder, work addiction, exercise addiction, compulsive sexual behavior disorder, and food addiction.<ref name=":0" /><ref name=":3">{{Cite journal |last1=Brand |first1=Matthias |last2=Rumpf |first2=Hans-JÜrgen |last3=Demetrovics |first3=Zsolt |last4=MÜller |first4=Astrid |last5=Stark |first5=Rudolf |last6=King |first6=Daniel L. |last7=Goudriaan |first7=Anna E. |last8=Mann |first8=Karl |last9=Trotzke |first9=Patrick |last10=Fineberg |first10=Naomi A. |last11=Chamberlain |first11=Samuel R. |last12=Kraus |first12=Shane W. |last13=Wegmann |first13=Elisa |last14=Billieux |first14=JoËl |last15=Potenza |first15=Marc N. |date=2020-06-30 |title=Which conditions should be considered as disorders in the International Classification of Diseases (ICD-11) designation of "other specified disorders due to addictive behaviors"? |journal=Journal of Behavioral Addictions |volume=11 |issue=2 |pages=150–159 |doi=10.1556/2006.2020.00035 |issn=2062-5871 |pmc=9295220 |pmid=32634114}}</ref><ref name=":2">{{Cite journal |last=Griffiths |first=Mark D. |date=2022-07-13 |title=Disorders due to addictive behaviors: Further issues, debates, and controversies •: Commentary to the debate: "Behavioral addictions in the ICD-11" |journal=Journal of Behavioral Addictions |volume=11 |issue=2 |pages=180–185 |doi=10.1556/2006.2022.00025 |issn=2062-5871 |pmc=9295243 |pmid=35895451}}</ref><ref>{{Cite journal |last1=Hauck |first1=Carolin |last2=Cook |first2=Brian |last3=Ellrott |first3=Thomas |date=20 November 2019 |title=Food addiction, eating addiction and eating disorders |journal=Proceedings of the Nutrition Society |language=en |publisher=Cambridge University Press |volume=79 |issue=1 |pages=103–112 |doi=10.1017/S0029665119001162 |pmid=31744566 |s2cid=208186539 |issn=0029-6651|doi-access=free }}</ref>
==Types==
===Exercise addiction=== {{main|Exercise addiction}} Exercise addiction is a state characterized by a compulsive engagement in any form of physical exercise, despite negative consequences. While regular exercise is generally a healthy activity, exercise addiction generally involves performing excessive amounts of exercise to the detriment of physical health, spending too much time exercising to the detriment of personal and professional life, and exercising regardless of physical injury.<ref name="Exercise addiction review">{{cite journal | vauthors = Landolfi E | title = Exercise addiction | journal = Sports Med | volume = 43 | issue = 2 | pages = 111–9 | year = 2013 | pmid = 23329605 | doi = 10.1007/s40279-012-0013-x | s2cid = 35726964 }}</ref><ref name=Demetrovics/><ref name=Sussman>{{cite journal |vauthors=Sussman S, Lisha N, Griffiths M |title=Prevalence of the addictions: a problem of the majority or the minority? |journal=Eval Health Prof |volume=34 |issue=1 |pages=3–56 |date=March 2011 |pmid=20876085 |pmc=3134413 |doi=10.1177/0163278710380124}}</ref> It may also involve a state of dependence upon regular exercise which involves the occurrence of severe withdrawal symptoms when the individual is unable to exercise.<ref name="Exercise addiction review" /> Differentiating between addictive and healthy exercise behaviors is difficult but there are key factors in determining which category a person may fall into.<ref name=Krivoschekov>{{cite journal |vauthors=Krivoshchekov SG, Lushnikov ON |title=[Psychophysiology of sports addiction (exercises addiction)] |language=ru |journal=Fiziol Cheloveka |volume=37 |issue=4 |pages=135–40 |year=2011 |pmid=21950095 |doi=10.1134/S0362119711030030|s2cid=20543670 }}</ref> Exercise addiction shows a high comorbidity with eating disorders.<ref name=Demetrovics>{{cite journal |vauthors=Demetrovics Z, Kurimay T |title=[Exercise addiction: a literature review] |language=hu |journal=Psychiatr Hung |volume=23 |issue=2 |pages=129–41 |year=2008 |pmid=18956613 }}</ref>
Exercise addiction is not listed as a disorder in the fourth revision of the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM-IV). This type of addiction can be classified under a behavioral addiction in which a person's behavior becomes obsessive, compulsive, or causes dysfunction in a person's life.<ref name=Villella>{{MEDRS|date=November 2011}}<!--this is a primary study, used incorrectly in this article-->{{cite journal |vauthors=Villella C, Martinotti G, Di Nicola M |title=Behavioural addictions in adolescents and young adults: results from a prevalence study |journal=J Gambl Stud |volume=27 |issue=2 |pages=203–14 |date=June 2011 |pmid=20559694 |doi=10.1007/s10899-010-9206-0|s2cid=19239770 |display-authors=etal}}</ref>
===Gambling addiction=== {{main|Problem gambling}}Problem gambling, ludopathy<ref>{{Cite book |last=Zollinger |first=Manfred |url=https://books.google.com/books?id=3f_dCwAAQBAJ |title=Random Riches: Gambling Past & Present |date=2016-03-31 |publisher=Routledge |isbn=978-1-317-07156-3 |page=34 |access-date=2024-10-30}}</ref> or ludomania is repetitive gambling behavior despite harm and negative consequences. Problem gambling may be diagnosed as a mental disorder according to DSM-5 if certain diagnostic criteria are met. Pathological gambling is a common disorder associated with social and family costs. Estimates suggest the affected global population is between 0.1% and 6%.<ref name=":4">{{Cite journal |last=Li |first=Zhaolan |last2=He |first2=Quanxing |last3=Elhai |first3=Jon D. |last4=Montag |first4=Christian |last5=Yang |first5=Haibo |date=2025-03-28 |title=Neural mechanisms of behavioral addiction: An ALE meta-analysis and MACM analysis |url=https://akjournals.com/view/journals/2006/14/1/article-p18.xml |journal=Journal of Behavioral Addictions |volume=14 |issue=1 |pages=18–38 |doi=10.1556/2006.2024.00082 |issn=2062-5871 |pmc=11974436 |pmid=39853319}}</ref>
The DSM-5 has re-classified the condition as an addictive disorder, with those affected exhibiting many similarities to those with substance addictions. The term ''gambling addiction'' has long been used in the recovery movement.<ref>{{cite book |last=Eades |first=John |year=2003 |title=Gambling Addiction: The Problem, the Pain, and the Path to Recovery |publisher=Vine Books |isbn=978-0-8307-3425-2 |url-access=registration |url=https://archive.org/details/gamblingaddictio00john }}{{Page needed |date=May 2012}}</ref> Pathological gambling was long considered by the American Psychiatric Association to be an impulse-control disorder rather than an addiction.<ref>{{cite journal |last=Petry |first=Nancy |title=Should the Scope of Addictive Behaviors be Broadened to Include Pathological Gambling? |journal=Addiction |date=September 2006 |volume=101 |issue=s1 |doi=10.1111/j.1360-0443.2006.01593.x |pages=152–60 |pmid=16930172 }}</ref> However, data suggests a closer relationship between pathological gambling and substance use disorders than exists between PG and obsessive–compulsive disorder, mainly because the behaviors in problem gambling and most primary substance use disorders (i.e., those not resulting from a desire to "self-medicate" for another condition such as depression) seek to activate the brain's reward mechanisms, while the behaviors characterizing obsessive-compulsive disorder are prompted by overactive and misplaced signals from the brain's fear mechanisms.<ref>{{cite journal |last1=Potenza |first1=M. N. |title=The neurobiology of pathological gambling and drug addiction: an overview and new findings |journal=Philosophical Transactions of the Royal Society B: Biological Sciences |date=12 October 2008 |volume=363 |issue=1507 |pages=3181–3189 |doi=10.1098/rstb.2008.0100 |pmc=2607329 |pmid=18640909}}</ref>
Problem gambling is an addictive behavior with a high comorbidity with alcohol problems.<ref>{{Cite journal |last1=Grant |first1=Jon E. |last2=Chamberlain |first2=Samuel R. |date=2020-04-20 |title=Gambling and substance use: Comorbidity and treatment implications |url=https://www.sciencedirect.com/science/article/abs/pii/S0278584619307456 |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=99 |article-number=109852 |doi=10.1016/j.pnpbp.2019.109852 |pmid=31881248 |issn=0278-5846|url-access=subscription }}</ref> A common tendency shared by people who have a gambling addiction is impulsivity.
===Internet addiction=== {{Excerpt|Internet addiction disorder}}Internet addiction has also been suggested to have negative effects and lead to harmful behavior in circumstances in which overuse or misuse of technology is present.<ref>{{Cite journal |last=Chou |first=Chien |last2=Condron |first2=Linda |last3=Belland |first3=John C. |date=2005 |title=A Review of the Research on Internet Addiction |url=https://www.jstor.org/stable/23363971 |journal=Educational Psychology Review |volume=17 |issue=4 |pages=363–388 |issn=1040-726X}}</ref> In terms of stability and change regarding internet addiction, the relationship between psychological well-being and internet use has been suggested to change over time depending on age.<ref>{{Cite journal |last=Huang |first=Chiungjung |date=2010 |title=Internet addiction: stability and change |url=https://www.jstor.org/stable/23421688 |journal=European Journal of Psychology of Education |volume=25 |issue=3 |pages=345–361 |issn=0256-2928}}</ref> Internet addiction rates have also been on the rise, becoming a public health concern among young adults, specifically in association with mental health disturbances in college students.<ref>{{Cite journal |last=Tang |first=Catherine So-Kum |last2=Koh |first2=Yee Woen |last3=Gan |first3=YiQun |date=2017 |title=Addiction to Internet Use, Online Gaming, and Online Social Networking Among Young Adults in China, Singapore, and the United States |url=https://www.jstor.org/stable/27009061 |journal=Asia Pacific Journal of Public Health |volume=29 |issue=8 |pages=673–682 |issn=1010-5395}}</ref>
Research has additionally categorized patterns of internet addiction as general or more specific in terms of internet applications, suggesting that certain applications may be predictors of internet addiction.<ref>{{Cite journal |last=Huang |first=Chiungjung |date=2010 |title=Internet addiction: stability and change |url=https://www.jstor.org/stable/23421688 |journal=European Journal of Psychology of Education |volume=25 |issue=3 |pages=345–361 |issn=0256-2928}}</ref>
===Pornography addiction=== {{Excerpt|Porn addiction}}
===Sexual addiction=== {{Excerpt|Sexual addiction}}Some research has discussed the term of “internet sex addiction” as a way to define a medium of expression in which anonymity and disinhibition increase excessive participation in online sexual behaviors, though there is not much data to back this claim it is still believed that such a condition does exists and needs further study.<ref>{{Cite journal |last=Griffiths |first=Mark |date=2001 |title=Sex on the Internet: Observations and Implications for Internet Sex Addiction |url=https://www.jstor.org/stable/3813457 |journal=The Journal of Sex Research |volume=38 |issue=4 |pages=333–342 |issn=0022-4499}}</ref>
Further perspectives on sex addiction have suggested that it is a social construction which only becomes harmful when it is perceived and defined as a problem of sexual ambivalence, this implies that it should not be classified as a medical disorder.<ref>{{Cite journal |last=Irvine |first=Janice M. |date=1995 |title=Reinventing Perversion: Sex Addiction and Cultural Anxieties |url=https://www.jstor.org/stable/4617181 |journal=Journal of the History of Sexuality |volume=5 |issue=3 |pages=429–450 |issn=1043-4070}}</ref>
===Shopping addiction=== {{Excerpt|Shopping addiction}}
===Video game addiction=== {{Excerpt|Video game addiction}}Internet gaming disorder (IGD) affects an estimated 5% of the global population.<ref name=":4" />
Multiplayer games are created in a way to encourage engagement which can be a positive experience, but it can negatively affect individuals with low self-esteem and real-world problems such as unfulfilled needs in the way of connecting with other individuals.<ref>{{Cite journal |last=Holt |first=Nicholas A. |last2=Kleiber |first2=Douglas A. |date=2009 |title=The Sirens' Song of Multiplayer Online Games |url=https://www.jstor.org/stable/10.7721/chilyoutenvi.19.1.0223 |journal=Children, Youth and Environments |volume=19 |issue=1 |pages=223–244 |doi=10.7721/chilyoutenvi.19.1.0223 |issn=1546-2250}}</ref> Intervention strategies that are proposed to treat gaming addiction include support groups and screening instruments such as Young’s Diagnostic Questionnaire and the On-Line Gamers Anonymous Web site.<ref>{{Cite journal |last=Hagedorn |first=W. Bryce |last2=Young |first2=Tabitha |date=2011 |title=Identifying and Intervening with Students Exhibiting Signs of Gaming Addiction and other Addictive Behaviors: Implications for Professional School Counselors |url=https://www.jstor.org/stable/42732906 |journal=Professional School Counseling |volume=14 |issue=4 |pages=250–260 |issn=1096-2409}}</ref>
The question of whether gaming addiction is truly an addiction is still relevant, as the way it is defined is still being developed to understand how much attention should be given to the condition.<ref>{{Cite journal |last=Zastrow |first=Mark |date=2017 |title=Is video game addiction really an addiction?: Adding video gaming to the list of recognized behavioral addictions could help millions in need. It could also pathologize a normal behavior and create a new stigma |url=https://www.jstor.org/stable/26480727 |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=114 |issue=17 |pages=4268–4272 |issn=0027-8424}}</ref>
===Work addiction=== {{Excerpt|Work addiction}}
==Treatment==
Behavioral addiction is a treatable condition.<ref>{{cite book |last1=Rosenberg |first1=Kenneth Paul |chapter=An Introduction to Behavioral Addictions |date=2014 |title=Behavioral Addictions |pages=1–17 |publisher=Elsevier |last2=Feder |first2=Laura Curtiss|doi=10.1016/b978-0-12-407724-9.00001-x |isbn=978-0-12-407724-9 }}</ref> Treatment options include psychotherapy and psychopharmacotherapy (i.e., medications) or a combination of both. Cognitive behavioral therapy (CBT) is the most common form of psychotherapy used in treating behavioral addictions; it focuses on identifying patterns that trigger compulsive behavior and making lifestyle changes to promote healthier behaviors. Because cognitive behavioral therapy is considered a short-term therapy, the number of sessions for treatment normally ranges from five to twenty.<ref>{{Cite journal |last=Bannink |first=F. P. |date=2013-06-26 |title=Positive CBT: From Reducing Distress to Building Success |journal=Journal of Contemporary Psychotherapy |volume=44 |issue=1 |pages=1–8 |doi=10.1007/s10879-013-9239-7 |s2cid=24029889 |issn=0022-0116}}</ref> During the session, therapists will lead patients through the topics of identifying the issue, becoming aware of one's thoughts surrounding the issue, identifying any negative or false thinking, and reshaping said negative and false thinking. While CBT does not cure behavioral addiction, it does help with coping with the condition in a healthy way. Currently, there are no medications approved for treatment of behavioral addictions in general, but some medications used for treatment of drug addiction may also be beneficial with specific behavioral addictions.<ref name="Behavioral addictions">{{cite journal | vauthors = Grant JE, Potenza MN, Weinstein A, Gorelick DA | title = Introduction to behavioral addictions | journal = Am. J. Drug Alcohol Abuse | volume = 36 | issue = 5 | pages = 233–241 | date = September 2010 | pmid = 20560821 | pmc = 3164585 | doi = 10.3109/00952990.2010.491884 | quote = Naltrexone, a mu-opioid receptor antagonist approved by the US Food and Drug Administration for the treatment of alcoholism and opioid dependence, has shown efficacy in controlled clinical trials for the treatment of pathological gambling and kleptomania (76–79), and promise in uncontrolled studies of compulsive buying (80), compulsive sexual behavior (81), internet addiction (82), and pathologic skin picking (83). ... Topiramate, an anti-convulsant which blocks the AMPA subtype of glutamate receptor (among other actions), has shown promise in open-label studies of pathological gambling, compulsive buying, and compulsive skin picking (85), as well as efficacy in reducing alcohol (86), cigarette (87), and cocaine (88) use. N-acetyl cysteine, an amino acid that restores extracellular glutamate concentration in the nucleus accumbens, reduced gambling urges and behavior in one study of pathological gamblers (89), and reduces cocaine craving (90) and cocaine use (91) in cocaine addicts. These studies suggest that glutamatergic modulation of dopaminergic tone in the nucleus accumbens may be a mechanism common to behavioral addiction and substance use disorders (92).}}</ref><ref>[https://www.betterliferecovery.com/ Better Life Recovery]</ref>
Another form of treatment is recreational therapy. A Certified Therapeutic Recreation Specialist (CTRS) uses leisure and recreation to help individuals recover from their injuries, ailments, or addictions. Therapeutic recreation can help an individual struggling with addiction to improve their self-esteem, confidence, motivation, resiliency, autonomy, enjoyment, and overall emotional state.<ref>{{Cite journal |last1=Litchke |first1=Lyn Gorbett |last2=Quinn |first2=Bonnie |last3=Turner |first3=Kassandra |last4=Trapp |first4=Kelci |date=2022-04-03 |title=Therapeutic Recreation Activities Combined with a 12-Step Faith-Based Program for Adults Experiencing Addiction, Mental Health, and Homelessness: A Case Study |url=https://www.tandfonline.com/doi/full/10.1080/07347324.2021.1981181 |journal=Alcoholism Treatment Quarterly |language=en |volume=40 |issue=2 |pages=217–228 |doi=10.1080/07347324.2021.1981181 |issn=0734-7324|url-access=subscription }}</ref><ref>{{Cite web |last=Staff |first=Lakeview Health |date=2021-07-19 |title=How Therapeutic Recreation Helps With Addiction Treatment |url=https://www.lakeviewhealth.com/blog/how-therapeutic-recreation-helps-with-addiction-recovery/ |access-date=2024-10-22 |website=Lakeview Health |language=en}}</ref>
==Research==
The classification and diagnostic framework of behavioral addictions under DSM-5 and ICD-11 has been a controversial subject among the clinical research field.<ref name=":2" /> For example, this 2020 narrative review<ref name=":3" /> considered ICD-11's guidelines to be adequate to include more behavioral addictions based on clinical relevance and empirical evidence, while this 2015 journal article questioned<ref>{{Cite journal |last1=Billieux |first1=Joël |last2=Schimmenti |first2=Adriano |last3=Khazaal |first3=Yasser |last4=Maurage |first4=Pierre |last5=Heeren |first5=Alexandre |date=2015-05-27 |title=Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research |journal=Journal of Behavioral Addictions |language=en |volume=4 |issue=3 |pages=119–123 |doi=10.1556/2006.4.2015.009 |issn=2062-5871 |pmc=4627665 |pmid=26014667}}</ref> the atheoretical and confirmatory research approaches on the accuracy of qualitative factors and criticized the lack of consideration of social elements and psychological processes.
A recent narrative review<ref>{{Cite journal|last1=Starcevic|first1=Vladan|last2=Khazaal|first2=Yasser|date=2017-04-07|title=Relationships between Behavioural Addictions and Psychiatric Disorders: What Is Known and What Is Yet to Be Learned?|journal=Frontiers in Psychiatry|volume=8|page=53|doi=10.3389/fpsyt.2017.00053|pmid=28439243|pmc=5383701|issn=1664-0640|doi-access=free}}</ref> in 2017 examined the existing literature for studies reporting associations between behavioral addictions (e.g., pathological gambling, problematic internet use, problematic online gaming, compulsive sexual behavior disorder, compulsive buying, and exercise addiction) and psychiatric disorders. Overall, there is solid evidence for associations between behavioral addictions and mood disorders, anxiety disorders, as well as substance use disorders. Associations between ADHD may be specific to problematic internet use and problematic online gaming. The authors also conclude that most of current research on the association between behavioral addictions and psychiatric disorders has several limitations: they are mostly cross-sectional, are not from representative samples, and are often based on small samples, among others. Especially more longitudinal studies are needed to establish the direction of causation, i.e. whether behavioral addictions are a cause or a consequence of psychiatric disorders.
A systematic review in 2021 investigating the correlation between autism and behavioral addiction<ref>{{Cite journal |pmid=34325098 |date=2021 |last1=Kervin |first1=R. |last2=Berger |first2=C. |last3=Moon |first3=S. J. |last4=Hill |first4=H. |last5=Park |first5=D. |last6=Kim |first6=J. W. |title=Behavioral addiction and autism spectrum disorder: A systematic review |journal=Research in Developmental Disabilities |volume=117 |article-number=104033 |doi=10.1016/j.ridd.2021.104033 }}</ref> found inconclusive evidence for a general correlation. However found evidence of correlation when comorbid mental health conditions were present. Another systematic review in 2022 estimating the prevalence of behavioural addiction during the COVID-19 pandemic<ref>{{Cite journal |pmc=9465150 |date=2022 |last1=Alimoradi |first1=Z. |last2=Lotfi |first2=A. |last3=Lin |first3=C. Y. |last4=Griffiths |first4=M. D. |last5=Pakpour |first5=A. H. |title=Estimation of Behavioral Addiction Prevalence During COVID-19 Pandemic: A Systematic Review and Meta-analysis |journal=Current Addiction Reports |volume=9 |issue=4 |pages=486–517 |doi=10.1007/s40429-022-00435-6 |pmid=36118286 }}</ref> found the prevalence to be 11.1%.
== Behavioral addiction and the brain == Several recently published studies have investigated potential brain abnormalities associated with behavioral addiction. A 2024 meta-analysis of neuroimaging studies related to specific types of behavioral addiction aimed to distinguish whether subtypes of behavioral addiction share a common neural basis. It found that research subjects affected by various behavioral addictions demonstrate similarities in the role of the frontostriatal circuits. Findings confirmed previous studies, highlighting the role of hyperactivation in the bilateral caudate nucleus, a part of the basal ganglia. Likewise, hyperactivation of the right inferior frontal gyrus (IFG) and left middle frontal gyrus (MFG), both located in the brain's frontal lobe, was observed.<ref>{{Cite journal |last=Li |first=Zhaolan |last2=He |first2=Quanxing |last3=Elhai |first3=Jon D. |last4=Montag |first4=Christian |last5=Yang |first5=Haibo |date=2025-03-28 |title=Neural mechanisms of behavioral addiction: An ALE meta-analysis and MACM analysis |url=https://akjournals.com/view/journals/2006/14/1/article-p18.xml |journal=Journal of Behavioral Addictions |volume=14 |issue=1 |pages=18–38 |doi=10.1556/2006.2024.00082 |issn=2062-5871 |pmc=11974436 |pmid=39853319}}</ref>
A similar 2024 meta-analysis likewise identified abnormalities in cortical thickness among subjects affected by differing behavioral addictions. These subjects were noted to have a thinner cerebral cortex than individuals without behavioral addiction. Areas of the cerebral cortex affected were specifically the precuneus, postcentral gyrus, orbital-frontal cortex, and dorsolateral prefrontal cortex. An association between these areas and specific genes thought to be involved in dopamine metabolism and behavioral regulation was identified, the most significant of which was the dopamine D2 receptor. Additionally, researchers found that increased severity of behavioral addiction was linked to increased thinning of the cerebral cortex within the precuneus and postcentral gyrus.<ref>{{Cite journal |last=Xie |first=Hongsheng |last2=Wang |first2=Yuanyuan |last3=Zhu |first3=Fei |last4=Zhang |first4=Feifei |last5=Wu |first5=Baolin |last6=Zhao |first6=Ziru |last7=Gan |first7=Ruoqiu |last8=Gong |first8=Qiyong |last9=Jia |first9=Zhiyun |date=2024-07-03 |title=Genes associated with cortical thickness alterations in behavioral addiction |url=https://academic.oup.com/cercor/article/doi/10.1093/cercor/bhae298/7720605 |journal=Cerebral Cortex |language=en |volume=34 |issue=7 |doi=10.1093/cercor/bhae298 |issn=1047-3211|url-access=subscription }}</ref>
Likewise, a 2023 meta-analysis found that subjects affected by differing behavioral addictions demonstrated similarities in gray matter volume, specifically a marked loss of gray matter volume in the anterior cingulate cortex, middle cingulate cortex, and superior frontal gyrus. This decrease in gray matter volume is associated with a decrease in brain connectivity. The meta-analysis suggests that this lack of gray matter could be associated with behavioral aspects of behavioral addiction, such as inhibition.<ref>{{Cite journal |last=Zeng |first=Xinglin |last2=Han |first2=Xinyang |last3=Gao |first3=Fei |last4=Sun |first4=Yinghao |last5=Yuan |first5=Zhen |date=2023-10-05 |title=Abnormal structural alterations and disrupted functional connectivity in behavioral addiction: A meta-analysis of VBM and fMRI studies |url=https://akjournals.com/view/journals/2006/12/3/article-p599.xml |journal=Journal of Behavioral Addictions |volume=12 |issue=3 |pages=599–612 |doi=10.1556/2006.2023.00025 |issn=2062-5871 |pmc=10562811 |pmid=37505987}}</ref>
==Addiction and the reward system== {{main|ΔFosB|Reward system}}
ΔFosB, a gene transcription factor, has been identified as playing a critical role in the development of addictive states in both behavioral addictions and drug addictions.<ref name="Nestler" /><ref name="Natural and drug addictions" /><ref name="ΔFosB reward" /> Overexpression of ΔFosB in the nucleus accumbens is necessary and sufficient for many of the neural adaptations seen in drug addiction;<ref name="Nestler" /> it has been implicated in addictions to alcohol, cannabinoids, cocaine, nicotine, phenylcyclidine, and substituted amphetamines<ref name="Nestler" /><ref name="Nestler, Hyman, and Malenka 2">{{cite journal|year=2006|title=Neural mechanisms of addiction: the role of reward-related learning and memory|journal=Annu. Rev. Neurosci.|volume=29|pages=565–598|doi=10.1146/annurev.neuro.29.051605.113009|pmid=16776597|vauthors=Hyman SE, Malenka RC, Nestler EJ|s2cid=15139406}}</ref><ref name="Addiction genetics">{{cite journal|date=January 2013|title=Addiction-related gene regulation: risks of exposure to cognitive enhancers vs. other psychostimulants|journal=Prog. Neurobiol.|volume=100|pages=60–80|doi=10.1016/j.pneurobio.2012.10.001|pmc=3525776|pmid=23085425|vauthors=Steiner H, Van Waes V}}</ref><ref name="Alcoholism ΔFosB">{{cite web|url=http://www.genome.jp/kegg-bin/show_pathway?hsa05034+2354|title=Alcoholism – Homo sapiens (human)|author=Kanehisa Laboratories|date=2 August 2013|website=KEGG Pathway|access-date=10 April 2014}}</ref> as well as addictions to natural rewards such as sex, exercise, and food.<ref name="Natural and drug addictions" /><ref name="ΔFosB reward" /> A recent study also demonstrated a cross-sensitization between drug reward (amphetamine) and a natural reward (sex) that was mediated by ΔFosB.<ref name="Amph and sex addiction">{{cite journal|date=February 2013|title=Natural and drug rewards act on common neural plasticity mechanisms with ΔFosB as a key mediator|journal=J. Neurosci.|volume=33|issue=8|pages=3434–42|doi=10.1523/JNEUROSCI.4881-12.2013|pmc=3865508|pmid=23426671|quote=Together, these findings demonstrate that drugs of abuse and natural reward behaviors act on common molecular and cellular mechanisms of plasticity that control vulnerability to drug addiction, and that this increased vulnerability is mediated by ΔFosB and its downstream transcriptional targets.|vauthors=Pitchers KK, Vialou V, Nestler EJ, Laviolette SR, Lehman MN, Coolen LM}}</ref>
One of the major areas of study is the amygdala, a brain structure which involves emotional significance and associated learning. Research shows that dopaminergic projections from the ventral tegmental area facilitate a motivational or learned association to a specific behavior.<ref>{{cite journal|last1=Brewer|first1=Judson A.|last2=Potenza|first2=Marc N.|year=2008|title=The neurobiology and genetics of impulse control disorders: Relationships to drug addictions|journal=Biochemical Pharmacology|volume=75|issue=1|pages=63–75|doi=10.1016/j.bcp.2007.06.043|pmc=2222549|pmid=17719013}}</ref> Dopamine neurons take a role in the learning and sustaining of many acquired behaviors. Research specific to Parkinson's disease has led to identifying the intracellular signaling pathways that underlie the immediate actions of dopamine. The most common mechanism of dopamine is to create addictive properties along with certain behaviors.<ref>{{cite journal|last1=Girault|first1=Jean-Antoine|last2=Greengard|first2=P|year=2004|title=The Neurobiology of Dopamine Signaling|journal=Archives of Neurology|volume=61|issue=5|pages=641–4|doi=10.1001/archneur.61.5.641|pmid=15148138|doi-access=free}}</ref> There are three stages to the dopamine reward system: bursts of dopamine, triggering of behavior, and further impact to the behavior. Once electronically signaled, possibly through the behavior, dopamine neurons let out a 'burst-fire' of elements to stimulate areas along fast transmitting pathways. The behavior response then perpetuates the striated neurons to further send stimuli. The fast firing of dopamine neurons can be monitored over time by evaluating the amount of extracellular concentrations of dopamine through micro dialysis and brain imaging. This monitoring can lead to a model in which one can see the multiplicity of triggering over a period of time.<ref name="dichiara">{{cite journal|last1=Dichiara|first1=G|last2=Bassareo|first2=V|year=2007|title=Reward system and addiction: What dopamine does and doesn't do|journal=Current Opinion in Pharmacology|volume=7|issue=1|pages=69–76|doi=10.1016/j.coph.2006.11.003|pmid=17174602}}</ref> Once the behavior is triggered, it is hard to work away from the dopamine reward system.
Behaviors like gambling have been linked to the newfound idea of the brain's capacity to anticipate rewards. The reward system can be triggered by early detectors of the behavior, and trigger dopamine neurons to begin stimulating behaviors. But in some cases, it can lead to many issues due to error, or reward-prediction errors. These errors can act as teaching signals to create a complex behavior task over time.<ref name="dichiara" />
==See also== *Addictive behavior *Addictive personality *{{slink|ANKK1|Addictive behaviors}} *Habit
==References== {{reflist|2}} {{sfn whitelist|CITEREFNeves2021}}
==External links== *{{Commons category-inline}} *{{YouTube|eqOIlscDfYI|Valerie Voon – Impulse control disorders – behavioural addictions – insights from dopaminergic ...}} Technical review of biomolecular-neurobehavioral research
{{Addiction|state=expanded}} {{Digital media use and mental health}} {{Authority control}}
Category:Behavioral addiction Category:Mass psychogenic illness Category:Addiction Category:Conformity Category:Social influence