Apr 17, 2019
MDedge Psychiatry live Twitter chat on the aftermath of losing a
patient to suicide.
April 24th, 6 - 7 p.m. EST.
Donald Black, MD, gives a
masterclass lecture on behavioral addictions and Renee Kohanski
talks about what normal is.
By Jacquiline Posada, MD.
Gambling disorder (previously pathological gambling) is widespread,
though not commonly assessed
Patients may not volunteer information related to gambling unless
asked, so questions about gambling should be included in routine
Assessment should include questions about legal and illegal
Explore extent: Ask about the level of financial burden; impact on
home life, such as marital problems and divorce; legal
complications like bankruptcy. Finally, ask about suicide risk
related to gambling
Treatment: There is strong data for SSRI medications
naltrexone for urges
Therapy is more efficacious, such as CBT therapy and Gamblers
In certain states, such as Iowa, a person can ask for
“self-exclusion,” which is essentially banning oneself from a
casino or lottery. Also, participation in gambling results in
addictions: Behavior that is out of control and has qualities
and consequences similar to drug and alcohol addiction
Examples include gambling disorder, compulsive buying, compulsive
sexual behaviors (hypersexuality), and Internet
Gambling disorder is similar enough to substance addictions that it
is included in the DSM-5 in the “substance-related and addictive
Addiction neurocircuitry active in these behavioral addictions:
Dopamine driven in the nucleus accumbens
Compulsive shopping: primarily a female disorder, onset in late
20s, with shopping and spending that are chronic and
CBT programs developed to target compulsive shopping, studies about
medications for this disorder are mixed
Compulsive sexual behavior: Primarily a male disorder affecting 5%
of the population; onset late teens, early 20s. The addiction will
combine conventional sexual behaviors taken to extremes often
combined with an addiction to pornography
This disorder will often overlap with an Internet
No evidence-based treatments exist, though CBT-driven models and
12-step programs exist
SSRI or TCA antidepressants may be helpful in dampening sex
Internet addiction has developed in our technologically enabled
world; most psychiatrists have encountered this
Most data come from Asia, where children are exposed to
technology at an even earlier age than in the U.S.
China has developed residential treatment programs involving
individual and group therapies.