To review the neurobiological substrates of impulse control disorders (ICDs). Pathological gambling (PG) is a main focus of the review in that most biological studies of the formal ICDs have examined this disorder.
The medical database MedLine from 1966 to present was searched to identify relevant articles that were subsequently reviewed to generate this manuscript.
Preclinical studies suggest that differential brain monoamine neuromodulation is associated with impulsive decision-making and risk-taking behaviors. Clinical studies implicate multiple neurotransmitter systems (serotonergic, dopaminergic, adrenergic, and opioidergic) in the pathophysiology of PG and other ICDs. Initial neuroimaging studies have implicated the ventromedial prefrontal cortex and ventral striatum in the pathophysiology of PG and other ICDs. Genetic contributions to PG seem substantial and initial studies have implicated specific allelic polymorphisms, although genome-wide analyses have yet to be published.
Although significant advances have been made in our understanding of the neurobiology of ICDs, more research is needed to extend existing knowledge and translate these findings into clinical advances.
Pathological Gambling; Serotonin; Norepinephrine; Dopamine; Opioids; Impulsivity; Stress; Genetics; Brain Imaging; Biochemistry
Pathological gambling (PG) has been considered as a behavioral addiction having similarities with substance use disorders (SUDs). Shared features exist in diagnostic, clinical, physiological, and behavioral domains. Current conceptualizations of addiction, as well as experimental studies of PG and SUDs, are reviewed in order to provide a perspective on the areas of convergence between addictive behaviors in PG and SUDs.
Pathological gambling; gambling; substance use disorder; addiction; substance dependence; impulsivity
To describe, in the context of DSM-V, how a focus on addiction and compulsion is emerging in the consideration of pathological gambling (PG).
A systematic literature review of evidence for the proposed re-classification of PG as an addiction.
Findings include: 1. Phenomenological models of addiction highlighting a motivational shift from impulsivity to compulsivity associated with a protracted withdrawal syndrome and blurring of the ego-syntonic/ego-dystonic dichotomy; 2. Common neurotransmitter (dopamine, serotonin) contributions to PG and substance use disorders (SUDs); 3. Neuroimaging support for shared neurocircuitries between “behavioral” and substance addictions and differences between obsessive-compulsive disorder (OCD), impulse control disorders (ICDs) and SUDs; 4. Genetic findings more closely related to endophenotypic constructs like compulsivity and impulsivity than to psychiatric disorders; 5. Psychological measures such as harm avoidance identifying a closer association between SUDs and PG than with OCD; 6. Community and pharmaco-therapeutic trials data supporting a closer association between SUDs and PG than with OCD. Adapted behavioral therapies, such as exposure therapy appear applicable to OCD, PG, or SUDs, suggesting some commonalities across disorders.
PG shares more similarities with SUDs than with OCD. Similar to the investigation of impulsivity, studies of compulsivity hold promising insights concerning the course, differential diagnosis and treatment of PG, SUDs, and OCD.
Compulsivity; Impulsivity; Addiction; Pathological Gambling; Endophenotypes
Mentalization refers to the ability to infer mental states of self and others, and this capacity facilitates social interactions. Advances in mentalization theory have proposed that there are both explicit and implicit mentalizing capacities and language may be identified as being an important factor in differentiating these two components of mentalization. Moreover, given apparent sex differences in language and mentalization, we hypothesized that sex may moderate the relationship between language and mentalization. In this study, measures assessing implicit and explicit mentalization as well as language were examined in 49 adolescents (25 girls and 24 boys) aged 14 to 18 years. Participants were administered the Mentalizing Stories for Adolescents to assess explicit mentalization, and the Reading Mind in the Eyes Task to assess implicit mentalization. Language was assessed using the Clinical Evaluation of Language Fundamentals. Sex was found to moderate the relationship between language and explicit mentalization; while language and explicit mentalization were related in boys, these domains were unrelated in girls. There was no moderation of language and implicit mentalization by sex, and these two domains were also uncorrelated. These findings suggest an important role for language development in the capacity for explicit mentalization in boys, and we interpret this as a benefit in girls who may be more socially motivated and less limited by language in their efforts to mentalize.
Mentalization; language; adolescence; sex differences
Although self-reported gambling urge intensities have clinical utility in the treatment of pathological gambling (PG), prior studies have not investigated their neural correlates. Functional magnetic resonance imaging (fMRI) was conducted while 10 men with PG and 11 control comparison (CON) men viewed videotaped scenarios of gambling, happy or sad content. Participants rated the intensity of their emotions and motivations and reported the qualities of their responses. Relative to the CON group, the PG group reported similar responses to sad and happy scenarios, but stronger emotional responses and gambling urges when viewing the gambling scenarios. Correlations between self-reported responses and brain activations were typically strongest during the period of reported onset of emotional/motivational response and more robust in PG than in CON subjects for all conditions. During this epoch, corresponding with conscious awareness of an emotional/motivational response, subjective ratings of gambling urges in the PG group were negatively correlated with medial prefrontal cortex activation and positively correlated with middle temporal gyrus and temporal pole activations. Sadness ratings in the PG group correlated positively with activation of the medial orbitofrontal cortex, middle temporal gyrus, and retrosplenial cortex, while self-reported happiness during the happy videos demonstrated largely inverse correlations with activations in the temporal poles. Brain areas identified in the PG subjects have been implicated in explicit, self-referential processing and episodic memory. The findings demonstrate different patterns of correlations between subjective measures of emotions and motivations in PG and CON subjects when viewing material of corresponding content, suggesting in PG alterations in the neural correlates underlying experiential aspects of affective processing.
Emotion; fMRI; Gambling urges; Motivation; Temporal pole
[11C]-(+)-PHNO; [11C]-raclopride; addiction; D2/D3 dopamine; gambling; striatum
An important endeavor involves increasing our understanding of biobehavioral processes underlying different types of obesity. The current study investigated the neural correlates of cognitive control (involving conflict monitoring and response inhibition) in obese individuals with binge eating disorder (BED) as compared to BMI-matched non-BED obese (OB) individuals and lean comparison (LC) participants. Alterations in cognitive control may contribute to differences in behavioral control over eating behaviors in BED and obesity. Participants underwent functional magnetic resonance imaging (fMRI) while completing the Stroop color-word interference task. Relative to the OB and LC groups, activity in the BED group was differentiated by relative hypoactivity in brain areas involved in self-regulation and impulse control. Specifically, the BED group showed diminished activity in the ventromedial prefrontal cortex (vmPFC), inferior frontal gyrus (IFG) and insula during Stroop performance. In addition, dietary restraint scores were negatively correlated with right IFG and vmPFC activation in the BED group, but not in the OB or HC groups. Thus, BED individuals’ diminished ability to recruit impulse-control-related brain regions appears associated with impaired dietary restraint. The observed differences in neural correlates of inhibitory processing in BED relative to OB and LC groups suggest distinct neurobiological contributions to binge eating as a subgroup of obese individuals.
binge eating disorder; obesity; inhibition; ventromedial prefrontal cortex; inferior frontal gyrus; restraint; fMRI
Objective: to examine gender differences in the relationship between weight group (under-weight to morbidly obese), and Axis I and Axis II psychopathology. Method: data from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC) were analyzed. Logistic regression models examined the past-year likelihood for meeting diagnostic criteria for psychiatric disorders, and interactions between weight group and gender were utilized to determine whether associations were significantly different in men and women after adjusting for demographic characteristics. Results: First, consistent with previous NESARC analyses, the prevalence estimates of psychiatric disorders were higher among people of higher BMI group, regardless of gender. However, these patterns differed across genders. Both morbidly obese women and men, in comparison to normal weight respondents, were much more likely to meet criteria for affective and anxiety disorders, but these associations were significantly (1.5–2 times) stronger among women. For Axis II disorders while there were very few associations between personality disorders and weight in men, among women increases in weight group were associated with increases in the likelihood of meeting criteria for a personality disorder. Conclusions: Weight and psychopathology appear more strongly associated in women than in men. While these data do not allow for identification of underlying mechanisms, they highlight the importance of assessing for psychopathology in overweight and obese patients and suggest that education related to healthy eating and exercise be incorporated into treatment plans for people with psychiatric disorders.
obesity; psychopathology; gender differences
Background: Psychiatric disorders frequently co-occur with pathological gambling. The extent to which co-occurence extends to subsyndromal levels of gambling or differs between women and men is incompletely understood. Aim: To examine whether the association between psychiatric disorders and past-year gambling problems is stronger in women than men. Methods: Data from the National Epidemiological Survey of Alcoholism and Related Disorders (NESARC) (n = 43,093) were analyzed. Results: Increasing severity of past-year gambling problems was associated with increasing odds of most past-year Axis I and lifetime Axis II disorders, regardless of gender. Associations between gambling problems and major depression, dysthymia, panic disorder, and nicotine dependence were statistically stronger in women than in men. Conclusions: A severity-related association exists between past-year gambling problems and psychiatric disorders. The stronger associations in women suggest that gambling research, prevention and treatment efforts consider gender differences.
Although adolescents frequently engage in a variety of risky behaviors, much remains unknown about the specific etiologies of such tendencies. Candidate genetic variants, such as the COMT Val158Met polymorphism, may be related to risk-taking propensity, particularly as this variant is linked to functional enzymatic differences influencing dopamine function in regions including the prefrontal cortex. The present study aimed to examine the COMT Val158Met variant in relation to risk taking propensity in a community sample of youth. As part of a larger longitudinal study on adolescent risk behaviors, 223 youths (average age 11.3 years) from the metropolitan Washington D.C. area completed a measure of risk-taking propensity, the Balloon Analogue Risk Task-Youth Version (BART-Y), and provided saliva samples for DNA extraction and genotyping. Results indicate that females, but not males, who are carriers of the COMT158Met allele had higher risk-taking propensity scores on the BART-Y compared to Val homozygotes. Analyses were also conducted in the 111 European American participants, and results were consistent with those of the full sample analyses. This study represents the first investigation of a genetic substrate of risk-taking propensity, measured by a behavioral task, in youth. Results should be taken as quite preliminary, given the small sample. Implications are discussed.
Risk taking; BART; COMT Val158Met; Dopamine; Adolescents
Community data suggest frequent co-occurrence between schizophrenia/schizoaffective disorder and problem gambling. However, gambling behaviors in large samples of patients with schizophrenia/schizoaffective disorder have not been systematically examined to date.
A sample of outpatient subjects (n=337) diagnosed with schizophrenia/schizoaffective disorder or schizoaffective disorder and treated in either a VA hospital or a local state mental health center was interviewed in order to examine the prevalence estimates and clinical correlates of problem and pathological gambling. Multinomial logistic regression models investigated clinically relevant measures in recreational or problem/pathological gamblers, as compared to non-gamblers.
Sixty-five participants (19%) met criteria for past-year problem/pathological gambling, with 10% meeting criteria for pathological gambling. Significant correlates of problem and pathological gambling from multivariable models included greater alcohol use severity (p=0.007), higher depression scores (p=0.04), and more outpatient mental health care utilization (p=0.03). Participants with problem/pathological gambling were more likely than recreational gamblers to gamble for excitement, gamble more frequently and heavily, and report either sports or card gambling as favorite.
A substantial proportion of individuals in treatment for psychotic disorders report past-year gambling problems. Patients with co-occurring alcohol use problems and depression may be at particularly high risk. These findings suggest the need for improved prevention and treatment efforts related to problem/pathological gambling in individuals with psychotic disorders.
Although stress and drug cue exposure each increase drug craving and contribute to relapse in cocaine dependence, no previous research has directly examined the neural correlates of stress-induced and drug cue-induced craving in cocaine-dependent women and men relative to comparison subjects.
Functional MRI was used to assess responses to individualized scripts for stress, drug/alcohol cue and neutral-relaxing-imagery conditions in 30 abstinent cocaine-dependent individuals (16 women, 14 men) and 36 healthy recreational-drinking comparison subjects (18 women, 18 men).
Significant three-way interactions between diagnostic group, sex, and script condition were observed in multiple brain regions including the striatum, insula, and anterior and posterior cingulate. Within women, group-by-condition interactions were observed involving these regions and were attributable to relatively increased regional activations in cocaine-dependent women during the stress and, to a lesser extent, neutral-relaxing conditions. Within men, group main effects were observed involving these same regions, with cocaine-dependent men demonstrating relatively increased activation across conditions, with the main contributions from the drug and neutral-relaxing conditions. In men and women, subjective drug-induced craving measures correlated positively with corticostriatal-limbic activations.
In cocaine dependence, corticostriatal-limbic hyperactivity appears to be linked to stress cues in women, drug cues in men, and neutral-relaxing conditions in both. These findings suggest that sex should be taken into account in the selection of therapies in the treatment of addiction, particularly those targeting stress reduction.
Nicotine dependence frequently co-occurs with subsyndromal and pathological levels of gambling. The relationship of nicotine dependence, levels of gambling pathology, and other psychiatric disorders, however, is incompletely understood.
To use nationally representative data to examine the influence of DSM-IV nicotine dependence on the association between pathological gambling severities and other psychiatric disorders. Face-to-face interviews were conducted in 43,093 household and group-quarters adults in the United States. The main outcome measure was the co-occurrence of current nicotine dependence and Axis I and II disorders and severity of gambling based on the ten inclusionary diagnostic criteria for pathological gambling.
Among non-nicotine-dependent respondents, increasing gambling severity was associated with greater psychopathology for the majority of Axis I and II disorders. This pattern was not uniformly observed among nicotine dependent subjects. Significant nicotine-by-gambling-group interactions were observed for multiple Axis I and II disorders. All significant interactions involved stronger associations between gambling and psychopathology in the non-nicotine-dependent group.
In a large national sample, nicotine dependence influences the associations between gambling and multiple psychiatric disorders. Subsyndromal levels of gambling are associated with significant psychopathology. Nicotine dependence accounts for some of the elevated risks for psychopathology associated with subsyndromal and problem/pathological levels of gambling. Additional research is needed to examine specific prevention and treatment for individuals with problem/pathological gambling with and without nicotine dependence.
gambling; co-occurring disorders; nicotine dependence; addiction; impulse control disorders; epidemiology
Delay discounting is a type of impulsivity in which smaller, immediate rewards are preferred over larger, delayed ones. Impulsivity is associated with harmful behaviors, including substance abuse and financial mismanagement.
Delay discounting as related to addiction and financial mismanagement was reviewed from psychological, neurobiological, and behavioral economic perspectives.
Addiction and financial mismanagement frequently co-occur, and elevated delay discounting may be a common mechanism contributing to both of these problematic behaviors.
Future research on the relationships between delay discounting, substance abuse, and financial mismanagement can provide important insights for developing improved prevention and treatment strategies.
delay discounting; impulsivity; substance abuse; financial mismanagement; addiction; neurobiology
To empirically derive latent classes based on PG criteria and to assess the association between non-gambling psychiatric disorders and specific classes.
8,138 community-based middle-aged men were surveyed and 2,720 were assessed for DSM-III-R pathological gambling (PG). Latent class analysis (LCA) was applied to DSM-III-R PG criteria to identify gambling classes. Chi-square and logistic regression models evaluated the association between gambling classes and lifetime psychiatric disorders.
The final model included four classes: class 0 (i.e., 5,418 individuals who never gambled 25 or more times in a year) and classes 1–3 (identified by the LCA and comprising 2,720 respondents assessed for PG). For the nine individual criteria of PG, endorsement percentages ranged from 2% - 6%, 4% - 58%, and 53% −100% for classes 1–3, respectively. Non-gambling psychiatric disorders were differentially associated with the four gambling classes, and psychopathology was more common in groups more frequently acknowledging PG criteria.
Empirical support is provided for distinct classes of gambling behaviors demonstrating differential associations with individual PG criteria and non-gambling psychiatric disorders. The data-driven categorization of gambling behaviors provides direction for research on defining, preventing and treating syndromal and subsyndromal PG.
Pathological Gambling (PG); Latent Class; PG Criteria
Both theory and empirical evidence support possible associations between two candidate genetic polymorphisms (SLC6A4 5-HTTLPR l/s and COMT Val158Met – rs4680 variants) and emotion-regulation difficulties. One particular form of emotion-regulation difficulty, distress intolerance, has been measured using a behavioral assessment in youth; data indicate a relationship with poor psychological functioning. No prior study has investigated genetic influences on emotion-regulation difficulties in youth. As part of a larger longitudinal study on adolescent risk behaviors, 218 10-14 year-old youths from the metropolitan Washington, D.C., area completed a measure of distress intolerance, the Behavioral Indicator of Resilience to Distress (BIRD), and provided saliva samples for DNA extraction and genotyping. Results indicate that those with one or two copies of the s allele of the 5-HTTLPR polymorphism were more likely to perform poorly on the task (i.e., choose to quit) than were those homozygous for the l allele. Participants who were Val allele carriers of the COMT Val158Met polymorphism were also more likely to quit the task compared to Met homozygotes. A summative risk allele score was created to combine the two polymorphisms, and each risk allele was associated with a 1.75 fold increased likelihood of quitting the task. Exploratory analyses revealed that emotional abuse moderated the relationship between the 5-HTTLPR and BIRD performance, as well as the genetic risk allele and the BIRD. This is the first investigation of genetic predictors of a behavioral measure of tolerance to distress. Results suggest that distress tolerance is at least partially regulated by specific genetic variants. Implications are discussed.
COMT; 5-HTTLPR; Distress Tolerance
This study aims to explore the prevalence and health correlates of problematic internet use among high school students in the United States.
A cross-sectional survey with a sample size of 3560 students was conducted among high schools in Connecticut, USA. Demographic data, characteristics of internet use, health measures and risk behaviors were assessed. Chi square and logistic regression analyses were used to study the relationship between problematic internet use and risk behaviors as well as related gender differences.
When problematic internet use was diagnosed with criteria that address core features of impulse-control disorder (strong urge, growing tension and attempts to cut back), the overall prevalence was about 4% with no significant difference between genders. Problematic internet use was more common among Asian and Hispanic students. Even though boys spent significantly more time on the internet and more frequently missed important school or social activities as a result, girls more frequently self-reported measures of excessive use of the internet. After adjustment of socio-demographic factors, problematic internet use was found to associate significantly with substance use, depression and aggression, with largely similar patterns of associations between genders.
Problematic internet use may be present in about 4% of high school students in the United States. It may be associated with depression, substance use and aggressive behaviors. High school boys, though may have heavier internet use, may be less self-aware of the related problems.
adolescence; aggression; depression; impulsivity; internet; prevalence
Although opiate antagonists have shown promise in the treatment of pathological gambling (PG), individual responses vary. No studies have systematically examined predictors of medication treatment outcome in PG. Understanding clinical variables related to treatment outcome should help generate treatment algorithms for PG.
We sought to identify clinical variables associated with treatment outcome in PG subjects receiving opiate antagonists.
284 subjects (137 [48.2%] women) with DSM-IV PG were treated in one of two double-blind placebo-controlled trials (16 weeks of nalmefene or 18 weeks of naltrexone). Gambling severity was assessed with the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling [PG-YBOCS] with positive response defined as ≥ 35% reduction in PG-YBOCS score for at least one month by study endpoint. Depression, anxiety, and psychosocial functioning were included in stepwise logistic regression analyses designed to identify clinical factors independently associated with treatment response.
The clinical variable most strongly associated with a positive response to an opiate antagonist was a positive family history of alcoholism (p=.006). Among individuals receiving higher doses of opiate antagonists (i.e., nalmefene 50mg/d or 100mg/d or naltrexone 100mg/d or 150mg/d), intensity of gambling urges (PG-YBOCS urge subscale) was associated with a positive response on a trend level (p=.036). Among individuals receiving placebo, younger age was associated, on a trend level, with positive treatment outcome (p=.012).
A family history of alcoholism appears to predict response to an opiate antagonist in PG. Future research is needed to identify specific factors (e.g., genetic) mediating favorable responses.
opiate antagonists; impulsivity; impulse control disorders; addiction; pharmacotherapy; placebo
In adults, different levels of gambling problem severity are differentially associated with measures of health and general functioning, gambling behaviors and gambling-related motivations. Here we present data from a survey of 2,484 Connecticut high school students, and investigate the data stratifying by gambling problem severity based on DSM-IV criteria for pathological gambling. Problem/pathological gambling was associated with a range of negative functions; e.g., poor academic performance, substance use, dysphoria/depression, and aggression. These findings suggest a need for improved interventions related to adolescent gambling and a need for additional research into the relationship (e.g., mediating factors) between gambling and risk and protective behaviors.
gambling; adolescence; risk behaviors; substance use
There is concern about the potential for negative impact of video games on youth. However the existing literature on gaming is inconsistent and has often focused on aggression. Health correlates of gaming and the prevalence and correlates of problematic gaming have not been systematically studied. We anonymously surveyed 4,028 adolescents about gaming, reported problems with gaming, and other health behaviors. 51.2% of the sample reported gaming (76.3% of boys and 29.2% of girls). There were no negative health correlates of gaming in boys, and lower odds of smoking regularly; however, girls who reported gaming were less likely to report depression, and more likely to report getting into serious fights and carrying a weapon to school. Among gamers, 4.9% reported problematic gaming, defined as reporting trying to cut back, experiencing an irresistible urge to play, and experiencing a growing tension that could only be relieved by playing. Boys were more likely to report these problems (5.8%) than girls (3.0%). Correlates of problematic gaming included regular cigarette smoking, drug use, depression, and serious fights. Results suggest that gaming is largely normative in boys and not associated with many health factors. In girls, however, gaming appears associated with more externalizing behaviors and fewer internalizing symptoms. The prevalence of problematic gaming is low but not insignificant, and problematic gaming may be contained within a larger spectrum of externalizing behaviors. More research is needed to define safe levels of gaming, refine the definition of problematic gaming, and evaluate effective prevention and intervention strategies.
impulse control disorders; adolescents; video gaming; risk behaviors; gender
Alcohol abuse and/or dependence (Alcohol Use Disorders, AUDs) and problem and/or pathological gambling (PPG) frequently co-occur with each other and other psychiatric disorders. However, prior studies have not investigated the relative influence of AUD on the associations between PPG and other psychiatric disorders.
To use nationally representative data (the National Epidemiologic Survey on Alcohol and Related Conditions, NESARC, n = 43,093 U.S. Residents ages 18 years and older) to examine the influence of DSM-IV AUD on the associations between gambling and other psychiatric disorders and behaviors.
Main Outcome Measures
Co-occurrence of past-year AUD and Axis I and II disorders and severity of gambling based on the ten inclusionary diagnostic criteria for pathological gambling.
Among non-AUD respondents, increasing gambling severity was associated with increasingly elevated odds for the majority of Axis I and II disorders. Among AUD respondents, this pattern was typically not observed. Alcohol-by-gambling-group interactions for PPG were also found and the odds of these disorders was significantly increased in non-AUD respondents with PPG, but either unchanged or significantly lower in AUD respondents with PPG.
Gambling-related associations exist with multiple psychiatric disorders, but particularly in those without AUD. These associations have important implications with respect to conceptualization, prevention and treatment of psychiatric disorders in individuals with gambling and/or alcohol use disorders.
gambling; co-occurring disorders; alcohol dependence; impulse control disorders; epidemiology
Dopaminergic medication-related Impulse Control Disorders (ICDs) such as pathological gambling and compulsive shopping have been reported in Parkinson disease (PD).
We hypothesized that dopamine agonists (DAs) would be associated with greater impulsive choice, or greater discounting of delayed rewards, in PD patients with ICDs (PDI).
Fourteen PDI patients, 14 PD controls without ICDs and 16 medication-free matched normal controls were tested on (i) the Experiential Discounting Task (EDT), a feedback-based intertemporal choice task, (ii) spatial working memory and (iii) attentional set shifting. The EDT was used to assess impulsivity choice (hyperbolic K-value), reaction time (RT) and decision conflict RT (the RT difference between high conflict and low conflict choices). PDI patients and PD controls were tested on and off DA.
On the EDT, there was a group by medication interaction effect [F(1,26)=5.62; p=0.03] with pairwise analyses demonstrating that DA status was associated with increased impulsive choice in PDI patients (p=0.02) but not in PD controls (p=0.37). PDI patients also had faster RT compared to PD controls F(1,26)=7.51 p=0.01]. DA status was associated with shorter RT [F(3,24)=8.39, p=0.001] and decision conflict RT [F(1,26)=6.16, p=0.02] in PDI patients but not in PD controls. There were no correlations between different measures of impulsivity. PDI patients on DA had greater spatial working memory impairments compared to PD controls on DA (t=2.13, df=26, p=0.04).
Greater impulsive choice, faster RT, faster decision conflict RT and executive dysfunction may contribute to ICDs in PD.
dopamine agonist; gambling; impulse control; Parkinson disease; delay discounting
Substance abusing individuals tend to display abnormal reward processing and a vulnerability to being impulsive. Detoxified alcoholics show differences in regional brain activation during a monetary incentive delay (MID) task. However there is limited information on whether this uncharacteristic behavior represents a biological predisposition towards alcohol abuse, a consequence of chronic alcohol use, or both.
We investigated proposed neural correlates of substance disorder risk by examining reward system activity during a MID task with separate reward prospect, reward anticipation, and reward outcome phases in 30 individuals with and 19 without family histories of alcoholism. All subjects were healthy, lacked DSM-IV past or current alcohol or substance abuse histories, and were free of illegal substances as verified by a urine toxicology screening at the time of scanning. Additionally, we explored specific correlations between task-related nucleus accumbens (NAcc) activation and distinct factor analysis-derived domains of behavioral impulsivity.
During reward anticipation, fMRI data confirmed blunted NAcc activation in family history positive subjects. In addition, we found atypical activation in additional reward-associated brain regions during additional task phases. We further found a significant negative correlation between NAcc activation during reward anticipation and an impulsivity construct.
Overall, results demonstrate that sensitivity of the reward circuit, including NAcc, is functionally different in alcoholism FHP individuals in multiple regards.
Reward; Incentive; Anticipation; Alcoholism; fMRI; Impulsivity; Nucleus Accumbens; Ventral Striatum; Family History
Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for prevention and treatment strategies. Few empirical investigations have been performed in kleptomania, particularly with respect to gender-related influences.
From 2001 to 2007, 95 adult subjects (n=27 [28.4%] males) with DSM-IV kleptomania were assessed on sociodemographics and clinical characteristics including symptom severity, comorbidity, and functional impairment to identify gender-related differences.
Men and women both showed substantial symptom severity and functional impairment. Compared to affected men, women with kleptomania were more likely to be married (47.1% compared to 25.9%; p=.039), have a later age at shoplifting onset (20.9 compared to 14 years; p=.001), steal household items (p<.001), hoard stolen items (p=.020), and have an eating disorder (p=.017) and less likely to steal electronic goods (p<.001) and have another impulse control disorder (p=.018).
Kleptomania is similarly associated with significant impairment in women and men. Gender-related differences in clinical features and co-occurring disorders suggest that prevention and treatment strategies incorporate gender considerations.
gender; impulse control disorders; kleptomania; phenomenology