9 addictive and compulsive behaviours Flashcards
What are clinical expressions of maladapive behaviours overlaping with substance use?
- craving
- tolerance
- withdrawal
- compulsion
- inability to control, cut down
What behavioural addictions does the DSM characterise?
- 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
What are some biological and environmental risk factors for behavioural addictions?
- 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
What is the epidemiology of gambling?
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
What is the epidemiology of technology misuse?
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
What is the epidemiology of maladaptive eating?
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
What is the epidemiology of sex/porn addiction?
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)
What are other behaviours, but they dont have enough evidence for a classified addiction frameworks?
- workaholism
- execissve exercise
- sunbathing
- shopping
- orthorexia (dieting)
- kleptomania (urge to steal)
- trichotillomania (hair pulling)
How can you define a behavioural addiction?
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.
What are the similarities in the psychological mechanisms underlying both behavioural and substance addiction?
- onset in adolescence and young adulthood
- natural histories that may exhibit chronic, relapsing patterns, many people recover without formal treatment
- feelings of tension or arousal before commiting the act
- pleasure, gratification, relief at the time of commiting the act
- ego-syntonic nature
- over time more ego-dystonic → less pleasurable, more a compulsion
- urge or craving prior to the action
- decrease in anxiety and positive mood state as a result
- emotional dysregulation
- need to increase intensity of behaviour to achieve same mood effects (tolerance)
- higher rates in men, and earlier
- 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)
- financial and marital problems are common
- illegal acts and criminalisation is frequent
What personality traits are associated with behavioural addiction?
- high scores on impulsivity and sensation-seeking
- low on measures of harm avoidance
- aspects of psychoticism, interpersonal conflict, and self-directedness may all play a role
- impaired inhibition of motor responses
- cognitive inflexibility
What are the comorbidity rates of behavioural addictions?
- 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
What is the neurobiology behind behavioural addiction?
- discount rewards rapidly
- disadvantageously on decision-making tasks
- worse planning abilities
- no differences in executive functioning
- almost all NTM systems involved
- serotonin in particular
What is the evidence on genetic contributions in behavioural addiction?
- first-degree relatives have significantly higher lifetime rates
- gene x environment expressions
- few molecular genetic studies
What is gambling? and why is it addictive?
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
What are the DSM-4 criteria for pathologic gambling?
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
What types of gambling exist?
disordered gambling
recreational gambling
problem gambling
What is impulse control disorder?
→ 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
How does gambling differ from OCD?
- PG: ego-syntonic (consistent with their self-image)
- OCD: ego-dystonic (inconsistent with their self-image, distressing)
What is the epidemiology of gaming in terms of prevalence?
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
What are social and environmental factors contributing to gambling?
acceptability and accessability
increase in PG in adults
not adolescents
legalised gambling
increased rates in juvenile gambling
What are the most common comorbidities with gambling?
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
What are some elevated cognitive distortions in gamblers?
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)
Which NTMs are involved in gambling?
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
What is the neuroanatomy behind gambling?
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
What treatment for gambling exists?
pharmacologic approaches
naltrexone, nalmefene
psychotherapies
CBT
motivational enhancement therapy
Why is gambling so dangerous?
- 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.
What types of internet addiction exist?
- Cybersexual addiction: Compulsive Internet use to access pornographic material.
- Cyber-relationship addiction: Maintaining online relationships to excess.
- Net compulsions: Compulsive online gambling, shopping, or online trading.
- Information overload: Excessive website surfing or search engine use.
- Computer addiction: Using the computer to play games compulsively.
What does social media addiction contribute to?
correlated with academic outcomes
learning engagement, time, motivation
lower self-esteem
decrease in mental health
lifestyle apps are addictive
