Gambling, Internet, and Beyond: Types of Behavioural Addictions

When most people think of addiction, substances like alcohol or drugs come to mind first. But addiction isn’t always chemical. Behavioural addictions – where a person becomes compulsively dependent on an activity rather than a substance – are increasingly recognised as serious mental health concerns. From gambling and gaming to shopping, exercise, and work, these patterns share the same core hallmarks as substance use disorders: loss of control, compulsive repetition, and continued behaviour despite harmful consequences. Understanding how these addictions are defined, how they progress, and how they differ from each other is the first step toward recognising them in real life.

Gambling disorder: phases and levels of severity
The four phases of gambling disorder
Internet gaming disorder: a condition still under study
The nine DSM-5 provisional criteria for IGD
Withdrawal symptoms and neurological parallels
Young’s 8-question diagnostic test
Lesser-known behavioural addictions: shopping, exercise, and work
Compulsive buying disorder (shopping addiction)
Exercise addiction: when healthy becomes harmful
Workaholism: addiction dressed as ambition
What ties these addictions together?

Gambling disorder: phases and levels of severity

Gambling disorder holds a distinct place in the world of behavioural addictions. It is the only non-substance addictive disorder formally endorsed as a diagnosis in the DSM-5, where it was reclassified from an impulse-control disorder into the “Substance-Related and Addictive Disorders” category. This move reflects decades of research showing that problematic gambling activates the brain’s reward system in ways remarkably similar to drug use.

The DSM-5 renamed pathological gambling as Gambling Disorder and lowered the diagnostic threshold, requiring four or more of nine criteria to be met within a 12-month period, rather than the five required previously. The “illegal acts” criterion was also removed, since research showed it rarely distinguished those with the disorder from those without it. Severity is classified into three levels: mild (four to five criteria met), moderate (six to seven), and severe (eight or nine).

The four phases of gambling disorder

Gambling disorder typically unfolds in a recognisable sequence of four phases, each more damaging than the last.

The winning phase is often where it begins. The person experiences early wins, develops a sense of excitement and confidence, and gambling takes on a thrilling quality. This phase can create a distorted belief that winning is the norm and that skill or luck is on their side.

The losing phase follows, as losses mount. The person starts to chase losses – a behaviour specifically noted in the DSM-5 – returning repeatedly to gambling to try to recover what they have lost. Research shows that withdrawal – the discomfort experienced when not gambling – is strongly linked to the overall severity of gambling disorder, suggesting that compulsive motives increasingly drive the behaviour at this stage.

In the desperation phase, the person’s gambling is now beyond their control. Lies to family, borrowing money, and neglecting responsibilities become common. The DSM-5 criteria for deception and preoccupation with gambling reflect this stage most directly. Importantly, DSM-5 requires that all criteria occur within a 12-month period, meaning isolated past episodes don’t count toward a diagnosis.

The final hopeless phase involves a complete breakdown of the person’s personal, financial, and social life. Depression, anxiety, and in serious cases, suicidal ideation may emerge. The gambler may feel that recovery is impossible, making professional intervention all the more critical at this stage.

Internet gaming disorder: a condition still under study

While gambling disorder has full diagnostic status, Internet Gaming Disorder (IGD) was included in the DSM-5 as a condition for further study, placed in Section III – a section reserved for emerging conditions that require more research before they can be formally classified as disorders. Despite this provisional status, the IGD framework has generated significant global research and continues to be taken seriously by clinicians, particularly for adolescents and young males.

The nine DSM-5 provisional criteria for IGD

The DSM-5 defines IGD as a pattern of excessive and prolonged internet gaming resulting in cognitive and behavioural symptoms including progressive loss of control, tolerance, and withdrawal symptoms, analogous to substance use disorders. A diagnosis requires five or more of the following nine criteria to be met over a 12-month period:

Preoccupation with internet games
Withdrawal symptoms – irritability or anxiety when gaming is taken away
Tolerance – the need to spend increasing amounts of time gaming
Loss of control – unsuccessful attempts to stop or reduce gaming
Loss of interest in previous hobbies due to gaming
Continued use despite knowing it is causing psychosocial problems
Deception – lying to family members or therapists about gaming
Mood regulation – using gaming to escape or relieve a negative mood
Risk or loss of a significant relationship, job, or educational opportunity due to gaming

Withdrawal symptoms and neurological parallels

Research on IGD shows that certain brain pathways are triggered during gaming in the same intense, direct way that a drug addict’s brain is affected by a substance – producing neurological responses that influence feelings of pleasure and reward. When gaming is taken away, individuals experience withdrawal-related symptoms including unpleasant emotional states, cravings, and even physical signs of distress.

Young’s 8-question diagnostic test

Prior to the DSM-5 criteria, clinical psychologist Kimberly Young developed an influential 8-question screening tool based on the criteria for pathological gambling, adapted for internet use. This tool asks whether a person feels preoccupied with the internet, needs to use it in increasing amounts to feel satisfied, has tried unsuccessfully to cut back, feels restless or irritable when trying to reduce use, uses it to escape problems or relieve negative moods, lies to others about how much they use it, risks relationships or career opportunities because of it, or returns to excessive use after an attempt to stop. The APA’s criteria for IGD were directly shaped by Gambling Disorder’s diagnostic framework, sharing criteria such as preoccupation, loss of control, tolerance, withdrawal, deception, and jeopardising important relationships. Young’s earlier work laid important groundwork for this convergence.

Lesser-known behavioural addictions: shopping, exercise, and work

Beyond gambling and gaming, a growing body of research points to other behavioural patterns that can develop the hallmarks of addiction. Shopping, exercise, and work may seem ordinary, even admirable, activities – but in their compulsive forms, they can cause serious harm to mental health, relationships, and quality of life. At the time of DSM-5’s publication, the working group noted insufficient evidence to formally include sex, exercise, or shopping as recognised mental disorders, but research in these areas continues to grow.

Compulsive buying disorder (shopping addiction)

Compulsive Buying Disorder (CBD) is defined as a chronic, repetitive condition that becomes a primary response to negative events and feelings, characterised by craving, euphoria, and relief from negative emotions – paralleling chemical addictions. Prevalence estimates suggest between 2% and 8% of adults may be affected, though some studies place this higher.

The cycle of CBD typically follows a predictable arc. Many individuals with CBD describe the shopping experience itself as intensely exciting, while the purchase is often followed by a sense of letdown or disappointment with oneself. Research confirms that negative emotions such as depression, anxiety, boredom, and anger are the most commonly cited triggers, while euphoria or relief from those emotions are the most common consequence. Over time, this cycle deepens: items bought are frequently unused, guilt accumulates, debt grows, and the buying may become secretive.

In the DSM-5, compulsive buying is described in the context of behavioural addiction but has not been formally defined as a standalone disorder due to ongoing debate about whether it should be classified under impulse control disorders, mood disorders, or addictive behaviours. The ICD-11 classifies it among “other specified impulse control disorders.”

Exercise addiction: when healthy becomes harmful

Exercise is widely celebrated for its physical and mental health benefits. But for a small minority, exercise stops being about wellbeing and becomes something they cannot stop doing – even when injured, ill, or despite serious social consequences. Researchers Hausenblas and Downs identified exercise addiction based on seven criteria adapted from the DSM-IV criteria for substance dependence: tolerance (needing more exercise to achieve the same effect), withdrawal (anxiety, irritability, and sleep problems when unable to exercise), lack of control, intention effects (exceeding intended duration), time (excessive time spent preparing, doing, and recovering from exercise), reduction in other activities, and continuance (exercising despite knowing it causes harm).

This framework, known as the Exercise Dependence Scale, distinguishes those who exercise excessively but healthily from those for whom exercise has become a compulsive, life-disrupting pattern – what Hausenblas and Downs term a “multidimensional maladaptive pattern.” The key difference is not how much a person exercises, but whether exercise is causing impairment and occurring despite negative consequences.

Exercise addiction is also sometimes referred to in the literature as obligatory exercise – a term emphasising its driven, non-negotiable quality – and has known overlaps with eating disorders, particularly hyperactive forms of anorexia nervosa.

Workaholism: addiction dressed as ambition

Workaholism is perhaps the most socially accepted of all behavioural addictions, often praised as dedication or ambition rather than recognised as a problem. The term was coined by psychiatrist Wayne Oates in 1971, who described a workaholic as someone whose need for work had become so excessive it interfered with their health, happiness, and personal relationships.

Researcher Lynne Porter (1996) defined workaholism as excessive involvement with work evidenced by neglect in other areas of life, driven by internal motives rather than the requirements of the job or organisation – highlighting the compulsive inner drive that distinguishes workaholics from simply hardworking individuals.

Porter’s framework identifies several key characteristics of workaholism as a behavioural addiction. These include: a compulsive, internally driven need to work regardless of external demands; neglect of personal relationships, health, and leisure; perfectionism and rigid thinking that impairs flexibility and effectiveness; using work as a way to escape or avoid dealing with personal and emotional life; continued overwork despite negative consequences such as burnout, marital conflict, or deteriorating health; and an inability to psychologically disengage from work even during supposed leisure time.

Porter (1996) estimated that as many as one in four employed people could be described as workaholics, with particularly high rates in professional groups such as medicine. Work addiction has been linked to significant negative outcomes including burnout, anxiety, depression, and poor work-life balance – consequences that may be invisible to colleagues or even to the workaholic themselves.

The distinction between a dedicated professional and a work addict lies not in hours logged, but in psychology: whether work is chosen with agency, or whether it feels impossible to stop.

What ties these addictions together?

The reclassification of gambling disorder as a behavioural addiction in DSM-5, alongside the emergence of internet gaming disorder as a condition for further study, reflects growing scientific recognition that some behaviours become addictive due to similarities in symptoms, neuropathology, and effective treatment approaches. Shopping, exercise, and workaholism share this same underlying architecture: a behaviour that begins as rewarding, escalates beyond the person’s control, persists despite harm, and comes with withdrawal-like distress when interrupted.

What makes behavioural addictions particularly challenging is their social camouflage. A workaholic is praised. A fitness fanatic is admired. A shopaholic is teased rather than treated. Recognising where normal behaviour ends and addiction begins requires looking beyond the activity itself – at the loss of control, the emotional dependency, and the mounting cost to the person’s life.

What do you think? If socially accepted behaviours like working hard or exercising regularly can become genuine addictions, how do we distinguish healthy commitment from harmful compulsion? And does the social praise that surrounds activities like work or exercise make it harder for people to recognise and seek help for these kinds of addictions?

References

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Table of Contents

Gambling disorder: phases and levels of severity 🔗

The four phases of gambling disorder 🔗

Internet gaming disorder: a condition still under study 🔗

The nine DSM-5 provisional criteria for IGD 🔗

Withdrawal symptoms and neurological parallels 🔗

Young’s 8-question diagnostic test 🔗

Lesser-known behavioural addictions: shopping, exercise, and work 🔗

Compulsive buying disorder (shopping addiction) 🔗

Exercise addiction: when healthy becomes harmful 🔗

Workaholism: addiction dressed as ambition 🔗

What ties these addictions together? 🔗