PEOPLE WHO GAMBLE (SHOP, EAT) TOO MUCH

Research Helps People Deal with Destructive Compulsions

Life’s little pleasures can become major problems for people who have compulsive disorders. Those who suffer from pathological gambling, compulsive shopping, sexual addiction and binge eating, for example, often land in serious financial and personal trouble.  Fortunately, research is helping both doctors and patients better understand these disorders.

OCD Spectrum Disorders

People engage in compulsive behaviors because those behaviors serve a purpose. The individual performs certain acts over and over again and cannot stop him/herself from acting.  People with obsessive-compulsive disorder (OCD) engage in compulsive activities to reduce anxiety and discomfort.  However, people who cannot stop gambling, shopping or eating are driven by pleasure-seeking arousal and by gratification.

While the “reward” for the behavior is different, the repetitive, stereotyped nature of behaviors of those in the latter group has led researchers in the last few years to suggest a clinical relationship between these disorders and OCD.  It is estimated that between 2% and 7% of the U.S. population suffers from one of these “OCD spectrum disorders,” which include pathological gambling, compulsive shopping, sexual addiction, binge eating, hair pulling, pyromania, kleptomania, and body dysmorphic disorder.

“A key symptom in many of these spectrum disorders is impulsivity.  People simply cannot control their urges to gamble, shop, or steal” said Donald Black, M.D., Professor of Psychiatry at the University of Iowa and an expert on compulsive buying and sexual behavior. Research shows that people who have trouble controlling impulses have less activity in the frontal lobes of their brains. Low levels of the neurotransmitter serotonin in the brain have also been implicated in impulsive disorders.

In fact, the biochemistry of the disorders may be very complex.  For example, several neurotransmitters may influence the development and severity of pathological gambling, which affects about 5% to 7% of the population.

“Diminished serotonin levels, as well as increased sensitivity of the post-synaptic serotonin II-C receptors, have both been implicated in the disorder,” said Eric Hollander, M.D., Professor of Psychiatry and Director of Clinical Psychopharmacology, Mt. Sinai School of Medicine.  Other neruotransmitters may influence different phases of the gambling cycle.  “The noradrenergic system may play a role in arousal and extroversion, while dopamine dysfunction may be associated with reward and reinforcement deficiency,” said Dr. Hollander.

Spectrum disorders, like OCD, tend to run in families, pointing to a possible genetic link.  There are also gender differences.  Women tend to go on shopping sprees, pull their own hair, go on eating binges and steal.  Men are more likely to engage in compulsive sexual behavior, gambling, pyromania, or have explosive emotional outbursts.

Environment may also play a role in the prevalence of some spectrum disorders.  Some experts believe pathological gambling, for example, is becoming more widespread as a result of the proliferation of gambling opportunities.  Constantly searching for ways to gamble money away, the problem gambler today has access to many different, convenient ways to gamble, including casinos, lotteries and the Internet.

Treatment

Treatments for OCD spectrum disorders include medications, such as selective serotonin reuptake inhibitors (SSRIs) or behavioral therapy, or a combination of the two. 

For example, an eight-week controlled trial with fluvoxamine maleate (Luvox) was shown to successfully treat pathological gambling.  The results suggest that medication may be more effective than another common intervention, Gamblers Anonymous, which has an estimated relapse rate of more than 90 percent.  “Individual and group counseling would probably also be effective but research shows people don’t stick with it,” said Dr. Hollander.

Compulsive buying is estimated to affect 2% to 3% of the population, primarily women.  Historically, this disorder has been treated with insight-oriented therapy, but a number of new case reports and open-label studies now suggest a combination of SSRIs and cognitive behavioral therapy may be helpful.

Compulsive sexual behavior, which affects about 5% of the population, is characterized by excessive and inappropriate sexual activity that leads to distress or impairment in some domain of life.  Treatment consists of both individual and group counseling, and SSRIs have been prescribed with some success, according to Dr. Black.

“Given their prevalence, impulsivity disorders are definitely understudied and under-recognized clinically” said Dr. Hollander.  Randomized controlled trials are needed to compare treatment strategies but in the meantime “it makes sense to intervene early on before there are a lot of negative consequences or before the disorder has become locked in.”

We are grateful to the OCD Resource Center for permission to reprint this article.

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