title: 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.
authors.affiliation: Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust (CPFT), UK. Electronic address: Srchamb@gmail.com.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Chamberlain
authors.affiliation: MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, South Africa.
authors.forename: Christine
authors.initials: C
authors.lastname: Lochner
authors.affiliation: MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, The Netherlands and Arkin Mental Health, Amsterdam, The Netherlands.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Goudriaan
authors.affiliation: Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, The Netherlands and Arkin Mental Health, Amsterdam, The Netherlands.
authors.forename: Ruth Janke
authors.initials: RJ
authors.lastname: van Holst
authors.affiliation: Division of Psychiatry, Chaim Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zohar
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Grant
mesh_terms: D000437:Alcoholism / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D000818:Animals; D016739:Behavior, Addictive / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003192:Compulsive Behavior / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D003193:Compulsive Personality Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D019317:Evidence-Based Medicine; D000066506:Heuristics; D006801:Humans; D008959:Models, Neurological; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D009626:Terminology as Topic
keywords: Addiction; Cognition; Compulsivity; Imaging; Impulsivity