Jon E. Grant’s research while affiliated with University of Chicago and other places

Despite rising rates of cannabis use across the United States, and in psychiatric populations especially, relatively limited attention has been paid to rates of cannabis use in individuals with body focused repetitive behaviors (BFRBs) such as trichotillomania and skin picking disorder. Using data from an online survey, we collected rates of past-year cannabis use among individuals with BFRBs and investigated whether cannabis use is associated with the clinical presentation of trichotillomania and/or skin picking disorder. We found that approximately 33% of individuals reported past-year cannabis use. Additionally, past-year cannabis use was associated with more days per week spent pulling or picking, and in the case of trichotillomania, cannabis use was associated with heightened distress due to the BFRB. These findings highlight the need for research to more fully investigate cannabis use in the BFRB population and its relationship to disorder symptomatology.

Background This study sought to examine the rate of compulsive sexual behavior disorder (CSBD) in a sample of adults drawn from the community and its associated mental health correlates. Methods An online survey of “Personality, Mental Health, and Well-Being” was distributed via Prolific to 300 adults aged 18 to 75 years. The survey measured a range of behaviors, such as sexual behavior, alcohol and drug use, and dimensional constructs of impulsivity and compulsivity using validated self-report instruments. Results A total of 296 participants (54.7% female) completed the survey and were included in the analysis. The overall prevalence of probable compulsive sexual behavior disorder (CSBD) was 10.8% (n=32). Compared to adults without CSBD, those with CSBD were more likely to be younger and identify as bisexual. In addition, they were more likely to have attention-deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) symptoms, social media and drug use problems, and higher levels of obsessionality, trans-diagnostic compulsivity, and trans-diagnostic impulsivity. Gender, race, and alcohol use did not significantly differ between groups. Conclusion CSBD appears to be common in adults and is equally represented in males and females. CSBD appears to have obsessive, compulsive, and impulsive traits and this may have nosological importance.

Introduction Dissociation involves a lapse in normal perception of reality or awareness; it has Q6 been associated with multiple psychiatric disorders and has been suggested as a contributing factor in trichotillomania and skin picking disorder. This study aimed to explore the relationship between dissociation and trichotillomania and/or skin picking disorder. Methods Three hundred and seventy adults with trichotillomania, skin picking disorder, or both (aged 18-65 years) were enrolled as part of an online survey. Participants completed a questionnaire on demographics, clinical characteristics, comorbidities, medications, and suicidality. Participants completed the Generic Body-Focused Repetitive Behaviors (BFRB) Scale-8 (GBS-8) and the Dissociative Experience Scale (DES). Regression analysis was used to examine the relationship between DES scores and GBS-8 scores, as well as clinical characteristics. Results DES scores significantly predicted GBS-8 impairment scores, suicidal ideation, non-suicidal self-injury, and suicide attempts. Discussion Dissociation may be either a driving force for many with hair pulling or skin picking, or pulling and picking may create a dissociative trance-like state. These findings suggest that dissociation is associated with greater impairment and worse clinical outcomes. Further research may elucidate whether there is benefit in treating dissociation in these patients.

Background The societal and public health costs of problematic use of the internet (PUI) are increasingly recognized as a concern across all age groups, presenting a growing challenge for mental health research. International scientific initiatives have emphasized the need to explore the potential roles of personality features in PUI. Compulsivity is a key personality trait associated with PUI and has been recognized by experts as a critical factor that should be prioritized in PUI research. Given that compulsivity is a multidimensional construct and PUI encompasses diverse symptoms, different underlying mechanisms are likely involved. However, the specific relationships between compulsivity dimensions and PUI symptoms remain unclear, limiting our understanding of compulsivity’s role in PUI. Objective This study aimed to clarify the unique relationships among different dimensions of compulsivity, namely, perfectionism, reward drive, cognitive rigidity, and symptoms of PUI using a symptom-based network approach. Methods A regularized partial-correlation network was fitted using a large-scale sample from the United Kingdom. Bridge centrality analysis was conducted to identify bridge nodes within the network. Node predictability analysis was performed to assess the self-determination and controllability of the nodes within the network. Results The sample comprised 122,345 individuals from the United Kingdom (51.4% female, age: mean 43.7, SD 16.5, range 9-86 years). The analysis identified several strong mechanistic relationships. The strongest positive intracluster edge was between reward drive and PUI4 (financial consequences due to internet use; weight=0.11). Meanwhile, the strongest negative intracluster edge was between perfectionism and PUI4 (financial consequences due to internet use; weight=0.04). Cognitive rigidity showed strong relationships with PUI2 (internet use for distress relief; weight=0.06) and PUI3 (internet use for loneliness or boredom; weight=0.07). Notably, reward drive (bridge expected influence=0.32) and cognitive rigidity (bridge expected influence=0.16) were identified as key bridge nodes, positively associated with PUI symptoms. Meanwhile, perfectionism exhibited a negative association with PUI symptoms (bridge expected influence=–0.05). The network’s overall mean predictability was 0.37, with PUI6 (compulsion, predictability=0.55) showing the highest predictability. Conclusions The findings reveal distinct relationships between different dimensions of compulsivity and individual PUI symptoms, supporting the importance of choosing targeted interventions based on individual symptom profiles. In addition, the identified bridge nodes, reward drive, and cognitive rigidity may represent promising targets for PUI prevention and intervention and warrant further investigation.

Purpose of Review Behavioural addictions involve loss of control over initially rewarding behaviours, which continue despite adverse consequences. Theoretical models suggest that these patterns of behaviour evolve over time, with compulsive and habitual behaviours held to reflect a loss of behavioural control. Compulsivity can be broadly described as a propensity for (or engagement in) repetitive behaviours that are not aligned with overall goals. Here, we consider whether compulsivity is associated with behavioural addictions at different stages of their development, based on self-report and neurocognitive measures. Recent Findings This review found that there is initial evidence that compulsive traits might predispose individuals to engage in problematic behaviours, and that self-report and neurocognitive measures of compulsivity are associated with severity of problematic behaviours even in the early stages of behavioural addictions. In the later stages of behavioural addiction, there is strong evidence for an association of gambling disorder with cognitive inflexibility, but less evidence for an association between compulsivity and other types of behavioural addiction. Summary Moving forwards, well-powered longitudinal studies, including studies using ecological momentary assessment (EMA), will be important in robustly developing our understanding of how compulsivity is related to behavioural addictions over their timecourse.

Objectives Impulsivity is thought to be a core feature of gambling disorder, yet little is known as to whether trait impulsivity predicts treatment response. Methods Data were pooled from 2 previous randomized controlled pharmacological trials using naltrexone and N-acetyl cysteine. Results Trait impulsivity statistically explained variation in medication treatment response ( P = 0.0260, R ² = 0.26). Higher baseline motor impulsiveness was associated with greater treatment response ( P = 0.009). Conclusions Measures of impulsivity may thus be important to include in future large-scale datasets, in trial settings but also routine clinical gambling clinic practice, toward building predictive algorithms that may ultimately help to inform optimal treatment choices and improve outcomes.

Background and aims Borderline personality disorder (BPD) is a serious and difficult to treat psychiatric condition characterized by affective and interpersonal instability, impulsivity, and self-image disturbances. Although the relationship between BPD and substance use disorders has been well-established, there has been considerably less research regarding behavioral addictions in this population. The purpose of this study is to determine the prevalence of social media addiction (SMA) among individuals with BPD and to explore whether it is related to aspects of disorder symptomology. Methods 300 adults completed an online survey via Prolific. Individuals completed the McLean Screening Instrument for BPD (MSI-BPD), along with the Bergen Social Media Addiction Scale (BSMAS). Additionally, all participants reported how often they use social media for the following reasons: distraction from interpersonal problems, reassurance seeking, self-confidence issues, and anger/revenge. Results Of the 289 subjects that completed all measures, 38 (13.1%) screened positive for BPD. Individuals screening positive for BPD were more likely to meet criteria for SMA than controls, and they were more likely to report using social media for interpersonal distraction, reassurance seeking, self-confidence issues, and anger/revenge seeking than controls. Among individuals with BPD, SMA was positively associated with the frequency of each of these behaviors, except for anger/revenge seeking. Discussion and conclusion The results of this study demonstrate that SMA is common among the BPD population and may be related to aspects of disorder symptomology. Whether SMA worsens BPD symptoms or whether addressing SMA could lead to improvements in the BPD remains to be seen and is an important area for future research.

Background Comorbidity studies in trichotillomania and skin picking disorder (known as Body-Focused Repetitive Behaviors, BFRBs) have traditionally not examined rates of borderline personality disorder. When it co-occurs, borderline personality disorder may necessitate different treatment approaches and if untreated may interfere with the response to the treatment for trichotillomania or skin picking disorder. The objectives of this study were to (1) examine the rate of co-occurring borderline personality disorder in BFRBs; and (2) explore associations between co-occurring borderline personality disorder and relevant clinical characteristics (such as demographic features, BFRB symptom severity, lifetime history of suicide attempt[s], levels of dissociation, and other comorbidities including impulsive conditions that are often unmeasured in studies). Methods Adults with skin picking disorder, trichotillomania, or both completed an online survey. The survey was comprised of demographic and clinical questions, plus instruments to measure for probable borderline personality disorder, as well as BFRB severity, dissociation, impulse control conditions (including BFRBs), and alcohol use disorder. Each participant also completed questions about previous formal mental health diagnoses. Results Of the 281 adults with BFRBs (n = 105 with skin picking disorder; 93 with trichotillomania, and 82 with both disorders), 105 (37.4%) screened positive for a probable diagnosis of borderline personality disorder. Participants screening positive for probable borderline personality disorder reported significantly worse pulling and picking symptoms (p < .001), higher rates of dissociation (p < .001), and were significantly more likely to report lifetime suicide attempts (p < .001) and to endorse co-occurring alcohol problems (p < .001), compulsive buying disorder (p < .001), gambling disorder (p < .001), compulsive sexual behavior (p < 001), and kleptomania (p = .005). Conclusions These data suggest relatively high rates of borderline personality disorder in people with BFRBs, in turn linked to more severe psychopathology and elevated lifetime suicide attempt risk. Perhaps the comorbidity with borderline personality disorder reflects a possible subtype of these behaviors that is more impulsive and may necessitate different treatment approaches.