9 addictive and compulsive behaviours Flashcards

1
Q

What are clinical expressions of maladapive behaviours overlaping with substance use?

A
  • craving
  • tolerance
  • withdrawal
  • compulsion
  • inability to control, cut down
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2
Q

What behavioural addictions does the DSM characterise?

A
  • gambling disorder
  • under substance-related and addictive disorders
    subcategory non-substance related disorders
  • DSM-iV: pathological gambling
    → DSM-V gambling disorder
    five to four criteria: illegal acts was removed
  • internet gaming disorder is not included, needs further research
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3
Q

What are some biological and environmental risk factors for behavioural addictions?

A
  • gambling might be 50% to 60% heritable
  • gene x environment
    vulnerability + childhood exposure + maltreatment
  • positive reinforcement and reward related aspects
  • cognitive deficits around decision-making inhibitory control and mental flexibility
  • brain structures: prefrontal cortex, ventral striatum, amygdala
  • same brain pathways: dopamine D2 receptors, dopamine release, HPA axis, negrostriatal pathway
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4
Q

What is the epidemiology of gambling?

A

young men, low SES, single
1-2% in western countries
elevated rates of personality disorders
elevated rates of disinhibition (impulsivity and poor risk assessment)
receiving large wins early appears to increase vulnerability
special population are involved in particular types (older women and slot machines, late onset gambling)
dopaminergic and serotonergic systems
glutamatergic, noradrenergic

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5
Q

What is the epidemiology of technology misuse?

A

internet use
internet gaming disorder = persistent and recurrent use of the Internet to engage in games, often with other players, leading to significant impairment or distress
social networking, shopping, pornography, illegal webs, gambling
maladaptative use of smartphones

phone addiction - more in women - depression, low-self esteem
social media addiction - more in women

UK - private clinics - there, more men

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6
Q

What is the epidemiology of maladaptive eating?

A

little evidence
not everyone that is obese has an eating disorder or food addiction
highly palatable foods

reward deficiency syndrome

some neuroimaging evidence for shared common pathways in obese people and drug dependence
more women than men
no genetic studies

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7
Q

What is the epidemiology of sex/porn addiction?

A

often overlaps
porn addiction - compulsive, excessive, impulsice viewing of porn - can interfere with ability to form relationships and existing ones
problem: technology or sexual arousal??

no validated measures

sex addiction - no evidence
higher in queer populations
more men (underreporting from women)

often co-occurs with substance use
depression and anxiety

dysfunctional family background
elevated risks of physiological issues (transmittable diseases, pregnancy)

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8
Q

What are other behaviours, but they dont have enough evidence for a classified addiction frameworks?

A
  • workaholism
  • execissve exercise
  • sunbathing
  • shopping
  • orthorexia (dieting)
  • kleptomania (urge to steal)
  • trichotillomania (hair pulling)
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9
Q

How can you define a behavioural addiction?

A

Several behaviors, besides psychoactive substance ingestion, produce short-term reward that may engender persistent behavior despite knowledge of adverse consequences, i.e., diminished control over the behavior. Diminished control is a core defining concept of psychoactive substance dependence or addiction.

This similarity has given rise to the concept of non-substance or “behavioral” addictions, i.e., syndromes analogous to substance addiction, but with a behavioral focus other than ingestion of a psychoactive substance.

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10
Q

What are the similarities in the psychological mechanisms underlying both behavioural and substance addiction?

A
  1. onset in adolescence and young adulthood
  2. natural histories that may exhibit chronic, relapsing patterns, many people recover without formal treatment
  3. feelings of tension or arousal before commiting the act
  4. pleasure, gratification, relief at the time of commiting the act
  5. ego-syntonic nature
  6. over time more ego-dystonic → less pleasurable, more a compulsion
  7. urge or craving prior to the action
  8. decrease in anxiety and positive mood state as a result
  9. emotional dysregulation
  10. need to increase intensity of behaviour to achieve same mood effects (tolerance)
  11. higher rates in men, and earlier
  12. a telescoping phenomenon observed in females (i.e., women have a later initial engagement in the addictive behavior, but foreshortened time period from initial engagement to addiction)
  13. financial and marital problems are common
  14. illegal acts and criminalisation is frequent
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11
Q

What personality traits are associated with behavioural addiction?

A
  1. high scores on impulsivity and sensation-seeking
  2. low on measures of harm avoidance
  3. aspects of psychoticism, interpersonal conflict, and self-directedness may all play a role
  4. impaired inhibition of motor responses
  5. cognitive inflexibility
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12
Q

What are the comorbidity rates of behavioural addictions?

A
  • elative risk for an alcohol use disorder increased 3.8-fold when disordered gambling was present
  • Internet addiction was associated with harmful alcohol use (odds ratio of 1.84)
  • Problem gamblers with frequent alcohol use have greater gambling severity and more psychosocial problems resulting from gambling than those without alcohol use histories (31), and adolescents who are moderate to high frequency drinkers are more likely to gamble frequently than those who are not
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13
Q

What is the neurobiology behind behavioural addiction?

A
  1. discount rewards rapidly
  2. disadvantageously on decision-making tasks
  3. worse planning abilities
  4. no differences in executive functioning
  5. almost all NTM systems involved
  6. serotonin in particular
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14
Q

What is the evidence on genetic contributions in behavioural addiction?

A
  1. first-degree relatives have significantly higher lifetime rates
  2. gene x environment expressions
  3. few molecular genetic studies
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15
Q

What is gambling? and why is it addictive?

A

gambling = placing something of value at high risks in the hopes of gaining something of greater value

high risk, fairly rapid outcomes

stock investment is not perceived as gambling

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16
Q

What are the DSM-4 criteria for pathologic gambling?

A

A) persistent and recurrent maladaptive gambling behaviour as indicated by five or more of the following:

  • preoccupied with gambling
  • increasing amounts of money
  • unsuccessful efforts to control behaviour
  • restless or irritable when cutting down
  • escapism
  • even after setback, returns to gambling
  • lies to members about the behaviour
  • illegal acts
  • has jeopardised relationships
  • tough financial situation

B) The gambling behaviour is not better accounted for by a manic episode

17
Q

What types of gambling exist?

A

disordered gambling
recreational gambling
problem gambling

18
Q

What is impulse control disorder?

A

→ failure to resist an performing act that is harmful to oneself or others
→ increased feelings of arousal or tension prior to the act
→ feelings of pleasure or release of tension when performing the act

19
Q

How does gambling differ from OCD?

A
  • PG: ego-syntonic (consistent with their self-image)
  • OCD: ego-dystonic (inconsistent with their self-image, distressing)
20
Q

What is the epidemiology of gaming in terms of prevalence?

A

vast majority of adults report having gambled at some point

2.5% of US population has disordered gambling
lifetime prevalence 0.4 - 3.4%

higher in adolescent populations

higher for adults in psychiatric treatment or prison

men are twice as likely

women may suffer from more health problems at the same severity of gambling tho

african americans are disproportionately represented

excitement-seeking
younger, more impaired impulse control, men

escape, relief
women

21
Q

What are social and environmental factors contributing to gambling?

A

acceptability and accessability

increase in PG in adults
not adolescents

legalised gambling

increased rates in juvenile gambling

22
Q

What are the most common comorbidities with gambling?

A

Axis I psychiatric disorders
stronger in women than in men

higher frequencies of attempted suicide

psychotic disorders

commorbid mood disorder
women appear more likely to present with that

substance use disorder!!

→ not in older adults when gambling contributes to overall better general health

23
Q

What are some elevated cognitive distortions in gamblers?

A

cognitive biases → failure to appreciate the independence of trails, randomness of outcomes

availability bias: selectively recall large wins
overestimation of size of future payouts

gamblers fallacy - unlikely event, soon the reverse outcome will occur
(after consecutive head tosses, tails is more likely to follow)

24
Q

Which NTMs are involved in gambling?

A

norepinephrine, serotonin, dopamine, opioids, gamma-amminubutyric acid

physiologic arousal and subjective reports
intense gambling-related excitement

norepinephrine - regulation of arousal, attention, and aspects of impulsivity

lower levels of dopaime and higher levels of domaine metabolites in the CSF of pathologic gamblers
→ abnormal regulation

parkinson´s disease - abnormal levels of dopamine

serotonin - impulse control
decreased levels

increased plasma concentrations of cortisil
activation of HPA axis

25
Q

What is the neuroanatomy behind gambling?

A

abnormal activations in frontal-striatal regions
impulse control and decision making

decreased activation of the right ventrolateral prefrontal cortex
→ hyporesponsiveness of that region

diminished activation of the vmPFC and ventral striatum

26
Q

What treatment for gambling exists?

A

pharmacologic approaches

naltrexone, nalmefene

psychotherapies
CBT
motivational enhancement therapy

27
Q

Why is gambling so dangerous?

A
  • Gambling addiction has been shown to have the same pharmacological effects as opiates.
  • Eighty-five percent of all gambling revenue comes from slot machines.
  • Casinos are designed to disorient and confuse patrons, from the lighting and carpeting to the key of machine sounds.
28
Q

What types of internet addiction exist?

A
  1. Cybersexual addiction: Compulsive Internet use to access pornographic material.
  2. Cyber-relationship addiction: Maintaining online relationships to excess.
  3. Net compulsions: Compulsive online gambling, shopping, or online trading.
  4. Information overload: Excessive website surfing or search engine use.
  5. Computer addiction: Using the computer to play games compulsively.
29
Q

What does social media addiction contribute to?

A

correlated with academic outcomes
learning engagement, time, motivation

lower self-esteem
decrease in mental health

lifestyle apps are addictive