This narrative review synthesizes current knowledge on behavioral addictions, emphasizing five conditions of increasing clinical and public health significance: gambling disorder, internet gaming disorder, compulsive sexual behavior disorder (CSexBD), compulsive buying-shopping disorder (CBuy-ShopD), and problematic use of social media (PUSM). These conditions are characterized by excessive engagement in non-substance-related behaviors despite adverse consequences, yet they remain underdiagnosed and undertreated.

The classification of behavioral addictions varies across diagnostic frameworks. The DSM-5-TR formally recognizes gambling disorder as a behavioral addiction, while internet gaming disorder is listed as a condition for further study. In contrast, the ICD-11classifies both gambling and gaming disorders under “disorders due to addictive behaviors” and categorizes CSexBD as an impulse control disorder. While CBuy-ShopD and PUSM are not explicitly included in ICD-11, they may be classified under “other specified disorders due to addictive behaviors,” reflecting ongoing nosological debates.

Behavioral addictions frequently co-occur with psychiatric disorders such as depression, anxiety, ADHD, and substance use disorders. Gambling disorder has an estimated international prevalence ranging from 0.1% to 5.8%, yet only 0.23% of affected individuals seek treatment. Internet gaming disorder affects approximately 2–3% of the population, with a two- to threefold male predominance. CSexBD and problematic pornography use (PPU) are reported in 8.2% of men, 2.4% of women, and 6.5% of gender-diverse individuals, often co-occurring with mood, anxiety, and personality disorders. CBuy-ShopD has an estimated prevalence of 5%, with higher rates in women and younger adults, and is frequently associated with mood disorders, hoarding, and other addictive behaviors. PUSM prevalence estimates vary widely (5–25%), largely due to inconsistent definitions, but it is particularly linked to impulsivity, reward-seeking behaviors, and social comparison, with adolescents at heightened risk.

The evaluation of behavioral addictions remains complex given the high comorbidity with other psychiatric conditions and the lack of universally accepted diagnostic criteria for some disorders. C-L psychiatrists should maintain a high index of suspicion for behavioral addictions in patients presenting with impulsivity, compulsivity, or comorbid psychiatric conditions. Several validated screening instruments are available:

• Gambling disorder: South Oaks Gambling Screen (SOGS), Problem Gambling Severity Index (PGSI)
• Internet gaming disorder: No consensus on a single diagnostic tool
• CSexBD: Compulsive Sexual Behavior Disorder Scale (CSBD-19)
• CBuy-ShopD: Bergen Shopping Addiction Scale
• PUSM: No standardized assessment criteria, contributing to variability in prevalence estimates

Cognitive-behavioral therapy (CBT) remains the most empirically supported intervention, particularly in group therapy settings. Mindfulness-based interventions show promise in addressing craving and impulsivity, though further validation is warranted. Internet-based therapies provide accessibility advantages, yet data on long-term efficacy are limited. While no pharmacotherapies are currently FDA-approved for behavioral addictions, certain medications show potential:

• Opioid antagonists (naltrexone, nalmefene): Demonstrated efficacy in gambling disorder
• Selective serotonin reuptake inhibitors (SSRIs): Potential benefit in CSexBD and PUSM
• Mood stabilizers (lithium, topiramate): Investigated for gambling disorder, particularly in cases with comorbid bipolar disorder
• N-acetylcysteine (NAC): Preliminary evidence suggests efficacy, though further research is needed
• Neuromodulation (tDCS targeting the dorsolateral prefrontal cortex): Investigational for gaming and gambling disorders, with early findings suggesting potential therapeutic benefits

Behavioral addictions are closely linked to multi-billion-dollar industries, necessitating regulatory and public health interventions. Policies targeting gaming, gambling, and social media platforms are increasing, with a focus on youth protection, digital well-being, and advertising restrictions. Further research is needed to refine diagnostic criteria, standardize assessment tools, and elucidate the neurobiological underpinnings of these disorders. Longitudinal studies are essential to understanding addiction trajectories, while treatment research should prioritize individualized interventions based on patient risk profiles.

In summary, behavioral addictions share core neurobiological, psychological, and clinical features with substance use disorders yet remain underrecognized in psychiatric practice. Given their frequent co-occurrence with depression, anxiety, and ADHD, unrecognized behavioral addictions may contribute to poorer treatment outcomes. C-L psychiatrists are uniquely positioned to identify these conditions in diverse patient populations. Increased awareness and utilization of validated screening instruments can facilitate early detection and referral to appropriate treatment. While no pharmacotherapies are formally approved, CBT remains the gold-standard intervention, and emerging psychopharmacological strategies warrant continued investigation. By integrating behavioral addiction screening into psychiatric evaluations, C-L psychiatrists can improve patient outcomes and contribute to the evolving landscape of addiction psychiatry.