Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions

Exploring Food Addiction Across Several Behavioral Addictions: Analysis of Clinical Relevance

BACKGROUND/OBJECTIVES

Recently, interest in studying food addiction (FA) in the context of behavioral addictions (BAs) has increased. However, research remains limited to determine the FA prevalence among various BAs. The current study aimed to investigate FA in a clinical sample of patients seeking treatment for gaming disorder, compulsive buying-shopping disorder (CBSD), compulsive sexual behavior disorder, and the comorbid presence of multiple BAs, as well as to determine the sociodemographic characteristics, personality traits, and general psychopathology of this clinical population. In addition, we analyzed whether FA is linked to a higher mean body mass index (BMI).

METHODS

The sample included 209 patients (135 men and 74 women) attending a specialized behavioral addiction unit. The assessment included a semi-structured clinical interview for the diagnosis of the abovementioned BAs, in addition to self-reported psychometric assessments for FA (using the Yale Food Addiction Scale 2. 0, YFAS-2), CBSD (using the Pathological Buying Screener, PBS), general psychopathology (using the Symptom Checklist-Revised, SCL-90-R), personality traits (using the Temperament and Character Inventory-Revised, TCI-R), emotional regulation (using Difficulties in Emotion Regulation Strategies, DERS), and impulsivity (using Impulsive Behavior Scale, UPPS-P). The comparison between the groups for the clinical profile was performed using logistic regression (categorical variables) and analysis of covariance (ANCOVA), adjusted based on the patients' gender. The sociodemographic profile was based on chi-square tests for categorical variables and analysis of variance (ANOVA) for quantitative measures.

RESULTS

The prevalence of FA in the total sample was 22.49%. The highest prevalence of FA was observed in CBSD (31.3%), followed by gaming disorder (24.7%), and the comorbid presence of multiple BAs (14.3%). No group differences (FA+/-) were found in relation to sociodemographic variables, but the comorbidity between FA and any BA was associated more with females as well as having greater general psychopathology, greater emotional dysregulation, higher levels of impulsivity, and a higher mean BMI.

CONCLUSIONS

The comorbidity between FA and BA is high compared to previous studies (22.49%), and it is also associated with greater severity and dysfunctionality. Emotional distress levels were high, which suggests that the group with this comorbidity may be employing FA behaviors to cope with psychological distress. However, a better understanding of the latent mechanisms that contribute to the progression of this multifaceted comorbid clinical disorder is needed. One aspect that future studies could consider is to explore the existence of FA symptoms early and routinely in patients with BAs.

A Hybrid SEM-ANN Approach to Investigate the Internet Addiction Among University Students Based on Psychological Resilience Theory and Cognitive-Behavioral Theory

The internet is now essential in college students' lives, but its overuse is turning into a worldwide issue, notably with rising internet addiction among students. Earlier studies have mainly explored the risk factors of internet addiction, yielding various findings. This study aims to delve into the key factors affecting internet addiction among university students by integrating the theory of psychological resilience with cognitive-behavioral theory. It thoroughly analyzes how self-control, emotional regulation, social support, perceived stress, and psychological resilience influence internet addiction and explores their interactions and underlying mechanisms. The study conveniently selected 999 university students for a survey to measure their self-reported ratings on six constructs: self-control, emotional regulation, perceived stress, psychological resilience, social support, and internet addiction. Employing a Structural Equation Modeling - Artificial Neural Network (SEM-ANN) approach, the study unveiled complex and non-linear relationships between predictors and internet addiction. Results indicated that self-control and psychological resilience significantly reduce internet addiction, while perceived stress notably increases the risk. Notably, emotional regulation and social support did not directly lower the risk of internet addiction. Further analysis revealed that psychological resilience plays a mediating role between self-control, emotional regulation, social support, and internet addiction. Additionally, multilayer perceptron analysis of normalized importance showed self-control as the most critical predictive factor (100%), followed by emotional regulation (9.1%), social support (8.4%), and psychological resilience (5.4%). The study contributes theoretical and practical insights into internet addiction among university students.

Gambling and Substance Use Disorders in U.S. Military Veterans: Prevalence, Clinical Characteristics, and Suicide Risk

Gambling and substance use disorders (SUDs) are prevalent among U.S. military veterans and often co-occur. However, little is known about the clinical and behavioral correlates and suicidal risk of SUDs and gambling among veterans that can help inform targeted interventions for their co-occurrence. In the current study, we analyzed data from a nationally representative sample of 4069 veterans who participated in the National Health and Resilience in Veterans Study. Self-reported measures of lifetime SUDs and past-year gambling (Brief Problem Gambling Screen) were administered. A multinomial logistic regression analysis was conducted to examine differences between four groups: non-SUD/non-gambling, 40.3%; SUD-only 27.3%; Gambling-only 16.3%; and SUD + Gambling, 16.1%. The Gambling-only, SUD-only, and SUD + Gambling groups reported more adverse childhood experiences relative to the non-SUD/non-gambling group. The SUD-only and SUD + Gambling groups had higher odds for all lifetime and current clinical and trauma variables relative to the non-SUD/non-gambling group. The SUD + Gambling group had higher odds of suicidality, non-suicidal self-injury, nicotine dependence and mental health treatment relative to the SUD-only group and all assessed clinical measures relative to the Gambling-only group. Results suggest that SUDs and gambling are associated with substantial trauma and mental health burden among U.S. veterans, with co-occurring SUDs and gambling linked particularly to suicidality/self-harm and mental health treatment. The findings underscore the importance of multicomponent assessments and interventions targeting SUDs, gambling, and related concerns, such as trauma-related mental health difficulties, in this population.

Differential Association of Preadolescent Risk Factors Across Developmental Patterns of Adolescent Concurrent Gambling Participation and Substance Use

Early risk factors for gambling participation (GP) and substance use (SU) in adolescents have usually been studied separately, although these disorders were integrated into the same clinical category over a decade ago. This exploratory study aimed to investigate the early individual, parental, familial and social risk factors associated with developmental patterns of adolescent GP and SU in a population-representative cohort (N = 1594, 51.2% boys). Using a person-centered strategy and multiple assessments from age 12 to 17, six developmental patterns describing joint GP and SU courses were revealed. Non-substance users/non-gamblers served as the reference class in an integrated longitudinal-multivariate analysis framework examining 15 distinct risk factors. Results showed that a core of risk factors were common to all trajectory-classes of substance users with or without GP. For a similar level of SU, most of the risk factors associated with non-gambling users also affected their gambling peers. However, additional risk factors were specifically related to GP. Thus, substance users who also gamble were affected by a greater number of risk factors than non-gambling substance users. Findings are consistent with a developmental syndrome of addiction, which posits a shared etiology between different expressions of addiction as well as differences in risk factors that lead to distinct trajectories of addictive behaviors. They highlight the importance of considering both GP and SU for a comprehensive assessment of adolescents' level of risk with regard to addictive behaviors.

Spanish Validation of the Brief Pornography Screen Within a Clinical Sample of Individuals with Gambling Disorder

Problematic pornography use (PPU) shares characteristics with behavioral addictions, such as gambling disorder (GD), and PPU and GD may frequently co-occur. In order to fill existing gaps in screening instruments for PPU validated in GD, the study examined the psychometric properties of the Spanish version of the Brief Pornography Screen (BPS) within a clinical sample of individuals with GD. A total of 200 individuals seeking treatment for GD were consecutively recruited. The psychometric properties of the BPS were examined by performing confirmatory factor analysis (CFA) and testing for evidence of convergent and discriminant validity. The CFA supported a one-factor solution showing high internal consistency (α = 0.81). The BPS showed convergent validity and correlated with psychological distress, general psychopathology, impulsive tendencies, and low self-directedness. The BPS demonstrated adequate psychometric properties and is therefore recommended as a brief screening tool for identifying probable PPU in individuals seeking treatment for GD.

Magnetoencephalographic correlates of pornography consumption: Associations with indicators of compulsive sexual behaviors

Pornography consumption is highly prevalent but can develop into problematic sexual behavior with severe negative emotional consequences. Neurobiological studies indicate that compulsive sexual behaviors (CSB) are associated with altered brain structure and function in processing pornography. This study investigated the neuroaffective mechanisms underlying exposure to erotic and explicit pornographic images and their relationship to CSB-relevant symptoms. Whole-head magnetoencephalography (MEG) assessed brain activity during passive viewing of opposite- and same-sex erotic and pornographic images in healthy heterosexual and homosexual women and men (N = 50). Correlations of estimated event-related neural activity with indicators of CSB (hypersexuality, sexual sensation seeking, problematic pornography use, and time spent on pornography use), mood and anxiety, as well as with subjective picture ratings of hedonic valence and emotional arousal were analyzed. Responses of brain regions to sexual content revealed hyper- and hypoactivation and were related to problematic pornography consumption, hypersexuality, time spent on pornography use, and perceived subjective arousal. The neural activation towards erotic and pornographic content revealed further significant associations with depression and anxiety scores. The findings suggest an involvement of prefrontal and temporo-parietal cortex regions in the divergent processing of sexual content in relation to indicators of CSBD. Insight into the neurobiological factors underlying CSB can contribute to a more precise clinical conceptualization of this problem and may promote the development of more effective therapeutic interventions.

Understanding the Co-occurrence of Gambling Disorder and Problematic Pornography Use: Exploring Sociodemographic and Clinical Factors

The co-occurrence between gambling disorder (GD) and problematic pornography use (PPU) has not yet been explored. Therefore, the present study compared (a) sociodemographic variables, (b) GD-related factors, (c) substance use, (d) psychopathology, (e) personality features, (f) impulsivity, and (g) emotion regulation between individuals with GD (GD group) and those with co-occurring GD and PPU (GD+PPU group). The sample consisted of 359 treatment-seeking individuals with GD: n = 332 individuals had GD only (GD group) and n = 37 individuals had GD and co-occurring PPU (GD+PPU group). GD severity, impulsivity, psychopathology, personality, emotion regulation, and other sociodemographic and clinical variables were assessed. No between-group differences in sociodemographic measures were observed. The GD+PPU group demonstrated greater GD severity and a higher likelihood of substance use compared to those without PPU. Furthermore, the presence of PPU was associated with worse psychopathology, higher impulsivity (except for lack of premeditation and positive urgency), more difficulties in emotion regulation (except for non-acceptance of emotions and limited access to emotions), and a personality profile characterized by lower levels of self-directedness and cooperativeness. The co-occurrence of GD and PPU seems associated with a more dysfunctional clinical profile.

Current Understanding of Compulsive Sexual Behavior Disorder and Co-occurring Conditions: What Clinicians Should Know about Pharmacological Options

Compulsive sexual behavior disorder (CSBD) has recently been recognized as a psychiatric disorder. Pharmacological treatments for CSBD have received little study and thus have limited empirical support. The main objective of the present work is to review existing literature on the efficacy of different drugs on the symptomatology of CSBD, including the subtype of problematic pornography use (PPU). The main pharmacological approaches to treating CSBD have included opioid antagonists (naltrexone and nalmefene), selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, and sertraline), mood stabilizers (topiramate), tricyclic antidepressants (clomipramine), serotonin antagonist and reuptake inhibitors (nefazodone), and N-acetylcysteine. Since people with CSBD may experience different co-occurring disorders, these should be considered when choosing the best pharmacological treatment. Pharmacological therapy for CSBD/PPU has been suggested as an adjunct to psychological therapies, which, for the moment, have the most empirical evidence. However, to evaluate the efficacy of most of the drugs presented in this narrative review, data to date have only been available from case studies. Thus, empirical support is scant and generalizability of results is limited, highlighting the need for more research in this area.

Evolutionary perspectives on substance and behavioural addictions: Distinct and shared pathways to understanding, prediction and prevention

Addiction poses significant social, health, and criminal issues. Its moderate heritability and early-life impact, affecting reproductive success, poses an evolutionary paradox: why are humans predisposed to addictive behaviours? This paper reviews biological and psychological mechanisms of substance and behavioural addictions, exploring evolutionary explanations for the origin and function of relevant systems. Ancestrally, addiction-related systems promoted fitness through reward-seeking, and possibly self-medication. Today, psychoactive substances disrupt these systems, leading individuals to neglect essential life goals for immediate satisfaction. Behavioural addictions (e.g. video games, social media) often emulate ancestrally beneficial behaviours, making them appealing yet often irrelevant to contemporary success. Evolutionary insights have implications for how addiction is criminalised and stigmatised, propose novel avenues for interventions, anticipate new sources of addiction from emerging technologies such as AI. The emerging potential of glucagon-like peptide 1 (GLP-1) agonists targeting obesity suggest the satiation system may be a natural counter to overactivation of the reward system.

Internet gaming disorder and psychological well-being among university students in Egypt

BACKGROUND

Internet gaming disorder (IGD) is a serious rising problem affecting people of all ages. Many researchers reported that students' addictive gaming behavior resulted in the loss of function and the development of psychological problems. In this study, we aimed mainly to measure the prevalence of internet gaming disorder among Mansoura University students and find its relationship with psychological well-being.

METHODS

A cross-sectional observational study was carried out during the academic year (2021-2022) at the University of Mansoura. Students from four different faculties were included. Participants ages ranged from 18 to 25 years old. An online Google Form questionnaire gathering the tools (questionnaire of demographic and clinical data, Internet Gaming Disorder Short Form scale, Ryff's scale of psychological well-being) was distributed among them.

RESULTS

In this study, 870 students were included. The age range was 18-25 years. They were divided into three groups: 315 normal gamers (36%), 500 risky gamers (58%), and 55 disordered gamers (6%), with no significant gender difference in each group (p-value = 0.138). A negative correlation was found between IGD and psychological well-being (r = -0.303).

CONCLUSIONS

The prevalence of IGD was 6% among Mansoura University students. Participants in the theoretical faculties who started playing internet gaming at a younger age and spent more than 2 h per week playing and more than 3 h per week thinking about playing internet games were more likely to develop IGD. Whenever IGD scores increased, psychological well-being scores were found to decrease (r = -0.303).

Psychometric properties of the generalised version of the Screener for Substance and Behavioural Addictions (SSBA-G): A comprehensive screening tool for substance-related and behavioural addictions

Assessing addictive behaviours comprehensively and efficiently is a challenge in both research and clinical practice. Consequently, we tested the psychometric properties of the Generalized Screener for Substance and Behavioural Addictions (SSBA-G), a novel, brief screening tool measuring functional impairment resulting from both substance and behavioural addictions. The SSBA-G was developed from the Screener for Substance and Behavioural Addictions (Schluter et al., 2018) and tested in four samples including university students in Canada (n = 481) and the US (n = 164) as well as community adults in Canada (n = 301), and Hungary (n = 79). Confirmatory factor analysis supported the hypothesized bifactor model of the SSBA-G. Receiver-operation characteristic analyses revealed high differentiation accuracy (AUC=0.86-.95), as well as identical ideal cut points across the Substance Addiction (SSBA-G-S) and Behavioural Addiction (SSBA-G-B) Subscales. Results indicated good-to-excellent sensitivity and moderate-to-good specificity. The SSBA-G demonstrated excellent internal consistency and test-retest reliability as well as promising concurrent validity in relation to the original SSBA and additional questions regarding addiction-related impairment. The SSBA-G also showed good convergent and divergent validity with indicators of general mental health. These results indicate that the SSBA-G is a psychometrically sound and efficient measure of addiction-related impairment across substances and excessive behaviours.

The Correlation between Neck Pain and Disability, Forward Head Posture, and Hyperkyphosis with Opium Smoking: A Cross-Sectional Study from Iran

Opium smoking has been a common practice in Iran for many years, with people often smoking for long hours. During the COVID-19 pandemic, there was an increase in opium smoking due to false beliefs about its protective effects against COVID-19 infection. In this study, we aimed to examine the association between the non-ergonomic positions associated with traditional opium smoking in Iran and the development of neck pain and disability, forward head posture (FHP), and hyperkyphosis (HK). In this cross-sectional, correlational study, a total of 120 individuals who smoked opium were selected based on the inclusion criteria. They were interviewed about their addiction profile using the Lite version of the Addiction Severity Index and the Leeds Dependence Questionnaire. The presence of neck pain and disability was also evaluated using the Visual Analog Scale and the Neck Disability Index. The participants were examined for FHP via side-view photography and for HK using a flexible ruler. Data were analyzed using correlation coefficient tests and stepwise linear regression analysis. Based on the results, homelessness, the lifetime duration of opium smoking (in months), the duration of daily opium smoking (in minutes), and the severity of drug dependence had significant relationships with the severity of neck pain, neck disability, FHP, and HK. Homelessness was the strongest predictor of neck pain and disability (R2 = 0.367, p < 0.001), FHP (R2 = 0.457, p < 0.001), and HK (R2 = 0.476, p < 0.001), followed by the lifetime duration of opium smoking and the duration of daily opium smoking, respectively, in which R2 increased to 0.505 (p = 0.011), 0.546 (p = 0.022), and 0.570 (p = 0.004) with the addition of two other variables. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to neck pain and disability, FHP, and HK due to the non-neutral posture of opium smokers.

Clinical Differences of mild, Moderate, and Severe Gambling Disorder in a Sample of Treatment Seeking Pathological Gamblers in Sweden

INTRODUCTION

Gambling disorder (GD) is classified among the addictive disorders in the DSM-5 and the severity of the diagnosis can be specified as mild, moderate and severe. It has been seen that individuals with more severe gambling problems have a higher rate of comorbid disorders and other health problems compared to individuals with a milder clinical picture.

AIMS

The aim of this study was to explore clinical psychiatric differences related to the severity of disorder in treatment-seeking patients with GD.

METHOD

A sample of 163 patients with GD seeking treatment at an outpatient clinic was diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring alcohol-, and drug-problems, symptoms of depression and anxiety, emotion regulation, cognitive distortions, and quality of life.

RESULTS

Greater severity was associated to more problems with alcohol and illicit drugs. Severe gamblers were more likely to gamble to "escape", and had more symptoms of depression and anxiety. Participants with moderate and severe gambling disorder had more difficulties with emotion regulation. Cognitive distortions were the same between severities. All groups had Quality-of-Life problems at a clinical level.

DISCUSSION

There are some distinctive differences between GD of different severities. The features shown by patients with severe GD indicates a more emotionally vulnerable group with increased symptom severity. Further knowledge about the features of GD severity levels is important for treatment planning in the clinic.

Developmental Patterns of Gambling Participation and Substance use Throughout Adolescence in a Population Birth Cohort

This study investigated adolescents' single and co-occurring developmental patterns of gambling participation and substance use and their association with gambling and substance use-related issues at age 17, controlling for confounders. Multiple assessments from age 12 to 17 were conducted in a population-based cohort (N=1594, 51.2% boys). Latent growth modeling was used to analyze developmental patterns and Generalized linear models to examine their association with age-17 gambling and substance use-related problems, types and variety of activities, and substance abuse. Results revealed six developmental patterns, including Low- or Non-substance Users or Gamblers (24.2% sample), two trajectory-classes of Later-Onset Increasing (to a moderate level) substance users, either with or without gambling participation (7.8% and 45.5%, respectively), two trajectory-classes of Early-Onset Increasing (to a higher level) substance users, either with or without gambling participation (6.2% and 12.7%, respectively), and a smaller trajectory-class of Slow-Increasing Substance Users and Early-Onset Gamblers, declining to non-gambling after age 13 (3.6%). Gambling participation and substance use did not appear to influence each other with regard to their onset and course throughout adolescence, and to age-17 types and variety of gambling activities or substances used, problems related to gambling participation or substance use, or substance abuse. These findings are consistent with the addictive syndrome model and with both common and individualized approaches to prevention and treatment for adolescent gamblers or substance users.

Latent Classes for the Treatment Outcomes in Women with Gambling Disorder and Buying/Shopping Disorder

BACKGROUND

The risk for behavioral addictions is rising among women within the general population and in clinical settings. However, few studies have assessed treatment effectiveness in females. The aim of this work was to explore latent empirical classes of women with gambling disorder (GD) and buying/shopping disorder (BSD) based on the treatment outcome, as well as to identify predictors of the different empirical groups considering the sociodemographic and clinical profiles at baseline.

METHOD

A clinical sample of n = 318 women seeking treatment for GD (n = 221) or BSD (n = 97) participated. Age was between 21 to 77 years.

RESULTS

The four latent-classes solution was the optimal classification in the study. Latent class 1 (LT1, good progression to recovery) grouped patients with the best CBT outcomes (lowest risk of dropout and relapses), and it was characterized by the healthiest psychological state at baseline, the lowest scores in harm avoidance and self-transcendence, and the highest scores in reward dependence, persistence, self-directedness and cooperativeness. Latent classes 3 (LT3, bad progression to drop-out) and 4 (LT4, bad progression to relapse) grouped women with the youngest mean age, earliest onset of the addictive behaviors, and worst psychological functioning.

CONCLUSIONS

GD and BSD are complex conditions with multiple interactive causes and impacts, which need wide and flexible treatment plans. Specific interventions should be designed according to the specific profiles of women for achieving early inclusion, retention and well-maintained long-term effects.

An Exploratory Study of Shopping to Relieve Tension or Anxiety in Adolescents: Health Correlates and Gambling-Related Perceptions and Behaviors

The desire to escape from pressures/anxiety represents an important motivation for problematic engagement with short-term rewarding behaviors that could contribute to the development of recognized and candidate behavioral addictions, including problematic shopping, a prevalent condition among youth in the U.S.A. characterized by excessive shopping cognitions/behaviors that lead to distress/impairment. However, to date, the specific correlates of shopping to relieve anxiety or tension have yet to be evaluated. We aimed at addressing this gap by analyzing data (N = 2556) from a high-school survey from Connecticut in an exploratory fashion. Adolescents who acknowledged experiencing a growing tension or anxiety that could only be relieved by shopping were classified as having negative-reinforcement shopping and compared to the remaining students. Data were analyzed in chi-square and logistic regression models to examine negative-reinforcement shopping in relation to socio-demographics, health correlates, gambling-related perceptions/attitudes, and problem-gambling severity/gambling behaviors. Negative-reinforcement shopping was more frequent in female and Hispanic students, was linked to more permissive gambling attitudes and at-risk/problematic gambling, and was associated with the use of alcohol, tobacco, marijuana, and other drugs, dysphoria/depression, and weapon-carrying and physical fighting. Taken together, these findings highlight adverse measures of health and functioning linked to negative-reinforcement shopping that may be particularly relevant to girls and Hispanic youth. Additional efforts to prevent negative outcomes are warranted.

Individual strategies in the rat gambling task are related to voluntary alcohol intake, but not sexual behavior, and can be modulated by naltrexone

INTRODUCTION

Gambling disorder (GD) is the first non-substance or behavioral addiction to be included in substance-related and addictive disorders in DSM-5. Since GD is a younger phenomenon relative to alcohol and substance use disorders, little is known about potential unique features in GD and to what extent characteristics are shared with alcohol and substance use disorders. The rat gambling task (rGT) is used to study decision-making in rats. This study aimed to identify individual differences in rGT strategies and explore the stability of these strategies over time. Moreover, motor impulsivity, sexual behavior, and voluntary alcohol intake were examined in rats with different rGT strategies. Finally, the response to naltrexone on performance in rats with different rGT strategies was investigated.

METHODS

Male Lister hooded rats (n = 40) underwent repeated testing in the rGT, repeated copulatory behavioral tests, and 7 weeks of voluntary alcohol intake through a modified intermittent two-bottle free-choice paradigm. Finally, rats were treated with naltrexone prior to testing in the rGT.

RESULTS

The results revealed individual choice strategies in the rGT that were stable over time, even after multiple interruptions and other behavioral testing. The rats with a risky choice strategy displayed higher motor impulsivity and voluntary alcohol intake than the other groups. No difference in sexual behavior was found between the different rGT groups. Finally, in all rats irrespectively of rGT strategy, treatment with naltrexone decreased the number of completed trials and premature responses, and increased omissions, which indicates an overall lowered motivation.

DISCUSSION

In conclusion, rats with risky rGT strategies had higher voluntary alcohol intake but not elevated sexual behavior, indicating shared underlying mechanisms between rGT strategies and alcohol intake but not natural rewards in terms of sexual behavior. Finally, naltrexone treatment resulted in an overall lowered motivation in the rGT.

Tracing 20 years of research on problematic use of the internet and social media: Theoretical models, assessment tools, and an agenda for future work

Over the past two decades, there has been increasing interest in the impact of internet use and growing concern about whether problematic use of the internet (PUI) constitutes an addiction. Despite the growing number of studies investigating PUI and PUI subtypes, its conceptualization and inclusion in a classification system have not been possible yet. Several models aimed at inspiring clinical research and practice have proposed possible mechanisms involved in PUI and problematic use of social media, and multiple self-report instruments have been consequentially developed. The diversity of theoretical models and instruments currently hinders standardized assessment procedures across studies and, in turn, their comparability. The purpose of the present overview is to highlight the current conceptualization and assessment of both PUI and problematic use of social media, in order to critically discuss the existing fragmentation in the field and the need to achieve conceptual convergence. Two suggestions for future directions are also provided, i.e., define diagnostic criteria by bottom-up and top-down processes and develop a psychobiological hypothesis including the description of higher-order mechanisms involved in PUI and not other psychopathological conditions (e.g., the multiple available internet-related cues and outcomes that may lead to parallel forms of associative learning; probabilities of obtaining internet-related reinforcements; and intrinsic motivation processes).

The Role of ADHD Symptomatology and Emotion Dysregulation in Gambling Disorder

Objectives: Although emotion regulation deficits have been implicated in gambling disorder and ADHD, the interplay between these factors has yet to be systematically studied. We examined relationships between ADHD symptoms, emotion regulation, and gambling disorder severity in a sample of treatment-seeking gambling disorder patients (n = 98). We also examined clinical differences between patients with and without ADHD symptomatology. Method: Structural equation modeling (SEM) evaluated direct and indirect effects of ADHD and emotion regulation on gambling disorder severity. Results: Significant correlations between ADHD symptomatology and emotion regulation and between emotion regulation and gambling disorder severity were identified. Differences in emotion regulation were found between gambling disorder patients with and without ADHD symptomatology. Path analysis revealed emotion regulation to be a mediator between ADHD and gambling disorder. Conclusion: Our findings indicate the presence of ADHD symptomatology to be associated with greater severity of gambling disorder and greater emotional dysregulation.

Predictive utility of the brief Screener for Substance and Behavioral Addictions for identifying self-attributed problems

BACKGROUND AND AIMS

The Brief Screener for Substance and Behavioral Addictions (SSBAs) was developed to assess a common addiction construct across four substances (alcohol, tobacco, cannabis, and cocaine), and six behaviors (gambling, shopping, videogaming, eating, sexual activity, and working) using a lay epidemiology perspective. This paper extends our previous work by examining the predictive utility of the SSBA to identify self-attributed addiction problems.

METHOD

Participants (N = 6,000) were recruited in Canada using quota sampling methods. Receiver Operating Characteristics (ROCs) analyses were conducted, and thresholds established for each target behavior's subscale to predict self-attributed problems with these substances and behaviors. For each substance and behavior, regression models compared overall classification accuracy and model fit when lay epidemiologic indicators assessed using the SSBA were compared with validated screening measures to predict selfattributed problems.

RESULTS

ROC analyses indicted moderate to high diagnostic accuracy (Area under the curves (AUCs) 0.73-0.94) across SSBA subscales. Thresholds for identifying self-attributed problems were 3 for six of the subscales (alcohol, tobacco, cannabis, cocaine, shopping, and gaming), and 2 for the remaining four behaviors (gambling, eating, sexual activity, and working). Compared to other instruments assessing addiction problems, models using the SSBA provided equivalent or better model fit, and overall had higher classification accuracy in the prediction of self-attributed problems.

DISCUSSION AND CONCLUSIONS

The SSBA is a viable screening tool for problematic engagement across ten potentially addictive behaviors. Where longer screening tools are not appropriate, the SSBA may be used to identify individuals who would benefit from further assessment.

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

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 over-pathologize everyday-life behavior while concurrently not trivializing conditions that are of clinical importance and that deserve public health considerations. The proposed meta-level-criteria may help guide both research efforts and clinical practice.

Clarifying terminologies in research on gaming disorder and other addictive behaviors: distinctions between core symptoms and underlying psychological processes

There exists ongoing debate regarding the clinical validity of single symptoms of and diagnostic criteria for gaming disorder. In particular, the potential symptom of gaming disorder that addresses coping with and escaping from negative feelings has received much attention and remains a focus of intensive discussion. We argue that it is important to consider differences or distinguish between, on the one hand, symptoms of and criteria for a disorder due to addictive behaviors, such as gaming disorder, versus, on the other hand, motivations, mechanisms, and psychological processes that may be involved in promoting addictive behaviors and that may explain symptom severity and course of the addictive disorder including potential treatment responses.

Gambling and substance use: Comorbidity and treatment implications

Gambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.

Review: Non-Invasive Brain Stimulation in Behavioral Addictions: Insights from Direct Comparisons With Substance Use Disorders

BACKGROUND AND OBJECTIVES

Treatment models developed for substance use disorders (SUDs) are often applied to behavioral addictions (BAs), even though the correspondence between these forms of addiction is unclear. This is also the case for noninvasive brain stimulation (NIBS) techniques being investigated as potential treatment interventions for SUDs and BAs.

OBJECTIVES

to contribute to the development of more effective NIBS protocols for BAs.

METHODS

Two literature searches using PubMed and Google Scholar were conducted identifying a total of 35 studies. The first search identified 25 studies examining the cognitive and neurophysiological overlap between BAs and SUDs. The second search yielded 10 studies examining the effects of NIBS in BAs.

RESULTS

Impulsivity and cravings show behavioral and neurophysiologic overlaps between BAs and SUDs, however, other outcomes like working-memory abilities or striatal connectivity, differ between BAs and SUDs. The most-employed NIBS target in BAs was dorsolateral prefrontal cortex (DLPFC), which was associated with a decrease in cravings, and less frequently with a reduction of addiction severity.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Direct comparisons between BAs and SUDs revealed discrepancies between behavioral and neurophysiological outcomes, but overall, common and distinctive characteristics underlying each disorder. The lack of complete overlap between BAs and SUDs suggests that investigating the cognitive and neurophysiological features of BAs to create individual NIBS protocols that target risk-factors associated specifically with BAs, might be more effective than transferring protocols from SUDs to BAs. Individualizing NIBS protocols to target specific risk-factors associated with each BA might help to improve treatment interventions for BAs. (Am J Addict 2019;00:1-23).

Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11?

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.

The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors

We propose an updated version of the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, which we argue to be valid for several types of addictive behaviors, such as gambling, gaming, buying-shopping, and compulsive sexual behavior disorders. Based on recent empirical findings and theoretical considerations, we argue that addictive behaviors develop as a consequence of the interactions between predisposing variables, affective and cognitive responses to specific stimuli, and executive functions, such as inhibitory control and decision-making. In the process of addictive behaviors, the associations between cue-reactivity/craving and diminished inhibitory control contribute to the development of habitual behaviors. An imbalance between structures of fronto-striatal circuits, particularly between ventral striatum, amygdala, and dorsolateral prefrontal areas, may be particularly relevant to early stages and the dorsal striatum to later stages of addictive processes. The I-PACE model may provide a theoretical foundation for future studies on addictive behaviors and clinical practice. Future studies should investigate common and unique mechanisms involved in addictive, obsessive-compulsive-related, impulse-control, and substance-use disorders.

Approach bias for erotic stimuli in heterosexual male college students who use pornography

BACKGROUND AND AIMS

Addicted individuals often demonstrate relatively automatic action tendencies in response to addiction-related stimuli, whereby they approach rather than avoid addictive stimuli. This study assessed whether an approach bias for erotic stimuli exists among heterosexual college-aged males who report using pornography.

METHODS

We tested 72 male undergraduate students using an approach-avoidance task employing erotic stimuli, during which participants were instructed to push or pull a joystick in response to image orientation. To simulate approach and avoidance movements, pulling the joystick enlarged the image and pushing shrunk the image. Frequency and severity of pornography use was assessed using a Brief Pornography Screener and the Problematic Pornography Use Scale (PPUS).

RESULTS

Participants demonstrated a significant approach bias for erotic stimuli as compared to neutral stimuli, and this approach bias significantly correlated with pornography-use measures. Moreover, individuals with problematic pornography use (as classified by the PPUS) showed more than double the approach bias than did non-problematic users.

DISCUSSION AND CONCLUSION

The observation of cognitive biases for erotic stimuli in individuals with problematic pornography use indicate similarities between behavioral and substance addictions.

Comparison of the Video Game Functional Assessment-Revised (VGFA-R) and Internet Gaming Disorder Test (IGD-20)

Initially labeled as internet addiction in the mid-1990s (e.g., Griffiths, 1996; Young, 1996), researchers have since focused on how specific online activities result in negative consequences for those who overuse and have problems with online applications such as online gambling and online sex (Griffiths, 2000; Potenza, 2017). More recently, this has been applied to online problematic video game play, often used synonymously with terms such as online video game addiction, online gaming addiction, and Internet gaming disorder (IGD). With the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013), IGD was identified by the APA as warranting further study. The current proposed diagnostic criterion in the DSM-5 requires the presence of five of nine symptoms over a 12-month period. These include: (a) preoccupation or obsession with Internet games, (b) withdrawal symptoms when not playing Internet games, (c) an increasing need over time to spend more and more time playing video games, (d) failed attempts to stop or curb Internet gaming, (e) loss of interest in other activities such as hobbies, (f) continued overuse of Internet games even with knowledge of the impact of overuse on their life, (g) lying about extent of Internet game usage, (h) uses Internet games to relieve anxiety or guilt, and (i) has lost or put at risk an opportunity or relationship because of Internet games (American Psychiatric Association [APA], 2013). However, it is unclear if the disorder represents addiction to the internet or if IGD evaluates specific behaviors occurring within the context of the video gaming (Starcevic and Billieux, 2017; Young and Brand, 2017).