THE BEHAVIORAL ADDICTIONS Petros Levounis, MD, MA Chair - - PowerPoint PPT Presentation
THE BEHAVIORAL ADDICTIONS Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School Rutgers New Jersey Medical School Fundamentals of Addiction Medicine Summer Series Newark, NJ August 21, 2013
Petros Levounis, MD, MA
Chair Department of Psychiatry Rutgers – New Jersey Medical School
Rutgers – New Jersey Medical School
Fundamentals of Addiction Medicine Summer Series Newark, NJ – August 21, 2013
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Outline
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Why did it take us that long?
Substance Use Disorders, Somatoform Disorders, and Behavioral Addictions
lawsuits, and organized medical professional organizations.
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Essential Features
Failure to resist an
to perform an act that is harmful to the person or others.
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Impulsivity vs. Compulsivity
repetitive behaviors.
reduce anxiety.
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Dimensional Approach
Adapted from: Hollander E, Clinical Manual of Impulse-Control Disorders, 2006.
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COMPULSIVE END – OCD
IMPULSIVE END – Antisocial PD
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Gender Differences
MEN Body Dysmorphic Sexual Compulsion Pyromania Gambling Internet Addiction WOMEN Anorexia Binge Eating Kleptomania Compulsive Buying Trichotillomania
Liu T, CNS Spectrum, 2007.
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Clinical Presentation DSM-5 Addiction Criteria, plus
“Chases” one’s losses Lies to conceal the extent of her or his gambling Relies on others for money
Phases
Blanco C, Cohen O, Luján JJ, et al: Pathological gambling and substance use disorders, in Substance Dependence and Co-Occurring Psychiatric Disorders: Best Practices for Diagnosis and Treatment. Edited by Nunes EV, Selzer J, Levounis P, Davies CA. New York, Civic Research Institute, 2010.
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Epidemiology
US Gambling Statistics:
$ 36 billion/year casino revenue (2011 data). 82% of US residents gamble. 1% - 3% meet criteria for PG.
Pathological Gamblers:
$ 40,000 average individual debt. 25 hours/week average time spent.
www.americangaming.org, accessed on February 13, 2013. Dickson-Gillespie L, Rugle L, Rosenthal R, Fong T: Preventing the incidence and harm of gambling problems. J Prim Prev 29:37-55, 2008. Fong TW: The biopsychosocial consequences of pathological gambling. Psychiatry 2(3):22-30, 2005.
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2002-2011 Commercial Casinos
US Consumer Spending
www.americangaming.org, accessed on February 13, 2013.
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Screening Tools
more and more money?
important to you about how much you gambled?
Johnson EE, Hamer R, Nora RM, et al: The lie/bet questionnaire for screening pathological gamblers. Psychological Reports 80:83-88, 1997.
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The Shell Game
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The Shell Game
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What would you do?
chance of winning is 50%.
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The Shell Game
CARD # 1 CARD # 2 CARD # 3 IF YOU STAY: IF YOU SWITCH:
King/Chosen Win Lose King Chosen Lose Win King Chosen Lose Win Chosen King Lose Win King/Chosen Win Lose King Chosen Lose Win Chosen King Lose Win Chosen King Lose Win King/Chosen Win Lose
CHANCE OF WINNING: 33% 66%
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Interpretative Biases
increases the chance of subsequent win
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Near Misses: Of Mice and Men
from winning the lottery!”
Interpretative Biases
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Superstitious Beliefs
Believing in:
Gaboury A, Ladouceur R: Erroneous perceptions and gambling. Journal of Social Behaviors and Personality 4:411-420, 1989.
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Selective Memory
losses.
amounts lost.
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Telescoping
Expecting that naturally occurring—that is, probabilistically expected—wins will happen sooner rather than later.
Expecting that naturally occurring—that is, probabilistically expected—wins will happen to oneself rather than others.
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perceived defects or flaws that are not
disorder, the person has performed repetitive behaviors or mental acts in response to the appearance concerns.
DSM-5 Criteria
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American Psychiatric Association, DSM-5, 2013.
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Specify if: Muscle dysmorphia form of BDD (i.e., the belief that one’s body build is too small or is insufficiently muscular). Indicate:
DSM-5 New Specifiers
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American Psychiatric Association, www.DSM5.org, 2012.
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surgical treatments
Associated Features
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The Big Three
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Phillips KA, The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder, 2005.
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Regions
Size
Affected Body Parts
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Normal concerns about appearance Healthy exercising Eating Disorders Gender Identity Disorder Major Depressive Episode Social Phobia Trichotillomania Koro
Differential Diagnosis
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The Feusner Experiments 1
Feusner JD, Arch Gen Psychiatry, 2010.
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The Feusner Experiments 2
Feusner JD, Psychological Medicine, 2011.
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Global v. Local Processing
Feusner JD, Psychological Medicine, 2011.
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Face Recognition Experiments
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Bindemann M, Experimental Psychology, 2007.
Face Recognition in BDD
Jefferies K, J Obsessive Compuls Relat Disord, 2012.
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Pathological Gambling
Adapted from: Hollander E, Clinical Manual of Impulse-Control Disorders, 2006.
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PG as an Impulsive Disorder
dopamine function, and reduce “Reward Cravings.”
Grant JE, Kim SW, Hollander E, et al: Predicting treatment response to opiate antagonists and placebo in the treatment of pathological gambling. Psychopharmacol 200:521-527, 2008. Grant JE, Potenza MN: Pathological Gambling: A Clinical Guide to Treatment. Washington, DC, American Psychiatric Publishing, 2004.
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serotonin function, and reduce “Self- Medication.”
anxiety.
Hollander E, Sood E, Pallanti S, et al: Pharmacological treatments of pathological gambling. Journal of Gambling Studies 21:101-110, 2005.
PG as an Compulsive Disorder
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Body Dysmorphic Disorder
Adapted from: Hollander E, Clinical Manual of Impulse-Control Disorders, 2006.
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0% 10% 20% 30% 40% 50% 60% Delusional (n=27) Non-Del. (n=37)
Placebo Fluoxetine
rates during a 12-week treatment trial with fluoxetine ~80 mg QD.
delusional and non- delusional subjects; however, no delusional patients responded to placebo.
Fluoxetine for BDD
Phillips KA, Arch Gen Psychiatry, 2002.
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compulsivity spectrum of illness.
Related and Addictive Disorders.”
“Obsessive-Compulsive and Related Disorders” chapter.
not for Gambling Disorder.
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