Abstract
This article provides a narrative review of the relationships between several behavioural addictions [pathological gambling, problematic Internet use (PIU), problematic online gaming, compulsive sexual behaviour disorder, compulsive buying, and exercise addiction] and psychiatric disorders. Associations between most behavioural addictions and depressive and anxiety disorders are strong and seem relatively non-specific. Strong links with substance use disorders may support the notion that some people are more prone to addictive behaviours, regardless of whether these involve substances or problematic activities. Other associations seem relatively specific, for example, those between PIU/online gaming and attention-deficit/hyperactivity disorder, between compulsive buying on the one hand and eating disorders and hoarding on the other hand and between exercise addiction and eating disorders. The quality of the research varies, but most studies suffer from methodological limitations, including a cross-sectional or correlational design, non-representative study populations, small sample sizes, reliance on self-report assessment instruments, diverse diagnostic criteria, and conceptual heterogeneity of most behavioural addictions. Due to these limitations, generalisability of the findings is questionable and the direction of causality, if any, is unknown in the relationships between behavioural addictions and psychiatric disorders. Regardless of the aetiological uncertainty, these relationships often call for a modified treatment approach. Prospective studies are needed to clarify the longitudinal relationships between behavioural addictions and psychiatric disorders.
Highlights
Behavioural addictions are a controversial concept [1, 2], sitting between the realms of impulse control disorders and substance use disorders
This review reported that impulsivity was an important, underlying factor in many cases of pathological gambling, facilitating both the onset of “problem” gambling and progression from less severe to more severe forms of pathological gambling, often in conjunction with depression and substance use disorders
While there is plenty of evidence that behavioural addictions frequently co-occur with various psychiatric disorders, the quality of that evidence is such that the central questions remain unanswered: When do certain psychiatric disorders predispose to or cause certain behavioural addictions and when do these disorders occur as a consequence of behavioural addictions? Are they related in some other ways, e.g., via a common underlying factor? Only prospective studies will shed more light on this important issue and clarify whether or not and under which circumstances some behavioural addictions may be conceptualised as distinct and independent psychopathological entities
Summary
Behavioural addictions are a controversial concept [1, 2], sitting between the realms of impulse control disorders and substance use disorders. One of the issues surrounding behavioural addictions has been the extent to which they can be conceptualised as distinct and independent entities. Related to this has been a question of the relationships between various behavioural addictions and other psychopathology
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