Shopping, Gaming & Addiction: Will the DSM Recognize New Behavioral Addictions?

The line between intense habit and clinical addiction is once again under scrutiny, as psychiatrists debate whether to broaden the definition of addiction to include behaviors like compulsive shopping and excessive gaming. Currently, gambling disorder is the only non-substance-related addiction recognized in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference guide for mental health conditions. But emerging research, and a growing understanding of the brain’s reward pathways, is prompting a re-evaluation of how we categorize problematic behaviors.

Compulsive Shopping: More Than Just a Subpar Habit?

A recent study published in Comprehensive Psychiatry suggests that compulsive shopping may indeed qualify as a behavioral addiction. Researchers compared three groups of shoppers – those with a pathological desire to shop (“compulsive buyers”), those whose buying is influenced by external factors (“risky” or impulsive shoppers), and those who shop intentionally and with planning. The study, involving 241 German adults, found that compulsive buyers exhibited characteristics commonly associated with addiction, including using shopping for emotional gratification, experiencing distress when unable to shop, and reporting lower self-esteem, anxiety, and depression. The findings indicate that for some individuals, shopping isn’t simply a recreational activity, but a compulsive behavior with significant psychological consequences.

This isn’t to say that enjoying retail therapy automatically indicates a problem. The key distinction, experts emphasize, lies in the degree to which the behavior disrupts a person’s life. Dr. Nathan Carroll, a board-certified psychiatrist and author of “Internet Gaming Disorder”, explains that addiction is defined by “functional impairment across multiple domains – socially, occupationally, educationally.” When a behavior becomes all-consuming and interferes with daily life, it crosses the threshold into addiction.

Defining the Boundaries of Addiction

The challenge lies in establishing a clear definition of addiction itself. It’s not simply about engaging in a behavior frequently or intensely. Mark Griffiths, a behavioral addiction researcher at Nottingham Trent University in the U.K., has identified six key criteria that help differentiate a true addiction from a strong habit. These include:

1. Salience: The behavior dominates a person’s thoughts and time.
2. Mood modification: The behavior is used to alter emotional states.
3. Tolerance: Increasing amounts of the behavior are needed to achieve the same effect.
4. Withdrawal: Stopping the behavior leads to negative psychological or physical symptoms.
5. Conflict: The behavior causes problems in relationships, work, or education.
6. Relapse: The person repeatedly returns to the behavior after attempting to stop.

Griffiths emphasizes that meeting all six criteria is crucial for a diagnosis of addiction. He notes that many people may exhibit several of these characteristics without necessarily being addicted, in which case the behavior might be more accurately described as “problematic.”

Gaming Disorder: Closer to Recognition

Whereas the debate around compulsive shopping continues, gaming disorder appears to be on a faster track toward formal recognition. The DSM-5 currently lists internet gaming disorder as a condition requiring further study, but experts believe the evidence base has grown significantly in recent years.

“DSM-5 was published 13 years ago, and there’s been so much research now,” Griffiths states. “In DSM-6, gaming disorder will definitely be a fully recognized disorder, just like gambling disorder.” This shift reflects a growing understanding of how excessive gaming can activate the brain’s reward system in a similar way to substance abuse. The diagnostic criteria for gambling disorder, which include frequent thoughts about the activity, needing to gamble with increasing amounts, and attempting to “chase” losses, are increasingly being seen in individuals with problematic gaming habits.

The Risks and Rewards of Expanding the Definition

Expanding the list of recognized behavioral addictions isn’t without potential drawbacks. One concern is the risk of “pathologizing normal behavior.” Could dedicated gamers or fitness enthusiasts be mislabeled as addicts simply because they devote a significant amount of time to their hobbies? Carroll cautions that overly rigid diagnostic criteria could lead to misdiagnosis, particularly for professionals whose livelihoods depend on these activities.

However, the benefits of broader recognition could be substantial. A clearer framework for distinguishing between healthy engagement and pathological behavior could help clinicians identify and treat individuals who are struggling. It could also empower people to recognize problematic patterns in their own lives. “The nature of addiction is that a lot of people don’t even see it in themselves when the addiction is occurring,” Carroll explains.

What’s Next for Behavioral Addictions?

The process of revising the DSM is ongoing, and the inclusion of new behavioral addictions in the DSM-6 is still subject to debate. However, the growing body of research, coupled with increasing awareness of the neurobiological similarities between substance and behavioral addictions, suggests that change is likely.

Beyond gaming disorder, Carroll believes there’s strong evidence to support the inclusion of compulsive shopping. He also points to emerging research on social media addiction and pornography addiction as areas warranting further investigation. Griffiths, while more cautious, acknowledges the potential for these behaviors to be classified as addictions in the future, but stresses the need for higher-quality research and evidence of effective treatments.

The World Health Organization’s International Classification of Diseases 11th Revision (ICD-11) already includes gambling disorder, gaming disorder, and compulsive sexual behavior disorder, signaling a global trend toward recognizing the validity of behavioral addictions. As our understanding of the brain and human behavior continues to evolve, the definition of addiction itself may continue to expand, offering new hope for those struggling with these complex conditions.