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Journal of Behavioral Addictions
Authors: Nuria Mallorquí-Bagué, Fernando Fernández-Aranda, María Lozano-Madrid, Roser Granero, Gemma Mestre-Bach, Marta Baño, Amparo Del Pino-Gutiérrez, Mónica Gómez-Peña, Neus Aymamí, José M. Menchón, and Susana Jiménez-Murcia

Background and aims

The recent growth of Internet use has led to an increase of potentially problematic behaviors that can be engaged online, such as online gambling or Internet gaming. The aim of this study is to better conceptualize Internet gaming disorder (IGD) by comparing it with gambling disorder (GD) patients who only gamble online (online GD).

Methods

A total of 288 adult patients (261 online GD and 27 IGD) completed self-reported questionnaires for exploring psychopathological symptoms, food addiction (FA), and personality traits.

Results

Both clinical groups presented higher psychopathological scores and less functional personality traits when compared with a normative Spanish population. However, when comparing IGD to online GD, some singularities emerged. First, patients with IGD were younger, more likely single and unemployed, and they also presented lower age of disorder onset. In addition, they displayed lower somatization and depressive scores together with lower prevalence of tobacco use but higher FA scores and higher mean body mass index. Finally, they presented lower novelty seeking and persistence traits.

Discussion

GD is fully recognized as a behavioral addiction, but IGD has been included in the Appendix of DSM-5 as a behavioral addiction that needs further study. Our findings suggest that IGD and online GD patients share some emotional distress and personality traits, but patients with IGD also display some differential characteristics, namely younger age, lower novelty seeking scores and higher BMI, and FA scores.

Conclusions

IGD presents some characteristics that are not extensive to online GD. These specificities have potential clinical implications and they need to be further studied.

Open access
Journal of Behavioral Addictions
Authors: Núria Mallorquí-Bagué, Teresa Mena-Moreno, Roser Granero, Cristina Vintró-Alcaraz, Jéssica Sánchez-González, Fernando Fernández-Aranda, Amparo Del Pino-Gutiérrez, Gemma Mestre-Bach, Neus Aymamí, Mónica Gómez-Peña, José M. Menchón, and Susana Jiménez-Murcia

Background and aims

Gambling disorder (GD) presents high rates of suicidality. The combined influences of emotion dysregulation and trait impulsivity are crucially important (albeit understudied) for developing strategies to treat GD and prevent suicide attempts. The aim of this study is to investigate the association between trait impulsivity, emotion dysregulation, and the dispositional use of emotion regulation (ER) strategies with suicidal ideation and psychopathological symptom severity in GD.

Methods

The sample composed of 249 patients with GD (166 with suicidal ideation) who underwent face-to-face clinical interviews and completed questionnaires to assess psychopathological symptoms, impulsive traits, and ER.

Results

Patients with GD who presented suicidal ideation were older and had a later age of GD onset and higher GD severity. Analyses of variance showed higher comorbid symptoms, emotion dysregulation, and trait impulsivity in patients with suicidal ideation. Still, no significant differences were found in the use of ER strategies. SEM analysis revealed that a worse psychopathological state directly predicted suicidal ideation and that both emotion dysregulation and GD severity indirectly increased the risk of suicidal ideation through this state. High trait impulsivity predicted GD severity. Finally, a history of suicide attempts was directly predicted by suicidal ideation.

Conclusions

Patients with GD are at risk of presenting suicidal behaviors. The results of this study revealed the importance of comorbid psychopathology in the occurrence of suicidal ideation and the indirect effect of trait impulsivity and emotion dysregulation on suicidality. Thus, suicidal rates in GD could possibly be reduced by specifically targeting these domains during treatment.

Open access
Journal of Behavioral Addictions
Authors: Roser Granero, Fernando Fernández-Aranda, Susana Valero-Solís, Amparo del Pino-Gutiérrez, Gemma Mestre-Bach, Isabel Baenas, S. Fabrizio Contaldo, Mónica Gómez-Peña, Neus Aymamí, Laura Moragas, Cristina Vintró, Teresa Mena-Moreno, Eduardo Valenciano-Mendoza, Bernat Mora-Maltas, José M. Menchón, and Susana Jiménez-Murcia

Abstract

Background and aims

Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.

Methods

Sample included n = 209 patients aged 18–77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.

Results

Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).

Conclusion

Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

Open access
Journal of Behavioral Addictions
Authors: Roser Granero, Susana Valero-Solis, Fernando Fernández-Aranda, Mónica Gómez-Peña, Laura Moragas, Teresa Mena-Moreno, Amparo del Pino-Gutierrez, Ester Codina, Virginia Martín-Romera, Gemma Casalé, Zaida Agüera, Isabel Baenas-Soto, Eduardo Valenciano-Mendoza, Bernat Mora-Maltas, Isabel Sánchez, María Lozano-Madrid, José M. Menchón, and Susana Jiménez Murcia

Abstract

Background and aims

The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

Methods

The sample included n = 192 patients, aged 19–35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

Results

Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

Discussion and conclusions

Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Open access
Journal of Behavioral Addictions
Authors: Fernando Fernández-Aranda, Roser Granero, Gemma Mestre-Bach, Trevor Steward, Astrid Müller, Matthias Brand, Teresa Mena-Moreno, Cristina Vintró-Alcaraz, Amparo del Pino-Gutiérrez, Laura Moragas, Núria Mallorquí-Bagué, Neus Aymamí, Mónica Gómez-Peña, María Lozano-Madrid, José M. Menchón, and Susana Jiménez-Murcia

Background and aims

Pathological buying (PB) is a behavioral addiction that presents comorbidity with several psychiatric disorders. Despite the increase in the prevalence estimates of PB, relatively few PB instruments have been developed. Our aim was to assess the psychometric properties of the Spanish version of the pathological buying screener (PBS) and to explore the associations between PB, psychopathology, and personality traits.

Methods

A total of 511 participants, including gambling disorder (GD) and eating disorder (ED) patients diagnosed according to DSM-5 criteria, as well as healthy controls (HCs), took part in the study.

Results

Higher PB prevalence was obtained in ED patients than in the other two study groups (ED 12.5% vs. 1.3% HC and 2.7% GD). Confirmatory factor analysis (CFA) verified the 13-item structure of the PBS, and indexes of convergent and discriminant capacity were estimated. CFA confirmed the structure in two factors (excessive buying behavior and loss of control) with excellent internal consistency (α = .92 and .86, respectively). Good convergent capacity was obtained with external psychopathology and personality measures (positive correlations with novelty seeking and negative associations with self-directedness and harm avoidance were found). Good discriminative capacity to differentiate between the study groups was obtained.

Discussion and conclusions

This study provides support for the reliability and validity of the Spanish adaptation of the PBS. Female sex, higher impulsivity, and higher psychopathology were associated with PB.

Open access
Journal of Behavioral Addictions
Authors: Ana Estévez, Raquel Rodríguez, Noelia Díaz, Roser Granero, Gemma Mestre-Bach, Trevor Steward, Fernando Fernández-Aranda, Neus Aymamí, Mónica Gómez-Peña, Amparo del Pino-Gutiérrez, Marta Baño, Laura Moragas, Núria Mallorquí-Bagué, Hibai López-González, Paula Jauregui, Jaione Onaindia, Virginia Martín-Romera, José M. Menchón, and Susana Jiménez-Murcia

Background and aims

Recent technological developments have brought about notable changes in the way people gamble. The widespread use of mobile Internet devices and gambling websites has led to a significant leap in the number of people who recreationally gamble. However, for some, gambling can turn into a psychiatric disorder resembling substance addiction. At present, there is a shortage of studies examining differences between adults with gambling disorder (GD) who exclusively make sports bets online, GD patients that are non-sports Internet gamblers, and offline gamblers. Therefore, this study was undertaken to determine the differences between these three groups, considering sociodemographic, personality, and clinical characteristics.

Methods

The sample consisted of 2,743 treatment-seeking male patients from the Pathological Gambling Unit at a university hospital. All patients met DSM-5 criteria for GD.

Results

We found that gamblers who exclusively engaged in non-sports Internet gambling activities were younger than offline gamblers and online sports gamblers. Non-sports Internet gamblers were also more likely to have greater levels of debt compared with offline gamblers. In terms of personality characteristics, our sample displayed low levels of self-directedness and cooperativeness and high levels of novelty seeking. In addition, online sports gamblers obtained higher scores in persistence than non-sports Internet gamblers and offline gamblers.

Discussion and conclusion

Although differences if terms of gambling severity were not identified between groups, GD patients who exclusively bet online appear to possess distinct personality characteristics and higher debt levels compared with offline gamblers.

Open access
Journal of Behavioral Addictions
Authors: Amparo del Pino-Gutiérrez, Susana Jiménez-Murcia, Fernando Fernández-Aranda, Zaida Agüera, Roser Granero, Anders Hakansson, Ana B. Fagundo, Ferran Bolao, Ana Valdepérez, Gemma Mestre-Bach, Trevor Steward, Eva Penelo, Laura Moragas, Neus Aymamí, Mónica Gómez-Peña, Assumpta Rigol-Cuadras, Virginia Martín-Romera, and José M. Menchón

Background and aims

The main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity–compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype.

Methods

The sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity.

Results

Marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles.

Discussion and conclusion

Our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness.

Open access
Journal of Behavioral Addictions
Authors: Gemma Mestre-Bach, Roser Granero, Trevor Steward, Fernando Fernández-Aranda, Marta Baño, Neus Aymamí, Mónica Gómez-Peña, Zaida Agüera, Núria Mallorquí-Bagué, Laura Moragas, Amparo del Pino-Gutiérrez, Carles Soriano-Mas, Juan Francisco Navas, José C. Perales, José M. Menchón, and Susana Jiménez-Murcia

Background and aims

Gray’s Reinforcement Sensitivity Theory has been widely applied to different clinical populations, but few studies have reported empirical evidence based on this theory for treatment outcomes in patients with gambling disorder (GD) and compulsive buying (CB). The aims of this study were to explore the association between clinical variables and personality traits with reward and punishment sensitivity (RPS) levels in women (n = 88) who met diagnostic criteria for GD (n = 61) and CB (n = 27), and to determine the predictive capacity of RPS for primary short-term outcomes in a cognitive-behavioral therapy (CBT) intervention.

Methods

The CBT intervention consisted of 12 weekly sessions. Data on patients’ personality traits, RPS levels, psychopathology, sociodemographic factors, GD, and CB behavior were used in our analysis.

Results

High RPS levels were associated with higher psychopathology in both CB and GD, and were a risk factor for dropout in the CB group. In the GD group, higher reward sensitivity scores increased the risk of dropout.

Discussion and conclusions

Our findings suggest that both sensitivity to reward and sensitivity to punishment independently condition patients’ response to treatment for behavioral addictions. The authors uphold that CBT interventions for such addictions could potentially be enhanced by taking RPS into consideration.

Open access
Journal of Behavioral Addictions
Authors: Roser Granero, Fernando Fernández-Aranda, Gemma Mestre-Bach, Trevor Steward, Bárbara García-Caro, Fulvia Prever, Belle Gavriel-Fried, Amparo del Pino-Gutiérrez, Laura Moragas, Neus Aymamí, Mónica Gómez-Peña, Teresa Mena-Moreno, Virginia Martín-Romera, José M. Menchón, and Susana Jiménez-Murcia

Background

The prevalence of gambling disorder (GD) in women has increased, but, to date, few studies have explored the features of clinical GD subtypes in female samples.

Aims

The aim of this study is to identify empirical clusters based on clinical/sociodemographic variables in a sample of treatment-seeking women with GD.

Methods

Agglomerative hierarchical clustering was applied to a sample of n = 280 patients, using sociodemographic variables, psychopathology, and personality traits as indicators for the grouping procedure.

Results

Three mutually exclusive groups were obtained: (a) Cluster 1 (highly dysfunctional; n = 82, 29.3%) endorsed the highest levels in gambling severity, comorbid psychopathology, novelty seeking, harm avoidance, and self-transcendence, and the lowest scores in self-directedness and cooperativeness; (b) Cluster 2 (dysfunctional; n = 142, 50.7%) achieved medium mean scores in gambling severity and psychopathological symptoms; and (c) Cluster 3 (functional; n = 56, 20.0%) obtained the lowest mean scores in gambling severity and in psychopathology, and a personality profile characterized by low levels in novelty seeking, harm avoidance, and self-transcendence, and the highest levels in self-directedness and cooperativeness.

Discussion and conclusions

This study sheds light on the clinical heterogeneity of women suffering from GD. Identifying the differing features of women with GD is vital to developing prevention programs and personalized treatment protocols for this overlooked population.

Open access