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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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“Besides, they include persistence over time to be part of the indicator to consider when addressing gaming disorder (Kardefelt-Winther et al., 2017).”
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Störung durch Glücksspielen und andere abhängige Verhaltensweisen
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Filtered States: Active Inference, Social Media and Mental Health
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Effect of video game addiction on the physical and mental wellbeing of adolescents of Karachi
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Philosophical Issues in the Addictions
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(2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.020 · Cited by 2
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“Hence, social media addiction should be carefully examined (Kardefelt-Winther et al., 2017) especially during pandemic isolation (Király et al., 2020).”
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Adicciones comportamentales: una nueva pandemia
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Adolescentes, juego online, uso problemático de internet y consumo de sustancias
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Validación de una escala para evaluar la adicción a Internet
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“These differences may propose that behavioural addictions’ risk tends to be more equally distributed among both higher and lower risk groups in the community, likely due to not possessing as equally strong neurological effects as substance and gambling addictions (Kardefelt-Winther et al., 2017; Najavits et al., 2014;…”
McAnally, H. M., Oi, A. W. T., Nada‐Raja, S., & Hancox, R. J. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00918-7 · Cited by 2
“For example, excessive television viewing might be more likely in those who have lower turnover of mesolimbic dopamine, or who are anxious or bored, or have difficulty with social communication (Kardefelt-Winther et al., 2017; Koob, 2006; Olsen, 2011).”
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“…of CSBD in the ICD-11, critics argued that the inclusion of sex and other behavioral addictions heralded the start of an avalanche of medicalising and pathologizing of behaviors which were part of a spectrum of normal human activity and sexuality (Frances, 2016; Kardefelt-Winther et al., 2017).”
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“Non-substance addiction was listed in neither DSM-IV nor ICD-10 (International Classification of Diseases) [4, 5].”
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“At the same time, it is important to stress that long hours spent playing games should not be automatically assumed as problematic, as they could be a matter of intentional choice, a coping mechanism, or a way of making a living (Kardefelt‐Winther et al., 2017).”
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Gómez, P., López, A. N., Liñares, D., Salmerón-Ruiz, M. A., & Boubeta, A. R. (2025) · Anales de Pediatría · doi:10.1016/j.anpedi.2025.503937 · Cited by 1
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Effects of problematic social media use on depressive symptoms
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Malkin, A., Rzeszutek, M. J., Moscovitz, A. M., Axenova, K., Walker, E., Randhawa, A., & Gunnarsson, K. F. (2026) · Journal of Applied Behavior Analysis · doi:10.1002/jaba.70062 · Cited by 1
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“We align with authors who argue that problematic behaviors are not clinical pathologies or syndromes but rather stem from maladaptive cognitions, behaviors, and coping strategies that result in negative daily life consequences (Kardefelt ‐ Winther et al., 2017).”
Lu, Z., Niu, Y., & Yao, Y. (2026) · Developmental Review · doi:10.1016/j.dr.2026.101264 · Cited by 1
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Shannon, H., Montgomery, M., Bush, K., Griffiths, M. D., Stead, J., Lemieux, M., Guimond, S., & Hellemans, K. G. C. (2026) · Addiction Research & Theory · doi:10.1080/16066359.2026.2650300 · Cited by 1
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“On one hand, there are concerns that such inclusions may lead to pathologizing common behaviours because of a lack of consensus on the definition or theoretical framework for NSRDs [8,9].”
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Strickland, J. C. (2019) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2019.030 · Cited by 1
“Although the debate over “behavioral addiction” versus the pathologizing of common behavior is beyond the scope of this review (see Kardefelt-Winther et al. 2017, for a relevant discussion of this issue), mTurk is becoming 47 an increasingly utilized resource for those interested in characterizing…”
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“That the constant and frequent use of the Internet to participate in games, often with other players, leads to clinically significant impairment or distress such as tolerance (i.e., spending more time playing), lack of control, and loss of other interests (Kardefelt-Winther et al., 2017).”
BackgroundSoldino, V., Miró, J., & Carbonell, E. (2021) · Victims & Offenders · doi:10.1080/15564886.2021.1963900 · Cited by 1
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“The internet gaming population still suffers stigmatization and since prevalence rates IGD are relatively low, the risk of pathologizing normal behavior is comparably high (Kardefelt-Winther et al., 2017).”
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“Behavioral addiction represents a persistent and repeated behavior that led to a significant distress or harm, whereas the behavior is not being reduced by the person and the associated distress or harm impairment of functions [22].”
BackgroundKern, L., Mattar, L., Kotbagi, G., Romo, L., & Morvan, Y. (2023) · Perceptual and Motor Skills · doi:10.1177/00315125231218745 · Cited by 1
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Reer, F., & Quandt, T. (2022) · merz | medien + erziehung · doi:10.21240/merz/2022.4.8 · Cited by 1
Selak, M. B., Merkaš, M., & Žulec, A. (2024) · Human Technology · doi:10.14254/1795-6889.2024.20-3.8 · Cited by 1
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Macovei, M., & Măirean, C. (2025) · Journal of Health Psychology · doi:10.1177/13591053251341191 · Cited by 1
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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