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Addiction and Compulsions

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An addiction a persistent need to consume a substance or commit an act—is distinct from a compulsion, which is an overwhelming and irresistible impulse to act. Usually, a compulsive act is preceded by obsessive, intrusive thoughts that compel the person to act, whereas an addiction is more of a habit that is not necessarily accompanied by obsessive thinking. Still, given how often an addict thinks about whatever he or she is addicted to, the line between “addiction” and “compulsion” can be somewhat unclear.


  • Identifying Signs and Symptoms
  • Related Conditions and Causes
  • Therapy for Addictions and Compulsions
  • Case Examples of Addictions and Compulsions

Identifying Signs and Symptoms

Compulsive behaviors include chronic gambling, substance abuse, sexual addictions, unrestrained shopping and spending, hoarding, excessive exercising, Internet gaming, eating issues, and other behaviors. Any compulsive behavior can become an addiction when the act spirals out of control, impairing a person’s ability to function socially, academically, and professionally.

 

Determining whether a habitual behavior has become problematic begins with evaluating the benefits associated with the activity and the feelings and beliefs surrounding it. The distinction between a passionate hobby and a compulsive behavior may be difficult to discern. For example, is running 10 miles every day—rain, shine, or snowstorm—an addiction, or is it good athletic discipline? Is a monthly trip to Vegas to play the slots a gambling problem, or just a fun escape from the daily grind? What about binging on ice cream, even when you know you should not? Addiction or compulsivity may be indicated when the behavior results in feelings of distress, guilt, or shame, or when abstaining from the behavior provokes anxiety or proves to be impossible.

 

Symptoms that suggest a compulsive behavior has become problematic include: 

  • Interpersonal and professional relationship problems 
  • Concealment of the behavior
  • Denial of a problem
  • Inability to stop the behavior
  • Alternating feelings of anxiety, confusion, shame, or elation that revolve around the behavior
  • Withdrawal from or a lack of enjoyment in other activities
  • Seeking the company of others who pursue the activity, or conducting the activity only in isolation
  • Fear surrounding the potential repercussions associated with discontinuing the activity  

Related Conditions and CausesA man lays on the couch surrounded by shopping bags

Typically, addictions or compulsions develop as a result of an underlying psychological issue, such as depression, and the behavior can temporarily relieve stress or anxiety for anywhere from several minutes to several days. Compulsive behaviors often trigger the same neurological pathways that specific substances stimulate in the brain of someone with drug addiction, and this cycle of reward can make the activity that much more attractive and, ultimately, addictive.

 

People with severe mental health conditions, such as bipolar, may experience poor impulse control that makes it difficult or impossible to resist compulsive urges. In addition, a rare side effect associated with dopamine agonist medications, which treat conditions like ADHD and Parkinson’s, can produce extreme compulsive behaviors, even in people who had no such inclinations previously.

 

Therapy for Addictions and Compulsions

Compulsive behaviors and addictions may provide a person with a sense of power, euphoria, confidence, validation or other feelings that may otherwise be lacking in their lives, and psychotherapy is designed to help people identify uncomfortable feelings and sources of distress in order to change and grow. People who struggle with compulsivity and addiction are unlikely to conquer those behaviors unless they work to address underlying causes. Working with a therapist is one of the most effective treatments for managing compulsive behaviors and addictions, and there are many types of therapy suited to addressing behaviors that a person wants to change. It is most important to find a therapist who is qualified to address the issue. In addition, self-help, support groups, and 12-step programs may facilitate recovery from addiction and compulsivity.

 

Case Examples of Addictions and Compulsions

  • Internet addiction: Morgan, 22, is a college student. He spends several hours on the Internet each night, sometimes staying awake until sunrise and having trouble functioning in class the next day. He has friends at school, but finds himself isolating from them and becoming absorbed in the virtual world of the web. Morgan obsessively plays games and engages in chats, and he does little else with his free time. His social life and grades suffer, but he cannot seem to stop. He reports feeling like he is in a daze, and says he is bored and anxious when he is not on the computer. Therapy reveals ambivalence about his major and the ensuing career it implies, as well as homesickness, social anxiety, and perhaps some chemical issues that tend toward depression. At the suggestion of his therapist, Morgan begins to involve friends in computer activities, watching movies with them and playing games in a group. This leads to extended social activities, and Morgan’s confidence improves. Career counseling steers him towards a more fulfilling path, and a few family sessions with his mother and brother uncover old grief that, once resolved, allows a better mood to prevail and socializing becomes enjoyable again.
  • Therapy for sex addiction: Daisy, 30, is disturbed by her own promiscuity, which has resulted in an unwanted pregnancy that she chose to terminate, as well as the contraction of sexually transmitted diseases, which were treated and remitted. Daisy is ashamed of her behavior but continues to meet new partners several times a week and engage in what she calls “totally meaningless sex.” Daisy does not know why she is driven to this behavior. In therapy, feelings of inadequacy, rooted in the experience of being criticized by, abused by, and eventually estranged from her parents, are discovered. Daisy realizes she is unsure of her own worth, and after several months discovers healthier ways of proving herself to herself, such as rock climbing and excelling at her job. Eventually, she begins dating and after experiencing true intimacy, she is able to abstain from compulsive sexual encounters.