DSM-5 and the Decision Not to Include Sex, Shopping or Stealing as Addictions

Abstract

For the first time substance use will not be required for the diagnosis of addiction in diagnostic classification manuals, such as DSM and ICD. The DSM-5 has included gambling disorder, along with substance use disorders, as forms of addictions in a new chapter named “Substance-related and addictive disorders”, thus reflecting evidence that gambling behaviors activate reward systems similarly to drugs of abuse. However, there is still debate on whether other less recognized forms of impulsive behaviors, such as compulsive buying (oniomania), compulsive sex, and kleptomania can be conceptualized as addictions. In this review, we critically evaluate the literature on these behaviors with a focus on socio-demographic and clinical characteristics, underlying neurobiology and treatment response, and their potential overlap with substance use disorders. We were unable to find a substantial number of studies supporting a relationship of the aforementioned reward-based conditions to substance use disorders, thus supporting the contention not to include compulsive buying, compulsive sex, and kleptomania in DSM-5 as behavioral addictions.