Psychiatrists and researchers are debating whether to broaden the definition of addiction to include behaviors beyond substance abuse, such as compulsive shopping and gaming. Currently, gambling disorder is the only officially recognized behavioral addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference guide for mental health professionals.
A recent study published in the journal Comprehensive Psychiatry suggests that compulsive shopping exhibits characteristics consistent with addiction. Researchers compared compulsive buyers to those who shop impulsively and individuals who engage in planned shopping, finding that compulsive buyers demonstrated higher levels of distress, used shopping for emotional regulation, and reported lower self-esteem, anxiety, and depression. They also showed reduced self-control. These findings, researchers argue, support classifying compulsive shopping as a behavioral addiction.
Defining what constitutes an addiction is central to this debate. Dr. Nathan Carroll, a board-certified psychiatrist and author of “Internet Gaming Disorder: A Clinical Strategy Guide for Providers, Parents, and Players,” emphasizes the degree to which a behavior disrupts an individual’s life. “When a behavior becomes so all-encompassing and so obsessive that you get functional impairment across multiple domains — socially, occupationally, educationally — that’s where it becomes an addiction,” Carroll told Live Science.
The DSM-5 outlines specific criteria for gambling disorder, requiring at least four of the following to be present within a 12-month period: a preoccupation with gambling, the necessitate to gamble with increasing amounts of money, repeated unsuccessful attempts to control or stop gambling, restlessness or irritability when trying to cut down, gambling to escape problems, returning to gambling to recoup losses, gambling when distressed, lying about gambling involvement, losing opportunities due to gambling, or relying on others for financial assistance related to gambling.
Behavioral addiction researcher Mark Griffiths of Nottingham Trent University in the U.K. Has identified six key criteria for defining addiction, applicable to both substance and behavioral forms: salience (the behavior becoming central to life), mood modification, tolerance, withdrawal, conflict (harm to relationships or work), and relapse. Griffiths cautions that meeting all six criteria is rare, and many individuals exhibit problematic behaviors without fulfilling the full definition of addiction.
Expanding the list of recognized behavioral addictions presents both potential benefits and risks. One concern is the potential to pathologize normal behaviors. Carroll notes that classifying behaviors too rigidly could label dedicated hobbyists as addicts. He also cautioned that overly broad criteria could undermine the credibility of the diagnosis.
Though, classifying more behaviors as addictions could provide clinicians with a framework for distinguishing between normal and pathological behavior, and assist individuals recognize problems they may not perceive themselves. Identifying an addiction is seen as the first step toward treatment, often involving addressing underlying conditions like anxiety or depression.
The evolution of recognizing behavioral addictions has been gradual. Pathological gambling was initially listed as an impulse-control disorder in the DSM-III in 1980, before being reclassified as gambling disorder—a behavioral addiction—in the DSM-5 in 2013, based on research showing its impact on the brain’s reward system, similar to drugs.
Griffiths anticipates that internet gaming disorder will be fully recognized as a disorder in the upcoming DSM-6. The World Health Organization’s International Classification of Diseases 11th Revision, finalized in 2019, already includes gambling disorder, gaming disorder, and compulsive sexual behavior disorder.
While there is growing evidence supporting the inclusion of gaming disorder, Carroll believes there is also strong evidence for shopping addiction. He also suggests that social media addiction and pornography addiction warrant consideration. Griffiths remains cautious, citing the need for higher-quality research and evidence of effective treatment before expanding the list of recognized behavioral addictions. He predicts that gaming disorder is the only new behavioral addiction likely to be included in the next DSM.
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