Behavioural addiction—A rising tide?

Abstract

The term 'addiction' was traditionally used in relation to centrally active substances, such as cocaine, alcohol, or nicotine. Addiction is not a unitary construct but rather incorporates a number of features, such as repetitive engagement in behaviours that are rewarding (at least initially), loss of control (spiralling engagement over time), persistence despite untoward functional consequences, and physical dependence (evidenced by withdrawal symptoms when intake of the substance diminishes). It has been suggested that certain psychiatric disorders characterized by maladaptive, repetitive behaviours share parallels with substance addiction and therefore represent 'behavioural addictions'. This perspective has influenced the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now has a category 'Substance Related and Addictive Disorders', including gambling disorder. Could other disorders characterised by repetitive behaviours, besides gambling disorder, also be considered 'addictions'? Potential examples include kleptomania, compulsive sexual behaviour, 'Internet addiction', trichotillomania (hair pulling disorder), and skin-picking disorder. This paper seeks to define what is meant by 'behavioural addiction', and critically considers the evidence for and against this conceptualisation in respect of the above conditions, from perspectives of aetiology, phenomenology, co-morbidity, neurobiology, and treatment. Research in this area has important implications for future diagnostic classification systems, neurobiological models, and novel treatment directions.

Pharmacological insights into impulsive‐compulsive spectrum disorders associated with dopaminergic therapy

“…This focus is warranted, for in each of the clinical uses of the drugs, the major risk factor for developing these disorders is indeed the dopaminergic therapy (Grall‐Bronnec et al., ). The neurobiological underpinnings for the development and maintenance of ICSD are areas of intense scientific study, and the reader is referred to several excellent recent reviews on these topics (Dalley et al., ; American Psychiatric Association, , ; Fineberg et al., ; Potenza, ; Chamberlain et al., ; Grant et al., ; van den Heuvel et al., ). Here we provide an overview of key concepts that are particularly relevant to dopamine agonist therapy.…”

Cognitive deficits in problematic internet use: meta-analysis of 40 studies

“…Conceptually, as noted above, PIU may share parallels with behavioural addiction, incorporating features such as escalating use over time, loss of control, concealing excessive use from others, failed attempts to cut back, and psychological distress when/if prevented from using the internet. 3,17 In integrating research on PIU phenomena, the interaction of person-affect-cognition-execution model was developed by Brand and colleagues. 18 Within this conceptual framework, reductions in executive functioning and inhibitory control contribute to engagement in online behaviours, leading to gratification and ultimately contributing to the emergence and persistence of PIU.…”

Interaction between trait and housing condition produces differential decision-making toward risk choice in a rat gambling task

“…Poor decision-making will eventually have harmful effects on an individual’s life, as demonstrated in people with some psychiatric conditions, such as pathological gambling and drug abuse 1–3 . Adopting the basic principle of the Iowa Gambling Task (IGT), which is widely used to assess decision-making in humans, the rodent version of the gambling task (rGT) has been developed in a few laboratories 4, 5 .…”