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

Impulse control disorders in non-treatment seeking hair pullers

Background and aims: Hair pulling is a common body focused repetitive behavior. The purpose of this paper is to examine the prevalence of impulse control disorders (as defined in DSM-IV-TR) in a non-treatment seeking sample of hair pullers. Methods: 1,717 college students with (n = 44) and without (n = 1673) hair pulling completed a mental health survey. The college students were sent an online survey assessing hair pulling behavior and other impulse control disorders using the Minnesota Impulsive Disorders Interview. Results: Students with hair pulling were significantly more likely to have a co-occurring impulse control disorder (20.5% vs. 8.9%, p = 0.009, OR = 2.71, CI = 1.28–5.75) and were significantly more likely to meet criteria for compulsive buying, compulsive sexual behavior and intermittent explosive disorder than students without hair pulling. Differences seemed to be moderated by the male gender among students with hair pulling. Discussion and conclusions: Hair pulling is often comorbid with another impulse control disorder, which suggests that elements of impulsivity may be important in our understanding of hair pulling. Furthermore, gender may moderate impulse control comorbidity in hair pulling disorder

Impact of ADHD symptoms on clinical and cognitive aspects of problem gambling.

BACKGROUND: Problem gambling is common across cultures, and has been conceptualized in terms of impulsivity. While elevated rates of attention deficit hyperactivity disorder (ADHD) have been observed in problem gamblers, the relationship between these two conditions, and other dissociable forms of impulsivity, has received little research attention. METHODS: N=126 non-treatment seeking young adults with problem gambling were recruited from the community, and were grouped according to the presence or absence of probable current ADHD. Clinical and cognitive measures pertaining to impulsivity were collected via detailed psychiatric assessment, questionnaires, and computerized neuropsychological tests. These variables were compared between groups. RESULTS: Probable current ADHD was identified in 21.4% of the sample, and was associated with earlier age at onset of gambling behaviors, higher Barratt impulsivity scores (all three subscales), greater caffeine intake, worse response inhibition (Stop-Signal Test), and impaired decision-making (greater proportion of points gambled, Cambridge Gamble Test). Problem gamblers with and without ADHD did not differ on demographic characteristics or the rate of other psychiatric disorders, depression scores, nicotine and alcohol consumption, and body mass index. No significant group differences were found for general response speed, working memory, or executive planning. CONCLUSIONS: ADHD is common in young adults with dysfunctional gambling behaviors and is associated with elevated questionnaire and cognitive based measures of impulsivity, along with heightened caffeine use. Future work should study the causal nature between these factors and the treatment implications of these findings.This work was supported by a Center of Excellence in Gambling Research grant from the National Center for Responsible Gaming (USA) to Dr. Grant. Dr. Chamberlain's involvement in this research was supported by a grant from the Academy of Medical Sciences (AMS, UK).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.comppsych.2014.10.01

A preliminary comparison of cannabis use in subsyndromal gamblers: select neurocognitive and behavioral differences based on use.

OBJECTIVES: Cannabis and gambling are 2 common forms of impulsive behavior among young adults. Although both cannabis use and gambling have been associated with specific cognitive deficits on tasks related to decision making, no studies to date have examined the possible effects on neurocognition in those who simultaneously gamble and use cannabis. METHODS: To address this question, the present study analyzed 214 subsyndromal gamblers from a larger study on impulsivity. Of these subjects, 64 (29.9%) were current cannabis users (last use within the last 3 months) and 150 (70.1%) had no history of cannabis use in the last 3 months, along with 163 healthy controls. Participants were assessed on various cognitive and clinical measures, including measures for gambling severity and impulsivity. RESULTS: Subjects using cannabis had higher rates of current alcohol use disorders and more frequent gambling behavior per week. Gamblers who used cannabis also exhibited significantly greater scores on one measure of attentional impulsivity. Both gambling groups differed from healthy controls on all clinical and select neurocognitive variables, consistent with previous research. CONCLUSIONS: These results indicate that cannabis use in young adults who gamble is associated with nuanced behavioral differences, although causality could not be determined. Longitudinal research should examine cannabis use in subsyndromal gamblers over time to characterize whether these findings are causative.Dr. Grant has received research grants from NIMH, NIDA, National Center for Responsible Gaming, Forest, Transcept, Roche, and Psyadon Pharmaceuticals, and the University of South Florida. He receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Dr. Chamberlain has consulted for Cambridge Cognition, P1Vital, and Shire Pharmaceuticals; and has received speaker honoraria from Lilly. Mr. Leppink and Ms. Derbyshire report no financial relationships with commercial interests.This is the author accepted manuscript. The final version is available from Wolters Kluwer via http://dx.doi.org/10.1097/ADM.000000000000007

Obesity and dissociable forms of impulsivity in young adults.

OBJECTIVE: Obesity is one of the leading causes of preventable morbidity and mortality, and young people are increasingly affected. The aim of this study was to examine relationships between obesity and dissociable forms of impulsivity in young adults. METHODS: A group of young adults (511) was recruited from city areas in the United States using media advertisements. These young adults were administered careful and extensive clinical and neurocognitive assessment in order to quantify different aspects of impulsivity (behavioral/phenomenological-, cognitive-, and personality-related measures). Associations between obesity and impulsivity were explored using multivariate analysis of variance and discriminant function analysis. RESULTS: 10.8% of the sample was obese, and 21.5% was overweight. Compared to controls, subjects with obesity showed significantly elevated rates of maladaptive gambling behaviors, monetary amounts lost to gambling, nicotine consumption, impulsive action (prolonged stop-signal reaction times in the Stop-Signal Test), and impulsive decision-making (reduced modulation of behavior as a function of risk in the Cambridge Gamble Test). Even accounting for potential confounding variables, obesity was significantly predicted by female gender, older age, more maladaptive gambling behaviors, and worse inhibitory control (stop-signal reaction times). CONCLUSION: Obesity is associated with several dissociable forms of impulsivity in young people, especially gambling and impulse dyscontrol. Family doctors should screen for gambling problems in obese young adults. Successful treatment of nicotine dependence in young obese people is likely to require intensive weight management support. Neuropsychological deficits relating to impulsivity occur in obese people in early adulthood, and may represent vulnerability markers rather than being due to chronic untoward metabolic effects on brain function.This research was supported by a Center for Excellence in Gambling Research grant to Dr. Grant from the National Center for Responsible Gaming (USA) and by the Academy of Medical Sciences (UK; grant to Dr. Chamberlain).This is the author accepted manuscript. The final version is available from CUP at http://dx.doi.org/10.1017/S109285291400062

Sleepiness and cognition in young adults who gamble and use alcohol

Abstract Background and aims Past research suggests that sleep problems are associated with increased risky decision-making. Similarly, gambling disorder and alcohol use disorder are also associated with increased risky decision-making. Individuals with gambling disorder or alcohol use disorder have also reported higher rates of sleep problems compared to normal healthy controls. As such, we sought to examine whether sleep problems play a role in the development of alcohol use disorder or gambling disorder. Methods One hundred and forty-one individuals who gamble and use alcohol, yet do not meet criteria for gambling disorder or alcohol use disorder, were assessed to determine the correlation between sleepiness, amount of sleep obtained, decision-making, and alcohol or gambling behaviors. Results Our results suggest that inconsistent sleep patterns may be associated with increased frequency of alcohol use and gambling. We did not, however, find a significant correlation between sleep factors and decision-making. Discussion Further research is needed to examine the specific relationship between sleep patterns and alcohol use and gambling frequency. Overall these data suggest that sleepiness or sleep and risky decision-making is not a significant factor in gambling and alcohol use behaviors in individuals not meeting criteria for alcohol use disorder or gambling disorder

Prevalence and correlates of being overweight or obese in college.

Recent statistics indicate that over one-third of college students are currently overweight or obese, however, the impact of weight in this population from academic and psychiatric perspectives is not fully understood. This study sought to examine the prevalence of overweight and obesity in college students and its association with stress, mental health disorders and academic achievement. A total of 1765 students completed the College Student Computer User Survey (CSCUS) online at a large Midwestern United States University. Responders were classified by weight as normal, overweight or obese based on body mass index. Data were stratified by sex, with cross-tabulation and t-tests, one-way analysis of variance, and logistic regression for analysis. A total of 492 (27.9%) students were overweight (20.2%; range 25.01-29.98) or obese (7.7%; range 30.04-71.26). Overweight and obesity were associated with significantly lower overall academic achievement, more depressive symptoms, and using diet pills for weight loss. Obese males had significantly higher rates of lifetime trichotillomania while overweight and obese females reported higher rates of panic disorder. Higher educational institutions should be aware of the significant burden associated with overweight and obesity in students, and of the differing demographic and clinical associations between overweight or obesity in men and women.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.psychres.2015.01.02

White matter tract integrity in treatment-resistant gambling disorder

Background Gambling disorder is a relatively common psychiatric disorder recently re-classified within the DSM-5 under the category of ‘substance-related and addictive disorders’. Aims To compare white matter integrity in patients with gambling disorder with healthy controls; to explore relationships between white matter integrity and disease severity in gambling disorder. Method In total, 16 participants with treatment-resistant gambling disorder and 15 healthy controls underwent magnetic resonance imaging (MRI). White matter integrity was analysed using tract-based spatial statistics. Results Gambling disorder was associated with reduced fractional anisotropy in the corpus callosum and superior longitudinal fasciculus. Fractional anisotropy in distributed white matter tracts elsewhere correlated positively with disease severity. Conclusions Reduced corpus callosum fractional anisotropy is suggestive of disorganised/damaged tracts in patients with gambling disorder, and this may represent a trait/vulnerability marker for the disorder. Future research should explore these measures in a larger sample, ideally incorporating a range of imaging markers (for example functional MRI) and enrolling unaffected first-degree relatives of patients.This research was supported by a grant from the National Center for Responsible Gaming to Dr. Grant, and by a grant from the Academy of Medical Sciences to Dr. Chamberlain (UK). Dr. Grant has received research grants from NIMH, National Center for Responsible Gaming, and Forest and Roche Pharmaceuticals Dr. Grant receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Dr. Chamberlain consults for Cambridge Cognition. Mr. Odlaug has received a research grant from the Trichotillomania Learning Center, consults for H. Lundbeck A/S, and has received royalties from Oxford University Press. Mr. Leppink and Ms. Derbyshire report no conflicts of interest.This is the author accepted manuscript. The final version is available from the Royal College of Psychiatrists via http://dx.doi.org/10.1192/bjp.bp.115.16550

White matter tract integrity in treatment-resistant gambling disorder.

BACKGROUND: Gambling disorder is a relatively common psychiatric disorder recently re-classified within the DSM-5 under the category of 'substance-related and addictive disorders'. AIMS: To compare white matter integrity in patients with gambling disorder with healthy controls; to explore relationships between white matter integrity and disease severity in gambling disorder. METHOD: In total, 16 participants with treatment-resistant gambling disorder and 15 healthy controls underwent magnetic resonance imaging (MRI). White matter integrity was analysed using tract-based spatial statistics. RESULTS: Gambling disorder was associated with reduced fractional anisotropy in the corpus callosum and superior longitudinal fasciculus. Fractional anisotropy in distributed white matter tracts elsewhere correlated positively with disease severity. CONCLUSIONS: Reduced corpus callosum fractional anisotropy is suggestive of disorganised/damaged tracts in patients with gambling disorder, and this may represent a trait/vulnerability marker for the disorder. Future research should explore these measures in a larger sample, ideally incorporating a range of imaging markers (for example functional MRI) and enrolling unaffected first-degree relatives of patients.This research was supported by a grant from the National Center for Responsible Gaming to Dr. Grant, and by a grant from the Academy of Medical Sciences to Dr. Chamberlain (UK). Dr. Grant has received research grants from NIMH, National Center for Responsible Gaming, and Forest and Roche Pharmaceuticals Dr. Grant receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Dr. Chamberlain consults for Cambridge Cognition. Mr. Odlaug has received a research grant from the Trichotillomania Learning Center, consults for H. Lundbeck A/S, and has received royalties from Oxford University Press. Mr. Leppink and Ms. Derbyshire report no conflicts of interest.This is the author accepted manuscript. The final version is available from the Royal College of Psychiatrists via http://dx.doi.org/10.1192/bjp.bp.115.16550