A recent opinion article published in Psychology Today and authored by Dr. Tom Bellamy, neuroscientist and honorary associate professor at the University of Nottingham, examined the boundaries between harmful habits, behavioural compulsions, and medically defined addictions.
Dr. Bellamy examined the use of the term “addiction,” and noted that while the DSM-5 formally classifies “Substance-Related and Addictive Disorders,” the everyday use of the term addiction has expanded far beyond substances. It is now used to describe compulsive behaviours, including gaming and shopping, that can override self-control and diminish quality of life.
“Part of the reason why the use of addiction as a medical term is contested is that it is often defined by symptoms, rather than biological mechanisms. Addiction involves insatiable desire, compulsions, obsessive thoughts, impulsiveness, and withdrawal pain when trying to break the habit,” wrote Dr. Bellamy. “Addicts also display characteristic behaviours: neglect of responsibilities, secrecy, lying to protect supply, and prioritising the addiction over all other concerns.”
Illicit substances such as cocaine, heroin, and alcohol produce specific changes in brain physiology, disrupting the reward system and weakening executive control. Moreover, the long-lasting molecular and neurobiological changes show that addiction is more than symptoms alone, and that it is a distinct condition of neurological dysregulation.
In addition, the article also discussed the concept of behavioural addictions. “The concept underlying behavioural, or process, addictions is that some natural rewards can drive the reward system into the same dysregulated state as addictive substances,” said Dr. Bellamy. He discussed the example of compulsive gambling, which is the only behaviour with clear evidence of producing the same neurobiological changes as substance addiction, including increased reward signalling and reduced sensitivity to other rewards. Because of this, it is formally recognised in the DSM-5 as an addictive disorder.
In addition, Dr. Bellamy also discussed the concept of limerence, the obsessive, romantic infatuation with another person. According to him, limerence highlights the grey zone of behaviours that can cause real harm and distress but don’t fit neatly into psychiatric categories. This uncertainty can contribute to the broader everyday use of the word addiction to describe compulsive behaviours, though it remains unclear which will ultimately prove to share the same neurobiological basis as substance addictions.