How can we conceptualize behavioural addiction without pathologizing common behaviours?
Open accessAbstract
Following the recent changes to the diagnostic category for addictive disorders in DSM‐5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM‐5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM‐5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.
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Almost all the examples of 'moot behavioural addictions' that Billieux et al. cited - as did the paper by Kardefelt-Winther et al. - are papers that Griffiths co-authored.
“Finally, I could not help but notice that almost all the examples of 'moot behavioural addictions' that Billieux et al. (16) cited - as did the paper by Kardefelt-Winther et al. (31) - are papers that I co-authored.”
From The evolution of the 'components model of addiction' and the need for a confirmatory approach in conceptualizing behavioral addictions (2020) · cites this paper as [31]
Section 2 lists seven examples of proposed behavioural addictions (refs. 14–20). The References show Griffiths co-authored four of those papers, while three—on mobile phones, social network sites, and fortune telling—do not list him. Thus, for the examples in Kardefelt-Winther et al., the claim that he co-authored almost all is contradicted; this source does not establish what Billieux et al. cited. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIf the four exclusion criteria proposed by Kardefelt-Winther et al. were applied to substance abuse, very few substance users would be classed as addicted.
“'[If] these criteria were applied to substance abuse, very few substance users would be classed as addicted.”
From The evolution of the 'components model of addiction' and the need for a confirmatory approach in conceptualizing behavioral addictions (2020) · cites this paper as [31]
The Introduction lists the four exclusion criteria proposed for behavioural addiction. It does not apply them to substance use or say that very few substance users would be classed as addicted; that predicted result is unsupported by our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe number of hours employed on the phone is used as criteria without considering that smartphone use is a normalized part of everyday life in many societies today even when engaged with very frequently.
“The number of hours employed on the phone is used as criteria without considering that smartphone use is a normalized part of everyday life in many societies today even when engaged with very frequently (Kardefelt-Winther et al., 2017); therefore, increase in use should not be a valid criterion.”
From Is smartphone addiction really an addiction? (2018) · cites this paper as Kardefelt-Winther et al., 2017
Section 3 (page not specified) says that using mobile phones can be part of everyday life even when very frequent, and warns against conflating high engagement with addiction. It does not specifically say that the number of hours spent on a phone is used as a diagnostic criterion. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIncrease in smartphone use should not be a valid criterion for tolerance.
“The number of hours employed on the phone is used as criteria without considering that smartphone use is a normalized part of everyday life in many societies today even when engaged with very frequently (Kardefelt-Winther et al., 2017); therefore, increase in use should not be a valid criterion.”
From Is smartphone addiction really an addiction? (2018) · cites this paper as Kardefelt-Winther et al., 2017
Section 3 says frequent mobile-phone use can be part of everyday life and warns against equating intensive involvement with addiction. Section 2 suggests not using tolerance as a criterion without more evidence. The paper does not specifically assess increased smartphone use as a measure of tolerance, and its recommendation is conditional rather than an unqualified declaration that the criterion is invalid. No page numbers are available in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredWeaker studies have relied extensively on self-selected samples that do not necessarily include regular and/or problematic gamers, have used unvalidated or psychometrically poor self-report assessment instruments, or have made causal inferences based on insufficient evidence.
“Weaker studies have relied extensively on self-selected samples that do not necessarily include regular and/or problematic gamers, have used unvalidated or psychometrically poor self-report assessment instruments, or have made causal inferences based on insufficient evidence 167,169,170 .”
From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [169]
Section 3, “Avoid creating new disorders with old recipes,” criticizes screening tools adapted from substance-addiction measures and conclusions drawn from cross-sectional survey correlations. Section 4 calls for evaluating instruments’ psychometric properties. The copy does not substantiate the specific claim about extensive reliance on self-selected samples lacking regular or problematic gamers, or explicitly say that studies made causal inferences. (LLM, conf=0.85)
Experimental — accuracy not yet measured
One of the essential features of a behavioral addiction should be functional impairment in clinical settings.
“One of the essential features of a behavioral addiction should be the functional impairment in clinical settings (Kardefelt-Winther et al., 2017).”
From Is smartphone addiction really an addiction? (2018) · cites this paper as Kardefelt-Winther et al., 2017
Diagnosing excessive, maladaptive, or problematic behavior as addictive can generate false epidemics of misidentified pseudopatients and pathologize common behaviors.
“It is important not to diagnose excessive, maladaptive, or problematic behavior as an addictive in order to avoid generating false epidemics of misidentified pseudopatients (Frances & Widiger, 2012) and pathologizing common behaviors (Kardefelt-Winther et al., 2017).”
From Is smartphone addiction really an addiction? (2018) · cites this paper as Kardefelt-Winther et al., 2017
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“Second, it supports the idea that SMU problems—as defined by substance dependence criteria—have harmful implications, which has been contested in scholarly debates (Kardefelt-Winther et al., 2017; Van Rooij et al., 2018).”
BackgroundVideo game addiction: The push to pathologize video games.
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Problematic smartphone use: an empirically validated model
Pivetta, E., Harkin, L., Billieux, J., Kanjo, E., & Kuss, D. J. (2019) · Computers in Human Behavior · doi:10.1016/j.chb.2019.06.013 · Cited by 149 · see citing works
Self-citationCurrent Research and Viewpoints on Internet Addiction in Adolescents
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“Cross-lagged effects estimate the reciprocal relationship between variables over time, describing their mutual influence on each other (Kearney, 2018).”
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“To address the concerns raised by other scholars (Griffiths, 2018; Kardefelt-Winther et al., 2017; Király et al., 2015; Kuss et al., 2017a; Mueller, 2018), in this study, we evaluated the diagnostic accuracy of IGD criteria, compared the DSM-5 criteria for IGD and the ICD-11 criteria for GD, and…”
MethodPersonality and Internet gaming disorder: a systematic review of recent literature
Gervasi, A. M., La Marca, L., Costanzo, A., Pace, U., Guglielmucci, F., & Schimmenti, A. (2017) · Current Addiction Reports · doi:10.1007/s40429-017-0159-6 · Cited by 137 · see citing works
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“…we acknowledge that its findings are based on the model of behavioral addiction that relies heavily on the conceptualization of substance addictions (e.g., Billieux, Schimmenti, Khazaal, Maurage, & Heeren, 2015; Kardefelt-Winther et al., 2017) and the corresponding assessment instruments.”
BackgroundSelf-citationLaier, C., Wegmann, E., & Brand, M. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00304 · Cited by 129 · see citing works
Penzenstadler, L. E., Soares, C., Karila, L., & Khazaal, Y. (2018) · Current Neuropharmacology · doi:10.2174/1570159x16666181108093520 · Cited by 126 · see citing works
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Digital detox: The effect of smartphone abstinence on mood, anxiety, and craving
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A Tripartite Neurocognitive Model of Internet Gaming Disorder
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“Hence, many conclude that moving forward we need to conduct more research on IGD and/or better synthesize prior studies (16).”
BackgroundGonzález-Bueso, V., Santamaría, J., Fernández, D., Merino, L., Montero, E., Jiménez-Múrcia, S., del Pino-Gutiérrez, A., & Ribas, J. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00787 · Cited by 101 · see citing works
Video game addiction and psychological distress among expatriate adolescents in Saudi Arabia
Saquib, N., Saquib, J., Wahid, A., Ahmed, A. A., Dhuhayr, H. E., Zaghloul, M. S., Ewid, M., & Almazrou, A. (2017) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2017.09.003 · Cited by 116 · see citing works
“Several studies have examined excessive use of video games, and others have tried to characterize video game addiction as well as to distinguish between the former and the latter (Billieux, Schimmenti, Khazaal, Maurage, & Heeren, 2015; Kardefelt-Winther et al., 2017; Schou Andreassen et al., 2016).”
BackgroundPeng, P., & Liao, Y. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04837-2 · Cited by 114 · see citing works
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“Mom, dad, look at me”: The development of the Parental Phubbing Scale
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Toward a qualitative understanding of binge-watching behaviors: A focus group approach
Flayelle, M., Maurage, P., & Billieux, J. (2017) · Journal of Behavioral Addictions · doi:10.1556/2006.6.2017.060 · Cited by 114 · see citing works
“…consistent with usual practices in behavioral addiction research (Billieux, Schimmenti, Khazaal, Maurage, & Heeren, 2015; James & Tunney, 2016; Kardefelt-Winther et al., 2017; Mihordin, 2012; Starcevic, 2016), this approach is not appropriate for initiating a genuine examination of such an…”
Self-citationDeleuze, J., Long, J., Liu, T., Maurage, P., & Billieux, J. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.02.031 · Cited by 110 · see citing works
Self-citationDigital Overuse and Subjective Well-Being in a Digitized Society
Büchi, M., Festic, N., & Latzer, M. (2019) · Social Media + Society · doi:10.1177/2056305119886031 · Cited by 110 · see citing works
“While the related but separate concepts of problematic Internet use or addiction rely on cutoff scoring (Kardefelt-Winther et al., 2017)—that is, the “desired” extent is exogenously defined by experts such as psychiatrists—PDO depends entirely on the individual and context: one person’s overuse is…”
BackgroundYOUNG, K. S., & Brand, M. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01853 · Cited by 112 · see citing works
“Applying different theoretical frameworks to studying IGD is important since some authors argue that one problem of this research field is the lack of a theoretical background in many studies (Billieux et al., 2015; Kardefelt-Winther et al., 2017).”
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“Furthermore, it has been proposed that gaming, even when performed excessively, may not represent an addictive behavior if it is done for coping with negative mood or stress [19].”
BackgroundKuss, D. J., Griffiths, M. D., & Pontes, H. M. (2017) · Journal of Behavioral Addictions · doi:10.1556/2006.6.2017.032 · Cited by 112 · see citing works
“Van Rooij and Kardefelt-Winther (2017) cite their own recent paper to assert “ we do not even have a clear idea of how to properly de fi ne overuse or problematic use of technology ” (Kardefelt-Winther et al., 2017, p. 2).”
BackgroundInfluentialSquires, L. R., Hollett, K. B., Hesson, J., & Harris, N. (2020) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-020-00224-0 · Cited by 112 · see citing works
“2019; Samaha and Hawi 2016), there is a longstanding and ongoing debate surrounding what should and should not constitute behavioural addiction (Griffiths 2017; Kardefelt-Winther 2017; Kardefelt-Winther et al. 2017; Petry et al. 2018; Sussman et al. 2017).”
BackgroundInfluentialDeleuze, J., Nuyens, F., Rochat, L., Rothen, S., Maurage, P., & Billieux, J. (2017) · Journal of Behavioral Addictions · doi:10.1556/2006.6.2017.074 · Cited by 102 · see citing works
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Risk and protective factors for (internet) gaming disorder: A meta-analysis of pre-COVID studies
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“Despite the prevalence of research using the language of smartphone addiction, researchers on behavioral addictions have cautioned against the formalization of addiction diagnoses [9,28,32].”
BackgroundInfluentialModeling the Engagement-Disengagement Cycle of Compulsive Phone Use
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“Kardefelt-Winther and colleagues argue that frequent, prolonged activities that distract an individual from daily life should not be considered “addictions” unless they also lead to distress and functional impairment [38].”
BackgroundColder Carras, M., & Kardefelt-Winther, D. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1108-1 · Cited by 99 · see citing works
Self-citationWhy and how to include parents in the treatment of adolescents presenting Internet gaming disorder?
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Discordance between self-report and clinical diagnosis of Internet gaming disorder in adolescents
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“According to recent findings (Daniel & Bridges, 2010; Karsay et al., 2018; Manago et al., 2015; Moradi, 2010; Vandenbosch & Eggermont, 2013), social and cultural stereotypes concerning beautiful and performing bodies, globally shared and reinforced through social media content creation, influenced…”
ResultBoer, M., van den Eijnden, R. J. J. M., Finkenauer, C., Boniel‐Nissim, M., Marino, C., Inchley, J., Cosma, A. P., Paakkari, L. T., & Stevens, G. W. J. M. (2021) · Addiction · doi:10.1111/add.15709 · Cited by 104 · see citing works
“However, this conceptualization may not sufficiently measure the detrimental impact of this behaviour for daily life, which is considered one of the core aspects of addiction-like behaviours [13,14].”
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Problematic social networking sites use and attachment: A systematic review
Musetti, A., Manari, T., Billieux, J., Starcevic, V., & Schimmenti, A. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107199 · Cited by 83 · see citing works
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“Confusion also surrounds what social media actually entails, and whether it is synonymous to social networking or not, as it is sometimes referred as [4, 10].”
BackgroundMotivational components of tolerance in Internet gaming disorder
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Assessing problematic use of social media: where do we stand and what can be improved?
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Self-citationGamers’ insights into the phenomenology of normal gaming and game “addiction”: A mixed methods study
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“…descriptions of problematic gaming, some population surveys do not always require the impairment criterion to be fulfilled when identifying problem cases (Kardefelt-Winther et al., 2017; Király et al., 2017; Lemmens et al., 2015; Pontes & Griffiths, 2015; Van Rooij, Van Looy, & Billieux, 2016).”
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The relationship between sleep and problematic smartphone use among adolescents: A systematic review
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Overcoming the unitary exploration of binge-watching: A cluster analytical approach
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“Such consequences caused by smartphone addiction, where people show recurrent failure to control their behavior of smartphone use with functional impairment or psychological distress, meet the criteria of behavioral addiction proposed by Kardefelt [19].”
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“Given the increased use and the fact that SM have become part of everyday life, it is particularly important not to exaggerate or globally pathologize intensive patterns of use (24, 40), but rather to detect individual behaviors that might need intervention.”
BackgroundBoer, M., Stevens, G. W. J. M., Finkenauer, C., Koning, I. M., & van den Eijnden, R. J. J. M. (2021) · Assessment · doi:10.1177/10731911211027232 · Cited by 77 · see citing works
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“These limitations must be accounted when reading scientific material and when outlining research (Kardefelt-Winther et al., 2017; Panova & Carbonell, 2018).”
Background
- Authors
- Kardefelt‐Winther, D., Heeren, A., Schimmenti, A., van Rooij, A., Maurage, P., Carras, M., Edman, J., Blaszczynski, A., Khazaal, Y., & Billieux, J.
- Affiliations
- Karolinska Institutet (SE)
- Harvard University (US)
- Università degli Studi di Enna Kore (IT)
- Department of Communication Sciences imec–mict–Ghent University Ghent Belgium
- UCLouvain (BE)
- Johns Hopkins University (US)
- Stockholm University (SE)
- Gambling Treatment Clinic and Research, School of Psychology University of Sydney Sydney Australia
- University of Geneva (CH)
- Cliniques Universitaires Saint-Luc (BE)
- Corresponding author
- Kardefelt‐Winther, Daniel
- Billieux, Joël
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2017-02-15
- Volume
- 112
- Issue
- 10
- Pages
- 1709-1715
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC5557689
- OpenAlex
- W2588289500
- Cited by
- 780
- References
- 40
- Citations by year
- 2026: 84 · 2025: 72 · 2024: 83 · 2023: 82 · 2022: 97 · 2021: 77 · 2020: 130 · 2019: 50 · 2018: 70 · 2017: 35
- FWCI
- 11.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Digital Access to Libraries (submittedVersion, other-oa)
- Open Repository and Bibliography (University of Luxembourg) (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (5T32MH014592‐39)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- behavioral addiction, DSM-5, addiction, operational definitions, exclusion criteria, diagnostic classification, conceptualization of addiction, leisure
- MeSH terms
- Humans, Behavior, Addictive
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