Back More

Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition

Women and behavioral addictions

by Janet Ober Berman, MS, CGC, Ing Wei Khor, PhD

Category: Social issues

Definition: Behavioral addictions are addictions to activities such as gambling, shopping, eating, exercising, sex, or using the Internet. In the case of behavioral addictions, what was originally a pleasurable activity manifests as a compulsion and results in excessive use with negative consequences. Women and men have different risk factors, responses, and incidences for these behavioral addictions. Both genders respond differently to societal factors and expectations, and show different interactions between these factors and their genes and sex hormones. Thus, behavioral addictions manifest differently in women than in men.

Studying Behavioral Addictions in Women

Behavioral addictions can be just as harmful to overall health and well-being as a substance addiction to drugs or alcohol. A behavioral addiction typically begins when the performance of a certain action elicits a feeling of pleasure, decreases depression, eases anxiety, or allows escape from a problem. Some behaviors can produce activate the reward mechanisms in the brain in a similar way as drugs. This reward (e.g., feeling of pleasure or wellbeing) is what the individual becomes addicted to, compelling them to repeat the behavior and eventually escalate it in an attempt to induce the same level of reward. The addicted individual will then engage in the behavior despite their better judgment and awareness that the behavior could have negative consequences.

Similar to a substance addiction, a behavioral addiction also comes with periods of withdrawal, urges or cravings, and dependence. Later research literature suggests that the resulting feeling of depression from the addiction does not get better as the behaviorally addicted person ages. A woman in her thirties or forties, for example, with a predisposition to an addiction, will usually have an increase in her depression.

Certain behavioral addictions occur more frequently in women than in men. According to a 2014 review of behavioral addiction studies, women are more likely to develop shopping, exercise and food addictions, while men are more likely to engage in excessive gambling, Internet use, and sex. However, the incidence in women of some of these behaviors (such as gambling and Internet use) is rising.

Behavioral and substance addictions are not mutually exclusive: A person may have more than one behavioral or substance addiction at any given time. Women and men have gender-specific risk factors for behavioral addiction. It is thought that there are underlying biological genetic predispositions and gender-specific hormonal systems that make women and men more prone to specific addictions. Furthermore, psychological diagnoses besides anxiety and depression are often present in any addicted person.

Women, however, are at risk for unique medical and health-related concerns from certain behavioral addictions. A compulsive sexual addiction places women at increased risk for unintended pregnancies or sexually transmitted diseases.

Spending Addictions

Compulsive shopping affects more women than men, with approximately 6 percent of women exhibiting a shopping addiction. However, this difference could be due to women being more open to admitting a shopping addiction than men. The potential negative consequences include financial debt and an excess of unused purchases.

Risk factors for compulsive shopping include episodes of anxiety or depression. Those suffering with a behavioral addiction often experience anxiety and a need to shop that is only relieved by shopping. An additional risk factor is the widespread availability of the Internet, which allows for purchases to be made at any moment. Although an immediate positive feeling results with shopping, the addicted individual eventually cycles back to the initial feelings of depression and anxiety; feelings of guilt may also arise after the purchases.

Women with a shopping addiction also commonly have other substance or behavioral addictions, or both. In particular, concurrent shopping and food addictions are common. For example, obese women who binge eat have greater rates of compulsive shopping than women who are not binge eaters.

Gambling Addictions

Although pathological gambling addictions used to be considered a condition only affecting men, the number of women who pathologically gamble is on the rise: Approximately 2.5 percent of American women have gambling addictions, according to a 2011–13 University of Buffalo study. Women begin gambling at a later age than men, but the disorder progresses more rapidly in women. Women also gambled for shorter periods of time than men, but had similar durations of pathological gambling as in men. Risk factors for women include being middle aged, having middle to low income, never having married, higher stress levels and poor coping skills. For adolescent girls, having parents who were gamblers increases the risk that they will also gamble..

The preferred type of gambling activity also differs for women and men. Women prefer gambling that does not involve a lot of decision making or skills such as playing slot machines, keno, bingo, or the lottery; while men prefer gambling that involves strategy such as card games, craps, and betting on sports or horse races. Women favor activities that require less social interaction such as keno and bingo, while men preferred gambling involving more interaction such as poker. Also, specific websites target female gamblers, thereby increasing their access to solo gambling, and women can gamble legally in the home, away from casinos. Many women also find it socially acceptable to gamble with friends or colleagues in a sporting pool.

Women also have different psychological and physiological responses to gambling. While men tend to use gambling to enhance their sense of self and indulge their desire for excitement, women typically gamble to relieve feelings of depression and to forget about life’s problems. Women also gamble because winning can help their self-esteem.

Treatment for gambling addictions should take into account the gender of the patient. Although women are more likely than men to seek help, they are less likely to recover without help. Women gamblers also tend to respond more poorly to treatment and progress more rapidly in their addiction than men. When treating women with pathological gambling, doctors should assess whether other psychological conditions such as depression and anxiety are also present and, if so, treat these conditions as well. Effective treatment may require a combination of medications and psychological or cognitive behavioral therapy.

Compulsive Sexual Behavior

Compulsive sexual behavior, often termed sex addiction or hypersexuality, involves obsessive sexual thoughts, feelings, or behaviors that interfere with routine functions. Initial studies focused on men and sexual predators because of a failure of clinicians to recognize the addiction in women and because of a failure in women to admit a sex addiction themselves. Oftentimes, feelings of guilt, shame, and isolation keep women from sharing their stories of sex addiction, contributing to under-diagnosis of the disorder.

Women also have different symptoms of sex addiction than do men. The addiction for men is associated with pornography, masturbation, and meaningless sexual relationships. Women may display these behaviors but much less frequently. Instead, relationship or love addictions are much more common among women.

Women who have compulsive sex addictions frequently have a history of sexual abuse or molestation. This type of trauma can lead to the additional diagnosis of post-traumatic stress disorder (PTSD) or an eating disorder. With sex addiction, women are reliving a painful part of their childhood and searching for the security that these traumas will not recur. Many professionals, however, treat the PTSD or eating disorder only and fail to recognize or address the behavioral addiction.

Food Addiction

Food addictions can appear as food cravings, binge eating or compulsive overeating. Women are more likely than men to have such addictions to food, especially food that are high in carbohydrates and fats and which induce positive feelings. The natural rewards obtained by consuming food are similar to the rewards induced by addictive drugs.

Internet Addiction

With regard to Internet use, women typically use the web to create relationships with others and to establish emotional bonds that are not available in their community. They may or may not seek sexual pleasure as part of these relationships. Rather than foster relationships online, men use the Internet as a coping mechanism for stress and to view pornography to avoid intimacy while still gaining sexual pleasure. Women also use the Internet to express a wide range of emotions, such as anger or aggression. These emotions may not be socially acceptable in their home environment or community. Women may also use the Internet excessively to gamble or shop. Thus, Internet addictions in women may coexist with gambling or shopping addictions. Internet use becomes an addiction when it interferes with daily functioning and with interpersonal relationships. A 2017 study of Internet use in men and women found a growing predominance of excessive Internet use in women compared with men.

Treatment

It is integral for psychotherapists to address the reason for the behavioral addiction and to provide methods to reduce its frequency. Cognitive-behavioral therapists and dialectical-behavioral therapists have been successful in treating these diagnoses. Some therapies involve the twelve steps modeled by Alcoholics Anonymous and other such treatment and recovery programs.

Family therapy is recommended too, especially if the woman is the primary caregiver or is being physically or emotionally abused. People struggling with addiction have a high rate of relapse because of the comorbid diagnosis of additional psychiatric diagnoses and other possible substance addictions.

Although specialty clinics now exist to handle specific behavioral addictions, services specializing in treating women with these disorders are lacking. Another lack is child care services for recovering addicts. Treatment centers that provide child care are crucial to allow the individual time to focus on her own recovery. It also may be necessary to combine psychotherapy with pharmacologic treatments for a comorbid psychiatric diagnosis.

The awareness of behavioral addictions as bona fide addictions (similar to substance misuse disorders), rather than merely problems of impulse control, has been growing in recent years. This change in perception has been aided by brain imaging studies, which revealed that behavioral addictions such as gambling, shopping and video games exhibit biological similarities with drug addictions, activating similar regions of the brain, including the mesocorticolimbic system and amygdala. Within these brain regions, the behavioral addictions also activate similar gene expression patterns as do drugs of misuse (Kelley, et al. 2005). People with fewer dopamine and serotonin receptors are more susceptible to becoming addicted to both drugs and behaviors.

Psychiatrists and psychologists are also more accepting of the concept that women with behavioral addictions have true addictions. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) includes pathological gambling under the “Substance-related Disorders” chapter. However, the perceptions of family members of women with behavioral addictions that their relatives do not have an addiction and do not need treatment remains a barrier to these women seeking and receiving the help that they require.

For Further Information

Fattore L, Melis M, Fadda P, Fratta W. “Sex differences in addictive disorders.” Front Neuroendocrinol. 2014;35:272–284.

Ferree, Marnie. “Females and Sex Addiction: Myths and Diagnostic Implications.” Sexual Addiction and Compulsivity 8 (2001): 287–300. Print.

Greenberg, Joshua, Stephen Lewis, and David Dodd. “Overlapping Addictions and Self-Esteem among College Men and Women.” Addictive Behaviors 4.8 (1999): 565–71. Print.

Holden, Constance. “Behavioral Addictions: Do They Exist?” Science 2 (2001): 980–82. Print.

Hollen, Kathryn H. Encyclopedia of Addictions. 2 vols. Westport: Greenwood, 2009. Print.

Jaafar NRN, Bahar N, Ibrahim N, Ismail WSW, Baharudin A. “Excessive internet use in young women: What are the implications?” Curr Opin Psychiatry. 2017;30:260-267.

Kuhn, Cynthia M., and George F. Koob, eds. Advances in the Neuroscience of Addiction. Boca Raton: CRC, 2010. Print.

McVeigh, Tracy. “Britain’s New Addicts: Women Who Gamble Online, at Home, and in Secret.” 16 Jan. 2010. Web. 11 Apr. 2012.

Citation Types

Type

Format

MLA 9th

Berman, Janet Ober, and Ing Wei Khor. "Women And Behavioral Addictions." Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition, edited by Paul Moglia, Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=Addictions2e_0328.

APA 7th

Berman, J. O., & Khor, I. W. (2018). Women and behavioral addictions. In P. Moglia (Ed.), Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Salem Press. online.salempress.com.

CMOS 17th

Berman, Janet Ober and Khor, Ing Wei. "Women And Behavioral Addictions." Edited by Paul Moglia. Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Hackensack: Salem Press, 2018. Accessed September 13, 2025. online.salempress.com.

Table of Contents