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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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“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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Substance and Behavioral Addictions Assessment Instruments
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Müller, K., Beutel, M., Reinecke, L., Dreier, M., Schemer, C., Weber, M., Schnauber-Stockmann, A., Stark, B., Quiring, O., & Wölfling, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010529 · Cited by 4
Yakut, E., Havva, S. A. R. I., & Özlem, K. U. R. U. (2022) · Bingöl Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi · doi:10.33399/biibfad.933191 · Cited by 7
Ince, C., Tiego, J., Albertella, L., Fontenelle, L. F., Chamberlain, S. R., Yücel, M., & Rotaru, K. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00022 · Cited by 4
Wachten, H., & Strahler, J. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01535-8 · Cited by 4
Xie, X., Hu, Z., Tian, X., Wang, X., Yang, Y., & Kong, L. (2026) · Addictive Behaviors · doi:10.1016/j.addbeh.2026.108656 · Cited by 4
Aslan, A. M., & Koç, H. (2026) · Psychiatric Quarterly · doi:10.1007/s11126-026-10269-4 · Cited by 6
“Many studies have relied on behavioral indicators of engagement rather than symptom-based assessments capturing impaired control, salience, or functional impairment [20, 21].”
InfluentialCross-domain online vigilance, boundary management and stress among knowledge workers
Conradie, L., Roux, D., & Parry, D. A. (2023) · South African Journal of Business Management · doi:10.4102/sajbm.v54i1.3896 · Cited by 6
Hassan, M., Orebi, H. A., Salama, B. M. M., & Kabbash, I. (2025) · BMC Psychiatry · doi:10.1186/s12888-024-05988-6 · Cited by 8
Blinka, L., Ťápal, A., & Škařupová, K. (2021) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-021-09907-x · Cited by 4
The effects of an early intervention on adults’ gaming-related problems – a pilot study
Männikkö, N., Ojala, P., Hylkilä, K., Kääriäinen, M., Vähänikkilä, H., & Mustonen, T. (2022) · Journal of Addictive Diseases · doi:10.1080/10550887.2022.2030640 · Cited by 4
Fusaroli, M., Pellegrini, L., Fusaroli, R., Raschi, E., Menchetti, M., & Poluzzi, E. (2022) · Addiction · doi:10.1111/add.16086 · Cited by 4
Pattern and Predictors of Internet Addiction among Secondary School Adolescents in Enugu, Nigeria
Odinka, J., Chinawa, A., Nduagubam, O., Ossai, E., Odinka, P. C., Ugwunna, N. C., & Chinawa, J. M. (2023) · Nigerian Journal of Clinical Practice · doi:10.4103/njcp.njcp_273_22 · Cited by 5
Thege, B. K., Moore, A., Szabó, G. S., Fitzgerald, M., Hodgins, D. C., & Kim, H. S. A. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115459 · Cited by 5
Tecnoestrés y tecnoadicción: el papel de la tecnodependencia en trabajadoresde Colombia y México
González, E. Q., Giraldo, V. O., & Villavicencio-Ayub, E. (2023) · Salud Uninorte · doi:10.14482/sun.39.02.020.359 · Cited by 4
“Los trastornos adictivos involucran la falta de control y la dependencia, factores que interfieren en la vida de las personas (9,10).”
BackgroundDavranışsal Bağımlılıklara Yönelik Müdahalelere İlişkin Bir Derleme
KARAHAN, A. S. (2023) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.1152083 · Cited by 4
Tambelli, R., Favieri, F., & Casagrande, M. (2024) · Healthcare · doi:10.3390/healthcare12050556 · Cited by 4
“…and habits that are cross-sectionally adopted by populations and can be characterized by compulsivity or lack of control (e.g., gaming, internet, social media, and smartphones) [3,4] but that are widely used in modern society, making it difficult to distinguish their positive and negative features.”
BackgroundKolas, J., & von Mühlenen, A. (2024) · Journal of Behavioral Addictions · doi:10.1556/2006.2023.00061 · Cited by 7
Donisi, V., Salerno, L., Delvecchio, E., & Brugnera, A. (2024) · JMIR Research Protocols · doi:10.2196/58739 · Cited by 8
Unplugging the threat: how internet addiction among adolescents undermines learning behavior
Islam, M. R. (2024) · SN Social Sciences · doi:10.1007/s43545-024-00966-x · Cited by 10
Methodological considerations for social media intervention studies
Abeele, M. V., Murphy, S. L., Lemahieu, L., & Koster, E. H. W. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00474-6 · Cited by 10
“However, this kind of thinking conflates the process with the outcome: it pathologizes the behaviour of social media use itself 82,83 thereby reify-ing withdrawal as the optimal alternative, while ignoring the myriad positive effects that social media use might have (for instance, for emotion…”
Prevention and Treatment of Sex Addiction
Reid, R. C., Grubbs, J. B., & Kraus, S. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.025 · Cited by 4
Olivella-Cirici, M., Sánchez, E., Continente, X., Clotas, C., & Pérez, G. (2021) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-021-00228-0 · Cited by 5
Current Issues in Conceptualisation, Measurement, and Research of Problematic Use of the Internet
Razum, J., Tkalić, R. G., Brkljačić, T., Sučić, I., & Wertag, A. (2021) · Drustvena istrazivanja · doi:10.5559/di.30.4.05 · Cited by 4
Sicilia, Á., Alcaraz-Ibáñez, M., Paterna, A., Griffiths, M. D., Pallanti, S., English, A. C., Ceci, F., Carlo, F. D., Burkauskas, J., Martinotti, G., et al. (2023) · Cambridge University Press eBooks · doi:10.1017/9781911623731 · Cited by 4
Akbari, M., Bahadori, M. H., Khanbabaei, S., Milan, B. B., Manchiraju, S., & Spada, M. M. (2023) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2023.100511 · Cited by 5
Tikhonov, P., Levchuk, A. G., Trufanov, A. G., Efimtsev, A., & Zubkov, M. A. (2023) · Computers in Human Behavior · doi:10.1016/j.chb.2023.108052 · Cited by 4
Oniomaniacs: the popular framing of consumption as a disease
Edman, J., & Berndt, J. (2017) · Addiction Research & Theory · doi:10.1080/16066359.2017.1396585 · Cited by 4
“This has been a process absorbing an ever-increasing number of behavioural patterns (Kardefelt-Winther et al. 2017).”
BackgroundSelf-citation
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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