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Behavioural Addictions: Where the Line Is

Only two behaviours are recognised as addictions: gambling and gaming. Why the bar is set there, what separates a heavy habit from a disorder, and what helps.

4 min read

Pop-art illustration of a bearded man frowning down at the phone he is holding up in front of him.

Key takeaways

  • Only two behaviours are formally recognised: gambling disorder in DSM-5-TR, and gaming disorder added to ICD-11 in 2019. Everything else being called an addiction is being called that informally.
  • That restraint is deliberate rather than slow. Calling every strong habit an addiction inflates the word until it stops distinguishing anything, and pathologises ordinary enthusiasm.
  • The bar is functional impairment, not quantity. What matters is loss of control, continuation despite harm, and displacement of other activities, sustained over about a year.
  • Gambling carries a specific and severe risk that gaming does not: it is associated with markedly elevated rates of suicidality, partly through debt.
  • Design is part of the picture rather than an excuse. Variable-ratio reward schedules produce unusually persistent behaviour, and both gambling and free-to-play games are built on them.

Two behaviours are formally recognised as addictions: gambling and gaming. [apa-2022-dsm5tr-gambling] [who-2019-icd11-gaming] Everything else being described that way is being described informally, and the restraint behind that is deliberate rather than a failure to keep up. This guide covers why the bar sits where it does, what actually separates a heavy habit from a disorder, and where the risk is genuinely severe.

Why the list is so short

The obvious objection to a short list is that plenty of behaviours clearly grip people. The reason for holding the line is that a term applying to everything distinguishes nothing.

If shopping, work, exercise, phone use and food all qualify as addictions, the word stops carrying information and starts pathologising ordinary enthusiasm. Somebody who loves running becomes a person with a disorder; somebody who is very committed to their job acquires a diagnosis. That is not a neutral expansion, because a diagnostic label changes how a person is treated and how they see themselves.

Gambling was moved in DSM-5 from impulse-control disorders into the addictive disorders chapter on the strength of evidence about shared mechanisms with substance addiction. [apa-2022-dsm5tr-gambling] Gaming disorder entered ICD-11 in 2019, and it was contested at the time by researchers who thought the evidence was not yet sufficient. [who-2019-icd11-gaming] That disagreement is a feature of a cautious system rather than a scandal.

The bar is impairment, not quantity

Hours are what people count because hours are easy to count, and they are close to the least informative measure available.

Three things define the disorders instead. Impaired control: you cannot stop when you intend to. Increasing priority: the behaviour displaces things that used to matter. Continuation despite harm: it carries on after the consequences are obvious. ICD-11 normally expects this sustained over about twelve months.

The practical consequence is that two people with identical hours can be in completely different situations. Twenty hours a week alongside sleep, work and friendships is a hobby. Ten hours a week that has eaten everything else, with repeated failed attempts to stop, is not.

What actually separates the two Illustrative
0 25 50 75 100 Diagnostic weight 9 Hours per week 6 Money spent 5 How it looks to others
0 25 50 75 100 Diagnostic weight 9 Impaired control 8 Displacement of other things 9 Continuing despite harm 2 Hours per week

A schematic contrast between the commonly used measure and the ICD-11 and DSM-5-TR criteria. Heights show relative diagnostic weight, not measured data.

Gambling is the serious one

Both conditions cause real impairment, and one of them carries a risk the other does not. Gambling disorder is associated with markedly elevated rates of suicidality, and Karlsson and Håkansson’s national register study found substantially increased mortality and suicide risk in people with the diagnosis. [karlsson-2019-gambling]

Debt is a large part of the mechanism, and it behaves unlike other addiction harms. It persists after the behaviour stops, it compounds, and it reaches family members who had no part in it. Somebody who stops gambling today still owes what they owed yesterday, which is why financial measures are not a side issue.

Our guide to the psychology of the lottery covers the design side of this, and is my gaming a problem covers the other condition in detail.

Design is part of it

Variable-ratio reinforcement, reward that arrives unpredictably, produces more persistent behaviour than reward that arrives reliably. This is among the most robust findings in behavioural psychology, and both slot machines and free-to-play game economies are built on it.

Naming that is not an excuse and it is not a reason to feel less responsible. It is a reason to change the environment rather than relying on resolve, because resolve is being tested against something engineered to outlast it. Self-exclusion schemes, blocking software and removing stored payment details do more than intention does.

Habit, or something more?

This is not a diagnostic tool. It asks about the three things the criteria actually use, rather than about hours.

0 of 6 ticked

What helps

For gambling, cognitive behavioural therapy has the best evidence, and Petry and colleagues found benefit for CBT-based approaches. [petry-2006-cbt] It targets the specific beliefs that sustain the behaviour: the gambler’s fallacy, the illusion of control, and the conviction that losses can be recovered by continuing.

Practical financial steps carry more weight here than in most conditions. Self-exclusion, blocking software, and handing financial control to somebody trusted are frequently what makes any of the psychological work possible.

For gaming the evidence is thinner. CBT-derived approaches are the usual starting point, and treating accompanying depression, anxiety or ADHD is often the highest-value move, since these co-occur frequently and the gaming is sometimes managing them. Our pillar on addiction covers the shared ground.

When to seek help

See a doctor if you have tried to stop and not managed it, if the behaviour has continued through clear harm, or if you are hiding its extent from people close to you.

If gambling is involved, treat it as more urgent than the equivalent gaming picture. The financial harm compounds while you decide, and the suicide risk is genuinely elevated.

If you are having thoughts of harming yourself, seek help now rather than at the next available appointment. Contact your local emergency services or a crisis helpline.

How MyFreud can help

The criteria turn on whether the behaviour is displacing things and continuing through harm, and both are far clearer in a record than in memory. Tracking mood alongside what you did shows what the week actually contained, which is usually less flattering and more useful than the impression of it.

Frequently asked questions

Which behavioural addictions are actually recognised?

Two. Gambling disorder is in DSM-5-TR, where it was moved in 2013 from the impulse-control chapter into the substance-related and addictive disorders chapter, a move that reflected evidence about shared mechanisms. Gaming disorder was added to ICD-11 in 2019, with criteria emphasising impaired control, increasing priority given to gaming over other interests, and continuation despite negative consequences, normally over at least twelve months. Everything else, including phone use, shopping, work, exercise, food and pornography, is used informally. Some are under active research and none is formally recognised as an addictive disorder.

Why is phone addiction not a real diagnosis?

Because the evidence has not established that it behaves like one, and because the phone is a container rather than an activity. What people do on a phone ranges from talking to friends to gambling, and lumping those together produces a measure that predicts very little. The bigger objection is conceptual: if any strong habit qualifies, the term stops distinguishing anything and starts pathologising ordinary enthusiasm. That does not mean heavy phone use is harmless. It means the useful questions are about what it displaces and what it costs, which our guide to screen time covers, rather than whether it earns a diagnostic label.

How do I know if my gaming is a problem?

The bar is not hours. It is impaired control, meaning you cannot stop when you intend to; increasing priority, meaning gaming displaces things that used to matter; and continuation despite clear negative consequences, sustained over about a year. Someone playing twenty hours a week who is sleeping, working, and seeing people is doing a hobby. Someone playing ten hours a week who has stopped attending anything else, is losing sleep, and cannot stop when they mean to may meet the criteria. Quantity is the thing people measure because it is easy, and it is close to the least informative variable available.

Is gambling more serious than gaming?

In one respect that matters enormously, yes. Gambling disorder is associated with markedly elevated rates of suicidal thoughts and attempts, and debt is a substantial part of the route. It also produces financial harm that persists long after the behaviour stops and that spreads to family members. Gaming disorder causes real impairment to sleep, work, study and relationships, and it does not typically carry the same financial catastrophe or the same suicide risk. If you are choosing where to direct concern first, gambling is the one where the downside is severe and fast.

What treatment works?

Cognitive behavioural therapy has the best evidence for gambling disorder, targeting the specific distorted beliefs that sustain it, particularly the gambler's fallacy and the illusion of control. Brief interventions and motivational approaches help, and mutual-aid groups suit some people well. Practical financial measures matter more here than in most conditions: self-exclusion schemes, blocking software and handing financial control to somebody else are not side issues but often the thing that creates enough space for anything else to work. For gaming, evidence is thinner and CBT-derived approaches are the usual starting point, alongside treating accompanying depression, anxiety or ADHD.

References

  1. 1.American Psychiatric Association ( 2022). Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision. American Psychiatric Association Publishing.
  2. 2.World Health Organization ( 2019). ICD-11 for Mortality and Morbidity Statistics: gaming disorder. World Health Organization.
  3. 3.Karlsson A, Håkansson A ( 2019). Gambling disorder, increased mortality, suicidality, and associated comorbidity: a longitudinal nationwide register study. Journal of Behavioral Addictions.
  4. 4.Petry NM, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, et al. ( 2006). Cognitive-behavioral therapy for pathological gamblers. Journal of Consulting and Clinical Psychology.