Behavioural addictions and autistic spectrum conditions
Professor Sam Chamberlain from the Substance use, Alcohol and Behavioural Addictions in Autism (SABAA) team summarises why behavioural addictions might be relevant for autistic spectrum disorder.
Some types of behaviour are experienced as being rewarding, pleasurable, or reinforcing (if we do them once, we might well do them again). While rewarding behaviours can be positive/helpful, for some people, they can get out of control and lead to what is called ‘behavioural addiction’. A key example of a behavioural addiction is Gambling Disorder, which is a recognized psychiatric condition.
Other types of repetitive behaviours may also fit within this ‘addiction’ model when they become excessive and distressing. Key examples include the body focused repetitive behaviours: skin picking and hair pulling (when people pick at their skin or pull out their own hair repetitively); as well as activities such as shopping/buying, or engaging with the internet (e.g. checking social media, streaming, or looking up medical information). Again, many people engage in these activities, but a minority of people can find they become impairing and hard to control.
Why might behavioural addictions be relevant for autistic spectrum conditions and vice versa?
First, Gambling Disorder and other behavioural addictions are common in the general population and so it is important to understand whether autistic people* experience these in similar or different ways. For example, in terms of how often they occur, how they are experienced (good and bad), as well as what contributes to the behaviours.
Second, some other types of repetitive activities can be experienced by autistic people: for example, repetitive movements (such as flapping hands or gestures), repetitive use of specific objects, or the desire for ‘sameness’ and well-established routines. As with non-autistic individuals, sometimes these are benign or positive and sometimes they can cause harm or distress. As such, insights from people familiar with autism, or autistic people themselves, could be very helpful to better understand other types of behaviours.
One major problem hindering this, is that researchers often study autism, or behavioural addictions, but often don’t talk to each other; similarly, researchers might learn from people with lived experience of one, or the other, but not both. This can mean that new knowledge about one might not inform knowledge about the other. This recognition led to SABAA, the current Priority Setting Partnership.
Sam Chamberlain would like to thank Dr Célia Sales, and several members of the international steering group, for their helpful feedback provided in the process of drafting this article.
*We have chosen to use identity-first language but understand there is no universally accepted way to describe autism
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