A hierarchical linear modeling assessment of dual-addiction status and change in sexual compulsivity over time

This study examined the association between dual-addiction status and sexual compulsivity over time in a sample of self-identified sexually compulsive males. Hierarchical linear modeling was utilized to address the study's research questions. Dually addicted sexually compulsive males exhibited lower rates of sexual compulsivity than their singularly addicted counterparts initially but displayed less precipitous declines in sexual compulsiveness over time. Implications for treatment providers are discussed.     

The internet and its role in the escalation of sexually compulsive behaviour

As increasing numbers of patients present with problems of compulsive use of internet sex and internet pornography, psychotherapists are challenged to develop models that address the powerful, and potentially disturbing effect of this stimulus. Internet sex does not just facilitate access to sexual materials but can act as a catalyst, affecting established defences and ego and superego functioning. Escalation in sexually compulsive behaviour, which affects a small proportion of those accessing online sex, may be thought of as a series of transitions: from casual to compulsive use, from compulsive use to illegal use, and from use of illegal pornography to contact offending. Drawing on clinical experience and the available research evidence, psychodynamic processes associated with movement through these transitions are considered. Internet sex has the potential to fuel manic defences, invites narcissistic and part-object relating, provides a vehicle for the expression and disowning of sadistic impulses and can potentially undermine superego functioning. The combined effect of these processes may lead to a breakdown of ego controls in vulnerable individuals.     

The piloting of a brief relational psychodynamic protocol (psychodynamic addiction model) for problem gambling and other compulsive addictions: A retrospective analysis

The paper describes a treatment pilot for gambling and compulsive addiction within an NHS problem gambling clinic. The pilot study used a brief relational psychodynamic treatment protocol specifically designed to meet the needs of a group of patients who had not responded to CBT and who had other addictions or co‐morbidities. Seventy‐two (n = 72) patients were offered 12 sessions of therapy by four psychodynamic counsellors. Results were assessed using scores from a pre‐ and post‐treatment patient health questionnaire, the generalised anxiety disorder—7 (GAD‐7) and the Problem Gambling Severity Index (PGSI). Weekly feedback and supervision from counsellors and patients were used to assess the treatment model. The results highlighted that the psychodynamic addiction model was associated with reduced depression (Mean = 14.9; SD: 6.7), anxiety (Mean = 11.5; SD: 5.9), and gambling severity (p < .001), suggesting that a relational psychodynamic treatment is needed for complex patients with compulsive addiction, where CBT had not been successful. These results also highlight the importance of the therapeutic relationship as a critical factor in the treatment of patients with compulsive addiction problems.     

Rituals, Compulsions, and Other Syncretic Tools: Insights from Werner's Comparative Psychology

In line with theme of this special issue, this article speaks to a topic in developmental psychology from a Wernerian perspective. We take a Wernerian, comparative, and orthogenetic approach in addressing rituals and other compulsive behaviors in a variety of contexts: Ritual as cultural practice, as a part of pathologic behavior, and as a normative aspect of child development. We discuss the similarities and differences in these various forms of ritual, and conclude by incorporating recent advances in the study of obsessive-compulsive disorder to shed light on the normative variant of compulsive behavior. Our goal is to emphasize the continued relevance Werner's work in light of contemporary trends in developmental psychology, developmental psychopathology, and neuroscience.     

A Qualitative Study of the Supports Women Find Most Beneficial When Dealing with a Spouse’s Sexually Addictive or Compulsive Behaviors: Insights for Pastoral Counselors and Clergy

There is currently a void in the literature regarding the kinds of support women find most beneficial when dealing with a spouse’s sexually addictive or compulsive behaviors. Addressing this void is particularly relevant for clergy, seeing as they are increasingly sought out as an initial and/or primary support for dealing with this marital issue. Using grounded theory methodology, 22 women from Canada and the USA were interviewed to find out what they found most helpful as they sought support to cope with a spouse’s sexually addictive and compulsive behaviors. Insights for pastoral counselors and clergy were highlighted.     

Mindsets,shopping motivations and compulsive buying: Insights from China

This study investigates how mindsets (i.e., the beliefs that individuals have about the nature of human characteristics) are associated with compulsive buying behavior (i.e., the tendency to buy impulsively and obsessively). In particular, we test the relationships between consumer mindsets, three shopping motivations (deal proneness, social comparison, and hedonic motives) and compulsive buying. Based on a survey of 421 respondents conducted in China, our findings reveal the mechanism through which mindsets affect compulsive buying. The results show that when consumers believe in the consistency of personal traits (fixed mindset), they tend to be more vulnerable to deal offers and social comparison. These motivations increase the desire to seek hedonic pleasure, which is associated with a greater propensity for compulsive buying. However, when consumers believe that personal traits can be changed and developed (growth mindset), they seek hedonic pleasure in shopping, which result in a greater tendency to engage in compulsive buying. The present study adds to the existing body of knowledge by unveiling how different mindsets are associated with compulsive buying. In terms of practical implications, this study provides policy makers and marketers with a better understanding of the different motivations that lead to compulsive buying.     

Psychostimulant-induced behavior as an animal model of obsessive-compulsive disorder: an ethological approach to the form of compulsive rituals

Rats treated chronically with the D2/D3 dopamine receptor agonist quinpirole show a pattern of behavior that meets a set of ethologically derived criteria of compulsive behavior in obsessive-compulsive disorder (OCD). Moreover, in both quinpirole-treated rats and OCD patients, the structure of compulsive rituals appear similar in being composed of relatively few motor acts that are organized in a flexible yet recurrent manner. In addition, the development of compulsive behavior in quinpirole-treated rats is attenuated by the OCD pharmacotherapeutic drug clomipramine. These similarities support the validity of quinpirole-treated rats as a psychostimulant-induced animal model of OCD. Considering that the induction of compulsive behavior in the rat model involves chronic hyperstimulation of dopamine receptors, this raises the possibility that dopaminergic mechanisms may play a role in OCD, at least in some subtypes of this disorder.     

Of mice and marbles: Novel perspectives on burying behavior as a screening test for psychiatric illness

Burying forms part of the normal behavioral routine of rodents, although its expression is species-specific. However, it has been suggested that aberrant burying behavior, of which marble-burying (MB) is an example, may represent neophobic and/or compulsive-like behavior. In the present investigation, we assessed MB in an established animal model of obsessive–compulsive disorder (OCD)—namely, spontaneous stereotypy in the deer mouse—to establish whether high (H) stereotypy is associated with neophobia and/or another compulsive endophenotype, i.e. MB, as compared to nonstereotypical (N) controls. A three-trial, one-zone MB test was performed over three consecutive evenings both before and after chronic treatment with high-dose (50 mg/kg/day) oral escitalopram. Neophobia was measured via the number of marbles buried during the first pre- and posttreatment MB trials, and compulsive-like behavior via the number of marbles buried over all pre- and posttreatment MB trials. The data from the present study support earlier findings that burying is a normal behavioral routine (inherent burying behavior, IBB) that is expressed by all deer mice, irrespective of stereotypical cohort, and is not associated with either neophobia or compulsiveness. Indeed, chronic escitalopram treatment, which is similarly effective in treating clinical anxiety and OCD, as well as in attenuating H behavior, failed to influence IBB. Although 11 % of the animals presented with a unique burying endophenotype (high burying behavior), escitalopram also failed to attenuate said behavior, necessitating further investigation as to its relevance. In conclusion, MB cannot be regarded as a measure of anxiety-like or compulsive behavior in the deer mouse model of OCD.     

Understandings,Definitions, and Experiences of Clergy in Residential Psychiatric Treatment

The author conducted a qualitative examination of the understandings, definitions, and experiences of forgiveness held by members of the clergy who reported initial or ongoing conflict with the religious superiors who mandated their entry into residential psychiatric treatment because of substance abuse/dependence, sexual misconduct, compulsive behavior disorder, or affective disorders. Participants completed an 8‐item reflection questionnaire constructed for this study. Responses were examined qualitatively to identify trends, commonalities, or differences in the understandings, definitions, and experiences expressed in these responses. The author compared the data collected with definitions presented by previous researchers who have examined forgiveness in other populations.     

Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.     

Potentials and Limitations of Cognitive Treatments for Obsessive‐Compulsive Disorder

Exposure and response prevention (ERP) is a well‐established treatment for obsessive‐compulsive disorder (OCD). However, it is not completely effective for many patients, and some do not benefit from or tolerate this treatment. Over the past 3 decades there has been growing interest in using cognitive interventions, either as adjuncts or alternatives to exposure‐based treatments such as ERP, to address these shortcomings. Cognitive therapy and cognitive behavior therapy for OCD have both demonstrated greater efficacy than no treatment at all, and appear to have a lower incidence of dropout than ERP. Unfortunately, however, for the average OCD patient, cognitive interventions have not improved treatment efficacy; that is, cognitive interventions, either alone or combined with ERP, are no more effective than ERP alone. Reasons for this disappointing result are considered, and indications for the use of cognitive interventions are discussed. Future research directions are suggested in order to evaluate more fully the merits of, and indications for, cognitive methods for treating OCD.     

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder

A childhood history of sexual or physical abuse is highly prevalent in borderline personality disorder (BPD) and is associated with self-destructive behavior in clinical and nonclinical samples. Viewing BPD as a "high risk" disorder, we asked if childhood abuse was a risk factor for adult suicidal behavior or if it was related to other known risk factors for suicide in BPD. A semistructured Abuse History was obtained in 61 criteria-defined BPD patients, who were characterized by structured interviews and self-reports for Axis I disorders, Suicide History, BPD severity, hopelessness, impulsivity, impulsive-aggression, and antisocial traits. Occurrence and severity of childhood sexual abuse, but not physical abuse, predicted adult suicidal behavior independent of other known risk factors. The odds of a sexually abused patient attempting suicide in adulthood was over 10 times that of a patient who was never sexually abused. Given a history of childhood sexual abuse, the risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode (MDE).     

Compulsive buying behavior: Re‐evaluating its dimensions and screening

Despite the significant research in the consumer behavior literature on compulsive buying behavior (CBB), there is still no general agreement about the dimensionality or diagnostic screening of the disorder. Previous studies have identified two principal dimensions: compulsivity and impulsivity, although more recent strands of theory characterize CBB with reference to loss of self‐control and behavioral addiction. This study challenges the impulsive–compulsive paradigm by validating a new model with compulsive and self‐control impaired spending dimensions. The model more closely reflects the disorder's ego‐dystonic character, routed in an anxiety‐based reactive mechanism with uncontrollable buying and an inability to rationalize the behavior and its consequences. The study also develops and cross‐validates a new seven‐item CBB screening tool, using a comparative analysis with three existing screeners and an independent sample. The findings indicate that compulsive buying results from both compulsive and self‐control impaired impulsive elements, which are characteristic of behavioral addiction.     

Effects of September 11 on patients with obsessive compulsive disorder

Effects of the September 11, 2001 terrorist attacks in the USA were investigated in 25 patients with obsessive compulsive disorder and 27 normal controls 4–6 months after the attacks. Participants completed a 15‐item questionnaire to retrospectively assess changes in mood, cognition, behavior and somatic complaints since September 11, 2001. Overall, both patients with obsessive compulsive disorder and normal controls reported minor changes in mood, behavior and somatic complaints. However, normal controls reported severe to extreme initial impact, slightly more cognitive symptoms (uncertainty about the future, intrusive recollections and greater desire to be with loved ones) and a slightly greater degree of overall impact on emotion and behavior at 1, 2 and 3 months after September 11 than did patients with obsessive compulsive disorder. Results support previous research that has found a relatively minor lasting impact of September 11 on both clinical and normal populations. Differences in cognition and coping mechanisms between normal controls and patients with obsessive compulsive disorder are proposed.     

Effects of September 11 on patients with obsessive compulsive disorder

Effects of the September 11, 2001 terrorist attacks in the USA were investigated in 25 patients with obsessive compulsive disorder and 27 normal controls 4-6 months after the attacks. Participants completed a 15-item questionnaire to retrospectively assess changes in mood, cognition, behavior and somatic complaints since September 11, 2001. Overall, both patients with obsessive compulsive disorder and normal controls reported minor changes in mood, behavior and somatic complaints. However, normal controls reported severe to extreme initial impact, slightly more cognitive symptoms (uncertainty about the future, intrusive recollections and greater desire to be with loved ones) and a slightly greater degree of overall impact on emotion and behavior at 1, 2 and 3 months after September 11 than did patients with obsessive compulsive disorder. Results support previous research that has found a relatively minor lasting impact of September 11 on both clinical and normal populations. Differences in cognition and coping mechanisms between normal controls and patients with obsessive compulsive disorder are proposed.     

Cognitive Restructuring-Assistance in the Clinical Extinction of Fear and Avoidance

Abstract

Two case studies are presented in which the attempted extinction of negative reinforcement-maintained behavior was unsuccessful because clients were unable to completely stop avoiding the target situations. Clinical treatment was based on the hypothesis that a self-control deficit caused the problem behavior to be maintained because of partial negative reinforcement. In the first case, a male college student experienced considerable anxiety while urinating in public restrooms. He frequently avoided or escaped restrooms with people in them, thus causing a number of secondary problems. The second case was a college female who engaged in an obsessive-compulsive chain in which a catastro-phizing thought set the occasion for engaging in compulsive behavior. The compulsive behavior was taking up a large amount of her time. After unsuccessfully using therapeutic instructions designed to preclude avoidance, systematic cognitive restructuring was used as a way to increase the likelihood clients would follow instructions and discontinue avoidance behavior by decreasing the mediational control of negative and irrational verbal behaviors. Both cases showed that compliance with the extinction instructions was enhanced by combining cognitive restructuring with the treatment program.     

Pointing and the interference effect in obsessive‐compulsive disorder (OCD)

The interference effect in obsessive‐compulsive disorder (OCD) was investigated in order to analyze cognitive aspects of motor stereotypy in OCD‐related compulsions. So far, the domain of cognitive control in compulsive behavior has been under‐investigated. Twelve participants (OCD patients and healthy controls) completed a newly created computer‐based pointing task as well as standard clinical and psychological background measures. Findings showed that the patients displayed a larger visual interference effect compared to the controls and pointing paths were longer in time as well as distance when a distractor stimulus was present. It is concluded that, for compensation, patients would need to generate excessive amounts of attentional resources not available to overcome motor rigidity on the one side and visual distraction on the other side.     

Sexual Efficacy of Adolescents,Permissiveness, and the Transition Toward Nonvirginity: From Intention to Behavior1

The current study examines teenage sexual behavior (in terms of having had sexual intercourse) as a function of sexual attitudes and sexual efficacy. At the heart of the study lies the assumption that sexual attitudes such as permissiveness are related to sexual behavior, but that this relation is stronger for sexually efficacious teenagers than for others. Using longitudinal data from 253 British adolescents, a structural equation model is tested and fit. The results provide partial support for the expectations, demonstrating the usefulness of sexual efficacy in predicting sexual behavior. Limitations and implications of the study are discussed.     

Exposure and response prevention of morbid ruminations and compulsive avoidance

Two patients with morbid ruminations and compulsive avoidance behavior were independently treated by the authors with exposure and response prevention strategies. The patients were quite different with respect to age (23 vs 58), occupational status (student vs civil servant) and length of disorder (2 vs 40 years), although their disorders were quite similar. The present report describes the patients and treatment procedures and reports on dramatic behavioral changes that occurred within brief time periods.     

Exposure and Response Prevention and Habit Reversal Training: Commonalities, Differential Use, and Combined Applications

Obsessive-compulsive spectrum disorders (OCSDs) have compulsive (i.e., anxiety reductive) and impulsive (i.e., driven by emotional or involuntary impulses) features. The best established psychological treatments for these disorders are behavioral/cognitive-behavioral in nature. More specifically, exposure and response prevention (ERP) (with or without cognitive therapy) and habit reversal training (HRT) are commonly indicated in the treatment of OCSDs. This paper reviews the use of various components of these therapeutic approaches to treat compulsive and impulsive symptomology in individuals with variants of these disorders. Specifically, ERP monotherapy for compulsive (e.g., obsessive-compulsive, body dysmorphic) and impulsive symptoms (e.g., tics, trichotillomania) is discussed as well as a combined treatment approach that integrates elements of ERP and HRT for individuals displaying mixed symptomology. A case example is also provided that illustrates the successful application of various components of ERP and HRT to treat OCSD symptoms. Lastly, other potential OCSD treatments are discussed.