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PubMedDate not supplied

Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior.

In recent years there has been an increase in identifying and treating a clinical syndrome that has been given many different names, including compulsive sexual behavior (CSB). The purpose of this study was to determine the prevalence of psychiatric disorders in a sample of individuals with CSB, as evaluated by a structured psychiatric interview. A secondary focus of this research was to determine if individuals with CSB exhibit obsessive-compulsive characteristics or exhibit impulse control problems. Participants were 23 men and two women who responded to newspaper advertisements and met criteria for CSB according to diagnostic criteria established and assessed by expert clinicians. The Structured Clinical Interview for DSM-III, patient version (SCID-P) and the Structured Clinical Interview for Axis II Disorders (SCID-II) were used to interview all participants. To study compulsive or impulsive traits the authors developed a semistructured interview. Standardized rating scales were also administered. Eighty-eight percent of the sample met diagnostic criteria for an axis I disorder at the time of the interview, and 100% of the sample met criteria for an axis I disorder at some time in their lives. The most common diagnoses were mood and anxiety disorders. The sample exhibited more traits of impulsivity than compulsivity. The data are consistent with the suggestion proposed by others that argues for conceptualizing these disorders as impulsive/compulsive spectrum disorders. Attention must be given to addressing these traits, as well as to the treatment of other axis I and axis II disorders, when treating CSB.

Adult↗
PubMed1985

Compulsive sexual behavior: definition of a problem and an approach to treatment.

Sexual compulsivity is defined as a lack of control over one's sexual behavior. Data were collected on 30 gay and bisexual men in New York City who defined themselves as sexually compulsive and who sought treatment for the problem, in order to determine: 1) whether they differed in psychological profile and sexual behavior from a matched control group of men seeking general psychotherapy; and 2) what the effect is of group psychotherapy for sexual compulsivity on the sexual behavior of group participants. It was found that men who are sexually compulsive differ from controls primarily in terms of the frequency and type of their sexual behavior. They do not display more neurotic symptoms. Further, it was found that group psychotherapy helps participants reduce the frequency of their sexual encounters with different partners. An objective measure of the sense of control one has over his/her sexual behavior is needed for further research on this subject.

Adult↗
PubMed1995

Compulsive sexual behaviors.

CSBs constitute a wide range of complex sexual behaviors that clinicians are increasingly encountering. This article has set forth four models of CSBs: compulsive, affective, addictive, and impulsive. Some of the CSBs appear to fit rather neatly into one of the models, whereas others have features of two or more of them. The identification of these various features has important treatment implications. Although a scientific demarcation of these sexually compulsive disorders awaits further research, clinicians should be aware of the growing number of assessment and treatment approaches for these disorders, as well as of the specialists in the field who can be turned to for consultation and referral depending upon the complexities and dangerousness of the case.

Adult↗
PubMed2006

Topiramate in the treatment of compulsive sexual behavior: case report.

BACKGROUND: Among the multiple mechanisms of action of topiramate, AMPA/kainate antagonism may be particularly interesting for the treatment of disorders characterized by conditioned cognitive and behavioral cue reactivity. CASE PRESENTATION: We report the case of a patient consulting primarily for obesity and cue triggered snacking, who responded well on topiramate at doses up to 50 mg. Coincidentally he reported on an improvement of compulsive nonparaphilic sexual behaviors (consumption of prostitution), which was also strongly triggered by environmental cues. Both addictive behaviors (snacking and consumption of prostitution) reoccurred after discontinuation of topiramate and again responded reintroduction of the drug. CONCLUSION: The present case report of topiramate's effect on comorbid obesity and nonparaphilic addiction could be interpreted as a further indication that topiramate acts on the common pathway underlying conditioned behaviors and seems to be a treatment of behavioral disorders associated with environmental cues.

Adult↗
PubMed1999

Studies of the 48 bp repeat polymorphism of the DRD4 gene in impulsive, compulsive, addictive behaviors: Tourette syndrome, ADHD, pathological gambling, and substance abuse.

Prior studies have reported an association between the presence of the 7 repeat allele of the 48 bp repeat polymorphism of the third cytoplasmic loop of the dopamine D4 receptor gene (DRD4) and novelty seeking behaviors, attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS), pathological gambling, and substance abuse. However, other studies have failed to replicate some of these observations. To determine whether we could replicate these associations we genotyped 737 individuals from four different groups of control subjects, and 707 index subjects from four different groups of impulsive, compulsive addictive behaviors including substance abuse, pathological gambling, TS, and ADHD. Chi-square analysis of those carrying the 7 allele versus non-7 allele carriers was not significant for any of the groups using a Bonferroni corrected alpha of.0125. However, chi-square analysis of those carrying any 5 to 8 allele versus noncarriers was significant for pathological gambling (p <.0001), ADHD (p </=.01) and the total index group (p </=.0004). When the comparison included all 7 alleles the results were significant for gamblers (p <.0001), TS (p </=.003), ADHD (p </=.003), and the total group (p </=.0002). There was a significant increase in the frequency of heterozygosity versus homozygosity for all alleles for pathological gamblers (p </=.0031) and the total index group (p </=.0015), suggesting that heterosis played a role. In the substance abuse subjects a quantitative summary variable for the severity of drug dependence, based on the Addiction Severity Index, showed that the scores varied by increasing severity across the following genotypes: 44 </= heterozygotes </= 77 </= 22. Studies of other quantitative traits indicated an important role for the 2 allele and the 22, 24, and 27 genotypes. All studies indicated that the role of the DRD4 gene in impulsive, compulsive, addictive behaviors is more complex than a sole focus on the 7 versus non-7 alleles.

Alleles↗
PubMed1999

[Relationship between tics and compulsion].

In children and adolescents motor/vocal tics and obsessive-compulsive behavior are known to be closely related. Thereby, a continuum of symptoms ranging from single tics to a mixed picture of tics/rituals/obsessive-compulsive traits to clinically relevant obsessions and compulsions could be described. As neurobiological substrates dysfunctions in corresponding cortico-striato-thalamocortical circuits (sensorimotor circuit in tic symptomatology, orbitofrontal circuit in obsessive-compulsive behavior) were postulated. For both disturbances behavioral therapy can be used to improve control mechanisms to counterregulate tics and obsessive-compulsive behavior, respectively, and psychopharmacological agents can be administered to compensate dysbalances in neurotransmitter systems. In case of a mixed symptomatologic picture it is necessary to include interventions for both pols of the symptom-continuum in the therapeutic programme to achieve extensive improvement as a basis for a further positive development of the patient.

Adolescent↗
PubMed1992

Serotonergic function in obsessive-compulsive disorder. Behavioral and neuroendocrine responses to oral m-chlorophenylpiperazine and fenfluramine in patients and healthy volunteers.

To evaluate serotonergic (5-hydroxytryptamine) function in obsessive-compulsive disorder, behavioral and neuroendocrine responses to m-chlorophenylpiperazine (m-CPP; 0.5 mg/kg orally) and fenfluramine hydrochloride (60 mg orally) were examined in 20 patients and 10 healthy controls under double-blind, placebo-controlled conditions. Following m-CPP, but not fenfluramine or placebo, 55% (11/20) of the patients with obsessive-compulsive disorder experienced a transient exacerbation of obsessive-compulsive disorder. Prolactin response was blunted in patients following m-CPP but not following fenfluramine. Patients with greater behavioral response to m-CPP had smaller prolactin responses. Cortisol response to m-CPP and fenfluramine did not significantly differ between the groups. Behavioral and neuroendocrine responses appeared divergent. This does not suggest simply upregulation or downregulation of 5-hydroxytryptamine receptors, but rather complex mechanisms involving multiple neurotransmitter and neuromodulator systems.

Administration, Oral↗
PubMed1996

Growth differences associated with compulsive and stereotyped behavior disorders in adults with mental retardation.

We have recently observed that compulsive behaviors in mentally retarded patients appear to be quite prevalent, can be reliably assessed, and have a high rate of co-occurrence with stereotyped and self-injurious behaviors in this population. As abnormal growth rate has been observed in obsessive-compulsive disorder (OCD) patients, we examined physical stature in adults with mental retardation who display repetitive movement disorders. Identification of cases with stereotypic movement disorder, and cases with compulsive behaviors was done using a symptom checklist and direct observation. Subjects with repetitive movement disorders were smaller in stature than control subjects, with gender differences observed across repetitive behavior disorders. Specifically, female subjects with compulsive behavior disorder, but not stereotypic movement disorder, were significantly shorter and weighted significantly less than same sex-matched controls. Conversely, male subjects with stereotypic movement disorder, but not compulsive disorder, were significantly shorter and weighed significantly less than same sex controls. These findings may point to a neuroendocrine abnormality associated with repetitive movement disorders.

Adolescent↗
PubMed1991

Noradrenergic function in obsessive-compulsive disorder: behavioral and neuroendocrine responses to clonidine and comparison to healthy controls.

To evaluate noradrenergic (NE) function in obsessive-compulsive disorder (OCD), behavioral, physiological, and neuroendocrine responses to the alpha 2-adrenergic agonist clonidine were examined in 18 patients with OCD and 10 healthy subjects. Subjects received single i.v. doses of 2 micrograms/kg of clonidine administered under double-blind, placebo-controlled, random-assignment conditions. Following clonidine, but not following placebo, patients transiently experienced a significant reduction of obsessions and compulsions. Significant drowsiness and a reduction in anxiety were also noted, but the antiobsessional effect appeared independent of the soporific and antianxiety effects. Growth hormone (GH), cortisol, and 3-methoxy-4-hydroxyphenylglycol responses to clonidine did not differentiate patients from healthy controls. Blood pressure and pulse in response to clonidine did not differ between groups. Improvement in OCD symptoms after clonidine significantly correlated with GH response to clonidine, suggesting specific noradrenergic mediation. This finding lends only partial support for a primary defect of noradrenergic function in OCD.

Adolescent↗
PubMed2006

Compulsive eating and weight gain related to dopamine agonist use.

Dopamine agonists have been implicated in causing compulsive behaviors in patients with Parkinson's disease (PD). These have included gambling, hypersexuality, hobbyism, and other repetitive, purposeless behaviors ("punding"). In this report, we describe 7 patients in whom compulsive eating developed in the context of pramipexole use. All of the affected patients had significant, undesired weight gain; 4 had other comorbid compulsive behaviors. In the 5 patients who lowered the dose of pramipexole or discontinued dopamine agonist treatment, the behavior remitted and no further weight gain occurred. Physicians should be aware that compulsive eating resulting in significant weight gain may occur in PD as a side-effect of dopamine agonist medications such as pramipexole. Given the known risks of the associated weight gain and obesity, further investigation is warranted.

Compulsive Behavior↗
PubMed2001

A compulsive collecting behavior following an A-com aneurysmal rupture.

Hoarding behavior associated with focal brain injury is rarely reported. The authors report a 46-year-old man with pathologic collecting behavior after a left orbitofrontal and caudate injury from an aneurysmal rupture of anterior communicating artery. His hoarding, an impulse control disorder or an ego-syntonic compulsion, was restricted to one specific item (toy bullet). Treatments with sertraline or fluoxetine were not effective for the hoarding.

Brain↗
PubMed1998

Compulsive sexual behaviors--difficult aeromedical disposition.

Axis I psychiatric disorders generally are considered incompatible with both the issuance and subsequent maintenance of aeromedical clearance certificates. Little doubt exists as to the impact that conditions such as anxiety disorders, mood disorders, or substance-related disorders have on the conduct of safe flight. Nevertheless, different compulsive sexual behaviors (CSBs), which now are thought to share similar origins and associated comorbidity, can similarly affect impulse control, judgment, concentration, and insight. Yet, these conditions frequently are handled administratively (if not legally). Moreover, in practice CSBs fall within a spectrum of behaviors from "normative" nonparaphilic sexuality to more deviant paraphilic behavior. Through the presentation of five selected cases seen at the Naval Operational Medicine Institute, this article explores examiner difficulty in establishing a diagnosis, discusses models useful in understanding the origins of these disorders, and highlights critical elements in establishing aeromedical disposition. The authors conclude that CSBs may be associated with anxiety, dysphoria, a pattern of increased risk taking, a high threshold for arousal, and poor judgment, which may impact the safety of flight. A comprehensive psychiatric evaluation is essential in determining aeromedical disposition, and consideration should be given to reviewing these cases from a medical perspective prior to any administrative disposition.

Adult↗
PubMed2002

Of human bondage: food craving, obsession, compulsion, and addiction.

Is it more than a linguistic accident that the same term, craving, is used to describe intense desires for both foods and for a variety of drugs of abuse? There is strong evidence for common pathways that are affected by most addictive drugs. As the other contributors to this volume will indicate, a strong case can also be made for some shared substrates for food and drug rewards in animals. There has been less explicit work on this topic in humans but many lines of evidence support the common mechanism view: Opioid peptides seem to influence food palatability for humans. There is mounting evidence for comorbidity between drug/alcohol abuse and excessive craving or liking for sweets. Anecdotally, elderly individuals tend to 'age-out' of drug abuse, and the elderly also experience markedly fewer food cravings with age. If we focus on the compulsive aspects of food and drug cravings, there is also evidence for overlap: for example, activity in the orbitofrontal cortex is associated with cocaine and alcohol craving. This area is also implicated in the pathology of obsessive-compulsive disorder. Although there is no direct evidence of orbitofrontal involvement in food cravings, there is indirect evidence such as higher than expected co-occurrence of obsessive-compulsive behavior and eating disorders. As a result of bringing together evidence for common substrates for food and for drug rewards, we hope to be able to advance fundamental knowledge of motivational processes and to promote the development of better treatments for drug addiction and for eating disorders.

Animals↗
PubMed2003

[Current status in drug addiction and addiction memory research].

The central feature of drug addiction is compulsive drug use--loss of control over apparently voluntary acts of drug seeking and drug taking. Drug addiction, as a chronic brain disease, may result from abnormal engagement of long-term associative memory. Addiction and memory are likely to share much in common in the aspects of neural adaptations, synaptic plasticity, and related molecular mechanisms. This paper reviews the possible roles of learning mechanisms in the development of relapse, sensitization, and drug addiction, abnormal associative learning and compulsive behavior, addiction memory and addiction, multiple memory systems and the development of addiction, and emphasize the importance of synaptic plasticity and addiction memory in drug addiction. Addiction is characterized by the involvement of specific learning patterns of information. Addiction is closely related to the disorder of associate learning that depends on dopamine. Hippocampus may play a key role in addiction. At last, we put forward the future directions for research.

Adaptation, Physiological↗
PubMed2006

Structure, developmental course, and correlates of children's anxiety disorder-related behavior in a Hellenic community sample.

The generality of the DSM-IV diagnostic structure for children's anxiety disorders, as measured by the Spence Children's Anxiety Scale (SCAS) was investigated with a Greek-language version of the scale. An exploratory factor analysis produced a six-factor solution in general accord with the DSM-IV-based theoretical structure of responding. However, a generalized anxiety factor incorporated three unexpected items interpreted as representing excessive worry, including two items intended to measure obsessions, raising the question of children's ability to discriminate the intrusiveness of vexatious cognition. Anxiety scores were negatively correlated with school adjustment and performance, and decreased with age, with the exception of social phobia scores, which increased. Anxiety scores were substantially higher than those observed in most cultures, particularly on social phobia and compulsive behavior subscales. Hellenic children might regard compulsive behaviors as more socially acceptable than other anxiety disorder-related behaviors, whereas higher overall anxiety scores appear to be related to socio-economic circumstances.

Achievement↗