In our last blog, we were discussing how the neural pathways for love, gratification and reward are changed in addiction, and how it changes the person’s behavior in relationships. And I promised you to explain what were the signs that you should look for to tell the difference between addiction and just bad behavior that could be willingly stopped?
There is much confusion and denial out there regarding which out-of-control and harmful behavior should be labelled addiction. Since we have argued that addiction is a disease, because we could prove there were demonstrable changes in the brains of the people who behaved like that long-term, we should expect that the doctors to have clear guidelines and criteria to distinguish between abuse and addiction. In truth, doctors themselves are struggling with this definition. As a result of that, and as a result of exciting new discoveries about the brain, the definition of addiction has changed a couple of times in the last ten years, and is even different in the USA than in Europe.
To help them sort things out, and balance the sort of help people need, the doctors have made official lists of diseases. They update the lists every couple of years, but some entries are still behind what we have come to know. According to that lists, addiction is still called substance related and addictive disorders, leaving little room for categorizing process addictions. Recently in the USA, pathological gambling has been included, and in Europe suggestions are being made to include gambling and gaming disorder, but for some conditions that have a lot in common with substance addictions, such as compulsive stealing, compulsive buying, compulsive sexual behavior, compulsive binge-purge syndrome or anorexia nervosa, it was decided that there was insufficient evidence for their inclusion in the list.
The lists are restrictive, because they have important consequences: whether or not you could ask your doctor for help depends upon them. But for your personal use, to know if you are addicted or not, you should be familiar with the signs that would alert you that you are running out of control. It is well known that some behaviors have a lot in common with substance addictions, and we call them process or behavior addictions. And it is also well known that you cannot tell an alcoholic from non-alcoholic just from the type or quantity of liquor they consume. There are other, more accurate tell-tale signs of addiction, and they may be used to define the boundaries also in process addictions. Let’s look at them:
In order for a person to be diagnosed with addiction, they must display 2 of the following 11 symptoms within 12-months. Two or three symptoms indicate a mild problem; four or five symptoms indicate a moderate problem, and six or more symptoms indicate severe addiction. Since we are talking about process addictions, I will use the examples of addictive behaviors instead of substance use.
Engaging in the behavior for longer than you're meant to. “Just a few minutes to check out what is new on Facebook!” turns into full three hours of designing and polishing your profile, while you know that you should walk the dog and start doing your homework instead. And it happens almost every time …
Wanting to cut down or stop the behavior but not managing to. “I’ll start the diet tomorrow!” is what you tell yourself, wolfing down another piece of cake you know you shouldn’t take. And when tomorrow comes, the day to start is again – the next day. Or if you do start, there is a temptation in the next couple of days, making you break your promise and postpone it again until tomorrow.
Spending a lot of time engaging in or recovering from the behavior. Pathological gamblers spend most of their time studying the game or the way the machine “gives away the cash”, making up theories, predicting the lucky strike, as well as chasing losses and working hard to earn the money to pay their gambling debts.
Cravings and urges to engage in the behavior. For a sex addict, just walking along the street may be full of cues and triggers: there are provocatively dressed people, large advertisement posters revealing body parts, magazines, pictures everywhere. Even when they don’t want to, they are attracted to the visual cues and their imagination starts working. Craving is much more than just wanting something really bad: it is an unstoppable feeling that you must absolutely do that or get that immediately, or else something terrible might happen.
Not managing to do what you should at work, home, or school because of the behavior. Take typical adolescents who spend most of their free time playing videogames, while they should be doing homework, hanging out with their friends or engaging in a hobby. There will be consequences, sooner or later. Their grades will drop, their social skills will not develop, soon they will find it too difficult to even leave the room.
Continuing to behave that way, even when it causes problems in relationships. When sex addicts continue to watch pornography even after entering a committed relationship, their partners will feel betrayed and offended. They will not understand and may be blaming themselves for not being attractive enough. To escape the conflicts, sex addicts may start lying or hiding their behavior, thus creating ever new problems in relationships which are supposed to be based on mutual trust and open communication.
Giving up important social, occupational, or recreational activities because of the behavior. Love addicts may be manipulated by their narcissistic partners to stop pursuing promising careers, and stay at home to take care of them. Or if their partner drinks too much, they may stay away from all social gatherings, in fear that their partner might get drunk there or behave inappropriately.
Behaving like that again and again, even when it puts you in danger. Sex addicts may be well aware that they risk contracting sexually transmitted diseases when having sex with people they do not know well, but often do not use protective measures. The risk and danger even seem to enhance their excitement and it is not so rare that they use the kind of behaviors that are shameful, dangerous or against the law.
Continuing the behavior, even when you know you have a physical or psychological problem that could have been caused or made worse by it. Love addicts stay with their abusive partners in spite of the covert and overt abuse, believing that letting them go is the worst thing that could happen to them. Social workers and police officials are often putting themselves in danger to save the victims of abuse from their perpetrators, and may be disappointed to find the victims return back after a couple of days, to give their partner yet another chance …
Needing more of the behavior to get the effect you want (tolerance). The behavior of sex addicts may progress from watching pornography to engaging in real-time online sexual activities with strangers, to paying for sex. Addicts are always chasing the perfect addictive experience, always wanting more and more excitement.
Development of withdrawal symptoms, which can be relieved by repeating the behavior. Nausea, vomiting, trembling, perspiration, chest and stomach pain … It’s well known that stopping the drug or alcohol consumption in an addict, triggers withdrawal symptoms, but stopping process addictions may produce similar response. I have had my love addicted clients taken to ER with symptoms typical of heart attack, to later find out that there was nothing wrong with their hearts. It is even called “the broken heart syndrome” when have severe physical reactions to breaking up with their lovers.
These are the eleven signs to look for if you want to know if you are in danger of addiction, or if you maybe have already crossed the line. You can watch my Youtube video on the topic here:
Sanja Rozman is a medical doctor, psychotherapist and author of 8 books on behavioral addictions.
Read more in her book Serenity: How to Recognize, Understand, and Recover from Behavioral Addictions
that is about to be published by Brandylane Publishers Inc., Belle Isle Books.