Background and rationale
Behavioral addictions (BAs) are non-substance addictions. The object of addiction can, therefore, be a sport, food, sex, gambling, gaming, or any behavior that could produce pleasure and provide relief from internal discomfort that is employed in a pattern characterized by (i) recurrent failure to control the behavior (powerlessness) and (ii) continuation of the behavior despite significant negative consequences (unmanageability).1
Regarding the actual recognition of BAs, international manuals of mental diseases recognize only two of them. The first BA to be acknowledged was gambling disorder (GbD) in the “Substance-related and addictive disorders” section of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013.2 The classification in the tenth edition of the International Classification of Disease (ICD-10) went from an impulse-control disorder to an addictive behavior in the ICD-11 in 2018. The second BA, gaming disorder (GmD), was defined more recently in 2018 in the ICD-11. Other pathological behaviors are often reported as BAs in the literature, such as sexual addiction (SA),3 food addiction (FA),4,5 excessive exercise,6 kleptomania,7 or shopping addiction.8 Recently, SA9,10 and FA4,11 have been under particular investigation regarding whether they should be considered BAs. However, the level of evidence is still too poor, and further research is needed.
Regarding SA in particular, the lack of evidence rather than contradictory pieces of evidence seems …….