Exploring Unlikely Addictions

In 2013, the American Psychiatric Association finally recognized compulsive gambling as an addictive disorder and included it in the fifth edition of the Diagnostic and Statistical Manual — otherwise known as the DSM, or ‘the psychiatrists bible’. Gambling disorder was therefore the first non-substance-based addiction to be officially recognized by the psychiatric establishment. To some extent this has vindicated what many researchers, practitioners and addiction sufferers themselves have long known or suspected: that there are an array of human behaviours that are both rewarding and compulsive and which are experienced as addictive in exactly the same way that drugs are.

“Rubbish,” I hear the highbrows chortle to themselves. “Help…I’m addicted to air!” as the witty refrain goes, In today’s world of endless confessionals it is not hard to see why people are so sceptical about these so-called ‘addictions’, especially when they appear to be an alibi for selfish or undisciplined behaviours. Words like ‘shopping addiction’, ‘smartphone addiction’ and ‘sex addiction’ have entered common parlance, but are these activities really addictions?

For many years now, a furious debate has raged with regard to the validity of behavioural addictions and sex addiction in particular. For some reason, sex addiction seems to have a particularly polarizing effect. This is most likely because it animates both progressive liberals eager for a more permissive society, and social conservatives desiring the opposite — in equal measure. For example, if we were to describe behaviour such as visiting sex-workers, or engaging in bondage and sado-masochism, as an addiction, the moral guardians might tell us that we are potentially providing camouflage for more pedestrian sins (i.e. lust). The libertarians and progressives however, might venture forth the view that we are over-pathologizing perfectly normal behaviour. It seems you can’t win. As usual — no middle ground.

Either way, for the average worker in the frontline of treating addiction, or for the ordinary addict suffering its effects — it’s not complicated. We know this much: there are a range of highly rewarding behaviours (such as sex) that can become addictive, or which for all intents and purposes, feel like they are addictive. These observations are validated to some extent by research, but of much greater significance (in my view) is the somewhat overwhelming amount of anecdotal evidence on the part of lay people (i.e. those who participate in mutual aid groups such as 12 Step fellowships).

Surely we should ask the question: Why would people gather in the kind of smelly, damp church rooms where 12 step meetings are usually held, and discuss their most embarrassing problems with a bunch of complete strangers — if their problems weren’t real? Perhaps the answer is fairly obvious. Perhaps it’s because they are real. Perhaps it’s because they can’t stop doing what they desperately want to stop doing, and that thus, far medicine (and clinical psychology) has not yielded a better solution.

Sex Addiction

To get technical and specific we should really refer to non-substance-based addictions as process addictions (rather than older term, behavioural addictions) because they often involve an elaborate ritualized process in order to deliver the high they confer. An example of this ‘process’ can best be seen in sex addiction — or sexual compulsivity if you prefer. I will use the former term for now.

The sex ‘addict’ (as opposed to someone who is not impulsive, compulsive and obsessive in their sexual behaviour) must control every aspect of the sexual act including the chase, the setting, the accessories to be used and most importantly of all, the outcome or climax. For a non-sex-addicted person, sex is merely a spontaneous and enjoyable experience, but for the sex addict it is a neurotic trial, and one which necessitates increasingly novel and risky behaviours in order to continue providing any medicinal value. Like heroin addiction (or any addiction) the sex addict is constantly in a state of wanting, although not necessarily in a state of liking.

Is Anorexia an Addiction?

It’s true that eating disorders like anorexia are not most people’s idea of an addiction, but if we reduce addiction down into its basic constituent parts then we can see that all the necessary ingredients are there, and that it can easily fit into the addiction model.

Addiction is pure reward seeking. It is not defined solely by the inability to stop, because there are other conditions which are also characterized by the inability to stop doing something that we don’t find enjoyable anymore — namely OCD (obsessive-compulsive disorder). People with OCD can’t stop doing what they’re doing any more than addicts can, but the difference between an obsessive hand-washer and an impulsive crack addict, is that while neither can stop doing what they’re doing — despite really wanting to — one is motivated by the need to remove a perceived threat (germs) while the other is motivated by the need to receive a reward (crack).

“So, where exactly,” I hear you ask, “is the reward in starving yourself to death?” Well, anorexia may seem like a highly unrewarding activity to those who haven’t suffered it, but for those who have, it is experienced as rewarding on a number of levels. For an anorexic, being in control of what they eat might be rewarding. It may be the only thing that they can control — and being in control is rewarding. Further, being thin can be rewarding, no matter how dysmorphic and dangerous that thin-ness may appear to others. Lastly, severe calorie restriction can be euphoric, and euphoric feelings are rewarding regardless (or even because of) the pain required to achieve them.

What Is Megarexia?

So now let us also consider megarexia. There are two different meanings to megarexia in common usage. First, a lack of awareness of one’s obesity, and second, a dissatisfaction with one’s muscle mass (technically known as muscle dysmorphia). I am discussing the latter.

Megarexia is a fast-growing phenomenon. Like anorexia, megarexia is a form of body dysmorphia, an obsession with the fact that one’s appearance is fundamentally flawed in some way. As opposed to anorexia however, it is a predominantly male type of body dysmorphia. It is anorexia for weightlifters, or body dysmorphia for boys.

Megarexics desire to both increase their bulk and reduce their body fat percentage. They use steroids to increase their muscularity, and often periodically use methamphetamine or other stimulants to assist with intermittent fasting. Thus, megarexics end up with a double whammy of consequences from their addictive behaviour. They have the problems which any long-term steroid user would face, such as rage attacks when they are using, and depression and weight gain when they stop. And they also have the issues that any other body-dysmorphic person would have, namely; they suffer from a delusional idea of what they really look like and see themselves as too fat or too thin. All of this is motivated by the need to perfect their ‘look’.

You might well ask, “what is the difference between a megarexic and a traditional body-builder then?” The answer would be — not much. What difference there is would probably come down to two things;

1. Your relationship with food. Is it neurotic and problematic, or is it comfortable and does it feel healthy? Only you, the individual, can decide this.

2. Your relationship with exercise. Is it sensible and considered, or do you train through injuries and place yourself in a dangerous position with regard to your long-term health, purely out of vanity?

The driver of this addictive mode of course, is social media, or in primate terms — social status. The reward lies in the twenty thousand ‘likes’ that this young man will receive on one social media platform or another. And this is where we really begin to see the unbelievably complex, powerful and intertwined nature of modern process addictions as driven by the vector of technology, which itself, becomes fundamental to the addiction. Or is it that addiction is fundamental to the technology?

As with all addictions there are primal, evolutionary motivations behind all of this social media obsession, as well as with the behaviours which are augmented by it. Megarexia is nothing more than a slightly twisted extrapolation of what young men have always done (and arguably need to do) which is — gain admiration — and the mating opportunities that follow from it. The same is true of course, for women.

The ideal of thinness in women is beginning to change somewhat. But in most societies (rightly or wrongly) it is still admired. In men, it is muscularity that is admired (aesthetically speaking). So is it any wonder then, that these body shapes are pursued obsessively and experienced as rewarding when they are attained? The fact that the pursuit of these body images may eventually kill the person pursuing them doesn’t matter to their poor, unrewarded brain any more than it matters to their genes. Their brain (and their genes) have more short-term goals in mind, such as indulging in the prolific mating opportunities which necessarily follow from being highly attractive.

Gaming & Social Media

‘Gaming’ refers to the impulsive and compulsive use of video games. These games stimulate dopamine via the exploration of novel stimuli in virtual environments. After gambling, “Internet Gaming Disorder” actually has the most literature to support it as an addictive disorder. In 2013 it made it into the American Psychiatric Association’s DSM-5 as a condition for further study. It is beginning to be taken seriously as a public health issue, especially in East Asia, where treatment centres geared specifically towards treating gaming have been operating for some time.

Excessive and obsessive use of social media use is also starting to be understood as an addictive process. For a damning indictment from someone who should know (Facebook’s former Vice President Chamath Palihapitiya) see here. Palihapitiya describes how this very familiar obsession is driven by ‘dopamine driven feedback loops’. “What the hell is one of those?” I hear you say.

Dopamine feedback loops work in the following way. Let’s say you decide to post something on Facebook, Twitter, or any other social media platform. You may feel that there is no particular urgency to this activity, and that you are simply updating a record of your personal life or opinions, albeit, with others looking on — a bit like we used to record and log our family events or adventures by updating our photo album. But the reality is (and unbeknownst to yourself) you actually have another agenda in mind — you want to be liked and approved of!

So now you proceed to upload your photos and the tense wait begins. How many likes will you get? Will you in fact, attract some negative criticism — hopefully not. Perhaps, and this is the worst fate of all, you will simply be ignored or damned with faint praise. Will your post fail to be as awesome and meaningful to others as it was to you when you wrote it? If you are lucky (in other words — if you are attractive to others) you will get positive feedback, or in neurochemical terms — dopamine — or even more obliquely — status. If you are unlucky, then you will get silence, or perhaps even some negative feedback. Either way you will be encouraged to try again, and so it is that we disappear again and again, down the plughole of one vacuous social media platform or another.

And if this is what happens to a seasoned, mature adult, well-versed with life’s vicissitudes, and possessed of a relatively robust personality, then just imagine how discouraging it is for individuals without a fully developed and robust personality — in other words — children and adolescents. As if adolescence wasn’t a terrifying enough maelstrom of social rejection already!

Worst affected of course, are girls, whose predominant method of bullying relies upon social shaming and reputational assault, rather than outright physical assault (as it tends to with boys). A form of bullying which seems tailor made for the social media age.

Other Unlikely Addictions

Two other behaviours which people have described as addictive but for which the scientific literature is less substantial are self-harming and performance (i.e. work). I have included them because I believe that the self-reported experiences of large numbers of people should be taken seriously, even if they aren’t heavily researched (yet). While these may seem the furthest thing from pleasurable or rewarding, they are subjectively experienced as such by a great many people.

Self-harming or self-mutilation as it is often known, involves cutting oneself (with razor blades or other ‘sharps’) without the intention of killing oneself. It can also refer to causing other kinds of bodily damage — ranging from burning oneself with cigarette ends, right through to compulsively acquiring excessive tattoos and body piercings. The literature seems to suggest that self-harm is done for the release of tension it provides, and the numbing feeling that comes by way of the release of endorphins and other endogenous painkillers.

Addiction to work and performance is referred to colloquially as workaholism, but this term is misleading because it should really include obsessions with sporting, or artistic achievements, or any other type of project or performance which accrues esteem. This mode of addiction is often acted out in tandem with other addictive drugs or behaviours such as stimulants (cocaine for example) which augment and intensify the sense of reward achieved, and also assist with the stamina necessary to achieve such feats.

There are many more human behaviours that we might loosely term ‘addictive’. Are they real addictions? Who knows? Or more accurately — who cares! Because whilst we don’t know exactly ‘what’ these behavioural illnesses are — we do know what to do about it. There are multiple modalities that work well to treat them, and which are to some extent effective (dependent on the individual’s preparedness to orientate their life differently). The efficacy of different models is a very controversial subject which I will leave for another article. Suffice to say that there are legions of people who have transformed their lives form these debilitating disorders. It can be done. And for those who have done it — quibbling over diagnoses seems like semantics. And it is.