PBS-5: a five-item screen for non-substance addictive behaviours, anchored to ICD-11

For the first time we have a brief, ICD-11-anchored instrument that lets you screen all five major behavioural addictions in a single visit without dragging the patient through a 60-item battery. Five items per behaviour. Same wording across domains. Designed for population work, but the structure is exactly what a busy outpatient clinic needs.

What the data shows

The authors started from ACSID-11 (Müller et al. 2022), the standard ICD-11-based instrument for Internet-use disorders, and selected five items that best preserved unidimensionality and discrimination. The same five items were administered for each of the five behaviours, with stem reformulation. In the 2023 Swiss national survey (n = 5,995, three languages), CFA confirmed a single factor; internal consistency was excellent. The 2025 replication (n = 5,818) reproduced the structure and the cut-offs — important, because cut-offs derived in one wave often drift in another.

Cut-offs were not set arbitrarily. The team ran multiple ROC regressions with PHQ-4 (general distress) as the criterion for each behaviour separately. External validity and classification quality the authors describe as "limited" — that is honest reporting, not a failure: PHQ-4 captures generic distress, not behaviour-specific impairment, so AUCs are bounded. The cut-offs are practical, not gold-standard. Use them as a triage threshold, not as a diagnosis.

The prevalence map matters for case-finding. Among Swiss regular users, problematic social-media use (27.7%) and pornography use (22.2%) are now more common than problematic gaming (21.0%); gambling, despite its visibility in addiction medicine, sits at 2.5%. Problematic shopping (13.6%) is concentrated in lower-education subgroups. Since 2023 every category has risen except gambling.

For your practice

Three concrete uses. First, intake screening: add PBS-5 (five items × five domains = 25 questions, ~3 minutes) to your standard intake for adults presenting with depression, anxiety, ADHD, or relational problems — the comorbidity load of behavioural addictions in these groups is high enough to justify routine ask. Second, monitoring: PBS-5 is short enough to repeat session-to-session in CBT for behavioural addiction, alongside a behaviour log. Third, differential signal: a patient who screens positive on social media + pornography + gaming but negative on gambling and shopping has a different clinical profile than one positive on shopping alone — emotion-regulation deficit vs. impulsivity/financial-stress phenotype.

Watch the failure modes. PBS-5 is a screener, not a structured interview — a positive result triggers a clinical conversation, not a label. The Swiss sample is European and middle-income; cultural calibration in RU/Asian populations is not yet done. And the gambling cut-off rests on only ~2.5% of the sample, so its precision is the lowest of the five.