The inclusion of Substance-Related and Other Addictive Disorders to the Diagnostic and Statistical Manual of Mental Disorders–5th ed. (DSM-5; American Psychiatric Association, 2013) signifies an enormous shift in the way mental health professionals conceptualize addictive disorders. For the first time in history, the term addiction is used as a formal diagnostic label in the DSM. Furthermore, it’s being used to formally diagnose a pathological pattern of behavior that leads to clinical impairment—that of pathological gambling—which is the only behavioral addiction currently listed. Similarly, the International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11; World Health Organization, 2019) included “Disorders Due to Addictive Behaviors” to their recent revision, adding Gambling Disorder and Gaming Disorder as diagnostic criteria.
In fact, research is surging on gambling and other potentially addictive processes including internet gaming, eating, sex, pornography, shopping, work, and even romantic love (see Kim & Hodgins, 2018; Kim, Hodgins, Kim, & Wild, 2020; Thege, Woodin, Hodgins, & Williams, 2015).
Yet, despite increased interest in behavioral addictions, conceptualizing and treating dysfunctional patterns of behavior from an addictive perspective is less mainstream. Consequently, the purpose of this article is to present a conceptualization of romantic love and breakups from an addictive lens in the interest of understanding the experiences of people struggling to get over a former romantic partner. In it, I describe the key components of addictive behavior, highlight emerging research suggesting that falling in love is naturally associated with some addictive features, and present a cyclical model for understanding love-addicted breakups when working with heartbroken clients.
What Makes a Behavior Addictive?
According to the American Society of Addiction Medicine (ASAM), addiction is a chronic but treatable condition caused by a complex interaction of brain processes, genetics, environmental influences, and an individual’s life experiences (2019). More specifically, people struggling with addiction “use substances or engage in behaviors that become compulsive and often continue despite harmful consequences” (ASAM, 2019). This definition reflects emerging research suggesting substantial similarity between substance-based addictions and addictive behaviors in their clinical expression, brain circuitry, comorbidity, physiology, and treatment response. For example, most addictions present clinically with a hyperfocus/fixation on the addictive stimulus (e.g., Kim, Hodgins, Kim, & Wild, 2020), activate the brain’s reward circuitry (e.g., Filbey, 2019; Koob & Volkow, 2016), have high comorbidity with other addictive behavior/substance use (Sussman, Lisha, & Griffiths, 2011), affect one’s physiology (Filbey, 2019), and are responsive to similar treatment interventions (Kim & Hodgins, 2018).
According to the components model of addiction proposed by Griffiths (2005), six core features must be present for a behavior to be considered pathologically addictive: salience, mood modification, tolerance, withdrawal, conflict, and relapse. More specifically, an addictive stimulus has salience—it becomes centrally important to a person’s life, consuming their time, energy, and attention—and use or non-use modifies a person’s mood. Over time, people develop tolerance such that they need increased amounts or greater frequency of use to get the same high while experiencing withdrawal symptoms or unpleasant side effects from lack of use. In addition, use is associated with conflict or problems in life, often related to interpersonal relationships, work or school performance, physical or mental health, legal status, or quality of life. Finally, addiction is associated with relapse such that attempts to stop generally fail.
Taken together, people who feel addicted to something—whether it’s to a substance or behavior—become so intensely focused on their addictive stimuli that they struggle to stop using even when they know that continued use is harmful (Grant, Potenza, Weinstein, & Gorelick, 2010). In this way, whether a person is actively using, going through withdrawal, or anticipating their next use, the addictive stimulus dominates their lived experience (Griffin, 2005; Koob & Volkow, 2016).
Romantic Love as a Naturally Addictive Process
Although most people don’t immediately think of romantic love when they hear the word addiction, people who report being ‘in love’ often talk about their partner as though they’re an addictive stimulus (Sussman, 2010). For example, people in love tend to become hyper-focused on their mate, spending up to 85% of their waking hours obsessively thinking about them in a highly preoccupying, obsessive way when in love (Aron, Fisher, Mashek, Strong & Brown, 2005). They physically crave them, want to be near them, plan for time together, and emotionally feel euphorically high when they’re together (Fisher, Xu Aron, & Brown, 2016). As such, four of the six components outlined by Griffith (2005) are generally present: one’s romantic partner has salience, modifies mood, is intensely desired (i.e., leading to tolerance), and is missed when physically absent (i.e., lack of contact is associated with withdrawal). Thus, being in love can be conceptualized as a naturally high-inducing experience that has features of addictive behavior—though not necessarily in a problematic way that’s associated with mental health impairment.
Consistent with these clinical observations, recent neurobiological research suggests activation of the dopaminergic reward pathway (like many drugs of abuse) in people who report feeling intense romantic love. These brain regions and neurotransmitters are associated with cravings, desires, and pleasure-seeking drives that promote survival (Fisher, Aron, & Brown, 2005; Fisher, et al., 2016). In fact, many evolutionary scholars argue that the experience of falling is love is biologically designed to encourage humans to crave a mate, have sex, produce children, and bond with them long enough to ensure survival of their offspring thereby promoting the survival of our species (Earp et al., 2017; Fisher, et al., 2016; Sussman, 2010).
Conceptualizing Problematic Love-Addicted Breakups
If falling in love is biologically designed to be a process that naturally has some addictive components, when does it become problematic, leading to problems and relapse? Peele and Brodsky first systematically explored this topic in the psychological literature in their book Love and Addiction (1975) in which they described clients who appeared to be addicted to their romantic partners in dysfunctional and harmful ways. Love addiction is a non-clinical term used to describe a pattern of behavior characterized by maladaptive, pervasive, and excessive interest towards one or more current or former romantic partners (Sanches and John, 2019). In intact romantic relationships, love addiction can manifest as dysfunctional patterns of relating (e.g., cycles of “love bombing” followed by rejection or abuse), attachment insecurity, separation anxiety, difficulty setting boundaries, an inability to leave an unhealthy relationship, and difficulty having an autonomous identity.
As applied to breakups, falling in love and then ending the relationship can lead some people to exhibit all six of the addictive components outlined by Griffiths (2005)—including conflict and relapse. Also sometimes referred to as exaholics in the literature (Bobby, 2015), people who feel addicted to their former partner (referred to as an ‘ex’ hereto) obsessively ruminate about their former lover, become emotionally reactive and distressed, and are easily triggered by reminders of their ex. They often report strong cravings for contact with their former mate—to touch them, talk to them, get answers—even though they rationally know the relationship is over and want to move on (relapse). These addictive symptoms are often associated with clinical impairment and significant mental health symptoms of depression, anxiety, and grief that can lead to disengagement from activities, diminished productivity and daily functioning, and prolonged emotional distress (conflict) (Bobby, 2015; Earp et al., 2017; Field, 2017).
In people who fell in love but are now struggling to move on after a breakup, it can be helpful to conceptualize a current or former lover as an addictive stimulus (see Figure 1, reprinted from Warren, 2023). From this perspective, contact with a former partner—whether in person or their own mind (e.g., searching for information online, looking through old photos, stalking behavior)— serves as active use of an addictive stimulus. As such, it provides short-term symptom relief. After the contact ends, however, an exaholic enters a state of withdrawal that leads their symptoms to come flooding back—obsessive thinking, cravings for contact, emotional distress and reactivity, and a desire to engage in harmful compulsive and impulsive behaviors. In this way, contact with an ex after a breakup can keep a person stuck in a cycle of heartache that revolves around their former lover and is very difficult to break.
Future Directions and Concluding Comments
Conceptualizing romantic love and breakups as a potentially addictive process may have great clinical utility for people going through difficult breakups because it helps them understand the biological and psychological underpinnings of their symptoms. Although there are no clinical trials testing psychotherapeutic outcomes in people going through love-addicted breakups to my knowledge, a large body of research supports the efficacy of psychotherapy to treat addictions and symptoms related to breakups. For example, emotional distress (e.g., sadness, anger, anxiety), cravings, impulsive and compulsive behaviors, irrational thinking patterns, and unwanted impulsive behaviors can all be improved using CBT skills (Hofmann et al., 2012). Treatment of addictions often includes identifying interpersonal, intrapersonal, and circumstantial triggers for use; developing coping skills to deal with unpleasant emotions; improving communication skills and setting boundaries to change behavior; increasing self-care and social support; and developing self-efficacy and responsibility for choices around use (Kim & Hodgins, 2018). In this way, targeting cognitive, affective, and situational factors that increase risk for contacting an ex while teaching new skills to self-soothe, rediscover their value as a single person, and intervene in the addictive cycle itself is key to healing after a bad breakup.
Scholars increasingly highlight the need for psychotherapeutic treatment research and protocols to effectively address the symptoms experienced by people struggling to get over an ex (Sanches & John, 2019). Not every breakup will lead to pathological addictive symptoms and some people are likely more vulnerable to love addiction than others (Fisher et al., 2016; Kim & Hodgins, 2018). That said, the increasing popularity of 12-step support groups like Sex and Love Addicts Anonymous and Codependency Anonymous suggest that many people are actively seeking help to change dysfunctional, addictive relationship patterns. For anyone looking for resources, I recently wrote a self-help book called Letting Go of Your Ex (2023) that offers CBT-based tools to clients and therapists alike.
In closing, it’s important to note that the contention that romantic love can be an addictive process—as well as the idea of addictive behavior is general—is very controversial (Brand & Potenza, 2023). Heated debate abounds around whether our field is over-pathologizing behaviors that feel good as addictive disorders (see Saving Normal by Allen Francis for a comprehensive discussion) and establishing meaningful differences between substance use disorders from addictive behavior. Furthermore, is the term “addiction” really the best way to describe the complex, human experience of human love—romantic or otherwise? For example, conceptualizing falling in love as a potentially addictive process is very one-sided and doesn’t capture the complexity and reciprocal nature of dyadic romantic relationships or their health. That said, continued research investigating romantic love—and its downfall—as an addictive process is warranted. Exploration of whether and how other forms of love (e.g., parent-child love, friendship) can manifest in problematic ways and whether an addictive framework can help in the conceptualization, assessment, and treatment of such experiences is warranted.
References
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Conflict of Interest Statement
The author declares that she earns royalties from sales of a self-help book called Letting Go of Your Ex written on this topic. That said, the research described here was conducted in the absence of a commercial or financial relationship.
Cortney S. Warren, PhD, ABPP
Board Certified in Clinical Psychology
Correspondence: CW@DrCortney.com