No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Behavioral Addiction: The Nexus of Impulsivity and Compulsivity
Abstract
Impulsivity and compulsivity have sometimes been viewed as lying at opposite ends of a single dimension. However, convergent evidence from research that informs clinical practice suggests that these are complex phenomena with some overlapping and some distinctive psychobiological mechanisms. The co-occurrence of impulsive and compulsive features may be relevant to understanding a number of disorders, including behavioral and substance addictions as well as obsessive-compulsive disorder and related disorders. Kleptomania is a diagnosis that elucidates the convergences between models of addiction, impulsivity, and compulsivity, and may provide a framework to understand these behaviors. A deeper understanding of the cognitive-affective neuroscience of compulsive-impulsive behaviors may have implications for the assessment and treatment of these conditions.
... Other forms of behavioural addiction reported include: (1) Impulse control disorders (ICDs) ( Schreiber et al. 2011), (2) Kleptomania, (3) Trichotillomania, (4) Intermittent explosive disorder, (5) Pyromania, (6) Pathological skin picking (Schreiber 2011;Cuzen and Stein 2014), (7) Compulsive buying (Schreiber 2011), (8) Exercise addiction ( Berczik et al. 2014). However, though exercise addiction is regarded as an addiction, it was excluded in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) (APA 2013;Cuzen and Stein 2014). ...
... Other forms of behavioural addiction reported include: (1) Impulse control disorders (ICDs) ( Schreiber et al. 2011), (2) Kleptomania, (3) Trichotillomania, (4) Intermittent explosive disorder, (5) Pyromania, (6) Pathological skin picking (Schreiber 2011;Cuzen and Stein 2014), (7) Compulsive buying (Schreiber 2011), (8) Exercise addiction ( Berczik et al. 2014). However, though exercise addiction is regarded as an addiction, it was excluded in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) (APA 2013;Cuzen and Stein 2014). ...
This chapter examines traditional sources of masculine rhetoric employed by Malawian youths to glorify alcohol addiction, their implications on social and behavioural change, and how the sources and the implications are, in turn, represented by the local media. Through rhetorical analysis of narratives from college students and new media adverts, the chapter finds that the youths utilise macho rhetorical metaphors rooted in the Malawian culture effectively to venerate alcohol consumption—an addictive culture further underlined by the news media. Consequently, the aim of this chapter is to provide an overview of how macho rhetoric has been employed by Malawian youths through history and its implications on social and behavioural change with regard to addiction from an African point of view.
... Importantly, behavioral addictions are considered the "nexus" of impulsive and compulsive actions (Cruzen & Stein, 2014). Impulsivity is characterized by reduced inhibition and lack of reflection when making decisions (Robbins, Curran, & de Wit, 2012). ...
... In the context of behavioral addictions, impulsivity of behavior leads to the initiation of the behavioral addiction, whereas compulsivity supports the maintenance of the behavior (Cuzen & Stein, 2014). Workaholics may engage in impulsive behavior through taking on more work tasks on impulse so that they always have work they need to be doing. ...
The meaning of the term “workaholism” has evolved in the last 47 years from working long hours to having an uncontrollable compulsion to work. More recent literature argues that workaholism as a construct should be considered an addiction and attempts have been made to measure it as such. Although the current measurement of workaholism as an addiction shows a faithful adherence to the components of addiction, it is still missing a key component of behavioral addictions: impulsivity. The present study examined workaholism in an adapted behavioral addiction framework that includes impulsive behavioral traits and external pressures to engage in overwork. Pilot studies were conducted to (a) develop measures used in the primary study and (b) identify the internal and external motivations behind overwork behaviors. The primary study used a longitudinal design to gather quantitative data to test the hypotheses at three separate time points via Amazon’s Mechanical Turk. There were 1,000 participants recruited at Time 1, 560 of those individuals completed Time 2, and 397 individuals completed all three surveys. Compulsive working behaviors predicted overwork over time after accounting for external pressures to engage in overwork. Linear growth curve modeling revealed that individuals classified as workaholics started with more working hours but had a significant decline in the number of working hours over time. When impulsivity was added as a predictor, the results showed that individuals with impulsive behavioral traits who were also classified as workaholics started with fewer hours worked, but hours worked for those individuals significantly increased over time. The interaction of compulsive working behaviors and impulsivity was found to predict positive and negative outcomes including burnout, family disengagement, job performance, extrinsic rewards, social rewards, and intrinsic rewards. Although there were mixed findings for the hypotheses and overwork did not contribute to the model in the expected way, this project shows the importance of including impulsivity in the model of workaholism in an adapted behavioral addiction framework. External pressures similarly did not play an integral role in the model, yet this study demonstrates the importance of identifying and distinguishing between external and internal pressures that influence overwork behaviors.
... All forms of substance abuse, including alcohol, opioids, cocaine, amphetamines, cannabis, and tobacco activate reward pathways (Breiter et al., 1997;Melis et al., 2005;Volkow et al., 2007;Frascella et al., 2010;Koob and Volkow, 2010;Diana, 2013), as do several of the behavioral addictions (see Cuzen and Stein, 2014); and several of these same reward pathways are also found to be activated among men and women who are happily in love, as well as those rejected in love Zeki, 2000, 2004;Fisher et al., 2003Fisher et al., , 2010Aron et al., 2005;Ortigue et al., 2007;Acevedo et al., 2011;Xu et al., 2011). So regardless of its official diagnostic classification, we propose that romantic love should be considered as an addiction (Fisher, 2004(Fisher, , 2016: a positive addiction when one's love is reciprocated, non-toxic and appropriate, and a negative addiction when one's feelings of romantic love are socially inappropriate, toxic, not reciprocated and/or formally rejected (Fisher, 2004;Frascella et al., 2010). ...
... Group activation occurred in several regions of the brain's reward system, including the VTA and caudate nucleus (Fisher et al., 2003;Aron et al., 2005), regions associated with pleasure, general arousal, focused attention and motivation to pursue and acquire rewards and mediated primarily by dopamine system activity (Delgado et al., 2000;Schultz, 2000;Elliott et al., 2003). These regions of the reward system are directly associated with addiction in many studies of drugs of abuse (Breiter et al., 1997;Panksepp et al., 2002;Melis et al., 2005;Volkow et al., 2007;Frascella et al., 2010;Koob and Volkow, 2010;Diana, 2013) and behavioral addictions (see Cuzen and Stein, 2014). ...
Individuals in the early stage of intense romantic love show many symptoms of substance and non-substance or behavioral addictions, including euphoria, craving, tolerance, emotional and physical dependence, withdrawal and relapse. We have proposed that romantic love is a natural (and often positive) addiction that evolved from mammalian antecedents by four million years ago as a survival mechanism to encourage hominin pair-bonding and reproduction, seen cross-culturally today in Homo sapiens. Brain scanning studies using functional magnetic resonance imaging (fMRI) support this view: feelings of intense romantic love engage regions of the brain’s “reward system,” specifically dopamine-rich regions, including the ventral tegmental area, also activated during drug and/or behavioral addiction. Thus, because the experience of romantic love shares reward pathways with a range of substance and behavioral addictions, it may influence the drug and/or behavioral addiction response. Indeed, a study of overnight abstinent smokers has shown that feelings of intense romantic love attenuate brain activity associated with cigarette cue-reactivity. Could socially rewarding experiences be therapeutic for drug and/or behavioral addictions? We suggest that “self expanding” experiences like romance and expanding one’s knowledge, experience and self-perception, may also affect drug and/or behavioral addiction behaviors. Further, because feelings of romantic love can progress into feelings of calm attachment, and because attachment engages more plastic forebrain regions, there is a rationale for therapies that may help substance and/or behavioral addiction by promoting activation of these forebrain systems through long-term, calm, positive attachments to others, including group therapies. Addiction is considered a negative (harmful) disorder that appears in a population subset; while romantic love is often a positive (as well as negative) state experienced by almost all humans. Thus, researchers have not categorized romantic love as a chemical or behavioral addiction. But by embracing data on romantic love, it’s classification as an evolved, natural, often positive but also powerfully negative addiction, and its neural similarity to many substance and non-substance addictive states, clinicians may develop more effective therapeutic approaches to alleviate a range of the addictions, including heartbreak--an almost universal human experience that can trigger stalking, clinical depression, suicide, homicide and other crimes of passion.
... In 'active addiction' gamblers were portrayed as driven by the compulsive elements of gambling, in line with widely accepted understanding that pathological gamblers do not have the ability to choose to stop their habitual patterns [45]. In this context, it was seen as likely gamblers would obtain money to gamble by whatever means they could, including deception. ...
Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.
... The first BA to be acknowledged was gambling (Goodman, 2001), food addiction (FA) (Hebebrand et al., 2014;Meule, 2015), excessive exercise (Chen, 2016), kleptomania (Cuzen & Stein, 2014), or shopping addiction (Hussain et al., 2015). Recently, SA (M. ...
Ce travail de thèse a pour objet l’exploration des capacités de cognition sociale (CS) dans les deux addictions comportementales (ACs) actuellement reconnues dans les classifications internationales : le jeu d’argent pathologique (JAP) et le jeu vidéo pathologique (JVP).La réalisation de deux revues de littérature systématiques a permis de démontrer la rareté des études faisant le lien entre CS et ACs. Cependant, les études trouvées ont suggéré la présence de difficultés pour les patients atteints de ces ACs sur certaines composantes de la CS. Par ailleurs, les éléments cliniques rapportés par ces patients confirmaient la présence de difficultés interpersonnelles.Ces éléments témoignaient de la nécessité d’explorer le profil de CS des patients avec un diagnostic de JAP ou JVP pour améliorer d’une part la compréhension des processus addictifs, et d’autre part de proposer des soins ciblant les difficultés mises en évidence. Nous avons ainsi mené trois études sur des joueurs de jeux vidéo ou de jeux d’argent, présentant ou non une addiction.La première étude a démontré des particularités dans le traitement attentionnel des informations sociales chez des joueurs de poker en comparaison de sujets contrôles. La seconde étude a mis en évidence un lien entre les difficultés d’identification des émotions faciales et le JAP, ainsi que des particularités sur le plan de la métacognition sociale en lien avec le JVP. Enfin, les résultats préliminaires de la troisième étude incluant des patients en début de prise en charge pour un JAP ont montré l’importance de prendre en compte les données rapportées par les patients dans le cadre de la CS.Ces résultats sont discutés au regard des aspects cliniques et scientifiques, et mis en perspective avec de futures recherches possibles.
... It seems to suggest that individuals frequently pandering to these behaviors may be at higher risk for other addictive behaviors. This result also seems to support further the notion that impulsivity and compulsivity are significantly associated with addictive behaviors [16,136]. Probably more attention should be devoted to discerning impulsive and compulsive urges in order not to misclassify behaviors as pathological, especially in the cases in which normal impulsive behavior does not cause evident harm (e.g., sporadic impulsive buying behavior or pornography consumption). ...
Background:
Relatively strong theoretical assumptions and previous studies concerning co-occurring addictive behaviors suggest a subpopulation representing general proclivity to behavioral addictions (BAs), and there are gender-specific subpopulations. This study aimed to compare latent profile analysis (LPA) and latent class analysis (LCA) as the methods of investigating different clusters of BAs in the general student population and among students positively screened for at least one BA. Participants and procedure: Analyses of six BAs (study, shopping, gaming, Facebook, pornography, and food) and their potential antecedents (personality) and consequences (well-being) were conducted on a full sample of Polish undergraduate students (N = 1182) and a subsample (n = 327) of students including individuals fulfilling cutoff for at least one BA.
Results:
LPA on the subsample mostly replicated the previous four profiles found in the full sample. However, LCA on a full sample did not replicate previous findings using LPA and showed only two classes: those with relatively high probabilities on all BAs and low probabilities. LCA on the subsample conflated profiles identified with LPA and classes found with LCA in the full sample.
Conclusions:
LCA on dichotomized scores (screened positively vs. negatively) were less effective in identifying clear patterns of interrelationships between BAs based on relatively strong theoretical assumptions and found in previous research. BAs can be investigated on the whole spectrum of behavior, and person-centered analyses might be more useful when they are based on continuous scores. This paper provides more detailed analyses of the four basic clusters of BAs, prevalence, and co-occurrence of particular BAs within and between them, their gender and personality risk factors, relationships to well-being, and their interrelationships as emerging from the results of this and previous studies.
... Furthermore, previous studies showed that negative affect is a key component of addictive behaviors (Cuzen & Stein, 2014;Di Nicola et al., 2010), especially in the starting and maintaining phase (Kassel et al., 2007). Similarly to substance-use disorders, SU, and subsequentially PSU, regulates mood and acts as a stress-coping and self-medication tool Flynn, Thériault, & Williams, 2020;Squires, Hollett, Hesson, & Harris, 2020). ...
Smartphones have become a ubiquitous part of adolescents' life, and studies have repeatedly revealed a positive association between smartphone use (SU) and problematic smartphone use (PSU). However, longitudinal research investigating the reciprocal relationship among SU and PSU during adolescence are scarce, and studies that take into consideration personality traits as predisposing factors are lacking. This study used survey data collected annually over four years from 855 adolescents aged 11 at time 1 and distributed across 37 Swiss middle schools. An Autoregressive Latent Trajectory Model with Structured Residuals (ALT-SR model) was used to investigate between- and within-person effects over time. Additionally, gender and personality traits, measured according to the recently developed DSM-5 domains, were entered as predictors of the latent intercepts and slopes. The final model showed that, at the within-person level, SU significantly increased PSU at all four time points, but not viceversa. At the between-person level, the personality traits antagonism and negative affect significantly and positively predicted the latent intercepts, whereas being female, psychoticism, and disinhibition significantly and positively influenced the latent slopes. This study highlights the importance of investigating predisposing factors of PSU in adolescence, using advance statistical approaches. The results are discussed against the background of the I-PACE model on predisposing factors and mechanisms that lead to addictive behaviors such as PSU.
... BA is hence characterized by impulsive initiation of an action and subsequent development of compulsive seeking of the action (1)(2)(3)(4). Owing to such characteristics, impulse control disorders, such as kleptomania (KM) and compulsive sexual behavior, are thought to meet the criteria of BA, and thereby often considered as this category of disorders (5)(6)(7)(8). Compulsive sexual behavior is excessive or uncontrolled sexual behaviors or thoughts that are either nonparaphilic or paraphilic (PP), whereas KM is characterized by repetitive, uncontrollable stealing of items for unintended personal use. Although the 5th version of Diagnostics and Statistical Manual of Mental Disorders (DSM-5) has included pathological gambling in the "Substance Related and Addictive Disorder" as a prototypical BA, KM and PP have remained within the category of disruptive, impulse control, and conduct disorders (9,10), primarily due to insufficient studies on KM and PP. ...
Although studies have demonstrated that negative affects are critical attributes of drug addiction, this has remained less clear in behavioral addiction. In this preliminary study with a relatively small number of samples, we investigated negative affects in patients diagnosed with behavioral addiction, particularly paraphilia and kleptomania. Negative affects were examined using self-rating questionnaire and further evaluated by objective assessments in behavioral addicts and normal subjects. Explicit, self-referential negative affects, such as anxiety, stress, and depression, were higher in behavioral addicts than control subjects. Such self-referential negative affects were, although not entirely, consistent with objective evaluations by others and blood stress hormone concentrations. Further investigation of personality traits in behavioral addicts unveiled that heightened negative affects were associated with stronger neurotic personality in behavioral addicts than normal subjects. These results suggest that behavioral addiction, such as paraphilia and kleptomania, may be characterized by heightened negative affects attributable to stronger neurotic personality.
... More recent conceptualisations suggest considerable phenotypic and neurobiological overlap between impulsivity and compulsivity 10,17,18 . This overlap may reflect dysfunction in top-down, goal-directed cognitive control mechanisms [19][20][21][22][23][24] and be particularly relevant to the aetiology and maintenance of impulse control, obsessive-compulsive, and addictive and related disorders 25,26 . ...
Impulsivity and compulsivity are traits relevant to a range of mental health problems and have traditionally been conceptualised as distinct constructs. Here, we reconceptualised impulsivity and compulsivity as partially overlapping phenotypes using a bifactor modelling approach and estimated heritability for their shared and unique phenotypic variance within a classical twin design. Adult twin pairs (N = 173) completed self-report questionnaires measuring psychological processes related to impulsivity and compulsivity. We fitted variance components models to three uncorrelated phenotypic dimensions: a general impulsive–compulsive dimension; and two narrower phenotypes related to impulsivity and obsessiveness.There was evidence of moderate heritability for impulsivity (A² = 0.33), modest additive genetic or common environmental effects for obsessiveness (A² = 0.25; C² = 0.23), and moderate effects of common environment (C² = 0.36) for the general dimension, This general impulsive–compulsive phenotype may reflect a quantitative liability to related mental health disorders that indexes exposure to potentially modifiable environmental risk factors.
... Furthermore, it is a known fact that impulsive people use smartphones as a gratifying means to engage in activities with no forethought about the consequences of their actions (Mitchell and Potenza, 2014). Thus, it can be postulated that impulsivity triggers the development of behavioral addictions (Cuzen and Stein, 2014). ...
Background: Problematic Instagram use (PIGU), a specific type of internet addiction, is prevalent among adolescents and young adults. In certain instances, Instagram acts as a platform for exhibiting photos of risk-taking behavior that the subjects with PIGU upload to gain likes as a surrogate for gaining peer acceptance and popularity.
Aims: The primary objective was to evaluate whether addiction-specific cues compared with neutral cues, i.e., negative emotional valence cues vs. positive emotional valence cues, would elicit activation of the dopaminergic reward network (i.e., precuneus, nucleus accumbens, and amygdala) and consecutive deactivation of the executive control network [i.e., medial prefrontal cortex (mPFC) and dorsolateral prefrontal cortex (dlPFC)], in the PIGU subjects.
Method: An fMRI cue-induced reactivity study was performed using negative emotional valence, positive emotional valence, and truly neutral cues, using Instagram themes. Thirty subjects were divided into PIGU and healthy control (HC) groups, based on a set of diagnostic criteria using behavioral tests, including the Modified Instagram Addiction Test (IGAT), to assess the severity of PIGU. In-scanner recordings of the subjects’ responses to the images and regional activity of the neural addiction pathways were recorded.
Results: Negative emotional valence > positive emotional valence cues elicited increased activations in the precuneus in the PIGU group. A negative and moderate correlation was observed between PSC at the right mPFC with the IGAT scores of the PIGU subjects when corrected for multiple comparisons [r = −0.777, (p < 0.004, two-tailed)].
Conclusion: Addiction-specific Instagram-themed cues identify the neurobiological underpinnings of Instagram addiction. Activations of the dopaminergic reward system and deactivation of the executive control network indicate converging neuropathological pathways between Instagram addiction and other types of addictions.
... A major aim of the present review is therefore to compare different psychometric instruments for problematic pornography use on their ability to assess common components of addiction. The addiction model is used as a framework for this evaluation because addiction symptoms share significant commonalities with symptoms of related theoretical models, for instance, accounting for impulsivity in impulse control disorder models and compulsivity in compulsive behavior models (Cuzen & Stein, 2014;Kingston & Firestone, 2008). Although having etiological dissimilarities with addiction, the symptoms proposed in diagnostic criteria for HD and CSBD can be interpreted using an addiction framework. ...
Despite a lack of consensus in the field about how best to conceptualize problematic pornography use, psychometric instruments have nonetheless been developed to assess the construct. The present systematic review aimed to (i) identify psychometric tools that have been developed to assess problematic pornography use; (ii) summarize key characteristics, psychometric properties, and strengths and limitations of instruments for problematic pornography use; (iii) compare the instruments’ theoretical conceptualizations of problematic pornography use; and (iv) evaluate each instrument on their ability to assess various core components of addiction. In this article, 22 instruments assessing problematic pornography use were reviewed. Results indicated that while the instruments had different conceptualizations of problematic pornography use, addiction still emerged as the most common theoretical framework used by the instruments. Five of the most commonly assessed addiction components across the different instruments were (1) impaired control, (2) salience, (3) mood modification, (4) interpersonal conflict, and (5) general life conflict. Contextual factors that may potentially affect the assessment of problematic pornography use and recommendations for researchers and clinicians are discussed.
... Other forms of behavioural addiction reported include: (1) Impulse control disorders (ICDs) (Schreiber et al. 2011), (2) Kleptomania, (3) Trichotillomania, (4) Intermittent explosive disorder, (5) Pyromania, (6) Pathological skin picking (Schreiber 2011;Cuzen and Stein 2014), (7) Compulsive buying (Schreiber 2011), (8) Exercise addiction (Berczik et al. 2014). However, though exercise addiction is regarded as an addiction, it was excluded in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) (APA 2013; Cuzen and Stein 2014). ...
This chapter introduces the book by making a case for addiction in Africa. It shows that there is no clear academic development of the concept of addiction in the Africa. Apparently, most of the studies have adopted the Western view and have attempted either to treat addicts as sick or correct their will power by attempting to make them ethical. Further to this, the chapter notes that there is no clear demarcation between the concept of addiction and abuse, in that most studies that claim addiction do actually investigate abuse. Because of these discrepancies in understanding addiction, the chapter makes a strong case for studying addiction on the African continent. The chapter concludes by introducing chapters in the book.
... Las adicciones comportamentales se caracterizan por encontrarse en la frontera entre la compulsividad y la impulsividad por lo que en ciertas ocasiones su denominación puede variar. Este tipo de adicción puede producirse por el deseo de regular los afectos negativos en un mecanismo similar al de las conductas compulsivas-impulsivas (Cuzen & Stein, 2014). El autocontrol insuficiente puede ser un factor de riesgo a la hora de desarrollar adicción a sitios de redes sociales (SRSs), a diferencia de los usuarios que son capaces de resistir tentaciones o impulsos (Błachnio, Przepiórka, & Pantic, 2015). ...
Objetivo: este estudio pretende revisar y analizar la evidencia actual sobre la adicción a internet y el uso de redes sociales en la población adolescente. Método: se llevó a cabo una revisión sistemática de las publicaciones científicas disponibles en las bases de datos PubMed, Web of Science, EBSCOhost y Scielo, entre el periodo 2007-2017, sobre el uso excesivo de redes sociales y adicción a internet en adolescentes. Resultados: la evidencia da cuenta de un uso excesivo de internet en población adolescente y demuestra la presencia de diferentes consecuencias y factores de riesgo asociados a esta problemática. Conclusiones: existe un importante número de investigaciones científicas que refieren las consecuencias, factores de riesgo y comorbilidades asociadas a la adicción a internet y su relación con redes sociales. Sin embargo, no es el único concepto utilizado para explicar este comportamiento lo que dificulta su definición.
... However, the most important thing to note is related to the specification that both obsessions and compulsions are characteristics of OCD symptoms (although compulsions are an orthogonal factor across other disorders, such as SUD; Cuzen & Stein, 2014), and that obsessions are experienced as unwanted or are not pleasurable. In line with this, the DSM-5 (APA, 2013) wrote that "compulsions are not done for pleasure, although some individuals experience relief from anxiety or distress" (p. ...
This commentary addresses Griffiths et al. (2018)’s sixth myth about work addiction. We agree that work addiction
could also be spread in the school context, although we propose that problematic overstudying may be more similar to
an obsession than to an addiction toward the study. We refer to the DSM-5 diagnostic criteria related to the obsessive–
compulsive disorder (OCD) and the substance-use disorder, presenting some theoretical considerations related to the
similarities and differences between problematic overstudying and these two diagnoses. Finally, we focus on the
obsessive–compulsive personality disorder. We conclude that problematic overstudying might better be conceptualized
as an OCD-related disorder.
... In other words, individuals with IGD seem to be more driven by reward-seeking and immediate gratification of their urges, whereby their decision-making is impaired and negative long-term consequences of gaming tend to be ignored; on the other hand, these people appear to be much less likely to engage in gaming with the aim of avoiding or preventing some adverse consequences of not gaming, such as withdrawal symptoms. If this is correct and if behavioral addictions are best understood as "impulsive-compulsive disorders" [54], the conceptualization of IGD as a behavioral addiction may not be adequate. Consequently, the classification of IGD among impulse-control disorders might provide a better home for it. ...
Purpose of Review
To examine the degree of relatedness between Internet gaming disorder (IGD), obsessive-compulsive disorder (OCD), and substance use disorders.
Recent Findings
IGD is phenomenologically distinct from OCD, and its relationship with OCD, although apparently strong, is not specific. At a neurobiological level, IGD and OCD appear to differ, but more studies directly comparing the two disorders are needed. IGD was conceptualized as a behavioral addiction, which has been controversial. Limited data on co-occurrence of IGD and substance use disorders do not suggest their strong relationship. However, they are similar in terms of greater sensitivity to reward, impaired executive control, and impaired risky decision-making—features that are also largely shared with impulsivity.
Summary
IGD appears to be more characterized by impulsivity than compulsivity. If the hallmark of behavioral addictions is the initial impulsivity followed by compulsivity, IGD may be more akin to an impulse-control disorder than a behavioral addiction.
... The occurrence of impulsivity and compulsivity at different times was postulated to characterise both substance use disorders (substance addictions) and behavioural addictions, and the notion of 'impulsivecompulsive disorder' was proposed to account for these conditions (Cuzen and Stein, 2014). According to this model, in the early stages of addictions, impulsivity plays a prominent role because of the reinforcement of behaviour that is motivated by reward seeking, whereas in the later stages, compulsivity 'takes over' and behaviour that is motivated by avoidance of the perceived negative consequences (e.g. ...
Disorders characterised by repetitive and problematic behaviours and poor impulse control have been increasingly conceptualised as behavioural addictions. This article examines the concept of behavioural addiction and argues that the addiction framework is only one approach to these behavioural disturbances. It cautions against a tendency to regard many activities that are performed with an extraordinary intensity or frequency and that have some negative consequences as behavioural addiction. There is a need for more research to better understand the links between repetitive and problematic behaviours and other psychopathology, as well as the function of these behaviours and factors that maintain them.
... OCD is a commonly reported comorbidity in PIU (Carli et al., 2013). It is theorized that behavioral addictions represent a "nexus of impulsivity and compulsivity" (Cuzen & Stein, 2014). This new understanding challenges clear boundary between impulsivity and compulsivity (Hollander, 2014). ...
Background
Problematic Internet use (PIU) is an emerging entity with varied contents. Behavioral addictions have high comorbidity of attention deficit hyperactivity disorder and obsessive–compulsive spectrum disorders. Social networking site (SNS) addiction and role playing game (RPG) addiction are traditionally studied as separate entities. We present a case with excessive Internet use, with a particular focus on phenomenology and psychiatric comorbidities.
Case presentation
Fifteen-year-old girl with childhood onset attention deficit disorder, obsessive–compulsive disorder, adolescent onset trichotillomania, and disturbed family environment presented with excessive Facebook use. Main online activity was creating profiles in names of mainstream fictional characters and assuming their identity (background, linguistic attributes, etc.). This was a group activity with significant socialization in the virtual world. Craving, salience, withdrawal, mood modification, and conflict were clearly elucidated and significant social and occupational dysfunction was evident.
Discussion
This case highlights various vulnerability and sociofamilial factors contributing to behavioral addiction. It also highlights the presence of untreated comorbidities in such cases. The difference from contemporary RPGs and uniqueness of role playing on SNS is discussed. SNS role playing as a separate genre of PIU and its potential to reach epidemic proportions are discussed.
Conclusions
Individuals with temperamental vulnerability are likely to develop behavioral addictions. Identification and management of comorbid conditions are important. The content of PIU continues to evolve and needs further study.
Introduction:
Only two behavioral addictions (BAs) are currently recognized in international classifications (gambling disorder: GbD; gaming disorder: GmD), while some of them await further investigation (food addiction: FA; sexual addiction: SA). Neurocognitive functioning is considered a risk factor for BAs. Research is quite abundant for GbD and highlights specific deficits in several cognitive functions. Nevertheless, grey areas still exist. The aim of this research programme is to investigate the neurocognitive profiles of patients presenting with various BAs and to establish parallels between different forms of BA to achieve a common addiction concept.
Methods and analysis:
This research program is composed of two studies sharing the same methodology but focusing on different samples: the BANCO study aims to include 30 individuals with a GbD, whereas the BANCO2 study aims to include 30 individuals with a GmD, 30 with a SA, and 30 with a FA. Moreover, for each BA group, 30 healthy controls will be recruited, matched by sex, age and education level. Several cognitive tasks will be completed by participants. Cue reactivity and physiological responses, as well as clinical data regarding addiction characteristics and personality, will also be investigated. A composite score based on the cognitive tasks will be computed using principal component analysis (PCA). Overall cognitive performance and detailed performance on the different cognitive tasks will be compared between individuals with BAs and their matched healthy controls using linear models with random effects. Comparisons will also be made between BA groups to investigate specific alterations associated with each disorder.
Discussion:
The results of this research programme will impact both research and clinical areas by (i) providing new knowledge for discussions regarding the inclusion of BAs under the spectrum of addictive disorders; (ii) improving understanding of addiction mechanisms in general; (iii) providing clarity in the grey areas in neurocognitive research on BAs and improving the understanding of less studied BAs, (iv) guiding clinicians to propose therapeutic alternatives and complementary programmes.
Trial registration:
BANCO study (ClinicalTrials.gov NCT03202290); BANCO2 study (ClinicalTrials.gov NCT03967418).
Addiction to substances of abuse (drugs) and behaviours is a common problem in various communities in Africa. These substances and behaviours influence neurobiological processes in the brain and mainly affect the mesolimbic dopaminergic pathway (reward pathway) that connects two important nuclei, the ventral tegmental area (VTA) and nucleus accumbens (NAc), in the brain, which are responsible for the individual happiness and pleasures. They also affect a multitude of neurons and the neurochemicals they release in the brain, their precursor molecules, synthesis, storage in the vesicles, release, transporters and their metabolizing systems at the synapses, receptors, transcription factors and their effects on the signal transduction pathways. However, race and ethnicity as well as tribal differences among whites, Blacks, Asians, Japanese and Chinese have been reported to play a role in individual responses to alcohol and other substances/drugs of abuse, and behavioural addictions and their effects on the brain. And the differences are mainly due to the pharmacokinetics (PK), pharmacodynamics (PD) and pharmacogenetics (PG), and transporters of the substances/drugs in the body. The chapter aims to ascertain the neurobiology of addiction in African population. It further seeks to interrogate African literature and compare and contrast the neurobiology of substance of abuse (drugs) and behavioural addiction globally.
The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.
Research on the relative impact of trait impulsivity vs. drug exposure on neuropsychological probes of response inhibition vs. response perseveration has been posited as a valid pathway to explore the transition between impulsivity and compulsivity on psychostimulant dependence.
The objectives of this study are to examine performance differences between cocaine-dependent individuals (CDI) and healthy comparison individuals (HCI) on neuropsychological probes of inhibition and perseveration and to examine the predictive impact of trait impulsivity-a proxy of premorbid vulnerability, and severity of cocaine use-a proxy of drug exposure, on CDI's performance.
Forty-two CDI and 65 HCI were assessed using the UPPS-P Scale (trait impulsivity), the Stroop and go/no-go (inhibition) and revised-strategy application and probabilistic reversal tests (perseveration).
CDI, compared to HCI, have elevated scores on trait impulsivity and perform significantly poorer on inhibition and perseveration, with specific detrimental effects of duration of cocaine use on perseveration.
CDI have both inhibition and perseveration deficits; both patterns were broadly indicative of orbitofrontal dysfunction in the context of reinforcement learning. Impulsive personality and cocaine exposure jointly contribute to deficits in response perseveration or compulsivity.
The basic concepts underlying compulsive, impulsive and addictive behaviours overlap, which may help explain why laymen use these expressions interchangeably. Although there has been a large research effort to better characterize and disentangle these behaviours, clinicians and scientists are still unable to clearly differentiate them. Accordingly, obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on different levels, including phenomenology, co-morbidity, neurocircuitry, neurocognition, neurochemistry and family history. In this review we summarize these issues with particular emphasis on the role of the opioid system in the pathophysiology and treatment of OCD, ICD and SUD. We postulate that with progression and chronicity of OCD, the proportion of the OCD-related behaviours (e.g. checking, washing, ordering and hoarding, among others) that are driven by impulsive 'rash' processes increase as involvement of more ventral striatal circuits becomes prominent. In contrast, as SUD and ICD progress, the proportion of the SUD- and ICD-related behaviours that are driven by compulsive 'habitual' processes increase as involvement of more dorsal striatal circuits become prominent. We are not arguing that, with time, ICD becomes OCD or vice versa. Instead, we are proposing that these disorders may acquire qualities of the other with time. In other words, while patients with ICD/SUD may develop 'compulsive impulsions', patients with OCD may exhibit 'impulsive compulsions'. There are many potential implications of our model. Theoretically, OCD patients exhibiting impulsive or addictive features could be managed with drugs that address the quality of the underlying drives and the involvement of neural systems. For example, agents for the reduction or prevention of relapse of addiction (e.g. heavy drinking), which modulate the cortico-mesolimbic dopamine system through the opioid (e.g. buprenorphine and naltrexone), glutamate (e.g. topiramate), serotonin (e.g. ondansetron) or γ-aminobutyric acid (e.g. baclofen and topiramate) systems, may prove to show some benefit in certain forms of OCD. Based on the available evidence, we suggest that the treatment of patients with these disorders must account for alterations in the underlying motivations and neurobiology of the condition. We provide an initial guide to the specific treatments that future clinical trials might consider in patients with OCD. For example, it might be wise to test naltrexone in patients with co-morbid SUD and ICD, topiramate in patients with co-morbid ICD and eating disorders, and baclofen in patients with co-morbid Tourette's syndrome. These trials could also include scales aimed at assessing underlying impulsivity (e.g. Barratt Impulsiveness Scale) to check whether this construct might predict response to drugs acting on the reward system.
Gorenstein and Newman (1980) proposed that poorly modulated responding for reward is the common diathesis underlying disinhibited behavior in several traditionally distinct person categories: psychopathy, hysteria, early onset alcoholism, childhood hyperactivity, and nonpathological impulsivity (e.g., extraversion). The authors extend this proposal by theorizing a psychological mechanism that highlights relations among disinhibition, reflection, and failures to learn from aversive feedback. The hypothesized mechanism is presented as 4 generic stages of response modulation: the dominant response set, the reaction to an aversive event, the subsequent behavioral adaptation, and the immediate and long-term consequences of reflection, or the lack thereof. The mechanism has implications for disinhibited individuals' impulsivity and provides a point of departure to study factors responsible for similarities and differences among these syndromes.
Drug abuse and dependence define behavioral states involving increased allocation of behavior towards drug seeking and taking at the expense of more appropriate behavioral patterns. As such, addiction can be viewed as increased control of behavior by the desired drug (due to its unconditioned, rewarding properties). It is also clear that drug-associated (conditioned) stimuli acquire heightened abilities to control behaviors. These phenomena have been linked with dopamine function within the ventral striatum and amygdala and have been described specifically in terms of motivational and incentive learning processes. New data are emerging that suggest that regions of the frontal cortex involved in inhibitory response control are directly affected by long-term exposure to drugs of abuse. The result of chronic drug use may be frontal cortical cognitive dysfunction, resulting in an inability to inhibit inappropriate unconditioned or conditioned responses elicited by drugs, by related stimuli or by internal drive states. Drug-seeking behavior may thus be due to two related phenomena: (1) augmented incentive motivational qualities of the drug and associated stimuli (due to limbic/amygdalar dysfunction) and (2) impaired inhibitory control (due to frontal cortical dysfunction). In this review, we consider the neuro-anatomical and neurochemical substrates subserving inhibitory control and motivational processes in the rodent and primate brain and their putative impact on drug seeking. The evidence for cognitive impulsivity in drug abuse associated with dysfunction of the frontostriatal system will be discussed, and an integrative hypothesis for compulsive reward-seeking in drug abuse will be presented.
The article reviews the current knowledge about the impulse control disorders (ICDs) with specific emphasis on epidemiological and pharmacological advances. In addition to the traditional ICDs present in the DSM-IV-pathological gambling, trichotillomania, kleptomania, pyromania and intermittent explosive disorder-a brief description of the new proposed ICDs-compulsive-impulsive (C-I) Internet usage disorder, C-I sexual behaviors, C-I skin picking and C-I shopping-is provided. Specifically, the article summarizes the phenomenology, epidemiology and comorbidity of the ICDs. Particular attention is paid to the relationship between ICDs and obsessive-compulsive disorder (OCD). Finally, current pharmacological options for treating ICDs are presented and discussed.
Psychogenic excoriation (also called neurotic excoriation, acne excoriée, pathological or compulsive skin picking, and dermatotillomania) is characterised by excessive scratching or picking of normal skin or skin with minor surface irregularities. It is estimated to occur in 2% of dermatology clinic patients and is associated with functional impairment, medical complications (e.g. infection) or substantial distress.
Psychogenic excoriation is not yet recognised in the DSM. We propose preliminary operational criteria for its diagnosis that take into account the heterogeneity of behaviour associated with psychogenic excoriation and allow for subtyping along a compulsivity-impulsivity spectrum.
Psychiatric comorbidity in patients with psychogenic excoriation, particularly mood and anxiety disorders, is common. Patients with psychogenic excoriation frequently have comorbid disorders in the compulsivity-impulsivity spectrum, including obsessive-compulsive disorder, body dysmorphic disorder, substance use disorders, eating disorders, trichotillomania, kleptomania, compulsive buying, obsessive-compulsive personality disorder, and borderline personality disorder.
There are few studies of the pharmacological treatment of patients with psychogenic excoriation. Case studies, open trials and small double-blind studies have demonstrated the efficacy of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors in psychogenic excoriation. Other pharmacological treatments that have been successful in case reports include doxepin, clomipramine, naltrexone, pimozide and olanzapine.
There are no controlled trials of behavioural or psychotherapeutic treatment for psychogenic excoriation. Treatments found to be effective in case reports include a behavioural technique called ‘habit reversal’ a multicomponent programme consisting of self-monitoring, recording of episodes of scratching, and procedures that produce alternative responses to scratching; and an ‘eclectic’ psychotherapy programme with insight-oriented and behavioural components.
‘Addiction’ denotes repetitive routines that aim to obtain chemicals and, less often, routines without that aim. The latter are behavioural addictions. They include obsessive-compulsive disorder (OCD), compulsive spending (including gambling), overeating (bulimia), hypersexuality (straight or deviant), and kleptomania. Common across dependence syndromes is: a repeated urge to engage in behaviour known to be counterproductive; mounting tension until it is completed; rapid temporary switching off of the tension by completing the behaviour; gradual return of the urge; syndrome-specific external and perhaps internal cues for the urge; secondary conditioning of the urge to external and internal cues; similar strategies for relapse prevention by cue exposure and stimulus control. The urge to complete a behaviour and discomfort if prevented from this resemble the craving and the withdrawal (WD) symptoms of substance abusers. Some WD symptoms are common to several addictive syndromes while others may be more specific. Addiction (pull) and compulsion (push) overlap and can occur sequentially or concurrently. Different addictions occur with varying amounts of pleasure at various stages. Prolonged exposure can enduringly reduce the urge and discomfort in OCD, and may help some other addictions. Conditioned cues are important and for lasting efficacy a therapist may need to know their details for each syndrome. There may be some similarities in the early management and prevention of relapse of behavioural and chemical addictions.
The legitimacy of nonsubstance addictions has received increased attention from clinicians, researchers and the general population as more and more individuals report symptoms consistent with impairment of impulse control. The clinical presentation of these disorders is varied, as compulsive activities may include: gambling, eating, sex, shopping, use of the Internet or videogames or even exercising, working or falling in love. As such, there is great controversy in diagnosing, treating or even naming these conditions, as many of these behaviors are daily rituals instrumental to our ultimate survival. Historically, the phrase "impulse control disorders" described these conditions but many researchers and clinicians also use the term "behavioral addictions," "process addictions" or "impulsive-compulsive behaviors" to report behavioral pathology. This review summarizes the data of each of these behavioral addictions from epidemiology to neurobiology to treatment options. Research suggests similarities between natural and drug reward processing but clinical evidence supports the utilization of treatment modalities for these behavioral conditions that can sometimes differ from traditional drug treatment.
The concept of impulsivity covers a wide range of "actions that are poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable outcomes". As such it plays an important role in normal behaviour, as well as, in a pathological form, in many kinds of mental illness such as mania, personality disorders, substance abuse disorders and attention deficit/hyperactivity disorder. Although evidence from psychological studies of human personality suggests that impulsivity may be made up of several independent factors, this has not made a major impact on biological studies of impulsivity. This may be because there is little unanimity as to which these factors are. The present review summarises evidence for varieties of impulsivity from several different areas of research: human psychology, psychiatry and animal behaviour. Recently, a series of psychopharmacological studies has been carried out by the present author and colleagues using methods proposed to measure selectively different aspects of impulsivity. The results of these studies suggest that several neurochemical mechanisms can influence impulsivity, and that impulsive behaviour has no unique neurobiological basis. Consideration of impulsivity as the result of several different, independent factors which interact to modulate behaviour may provide better insight into the pathology than current hypotheses based on serotonergic underactivity.
This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).
The current study was constructed to examine the family history and psychiatric comorbidity of a group of persons with kleptomania. Thirty-one subjects with DSM-IV kleptomania were administered the Structured Clinical Interview for DSM-IV (SCID) and the Minnesota Impulse Disorders Inventory (MIDI). The Family History Research Diagnostic Criteria (FH-RDC) were used to collect information about psychiatric disorders in first-degree relatives. Subjects with kleptomania were more likely than comparison subjects to have any lifetime impulse-control disorder (chi2=12.569; df=1; P<.001) and to have a first-degree relative with an alcohol use disorder (chi2=6.994; df=1; P=.008) or any psychiatric disorder (chi2=12.056; df=1; P=.001). Persons with kleptomania appear to have a higher lifetime prevalence of impulse-control disorders and are more likely to have first-degree relatives with alcohol problems than are comparison subjects.
This article highlights the proceedings of a symposium presented at the 27th Annual Scientific Meeting of the Research Society on Alcoholism in Vancouver, British Columbia, Canada, June 29, 2004. The organizers and co-chairs were Bankole A. Johnson, MD, PhD, and Robert M. Swift, MD, PhD. The presentations included (1) Introduction, by Bankole A. Johnson; (2) Safety, Tolerability, and Efficacy of gamma-Hydroxybutyric Acid and Baclofen in the Treatment of Alcohol Addiction, by Giovanni Addolorato; (3) Safety of Gabapentin in Treating Alcoholism, by Hugh Myrick; (4) New Data on the Safety and Effectiveness of Topiramate in the Treatment of Alcohol Dependence, by Bankole A. Johnson; (5) Evaluating the Risk of Benzodiazepine Prescription to Alcohol-Dependent Individuals, by Domenic A. Ciraulo; and (6) Safety and Efficacy of GABAergic Agents in Treating Alcoholics: Discussion, by Robert M. Swift.
In anticipation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to consider whether addictive disorders should include non-substance use disorders.
The author reviewed data and provided perspective to explore whether disorders such as pathological gambling (PG) should be grouped together with substance dependence, given that they share many features.
PG and substance dependence currently reside in the DSM, fourth edition, text revision (DSM-IV-TR) within separate categories, with PG classified as an impulse control disorder (ICD) and substance dependence as a substance use disorder (SUD). Arguments can be forwarded to support each categorization, as well as to justify their inclusion together as addictions.
The current state of knowledge suggests that there exist substantial similarities between PG and SUDs. Further research is indicated prior to categorizing PG and other ICDs together with SUDs.
With the increasing availability of gambling throughout North America, there is interest in developing more effective treatments. This study compares the effectiveness of two brief outpatient treatments for problem gambling: eight sessions of Cognitive-Behavioral Therapy (n = 65) and eight sessions of a twelve-step treatment-oriented approach based on the first five steps of Gamblers Anonymous (n = 61). There were no baseline group differences on gambling-relevant variables. Twelve months post-treatment showed no group differences on key gambling variables (eg, frequency, abstinence rates, money wagered) in an analysis of completers. Participants who attended more sessions and chose an initial abstinent treatment goal appeared to achieve better outcomes.