Process Addictions

Can Behaviors Be Addictive?

It is of consensus that alcohol and drugs are addictive. A concept that is still under much debate in the professional community is if certain behaviors or actions can be addictive, these behaviors are sometimes called “process addictions”.

As of right now the Diagnostic and Statistical Manual (DSM-5), the most recent version of the manual used by medical and mental health professionals to diagnose disorders, only recognizes one behavior to be addictive, that is gambling. It is very difficult to get a diagnosis recognized and into the DSM. There must be sufficient validated research to show that a disorder is real. This has been done with gambling and therefore it was included in the most recent DSM.

I think it is likely that other compulsive behaviors will be added to the DSM in the future as interest and research grows around the topic. So, to make it clear, one cannot be diagnosed with a shopping or compulsive buying addiction/use disorder as of yet.*

Despite no official diagnosis, many people experience the negative consequences of addictive behaviors. Here are a few of the behaviors that are being researched as possible process addictions: food, gaming, sex, plastic surgery, social media, internet, shopping, exercise and pornography.

Process Addictions vs. Substance Abuse

There are a few things that stand out about the above mentioned activities. First, many, although not all, of these behaviors are not required for survival. This is one of the things process addictions have in common with substance abuse, one does not need alcohol to survive just as one does not need internet gaming for survival.

Second, it would be difficult and likely not practical to abstain from all of these behaviors. Food is a very clear example. One must eat to survive. One could abstain from sex, but that may not be practical, or even desired, particularly in the context of a relationship. Never shop again? Conceivable, but very difficult and likely impractical.

Third, you will notice that it is not necessarily the behavior itself that is addictive, but the effect this behavior has on one’s mood and functioning that keeps the individual engaged in the process.** Shopping is not a substance, but the effect of shopping for some individuals supplies enough of a dopamine reward, distraction, what-have-you, to keep the individual coming back for more.

Characteristics of Addictions

I personally find the below guidelines outlined by the American Society of Addiction Medicine for identifying characteristics of addiction to be helpful:

• Abstinence Issues: The individual cannot stop on a consistent basis
• Behavioral control impairment: The individual cannot control the behavior
• Craving or increased “hunger” for the substance or reward experience
• Diminished insight into the problems caused by the behavior and the impact on others
• Emotional responses that contribute to problems and are ineffective

One’s behavior does not have to meet all of the ABCDEs to potentially be an addiction problem. You can see though that for some individuals, shopping can easily become problematic if it hits many of the above criteria.

So, how do you know if you have a shopping addiction? One key question I often ask myself and my patients is, “Is this effective?” Does this behavior contribute to or detract from a balanced life full of value, meaning, and health?***

One other thing to keep in mind is that there can be varying degrees of intensity in addictive behaviors, from mild to moderate to severe. It’s my personal observation that many people will engage in ineffective behaviors or compulsions throughout different periods of their lives, especially excessive shopping in the western culture. This does not mean everyone has a shopping addiction. If you are uncertain, it may be helpful to seek out a licensed therapist or counselor to help objectively look at your behaviors to determine if the behavior is to the degree that intervention such as therapy would be helpful.

* As a way of addressing the problem, professionals including myself may use the diagnosis “other specified impulse control disorder” until more specific diagnoses are added to the DSM. 
** As a side, I could argue that some of these behaviors do have clear chemical impact on our body and brain, such as consuming food and having sex, therefore, are similar to addictive substances.  
*** This is not to help anyone diagnose themselves. Again, there is no diagnosis for shopping addiction. However, this is a helpful question in many instances of life!