Risk of suicide in behavioral addictions
Current scientific evidence suggests that addictive behaviors are not limited to those involving substance use. A range of behaviors that initially generate pleasurable sensations have a very high addictive potential, such as gambling, sex, shopping, or video games , for example. These addictions are known as behavioral addictions. As with substance addictions, people with behavioral addictions experience symptoms such as tolerance, withdrawal, loss of control over the behavior, and persistence in the behavior despite the negative consequences it has on their daily lives, to name just a few of the most characteristic symptoms (Grant et al., 2010).
Suicide and behavioral addictions: scientific evidence and prevalence
Behavioral addictions often co-occur with other mental disorders, such as anxiety disorders, depressive disorders, and other addictive disorders, as well as suicidal behavior. The latter constitutes a serious public health problem insofar as it affects virtually all ages and, especially, certain age groups such as young adults and the elderly.
It is estimated that more than 700,000 people die by suicide each year worldwide , and a much larger number attempt suicide (World Health Organization, 2019). The risk of suicide is especially high in people with mental disorders (Too et al., 2019). While there is extensive scientific literature exploring suicidal behavior in certain mental disorders, such as depressive, bipolar, and psychotic disorders, the literature on this topic in other mental disorders, such as behavioral addictions, remains very limited.
Scientific literature exploring suicidal behavior in behavioral addictions is very scarce, and most of it focuses on gambling disorder.
Most studies published to date exploring the prevalence and clinical characteristics associated with suicidal behavior in behavioral addictions have focused on gambling disorder, neglecting other behavioral addictions . This is largely explained by the fact that gambling disorder was formally recognized as a mental disorder several decades ago, while other behavioral addictions are still in the very early stages of clinical characterization and formal recognition as mental health problems.
Thus, we do not have precise and agreed prevalence rates on the risk of suicide, due to the diversity of ways in which it is assessed, the lack of a clear consensus on the diagnostic criteria for behavioral addictions, the different compositions of the study samples and the time period examined.
Gambling disorder
Despite these methodological limitations, we can point out that in samples of people with gambling disorder, it is estimated that between 17% and 48% have a prior history of suicidal ideation and between 9% and 31% have attempted suicide (Battersby et al., 2006; Ronzitti et al., 2017). As noted previously, the scientific literature on other behavioral addictions is much more limited.
Gaming disorder
Regarding gaming disorder, the few studies published to date that have analyzed the relationship between this disorder and suicide risk have been conducted primarily on adolescent samples and have mainly assessed the presence of suicidal ideation. The results of these studies indicate that there is indeed an association between gaming disorder and suicidal ideation ; however, the cross-sectional design of these studies makes interpreting the results difficult, since it is not possible to determine whether suicidal ideation is a consequence of problematic video game use or whether people with suicidal ideation use video games more as a way to escape these thoughts (Erevik et al., 2022).
Sex addiction
Regarding sex addiction, a study conducted among individuals with sex addiction in France found that up to 41.7% of participants exhibited a risk of suicide (including suicidal ideation and/or attempts) (Wéry et al., 2016). Another study, which examined compulsive sexual behavior and psychopathology in a sample of men seeking treatment in Brazil, found a suicide risk in 22% of participants (Scanavino et al., 2013).
Shopping addiction
In the case of shopping addiction, a prevalence of suicidal ideation of 18.4% and of previous suicide attempts of 7.6% has been described in a sample of patients treated in a unit specializing in behavioral addictions in Spain (Valenciano-Mendoza et al., 2021).
Mental disorders associated with video game addiction
Risk factors for suicide in gambling disorder
Factors associated with suicide risk in gambling disorder can be grouped into four main categories (Armoon et al., 2023; Kristensen et al., 2023):
- Sociodemographic factors
- Factors related to gambling behavior
- Personality-related factors and other psychological factors
- Psychopathological factors
The inability to stop addictive behavior, feelings of guilt for the negative consequences generated in their environment, and the loneliness and lack of understanding with which they experience the problem are some of the factors that influence suicidal behavior.
Sociodemographic factors
In most studies, female gender has been associated with a higher risk of suicide. It is worth noting that, beyond gambling disorder, women generally have higher rates of suicide attempts than men , although men have significantly higher rates of death by suicide. Several hypotheses exist to explain this. One is that men tend to use more lethal methods of suicide (Berardelli et al., 2022).
Among the sociodemographic factors, the following have also been described:
- The low level of education
- Family and couple conflicts
- Separated, divorced, or widowed people
- Unemployment
Factors related to gambling behavior
- Early onset of the disorder.
- Economic problems and debts.
- Feelings of guilt and despair over the consequences caused by gambling.
Personality-related factors and other psychological factors
- High levels of impulsivity.
- Emotional dysregulation.
- Difficulties in cognitive flexibility and decision making.
Psychopathological factors and other medical factors
- Depressive disorders, and specifically the feeling of hopelessness upon perceiving that their situation will not change, that they will not have family support, and that they will not be able to cope with their debts.
- Substance use disorders.
- Anxiety disorders.
- ADHD.
- Personality disorders, especially borderline personality disorder.
- Chronic somatic diseases.
It is relevant to mention that several studies indicate that even after controlling for the effect of psychopathological factors (e.g., depressive symptoms), the relationship between gambling disorder and suicide remains significant (Wardle & McManus, 2021).
The role of the family and the environment of people at risk of suicide
Risk factors for suicide in other behavioral addictions
In the case of gaming disorder , the following have been described as relevant factors associated with the risk of suicide (Yu et al., 2020):
- Depressive symptoms.
- The female gender.
- Belonging to a low social class.
The following factors have been described in sex addiction (Blum et al., 2018; Chatzittofis et al., 2017)
- The presence of adverse events during childhood (including having suffered abuse).
- High levels of impulsivity.
- Difficulties in emotional regulation.
- Anxiety and depressive symptoms.
- Low self-esteem.
- Lack of family support.
- Low socioeconomic level.
In shopping addiction , the following have been described as factors associated with the risk of suicide (Valenciano-Mendoza et al., 2021):
- The low socioeconomic level.
- Unemployment.
- Lack of family support.
- A worse psychopathological state.
It is relatively common to hear accounts from people with these types of disorders who express suicidal thoughts when they experience intense frustration at their inability to stop the addictive behavior, feelings of guilt for the negative consequences for those around them, the loneliness and lack of understanding they face, and the negative impact on their mood caused by the addictive behavior. Therefore, it is essential to systematically assess the risk of suicide in people with behavioral addictions and provide them with the necessary support and guidance, both professional and familial, so they can envision a way out of a health problem with potentially such serious consequences.
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