Process addictions are addictions to an activity or process, such as gambling, eating, spending, sex, and work. As to whether they are real addictions, the prevailing view is that they are. At least, they share commonalities with substance abuse addiction. Let’s look at each of these process addictions briefly.
Pathological or compulsive gambling, for example, which is categorized as an impulse control disorder under the Diagnostic and Statistical Manual IV (DSM-IV), published by the American Psychiatric Association (APA), is increasingly viewed as part of the family of addictions. In fact, DSM-V is currently in process, which will most likely clarify the issue. Individuals diagnosed with this disorder are frequently highly competitive, prone to other addictive-type disorders, and overly concerned with others’ approval. The symptoms of pathological gambling include persistent gambling despite mounting difficulties and problems with financial, vocational, and interpersonal functioning. The most effective treatment is professional counseling and an adaptation of the Alcoholics Anonymous model for alcohol and drug addictions. As for the prognosis of the individual diagnosed with pathological gambling, some say there is no cure – just as there is no cure for alcoholism or drug addiction. However, prolonged or continued abstinence is possible – living in recovery. There are biochemical and etiological commonalities for pathological or compulsive gambling and substance dependence. There is also a relationship between pathological gambling and food, sex, and work addictions. And co-morbidity has also been found between pathological gambling and other psychiatric disorders, including clinical depression and other mood disorders, anxiety, personality disorders, and attention deficit hyperactivity disorder (ADHD).
The current edition of DSM-IV does not have a specific category for sexual addiction but, under the listing of “Sexual Disorders Not Otherwise Specified,” it describes sex addiction as “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used.” Symptoms of sexual addiction, according to DSM-IV, include compulsive searching for multiple partners, compulsive fixation on a partner who is unattainable, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship. The Society for the Advancement of Sexual Health defines sexual addiction as a persistent and escalating pattern (or patterns) of sexual behaviors acted out despite increasingly negative consequences to self or others. Sexual addiction is a very real – and very serious -problem affecting an estimated three to six percent of adults in the United States. Behaviors associated with sexual addiction include out-of-control, repetitive actions such as:
- Simultaneous or sequential repetitive affairs
- Multiple anonymous partners
- Unsafe sexual activity
- Visits to strip clubs and adult bookstores
- Cyber sex, phone sex
- Objectification, partner sexualization
- Sexual aversion
Treatment for sexual addiction, unlike treatment for alcohol or drug addiction does not have the goal of abstinence. Rather, the goal is elimination of compulsive, unhealthy sexual behavior. Since many individuals who have sexual addiction also have other types of addiction (alcohol, drugs), many addiction treatment centers have components in their treatment programs to simultaneously address/treat sexual addiction.
Another type of disorder associated with addictive behavior involves eating. There are two basic types of eating disorders: anorexia nervosa and bulimia nervosa. Eating disorders affect an estimated 10 million women and 1 million men in America. In essence, individuals who have an eating disorder may either eat too much, not eat enough, or eat in a manner that is extremely unhealthy (such as stuffing yourself and then vomiting or purging to get rid of the food). Research suggests that there is a strong familial as well as biological component with eating disorders. Individuals with anorexia, for example, may come from families with a parent or sibling who also has an eating disorder, or where nurturing is lacking, replaced by over control. Studies also show that sexual abuse survivors are more prone to the disorder. Treatment for eating disorders focuses on improving the individual’s health, restoring normal body weight, and counseling therapy to help the individual learn how to maintain normal eating habits and explore thinking that led to faulty or distorted body image and excessive need for control. Eating disorders are treatable, but can result in death if left untreated. Hospitalization or inpatient care may be required in cases where the individual is reluctant to seek treatment.
The process addiction involving work is a compulsive and repetitive pattern of working that ignores or denies increasing negative consequences. Like other process addiction, work addiction does not meet the clinical definition for addiction, and is not recognized by the APA as an addiction. Nevertheless, work addiction does share similarities with other related compulsive or impulse control disorders. Workaholics are those individuals who are obsessed with work, striving to work longer and harder than others, constantly bringing work home, working while on vacation, and tied to their cell phones, Blackberries, and computers. Symptoms of work addiction include low self-esteem, approval seeking, control and authority issues, perfectionism, escapism, preoccupation with work, and lying. Treatment for work addiction may be offered in conjunction with a co-occurring substance abuse problem, or through individual and group therapy. Individuals may also get help by attending Workaholics Anonymous, a 12-step fellowship group that operates under principles established by Alcoholics Anonymous.
Spending addiction is not a single instance of out-of-control shopping. When a person is a compulsive spender, he or she cannot get enough of spending. Instead, the individual is consumed with an insatiable desire to spend, spend, and spend – despite lack of money in the bank, maxed out credit cards, inability to pay bills and other household expenses. Like other addictions, a spending addict may experience guilt, shame, remorse, and lie constantly to cover up the addiction, deny there is a problem, seek to shift blame to others. At the root of spending addiction are deep-rooted feelings the individual is trying to avoid. It may be the person doesn’t feel loveable for who they are. Or they may be trying to buy approval, friendship, or love with lavish gifts. They may not be able to stand who they are themselves, feeling unworthy, a failure, a fraud – without the façade of the “big spender.” To numb themselves, they engage in non-stop spending which, for a brief period, makes them forget about their underlying issues. Treatment for spending addiction involves individual and group therapy as well as attendance at 12-step fellowship groups such as Spenders Anonymous.