Trichotillomania and Skin-Picking Disorder: Different Kinds of OCD

This is the author accepted manuscript. The final version is available from the American Psychiatric Association via http://dx.doi.org/10.1176/appi.focus.130212Trichotillomania (hair-pulling disorder) and skin-picking disorder are common neuropsychiatric disorders but are underrecognized by professionals. Affected individuals repeatedly pull out their own hair or pick at their skin, and these symptoms not only have a negative impact on the individual because of the time they occupy but also can lead to considerable physical disfigurement, with concomitant loss of self-esteem and avoidance of social activities and intimate relationships. The behaviors may also have potentially serious physical consequences. Trichotillomania and skin picking frequently co-occur, and both disorders commonly present with co-occurring depression or anxiety. Currently, behavioral therapy appears to be the most effective treatment of both disorders. Pharmacotherapy in the form of N-acetylcysteine or olanzapine may play a role in treatment as well.This research was supported by a grant from the National Center for Responsible Gaming to Dr. Grant. Dr. Chamberlain’s involvement in this work was funded by a grant from the Academy of Medical Sciences, UK

Expanding the definition of addiction: DSM-5 vs. ICD-11.

While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially "addictive" qualities of repetitive behaviors, and whether such behaviors constitute "behavioral addictions," is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, compulsive sexual behavior, and problem Internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of "behavioral addictions" has been handled by latest revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.Wellcome-trust and Academy of Medical Sciences

Compulsive sexual behavior: A review of the literature

Background and aims Compulsive sexual behavior (CSB) is a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual’s life. This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options. Methods We reviewed the literature regarding the clinical aspects of CSB and treatment approaches. Results The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm. Conclusions Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health. Further research needs to be completed to understand where CSB falls within the psychiatric nosology

Neurocognitive findings in compulsive sexual behavior: A preliminary study

Background and aims Compulsive sexual behavior (CSB) is a common behavior affecting 3–6% of the population, characterized by repetitive and intrusive sexual urges or behaviors that typically cause negative social and emotional consequences. Methods For this small pilot study on neurological data, we compared 13 individuals with CSB and gender- matched healthy controls on diagnostic assessments and computerized neurocognitive testing. Results No significant differences were found between the groups. Conclusions These data contradict a common hypothesis that CSB is cognitively different from those without psychiatric comorbidities as well as previous research on impulse control disorders and alcohol dependence. Further research is needed to better understand and classify CSB based on these findings

Gambling disorder and its relationship with substance use disorders: Implications for nosological revisions and treatment.

BACKGROUND: Gambling disorder, recognized by the DSM-5 as a behavioral addiction, affects .4-1.6% of adults worldwide, and is highly comorbid with other mental health disorders, particularly substance use disorders (SUDs). OBJECTIVES: To provide a concise primer on the relationship between gambling disorder and SUDs, focusing on phenomenology/clinical presentation, co-morbidity, familiality, cognition, neuroanatomy/neurochemistry, and treatment. METHODS: Selective review of the literature. RESULTS: Scientific evidence shows that gambling and SUDs have consistently high rates of comorbidity, similar clinical presentations, and some genetic and physiological overlap. Several treatment approaches show promise for gambling disorder, some of which have previously been effective for SUDs. SCIENTIFIC SIGNIFICANCE: It is hoped that recognition of overlap between gambling disorder and SUDs in terms of phenomenology and neurobiology will signal novel treatment approaches and raise the profile of this neglected condition. (Am J Addict 2013;XX:1-6).This research was supported by a Center for Excellence in Gambling Research grant by the National Center for Responsible GamingThis is the author accepted manuscript. The final version is available from Wiley via https://doi.org/10.1111/j.1521-0391.2013.12112.

Salivary Inflammatory Markers in Trichotillomania: A Pilot Study.

BACKGROUND: Immune dysregulation has been hypothesized to be important in the development and pathophysiology of compulsive disorders such as obsessive compulsive disorder (OCD), which has a high comorbid overlap with trichotillomania (both are OC-related disorders). The role of inflammation in the pathophysiology of trichotillomania has garnered little research to date. METHODS: Individuals with trichotillomania provided saliva sample for analysis of inflammatory cytokines. Additionally, these participants were examined on a variety of demographic variables (including body mass index [BMI], previously found to relate to inflammation) along with clinical measures (symptom severity, functioning, and comorbidity). RESULTS: Thirty-one participants, mean age of 24.7 (±10.2) years, 27 (87.1%) females were -included. The mean score on the Massachusetts General Hospital Hair Pulling Scale was 15.7 (±4.2), reflective of moderate symptom severity. Compared to normative data, the mean inflammatory marker levels in the trichotillomania sample had the following Z scores: interleukin-1β (IL-1β) Z = -0.26, IL-6 Z = -0.39, IL-8 Z = -0.32, and tumor necrosis factor-α Z = -0.83. Levels of inflammatory markers did not correlate significantly with BMI, depressive mood, symptom severity, or disability. CONCLUSIONS: The relatively low level of inflammatory saliva cytokines observed in the current study (negative z scores versus normative data with medium effect sizes) indicates that evaluation of blood inflammatory levels in trichotillomania versus matched controls would be valuable in future work. If a hypoinflammatory state is confirmed -using blood samples, this would differentiate trichotillomania from other mental disorders (such as OCD, schizophrenia, and depression), which have typically been linked with high inflammatory measures in the literature, at least in some cases

Symptom severity and its clinical correlates in kleptomania

BACKGROUND: Kleptomania (compulsive stealing) remains poorly understood, with limited data regarding its underlying pathophysiology and appropriate treatment choices. METHODS: Participants (N = 112) age 18 to 65 with a primary, current diagnosis of kleptomania were assessed for the severity of their stealing behavior and urges to steal, as well as related mental health symptoms. To identify clinical and demographic measures associated with variation in disease severity, we utilized the statistical technique of partial least squares. RESULTS: Greater kleptomania symptom severity was associated with having more frequent urges to steal, feeling excited by stealing, having a current eating disorder, and having a current diagnosis of obsessive-compulsive disorder (OCD). Worse symptom severity was associated with a shorter transition time (between first stealing and diagnosis of kleptomania), as well as with a higher chance of stealing from relatives and seeking treatment at some point. CONCLUSIONS: Feeling a sense of reward from stealing and co-occurrence of certain disorders associated with compulsivity (eg, OCD, anorexia nervosa) were strongly associated with worse illness severity in kleptomania. Treatment approaches should incorporate these disorders as possible treatment targets. These data also may support conceptualizing kleptomania as an obsessive-compulsive–related disorder rather than being allied to substance use or impulsive disorders

Lifetime alcohol use disorder and gambling disorder: Clinical profile and treatment response

Objectives: Gambling disorder affects 0.5-2.4% of the population and shows strong associations with lifetime alcohol use disorder. Very little is known regarding whether lifetime alcohol use disorder can impact the clinical presentation or outcome trajectory of gambling disorder. Methods: Data were pooled from previous clinical trials conducted on people with gambling disorder, none of whom had current alcohol use disorder. Demographic and clinical variables were compared between those who did versus did not have lifetime alcohol use disorder. Results: Of the 621 participants in the clinical trials, 103 (16.6%) had a lifetime history of alcohol use disorder. History of alcohol use disorder was significantly associated with male gender (relative risk [RR] = 1.42), greater body weight (Cohen's D = 0.27), family history of alcohol use disorder in first-degree relative(s) (RR = 1.46), occurrence of previous hospitalization due to psychiatric illness (RR = 2.68), and higher gambling-related legal problems (RR = 1.50). History of alcohol use disorder was not significantly associated with other variables that were examined, such as severity of gambling disorder or extent of functional disability. Lifetime alcohol use disorder was not significantly associated with the extent of clinical improvement in gambling disorder symptoms during the subsequent clinical trials. Conclusions: These data highlight that lifetime alcohol use disorder is an important clinical variable to be considered when assessing gambling disorder because it is associated with several untoward features (especially gambling-related legal problems and prior psychiatric hospitalization). The study design enabled these associations to be disambiguated from current or recent alcohol use disorder.</p