Hyoun S. Kim

Disordered gambling and psychosis: Prevalence and clinical correlates

A paucity of research has examined the relationship between psychosis and disordered gambling. Individuals with both psychosis and disordered gambling may represent a uniquely vulnerable clinical population given important commonalities in underlying brain pathology and clinical symptomatology that occur across both disorders (e.g., Potenza and Chambers, 2001), which may manifest in increased risk of poly-comorbidity and symptom severity among this dual disorder population. To our knowledge, only one study has examined rates of psychosis among disordered gamblers, which were found to be 3.5 times higher than non-gamblers (Cunningham-Williams et al., 1998), and no studies have examined the demographic and clinical correlates in a sample of disordered gamblers with and without psychosis. We addressed this empirical gap by examining the co-occurrence of psychosis and disordered gambling in a sample of treatment-seeking disordered gamblers to identify the rates and demographic and clinical correlates. We hypothesized that rates of psychosis would be higher in the population of disordered gamblers compared to the general population and that the dual diagnosis would be associated with greater severity of gambling-related problems and elevated rates of other psychiatric comorbidities.

When do gamblers help themselves? Self-discontinuity increases self-directed change over time ☆

Most disordered gamblers fail to take the necessary action to change their behavior. When action is taken, it is typically done under self-direction. Yet, little is known about what motivates gamblers to engage in self-directed change as researchers have focused almost exclusively on barriers to treatment seeking. Herein, we tested whether self-discontinuity (i.e., the notion that the self has undergone fundamental changes as a result of ones gambling) predicts self-directed change among gamblers experiencing sub-clinical levels of disordered gambling. Further, we tested whether this relationship would hold when controlling for feelings of shame and guilt about ones gambling as well as self-stigma as a disordered gambler (i.e., known barriers to change). To this end, 195 gamblers from the community completed a questionnaire battery that contained the variables of interest. Six months later, participants were re-contacted to assess whether they engaged in self-directed change. As hypothesized, the likelihood that self-directed change was attempted increased to the extent participants reported feeling self-discontinuous - an effect that remained significant when controlling for shame, guilt, and self-stigma. Results suggest that heightening the awareness that the gambling has fundamentally changed the self increases the likelihood of gamblers taking action to change their disordered gambling behaviors.

Who Spends Money to Play for Free? Identifying Who Makes Micro-transactions on Social Casino Games (and Why)

Social casino games are online gambling-like games found on social networking sites. They are initially free to play, however, players are encouraged to make micro-transactions (i.e., in-game purchases) for additional game credits or functionality. As a result, they generate billions of dollars in revenue. Yet, little is known as to who purchases virtual credits, let alone why. In the present research, we assessed whether there are individual differences (impulsivity, reward sensitivity, competitiveness, and problem gambling severity) between who is and who is not likely to make micro-transactions during social casino game play. Moreover, we examined possible motivations for making micro-transactions (e.g., extend play, win back lost credits) and whether the individual difference variables of interest predict reported motivation(s) for making micro-transactions. Results showed that social casino gamers who engaged in micro-transactions reported significantly higher levels of impulsivity, reward sensitivity and problem gambling severity, but not competitiveness. In terms of motivation to make micro-transactions, desire to extend play was endorsed most frequently, followed by a desire to access additional features, chasing lost credits, and to speed up play. Lastly, among participants who made micro-transactions, reward sensitivity predicted making micro-transactions to chase lost credits. These results suggest the personality make-up of social casino gamers is important to understand who is likely to make micro-transactions as well as their motivation to do so—information that could prove useful for regulation of the industry.

Assessing the Relationship between Disordered Gamblers with Psychosis and Increased Gambling Severity: The Mediating Role of Impulsivity

Objective: Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity. Method: The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale–11 provided a measure of impulsivity. Results: Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity. Conclusion: Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.

Betting to deal: coping motives mediate the relationship between urgency and Problem gambling severity

Abstract Background and aims: Elevated impulsivity traits, particularly negative and positive urgency, have been identified as robust predictors of problem gambling. However, the mechanisms that link urgency to problem gambling remain unknown. The present research examined whether self-reported gambling motives (social, coping, enhancement, financial) mediated the association between urgency and problem gambling severity. Methods: The sample consisted of 564 community gamblers (52.1% female; M age =36.10, SD = 11.25) including 156 (27.7%) who were classified as moderate risk gamblers and 141 (25%) as problem gamblers. Results: The mediation analyzes revealed that both negative and positive urgency were associated with problem gambling severity. Coping was the only motive that mediated these associations. The pattern of results remained the same when the analyzes were restricted to problem gamblers and when controlling for days gambled and money spent in the past 30 days. Conclusions: The desire to alleviate strong emotional states (negative or positive) maybe an important determinant of problem gambling. Furthermore, results indicate that treatment initiatives for problem gambling may benefit from including training for clients in alternative and more adaptive coping strategies for the effective management of intense affective states.

Kleptomania and Co-morbid addictive disorders

We examined the association between kleptomania and addictive disorders, including behavioral addictions. Fifty-three individuals with a diagnosis of kleptomania completed measures of kleptomania severity, semi-structured clinical interviews to assess co-morbid diagnosis of addictive disorders, and the Shorter PROMIS Questionnaire (SPQ) assessing an array of addictive behaviors. 20.75% of the sample met criteria for an addictive disorder; four for a substance use disorder and four for a behavioral addiction. Kleptomania severity was significantly associated with compulsive work and shopping measured by the SPQ. The results suggest the need to assess a wide array of addictive behaviors in individuals with kleptomania.

Assessing the role of impulsivity in smoking & non-smoking disordered gamblers

BACKGROUND Co-morbidity with other addictive behaviors is common in disordered gambling (DG). In particular, tobacco dependence has been found to be among the most prevalent disorders co-morbid with DG. While the extant literature has firmly established the co-occurrence of DG and smoking, there is a paucity of research examining factors that differentiate DGs who smoke from those who do not. OBJECTIVES To address this empirical gap, the current study tested whether dimensions of trait impulsivity as measured by the UPPS-P Impulsive Behavior Scale (positive urgency, negative urgency, lack of premeditation, lack of perseverance, and sensation seeking), discriminated between non-DGs and DGs based on their present smoking status: non-smoker, occasional smoker, and daily smoker. METHODS To this end, 564 community gamblers were recruited through a crowdsourcing platform (Amazons Mechanical Turk) and completed an online survey, assessing problem gambling severity, tobacco use, and trait impulsivity. RESULTS MANOVA analyses revealed significant main effects for both gambling severity and smoking status groups. Importantly, a significant gambling by smoking interaction was also found. Pairwise comparisons revealed that DGs who were daily smokers scored higher on negative urgency than those who smoked occasionally or not all. Furthermore, among non-DGs, smoking status failed to discriminate between mean scores on negative urgency. No other significant interaction effects were found for the remaining UPPS-P impulsivity facets. CONCLUSIONS Results suggest that individual components of trait impulsivity, and more specifically negative urgency, successfully differentiate DGs who do not smoke, or just smoke occasionally, from DGs who smoke daily. These findings suggest that the degree of trait impulsivity may potentially distinguish between DGs and DGs who are dually addicted to other substances such as tobacco.

Comorbid addictive behaviors in disordered gamblers with psychosis

Objective: While it has been shown that disordered gamblers with psychosis are at increased risk for comorbid psychopathology, it is unclear whether this dual-diagnosis population is also at greater risk of problematic engagement with comorbid addictive behaviors. Methods: We tested for association between disordered gambling with psychosis and comorbid addictive behaviors in a sample of 349 treatment-seeking disordered gamblers. Results: Twenty-five (7.2%) disordered gamblers met criteria for psychosis. Disordered gamblers with psychosis were no more likely to meet diagnostic criteria for current alcohol/substance use disorder than disordered gamblers without psychosis. However, this dual-disorder population reported greater misuse of shopping, food bingeing, caffeine, and prescription drugs. When controlling for multiple comparisons, binge eating was the only addictive behavior to remain significant. Conclusion: Given these findings, a comprehensive assessment of addictive behaviors – specifically food bingeing – in this population may be warranted.

Pathological jealousy and pathological love: Apples to apples or apples to oranges?

Pathological jealousy evokes emotions, thoughts, and behaviors that cause damage to social and interpersonal relationships. On the other hand, pathological love is the uncontrollable behavior of caring for a partner that results in neglecting the needs of the self. The aim of the present research was to assess the similarities and differences between the two psychopathologies of love. To this end, thirty-two individuals with pathological jealousy and 33 individuals with pathological love were compared on demographics, aspects of romantic relationship (jealousy, satisfaction, love style), psychiatric co-morbidities, personality and psychological characteristics (e.g., impulsivity). In a univariate analysis individuals with pathological jealousy were more likely to be in a current relationship and reported greater satisfaction. The avoidant attachment and the ludus love style were associated with pathological jealousy whereas the secure attachment and agape love style was associated with pathological love. Almost three-quarters (72.3%) of the sample met criteria for a current psychiatric disorder, however no differences emerged between the pathological jealousy and pathological love groups. In a binary logistic regression, relationship status and impairments in parenting significantly differentiated the groups. While both pathological jealousy and pathological love share similarities, they also present with unique differences, which may have important treatment implications.

The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating

INTRODUCTION Compulsive buying and binge eating are two frequently co-occurring psychiatric conditions. Hoarding, which is the psychological need to excessively gather and store items, is frequently associated with both compulsive buying severity and binge eating severity. In the present study, we explored whether different dimensions of hoarding are a shared feature of compulsive buying and binge eating. METHOD Participants consisted of 434 people seeking treatment for compulsive buying disorder. Registered psychiatrists confirmed the diagnosis of compulsive buying through semi-structured clinical interviews. Participants also completed measures to assess compulsive buying severity, binge eating severity, and dimensions of hoarding (acquisition, difficulty discarding, and clutter). Two-hundred and seven participants completed all three measures. RESULTS Significant correlations were found between compulsive buying severity and the acquisition dimension of hoarding. Binge eating severity was significantly correlated with all three dimensions of hoarding. Hierarchical regression analysis found that compulsive buying severity was a significant predictor of binge eating severity. However, compulsive buying severity no longer predicted binge eating severity when the dimensions of hoarding were included simultaneously in the model. Clutter was the only subscale of hoarding to predict binge eating severity in step two of the regression analysis. CONCLUSION Our results suggest that the psychological need to excessively gather and store items may constitute a shared process that is important in understanding behaviors characterized by excessive consumption such as compulsive buying and binge eating.