Craving and decision making in individuals with pathological buying

Das pathologische Kaufen gilt als klinisch relevantes Phänomen, bei dem Betroffene die Kontrolle über ihr Kaufverhalten verlieren. Das Phänomen ist aktuell nicht psychiatrisch klassifiziert und obwohl Parallelen zu Suchterkrankungen gezogen werden, fehlen experimentelle Studien, die diese Parallelen untersuchen und in ein Gesamtmodell der Entstehung und Aufrechterhaltung der Störung integrieren. Diese Forschungslücke soll mit der vorliegenden kumulativen Dissertation geschlossen werden. Schrift 1 des Kumulus adressiert die Nähe zu Suchterkrankungen. Unter Anwendung eines Cue-Reactivity Paradigmas mit kaufbezogenen Bildern wurden subjektive und physiologische Cravingreaktionen (Suchtmittelverlangen) bei Personen mit pathologischem Kaufverhalten festgestellt. Schrift 2 widmet sich dem pathologischen Kaufen im Online-Kontext und fand ebenfalls Cravingreaktionen bei Personen mit einer Tendenz zum pathologischen Online-Kaufen. Die Suchtkonzeption aufgreifend konnte in Analogie zu einem Modell für spezifische Formen einer Internetsucht gezeigt werden, dass der Zusammenhang zwischen einer prädisponierenden Erregbarkeit durch Einkaufen und der Symptomschwere bezüglich des Online-Kaufens durch die Nutzungserwartung mediiert wurde. Die Befunde aus Schrift 1 und 2 legen nahe, dass Cravingreaktionen, Belohnungsantizipation und Gratifikationsmechanismen in Analogie zu Suchterkrankungen einen wesentlichen Faktor in der dysfunktionalen Verhaltenssteuerung darstellen können. Schrift 3 untersucht Entscheidungsverhalten im Kontext von Suchterkrankungen bei pathologischem Kaufen. Es konnte gezeigt werden, dass Personen mit pathologischem Kaufverhalten Entscheidungsdefizite aufwiesen, wenn die Eintrittswahrscheinlichkeit und Konsequenzen einer Alternative unbekannt waren (Ambiguität), wohingegen sie keine Schwierigkeiten zeigten, wenn diese explizit vorlagen (Risiko). Die Ergebnisse legen nahe, dass dysfunktionales Entscheidungsverhalten durch ein Defizit in der emotionalen Feedbackverarbeitung bei intakten kognitiven Funktionen erklärt werden kann. Die vorliegenden Befunde aus den Schriften 1-3 des Kumulus werden in Bezug auf ein Gesamtmodell diskutiert, welches im Einklang mit Dual-Prozess-Theorien der Selbstregulation davon ausgeht, dass Cravingreaktionen und ein dysfunktionales Entscheidungsverhalten kovariieren und damit die Entscheidungen für die kurzfristig belohnende Alternative des Einkaufens ungeachtet der langfristig negativen Konsequenzen (Überschuldung, etc.) erklärt werden können. Zusammenfassend werden Parallelen des pathologischen Kaufens und Suchterkrankungen aufgezeigt und eine mögliche Klassifikation als Verhaltenssucht diskutiert.Pathological buying is a clinical relevant phenomenon, in which affected individuals lose control over their buying behavior. Currently, the phenomenon is not psychiatrically classified, and although parallels to addictive behaviors have been considered, there is a lack of experimental studies which investigate this relationship and integrate these findings with respect to a comprehensive model for the development and maintenance of the disorder. This cumulative dissertation aimed to address this research gap. Scripture 1 of the cumulus addresses the potential proximity to addictive behaviors and found craving reactions on a subjective and physiological level in a group of individuals with pathological buying by applying a cue-reactivity paradigm with shopping related pictures. Scripture 2 investigates pathological buying patterns in the online context and found craving in individuals with a tendency to pathological online buying. With respect to the addiction concept, in accordance with a current model for specific Internet addiction, it was demonstrated that the relationship of a predisposing excitability from shopping and the symptom severity of online shopping was mediated by specific online shopping expectancies. Taken together, the findings of scripture 1 and 2 emphasize the important role of craving, reward anticipation, and mechanisms of gratification with regard to the dysfunctional behavioral control of pathological buying. Scripture 3 addresses the role of decision making in the context of addictions for pathological buying. The results emphasize that individuals with pathological buying showed decision-making impairments when the probability of occurrence and consequences were unknown (ambiguity), whereas non-impairments were observed when they were explicitly given (risk). Potential correlates included emotional feedback-processing deficits, rather than executive dysfunctions. The findings of the scriptures 1-3 will be discussed in the context of a comprehensive model, which emphasizes in line with dual-process theories of self-regulation that craving and dysfunctional decision making may be related, explaining the preference for the short-term rewarding option of buying despite long-term negative consequences (such as financial difficulties, etc.). Altogether, parallels of pathological buying with addictive disorders are revealed and a potential classification with respect to behavioral addictions is discussed

Cue-reactivity in behavioral addictions: A meta-analysis and methodological considerations

Background and aims Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions. Methods The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients. Results Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p  Discussion and conclusions Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions

Facets of impulsivity and related aspects differentiate among recreational and unregulated use of Internet pornography

Background and aims: Unregulated Internet pornography (IP) use is discussed as a clinically significant disorder. Because of its primarily rewarding nature, IP is a predestinated target for addictive behaviors. However, not every user develops an unregulated usage pattern. In fact, most users tend to use IP recreationally. Impulsivity-related constructs have been identified as promoters of addictive behaviors. It is unclear whether these impulsivity-related constructs are specific for unregulated IP use or also play a role in recreational but frequent behaviors. In this study, we investigated impulsive tendencies (trait impulsivity, delay discounting, and cognitive style), craving toward IP, attitude regarding IP, and coping styles in individuals with recreational–occasional, recreational–frequent, and unregulated IP use. Methods: A total of 1,498 heterosexual males participated in an online survey. Groups of individuals with recreational–occasional use (n = 333), recreational–frequent use (n = 394), and unregulated use (n = 225) of IP were identified by screening instruments. Results: Craving and attitude regarding IP as well as delay discounting and cognitive and coping styles differed between groups. Individuals with unregulated use showed the highest scores for craving, attentional impulsivity, delay discounting, and dysfunctional coping, and lowest scores for functional coping and need for cognition. Recreational–frequent users had the most positive attitude toward IP. Motor and non-planning impulsivity did not differ between groups. Discussion and conclusions: The results indicate that some facets of impulsivity and related factors such as craving and a more negative attitude are specific for unregulated IP users. The results are also consistent with models on specific Internet use disorders and addictive behaviors

Which conditions should be considered as disorders in the International Classification of Diseases (ICD-11) designation of “other specified disorders due to addictive behaviors”?

© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.Background: Gambling and gaming disorders have been included as “disorders due to addictive behaviors” in the International Classification of Diseases (ICD-11). Other problematic behaviors may be considered as “other specified disorders due to addictive behaviors (6C5Y).” Methods: Narrative review, experts’ opinions. Results: We suggest the following meta-level criteria for considering potential addictive behaviors as fulfilling the category of “other specified disorders due to addictive behaviors”:1. Clinical relevance: Empirical evidence from multiple scientific studies demonstrates that the specific potential addictive behavior is clinically relevant and individuals experience negative consequences and functional impairments in daily life due to the problematic and potentially addictive behavior.2. Theoretical embedding: Current theories and theoretical models belonging to the field of research on addictive behaviors describe and explain most appropriately the candidate phenomenon of a potential addictive behavior.3. Empirical evidence: Data based on self-reports, clinical interviews, surveys, behavioral experiments, and, if available, biological investigations (neural, physiological, genetic) suggest that psychological (and neurobiological) mechanisms involved in other addictive behaviors are also valid for the candidate phenomenon.Varying degrees of support for problematic forms of pornography use, buying and shopping, and use of social networks are available.These conditions may fit the category of “other specified disorders due to addictive behaviors”. Conclusion: It is important not to overpathologize everyday-life behavior while concurrently not trivializing conditions that are of clinical importance and that deserve public health considerations. The proposed meta-level-criteria mayhelp guide both research efforts and clinical practice.Peer reviewe

Pathological Buying Online as a Specific Form of Internet Addiction: A Model-Based Experimental Investigation

<div><p>The study aimed to investigate different factors of vulnerability for pathological buying in the online context and to determine whether online pathological buying has parallels to a specific Internet addiction. According to a model of specific Internet addiction by Brand and colleagues, potential vulnerability factors may consist of a predisposing excitability from shopping and as mediating variable, specific Internet use expectancies. Additionally, in line with models on addiction behavior, cue-induced craving should also constitute an important factor for online pathological buying. The theoretical model was tested in this study by investigating 240 female participants with a cue-reactivity paradigm, which was composed of online shopping pictures, to assess excitability from shopping. Craving (before and after the cue-reactivity paradigm) and online shopping expectancies were measured. The tendency for pathological buying and online pathological buying were screened with the Compulsive Buying Scale (CBS) and the Short Internet Addiction Test modified for shopping (s-IATshopping). The results demonstrated that the relationship between individual’s excitability from shopping and online pathological buying tendency was partially mediated by specific Internet use expectancies for online shopping (model’s <i>R</i>² = .742, <i>p</i> < .001). Furthermore, craving and online pathological buying tendencies were correlated (<i>r</i> = .556, <i>p</i> < .001), and an increase in craving after the cue presentation was observed solely in individuals scoring high for online pathological buying (<i>t</i>(28) = 2.98, <i>p</i> < .01, <i>d</i> = 0.44). Both screening instruments were correlated (<i>r</i> = .517, <i>p</i> < .001), and diagnostic concordances as well as divergences were indicated by applying the proposed cut-off criteria. In line with the model for specific Internet addiction, the study identified potential vulnerability factors for online pathological buying and suggests potential parallels. The presence of craving in individuals with a propensity for online pathological buying emphasizes that this behavior merits potential consideration within the non-substance/behavioral addictions.</p></div

Illustration of the proposed mediation model.

<p>The tendencies towards online pathological buying are assumed to be predicted by the predisposing factor shopping excitability (operationalized by variables of cue-reactivity) and online shopping expectancies (operationalized by motives to shop and buy on the Internet). The expectancies should mediate the relationship between shopping excitability and tendencies towards online pathological buying. The direct effect is indicated by the continued arrow; the indirect effects are drawn dashed.</p

Description of the questionnaires and the experimental paradigm.

<p>^a CBS-score transformed; lower levels indicate lower levels of pathological buying.</p><p>s-IATshopping = Short Internet Addiction Test modified for shopping; CBS = Compulsive Buying Scale</p