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How can we conceptualize behavioural addiction without pathologizing common behaviours?
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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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“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]
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“'[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]
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In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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 ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [169]
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“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
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“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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Ropovik, I., Martončik, M., Babinčák, P., Baník, G., Vargová, L., & Adamkovic, M. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107590 · Cited by 111
Lanette, S., Chua, P. K., Hayes, G. R., & Mazmanian, M. (2018) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3274370 · Cited by 106
“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
Tran, J. A., Yang, K. S., Davis, K. S., & Hiniker, A. (2019) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3290605.3300542 · Cited by 116
“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
Self-citationWhy and how to include parents in the treatment of adolescents presenting Internet gaming disorder?
Bonnaire, C., Liddle, H. A., Har, A., Nielsen, P., & Phan, O. (2019) · Journal of Behavioral Addictions · doi:10.1556/2006.8.2019.27 · Cited by 99
Meier, A. (2022) · Mobile Media & Communication · doi:10.1177/20501579211029326 · Cited by 91
Discordance between self-report and clinical diagnosis of Internet gaming disorder in adolescents
Jeong, H., Yim, H. W., Lee, S.-Y., Lee, H. K., Potenza, M. N., Kwon, J.-H., Koo, H. J., Kweon, Y.-S., Bhang, S.-Y., & Choi, J.-S. (2018) · Scientific Reports · doi:10.1038/s41598-018-28478-8 · Cited by 104
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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
“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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Weinsztok, S. C., Brassard, S. L., Balodis, I. M., Martin, L. E., & Amlung, M. T. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.786358 · Cited by 95
Problematic social networking sites use and attachment: A systematic review
Musetti, A., Manari, T., Billieux, J., Starčević, V., & Schimmenti, A. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107199 · Cited by 102
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Exercise Addiction in Practitioners of Endurance Sports: A Literature Review
López, A. N., González, O. M., del Valle, A. S., & Márquez, S. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01484 · Cited by 90
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The personality, motivational, and need-based background of problematic Tinder use
Orosz, G., Benyó, M., Berkes, B., Nikoletti, E., Gál, É., Tóth-Király, I., & Bőthe, B. (2018) · Journal of Behavioral Addictions · doi:10.1556/2006.7.2018.21 · Cited by 82
Henzel, V., & Håkansson, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248406 · Cited by 107
“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
King, D. L., Herd, M. C. E., & Delfabbro, P. H. (2018) · Computers in Human Behavior · doi:10.1016/j.chb.2017.09.023 · Cited by 78
Assessing problematic use of social media: where do we stand and what can be improved?
Cataldo, I., Billieux, J., Esposito, G., & Corazza, O. (2022) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2022.101145 · Cited by 90
Self-citationGamers’ insights into the phenomenology of normal gaming and game “addiction”: A mixed methods study
Carras, M. C., Porter, A. M., van Rooij, A. J., King, D. L., Lange, A., Carras, M., & Labrique, A. B. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2017.10.029 · Cited by 74
“…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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“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.”
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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
Metadata
- 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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