Verified by 
When other people find out about a friend’s, relative’s, or partner’s impulse control disorder or behavioral addiction, they may not know how to respond or cope. They can have a profound sense of helplessness in watching a loved one suffer from a compulsive behavior. They may find that their attempts to help don’t help—or even seem to make matters worse.
Mary discovered that her husband had been going to the casino on nights when he told her he would be away on a business trip: “First, I felt angry and betrayed. Then I wondered if he’d been gambling because he didn’t love me anymore, and I wondered if gambling was just an excuse he used when in fact he was having an affair. He wasn’t. With time, I found out more and more about his gambling addiction and that it is a recognized condition. I had no idea what to do to help, even though I wanted to.”
Behavioral addictions impair function, can have legal and financial repercussions, and can lead to mental health issues such as depression and thoughts of suicide, as Andrew experienced: “I found myself getting stuck online using social media. I got so obsessed with other people’s lives, I forgot about my own. In the end, I was spending so much time online avoiding life that I became depressed. At times, I felt like ending my life.”
Susan, a young woman, picked at her face compulsively, and her face became so scarred that she did not want to leave her home: “I hate myself for doing it, but while I am doing it, I enjoy it. Afterward, I am so ashamed of myself and can’t leave the house for several days. I can’t go on living this way.”
These conditions can be difficult for other people to understand. One common question asked of people who struggle with compulsive behaviors is: “Why don’t you just stop?” But sufferers cannot just stop—at some point the behavior has become ingrained, compulsive, and, frequently, beyond their control. As we explain later in this book, recent research shows that behavioral addictions have a physical basis in the brain: evolutionarily, ancient parts of the human brain involving reward and reinforcement can become overactive, while brain regions responsible for exerting control over our habits and impulses do not work as they should. These neural imbalances perpetuate the behavior. Understanding these mechanisms helps researchers and physicians develop better treatments and may help explain why sufferers cannot “just stop,” even though they want to.
With the exception of Internet addiction, these behaviors have been recognized for centuries. Dice have been discovered in caves dating back to around 3500 BC. Gambling has been recognized and, because of its addictive potential, regulated in many ancient cultures, including in China, Egypt, and Rome. The potential problems associated with gambling are described in ancient religious texts such as the Koran of Islam (~600 CE) and the Talmud of Judaism (~400 CE). Stealing is as ancient as the existence of personal possessions, and compulsive sexual habits have probably existed for just as long, reflecting a deeply ingrained primal drive. Consuming excessive quantities of food (related to our modern concept of food addiction) was documented in the Middle Ages as a practice among wealthy families, when members engaged in deliberate vomiting as a consequence of overeating.
Although these behaviors have been documented throughout history, the extreme forms have been recognized as uncontrollable problems, or “disorders,” only since the nineteenth century. The term kleptomania, referring to compulsive stealing, was coined around 1816, when an apparent epidemic of young women stealing clothes in Paris was described in local newspapers. These women stole even though they did not need the items, and even though they had plenty of money to buy them. What we now call compulsive sexual behavior was described in the late 1700s as nymphomania (for females) and satyrism (for males), in people considered to have an overactive sex drive and excessive sexual activity. Compulsive shopping as a concept dates back to nineteenth- century America or earlier, referred to at that time as oniomania. Excessive grooming behaviors were first considered mental health problems during the nineteenth century too, with the medical community at a loss for how to explain these behaviors and what to do about them. Internet addiction is a more controversial concept that by definition only arose following the development of the Internet, from about 1970 onward.
Jon E. Grant, JD, MD, MPH, Brian L. Odlaug, PhD, MPH, and Samuel R. Chamberlain, MD, PhD are the co-authors of "Why Can't I Stop?: Reclaiming Your Life from a Behavioral Addiction"
