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Journal of Behavioral Addictions
Authors: Linda Lemón, Fernando Fernández-Aranda, Susana Jiménez-Murcia, and Anders Håkansson

Abstract

Background and aims

Theoretical background and previous data provide some similarities between problematic gambling and eating behaviors, and a theoretically increased clinical severity in individuals suffering from both conditions. However, large datasets are lacking, and therefore, the present study aimed to study, in a nationwide register material, psychiatric comorbidity, age and gender in gambling disorder (GD) patients with or without eating disorder (ED).

Methods

Diagnostic data from a nationwide register were used, including all individuals with a GD diagnosis in specialized health care in Sweden, in the years 2005–2016 (N = 2,099). Patients with GD and an ED diagnosis (n = 57) were compared to GD patients without ED.

Results

Patients with GD+ED were significantly more likely than other GD patients to also have a diagnosis of drug use disorder, depressive disorders, bipolar disorders, other mood disorder, anxiety disorders, personality disorders, and neuropsychiatric disorders, when controlling for gender. In logistic regression, a comorbid ED in GD was associated with female gender, younger age, depressive disorder and personality disorders.

Discussion and conclusion

In nationwide register data, despite the low number of GD+ED patients, GD patients with ED appear to have a more severe psychiatric comorbidity than GD patients without ED. The combined GD+ED conditions may require particular screening and clinical attention, as well as further research in larger and longitudinal studies.

Open access
Journal of Behavioral Addictions
Authors: Jon Arcelus, Walter Pierre Bouman, Bethany Alice Jones, Christina Richards, Susana Jimenez-Murcia, and Mark D. Griffiths

Background

There is anecdotal clinical evidence that transgender people use the online world – such as forums and online video gaming – for the purpose of experiencing their gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment.

Aims

To describe gaming behavior, degree of problematic gaming behavior and associated factors with problematic gaming in a comparatively large group of transgender people accessing transgender health services.

Methods

Every individual referred to a national transgender health service in the United Kingdom during a 12-month period was invited to complete a series of questionnaires to measure gaming behavior, interpersonal functioning, severity of autistic features, and anxiety and depressive symptoms.

Results

A total of 245 people agreed to participate in the study with 154 (62.9%) describing themselves as current gamers. Gaming behavior in the transgender population attending transgender health services was prevalent, but less than 1% of them presented with clinical scores for Internet Gaming Disorder, with no differences according to gender. Problematic gaming behavior was associated with general interpersonal problems, depression, and young age.

Discussion and conclusions

Transgender people who engage in problematic gaming behavior are younger, and present with high interpersonal problems, and depression, which can affect a successful transition. In view of the high levels of gaming activity in this population games that are designed to address these psychological problems may be well received by transgender people.

Open access
Journal of Behavioral Addictions
Authors: Francesco Del Prete, Trevor Steward, Juan F. Navas, Fernando Fernández-Aranda, Susana Jiménez-Murcia, Tian P. S. Oei, and José C. Perales

Background and aims

Abnormal cognitions are among the most salient domain-specific features of gambling disorder. The aims of this study were: (a) to examine and validate a Spanish version of the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004) and (b) to examine associations between cognitive distortion levels, impulsivity, and gambling behavior.

Methods

This study first recruited a convenience sample of 500 adults who had gambled during the previous year. Participants were assessed using the Spanish version of GRCS (GRCS-S) questionnaire, the UPPS-P impulsivity questionnaire, measures of gambling behavior, and potentially relevant confounders. Robust confirmatory factor analysis methods on half the sample were used to select the best models from a hypothesis-driven set. The best solutions were validated on the other half, and the resulting factors were later correlated with impulsivity dimensions (in the whole n = 500 factor analysis sample) and clinically relevant gambling indices (in a separate convenience sample of 137 disordered and non-disordered gamblers; validity sample).

Results

This study supports the original five-factor model, suggests an alternative four-factor solution, and confirms the psychometric soundness of the GRCS-S. Importantly, cognitive distortions consistently correlated with affect- or motivation-driven aspects of impulsivity (urgency and sensation seeking), but not with cognitive impulsivity (lack of premeditation and lack of perseverance).

Discussion and conclusions

Our findings suggest that the GRCS-S is a valid and reliable instrument to identify gambling cognitions in Spanish samples. Our results expand upon previous research signaling specific associations between gambling-related distortions and affect-driven impulsivity in line with models of motivated reasoning.

Open access
Journal of Behavioral Addictions
Authors: Romina Miranda-Olivos, Zaida Agüera, Roser Granero, Rhianna R. Vergeer, Carlos Dieguez, Susana Jiménez-Murcia, Ashley N. Gearhardt, and Fernando Fernández-Aranda

Abstract

Background and aims

Food addiction (FA) and substance use (SU) have frequently been reported in patients with eating disorders (EDs). Our study aimed to assess the prevalence rates of FA and/or lifetime problematic alcohol and illicit drug use among patients with specific ED, such as: bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorder (OSFED). We sought to identify clinical, psychopathological, and personality profiles involved in these addictive behavior-based phenotypes.

Methods

The total sample was 527 patients (176 BN, 115 BED, and 236 OSFED). FA was assessed through the Yale Food Addiction Scale 2.0. To determine lifetime SU, a semi-structured clinical interview was carried out.

Results

Patients with BN had the highest rates of FA both with and without SU. No gender differences were obtained for the prevalence of current FA and/or lifetime SU. Patients reporting at least one addictive-related behavior exhibited increased clinical severity compared to those who reported none. Increased impulsivity (such as high lack of premeditation, sensation seeking, and positive urgency) and low self-directedness were differentiating factors for presenting one or two addictive behaviors.

Discussion and Conclusions

Overall, patients presenting with at least one addictive-like behavior reported a poorer clinical status than those without. Also, patients with FA and SU exhibited a more dysfunctional profile characterized by high impulsivity and low self-directedness. These findings would support the need for targeted treatments to reduce impulsivity and increase self-directedness, especially in patients with any addictive-related behavior, as a step towards improving their treatment outcome.

Open access
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: 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: 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