Behavioral Addictions Criteria Evidence And Treatment Pdf
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- Behavioral addiction
- Behavioral Addictions
Metrics details. Resolving the theoretical controversy on the labeling of an increasing number of excessive behaviors as behavioral addictions may also be facilitated by more empirical data on these behavioral problems. For instance, an essential issue to the classification of psychiatric disorders is information on their natural course. However, longitudinal research on the chronic vs. The aim of the present study, therefore, was to provide data on prevalence, substance use comorbidity, and five-year trajectories of six excessive behaviors—namely exercising, sexual behavior, shopping, online chatting, video gaming, and eating.
Behavioral Addictions Criteria Evidence and Treatment.pdf (269.01 KB)
The European Journal of Psychiatry is a quarterly publication founded in and directed by Professor A. Seva until his death in The journal is indexed in different bibliographic data bases, including the Social Sciences Citation Index. It is supported by the University of Zaragoza Spain , has been open to contributions from all over the world, and also has North American and Asian-Pacific co- editors.
A new stage of development of the journal has started in A new Editorial Board has been appointed and an advanced on-line editorial system has been implemented. Our new publishing partners will help to assure that our valuable research gets broadly disseminated, providing a more accessible entry into our contribution. The overriding criteria for publication are originality, a high scientific quality and interest to a wide audience of those concerned with all aspects of mental illness.
The scope is broad and the journal is committed to present new developments in the full spectrum of issues related to psychiatry and mental health, in areas linked to biological, psychological and social sciences. It will include basic studies and the growing application of clinical laboratory techniques in psychiatry. The European Journal of Psychiatry is determined to place particular emphasis on clinical issues related to a personalised medicine, including prevention and early intervention.
All original papers will be refereed by independent experts in the field. Review articles and monographs designed to bring the reader up to date with research in the area will be a feature of the journal. There is a Book Review section and correspondence to the editor will be considered for publication. The journal will be of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in mental health professions, together with basic neurobiological researchers. Social Sciences Citation Index.
Mental Health Abstracts DataBase. Psychological Abstracts PA. Sociological Abstracts SA. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Even though love addiction is not recognized by DSM-5 as a specific diagnosis, there is enough literature data to support its characterization as an independent mental disorder.
Information on the treatment of love addiction is still scant.. The currently available therapeutic strategies for love addiction are discussed, as well as some perspectives in the treatment of love addiction from a pharmacological standpoint.. There is scant evidence regarding the treatment of love addiction in the medical literature, specially with respect to pharmacological interventions, although several agents may hypothetically be of benefit in this condition.
Psychotherapy is often cited as the cornerstone of the treatment of love addiction, but its efficacy has not been properly investigated.. LA, also called pathological love, 4,5,6 can be defined as a pattern of behavior characterized by a maladaptive, pervasive and excessive interest towards one or more romantic partners, resulting in lack of control, the renounce of other interests and behaviors, and other negative consequences.
The current paper focuses on the clinical management of LA. Initially, some clinical and nosological considerations are addressed, followed by a review on the currently available therapeutic strategies for LA found in the literature. Finally, the potential of pharmacological interventions in the treatment of LA are discussed, based on the putative mechanisms involved in the development of this condition.
Despite its proposed inclusion among the behavioral addictions, hence its name, there is no consensus regarding the nosology of LA.
Literature data suggest that different authors seem to utilize distinct criteria for its diagnosis, according to the clinical and phenomenological aspects emphasized in their descriptions.
Some authors propose a dimensional approach, according to which the differences between both conditions would be merely quantitative, given the several phenomenological similarities between addictive behaviors and the regular experience of being in love, including the grief associated with the end of a long-term romantic relationship.
From a nosological standpoint, based on the different descriptions found in the literature, LA can be characterized as: a a behavioral addiction , which would share several hallmark criteria with classic substance dependence.
The loss of or perspective of losing the partner is associated with important anxiety, depressive symptoms, and despair. When faced with the loss of the partner, these patients can either persist in trying to reinstate the relationship or quickly shift their focus to a new partner, replacing their source of dependence and perpetuating the dysfunctional relationship pattern.
Of notice, functional MRI studies suggest that romantic passion is associated with activation of areas belonging to the brain reward system, such as the ventral tegmental area, the striatum, the orbitofrontal cortex, and the cingulate cortex. Individuals rejected by their romantic partners displayed hyperactivation of the nucleus accumbens, an area known to be hyperactive during cocaine craving.
This model emphasizes the characterization of LA as an impulse control disorder. Novelty seeking is strongly associated with impulse control disorders, such as pathological gambling and compulsive buying. Therefore, some patients with LA would suffer from deficits in the attachment system and elevated rates of reward-seeking behaviors, with multiple romantic partners, excessive sexual interest, and poor impulse control.
Others, on the other hand, would have elevated rates of both reward-seeking and attachment-related behaviors, resulting in excessive dependence from the romantic partner and obsessive features. Despite the different considerations mentioned above, there is some consensus in regard to the fact that LA, as a primary disorder of love, should be distinguished from other conditions, which show love-related dysfunctional behaviors as part of a broader spectrum of psychopathological findings, such as manic states and primary psychotic disorders.
For example, in the case of manic states, an excessive interest in establishing a romantic relationship can sometimes be observed, but usually subsides once the mood symptoms improve. Similarly, some personality disorders, such as borderline and dependent personality disorders often display patterns highly suggestive of LA, but those are not usually restricted to the romantic sphere, affecting their relationships as a whole, as well as other areas of their functioning.
Moreover, even though some authors regard erotomania as a pathology of love, 18,20 that condition seems to be distinct from love addiction. Patients with erotomania, in addition to romantic feelings towards the supposed partner, experience a delusional belief in regard to the reciprocity of their love, regardless the lack of evidence to support that belief and reassurances in contrary.
In DSM-5, this condition is included as a subtype of delusional disorder. Impaired judgment is, to some extension, a common feature during romantic experiences and imaging studies point to deactivation of brain areas associated with critical judgment, such as the frontal lobes. Finally, despite the similarities and the overlap between LA and sex addiction from an epidemiological perspective, there is enough evidence to consider both disorders as distinct.
A detailed discussion on sex addiction and its treatment is beyond the scope of the present article. The search was complemented through manual search of cross-references.
Articles addressing solely the treatment of sex addiction were excluded. Through the search strategy described above, twelve papers containing information on the clinical management of LA were identified. However, only one original study specifically addressing the treatment of that condition could be found. Self-help groups are by far the most adopted intervention for the treatment of LA. Several Step groups are available in the United States for the treatment of love addiction, although most of them also address the treatment of sex addiction.
Despite the popularity of self-help groups and the fact that they are often cited by experts as a cornerstone in the treatment of LA, we were not able to identify controlled studies assessing their efficacy.
Furthermore, admission criteria for inclusion into these groups are usually broad and, sometimes, based on the administration of screening questionnaires.
Consequently, individuals who participate in these groups may suffer from other issues involving dysfunctional romantic relationships. Cognitive-behavioral therapy CBT has been cited by some authors as of potential benefit in the treatment of LA. The psychopathological features involved in love addiction point to a potential role of automatic thoughts and cognitive distortions such as generalization, catastrophizing, and arbitrary inference in the perpetuation of LA.
These distortions could be successfully addressed through CBT. Nevertheless, we were not able to identify any studies addressing the use of CBT in the treatment of LA. It has been advocated that the best results in the treatment of LA are achieved through the use of rational self-counseling.
Improvements in self-communication, as well as interventions aiming at enhancing the separation between feeling and facts related to the loss are some of the possible interventions that may be of benefit for patients with LA. Since it has been hypothesized that, from a psychological standpoint, LA would result from disturbances in attachment during early childhood, psychodynamic psychotherapy has been advocated by some as the treatment of choice for LA.
It has been suggested, though, that the treatment of patients with love addiction can be particularly prone to problematic transferential and counter-transferential reactions, due to the attachment and intimacy-related issues usually experienced by the patients.
Although many authors seem to believe that group therapy is the treatment of choice for LA, only one study analyzed the impact of this intervention in a systematic way.
Eight subjects with a putative diagnosis of pathological love underwent 8 weekly therapy sessions. Results indicated statistically significant increases in the mean scores of the LHS, after the intervention. Several methodological limitations limit the generalization of these findings, including the lack of a control group, the absence of a clear definition of LA as inclusion criteria, and the fact that five of the subjects also met criteria for major depressive disorder.
Whereas the pharmacological treatment of comorbid conditions associated with love addiction, such as depressive and anxiety disorders, would potentially be of benefit, no literature data specifically addressing the pharmacological treatment of LA without psychiatric comorbidities could be identified. Nevertheless, given the phenomenological characteristics of this condition, as well as some of the neurobiological mechanisms possibly involved in its pathophysiology, several psychopharmacological interventions could, hypothetically, be of benefit for the management of LA.
Some of them are outlined below. Again, it is important to emphasize that, to date, no scientific data is available in regard to the efficacy and safety of pharmacological agents in the treatment of LA and that the authors do not suggest or recommend their use in clinical practice, in light of the lack of available evidence. The phenomenological similarity between obsessive-compulsive disorder OCD and some cases of LA suggests that antidepressants, especially selective serotonin reuptake inhibitors SSRI could be of potential benefit in the treatment of these patients.
Given the efficacy of SSRIs in the treatment of the latter, one can hypothesize that this class of medications may play a role in the treatment of LA. One open-label clinical trial analyzed the efficacy of Lhydroxytryptophan, a serotonin precursor, in the treatment of patients with high levels of romantic distress. Improvements in romantic distress were found to be, at least in part, correlated with increases in the levels of platelet serotonin BDNF. The inexistence of a control group limits the interpretation of these findings.
Further, the release of oxytocin, a neuropeptide that can enhance the experience of secure attachment, improving well-being, and reducing separation anxiety, seems to be modulated by serotonergic activity. Moreover, SSRIs seem to decrease the dopaminergic transmission at the ventral tegmental area, one of the key areas involved with reward and motivation. In consonance with this hypothesis, venlafaxine, a dual-action antidepressant that seems to increase dopaminergic transmission in higher doses, has been associated with induction of erotomania in a case report.
Finally, there is evidence suggesting that patients with love addiction have higher rates of harm avoidance and reward dependence, what would make them more susceptible to anxious patterns of attachment and more likely to persist in unsatisfactory relationships in order to prevent loneliness.
The strong association between LA and impulsivity suggests that mood stabilizers may play a role in the treatment of this condition. Although there is evidence suggesting that lithium and other mood stabilizers seem to be effective in the treatment of aggression and other behaviors secondary to poor impulse control, 38 we are not aware of any clinical evidence regarding the efficacy of these medications in LA.
Given the putative association between dopaminergic activity and romantic feelings see above , one could hypothesize that antipsychotics, due to their dopaminergic antagonism, may play a role in the treatment of LA.
Furthermore, patients with LA seem to show higher novelty seeking than healthy controls 13 and this temperament trait seems to be modulated by dopaminergic activity, 36 more specifically the D4 subtype dopamine receptor. Animal research indicates that the neuropeptides oxytocin and vasopressin are involved in several neurobiological mechanisms related to romantic attachment. It has been proposed that the release of these hormones during mating is responsible for linking social signs to the dopamine reward systems in the brain, producing positive reinforcement, ultimately contributing to the establishment of bonding and attachment.
Moreover, classic research findings have demonstrated that differences in the expression of vasopressin receptor genes seem to explain the differences between two different species of male voles. Prairie voles, which show a higher number of vasopressin receptor 1a in the amygdala and ventral pallidum, show more monogamous behavior when compared to mountain voles, which usually have multiple partners.
Regardless of all the limitations that result from the extrapolation of animal research findings to the study of human behavior, the findings above suggest that, from a pathophysiological perspective, ministration of exogenous oxytocin and vasopressin might not be of benefit in the treatment of LA. Yet, it has been demonstrated that exogenous oxytocin seems to reduce the amygdala response to social fear signals.
ProQuest Ebook Central. Please choose whether or not you want other users to be able to see on your profile that this library is a favorite of yours. Finding libraries that hold this item It offers useful research and diagnostic and clinical information, and is primarily empirical in its presentation. It would serve a variety of professionals as a reference
The European Journal of Psychiatry is a quarterly publication founded in and directed by Professor A. Seva until his death in The journal is indexed in different bibliographic data bases, including the Social Sciences Citation Index. It is supported by the University of Zaragoza Spain , has been open to contributions from all over the world, and also has North American and Asian-Pacific co- editors. A new stage of development of the journal has started in A new Editorial Board has been appointed and an advanced on-line editorial system has been implemented.
Behavioral addiction [note 1] is a form of addiction that involves a compulsion to engage in a rewarding non- substance -related behavior — sometimes called a natural reward   — despite any negative consequences to the person's physical, mental, social or financial well-being. Diagnostic models do not currently include the criteria necessary to identify behaviors as addictions in a clinical setting. Behavioral addictions have been proposed as a new class in DSM-5 , but the only category included is gambling addiction. Internet gaming addiction is included in the appendix as a condition for further study. Behavioral addictions, which are sometimes referred to as impulse control disorders, are increasingly recognized as treatable forms of addiction.
Do you play video games on the Internet in excess? Are you compulsively shopping online? Is your excessive computer use interfering with your daily life — relationships, work, school? Ivan Goldberg, MD who compared its original model to pathological gambling.
This course will provide clinicians with the latest clinical and empirical evidence that addresses behavioral addictions, including phenomenology, epidemiology, comorbidity, neurobiologic mechanisms, genetic contributions, treatment response, and prevention. The distinction between impulse control disorders and behavioral addictions is discussed. For each behavioral disorder proposed for inclusion as a behavioral addiction, current evidence is presented that supports or refutes this designation.
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