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P01: olicognography

P02: addictions

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OLICOGNOGRAPHY on ADDICTIONS

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Non Product Addictions - Behavioral Addictions

Basic Olicognograph: Addict Psychological Management

Non pharmacologic addictions or behavioral addictions (often related to compulsions) present a wide variety as: gambling, internet (including buying, chats, sex and online games, sports, addiction to work ("workalcoholic"), compulsive buying, compulsive sex, affective relations, some forms of criminality (kleptomania), fasting (anorexia) or excessive feeding (boulimia), strong sensations seeking, celular-wireless phones users.

These disorders are classified in 3 groups: 1) Feeding disorders as mental anorexia and bulimia; 2) paraphilia concerning sexuality; 3) impulsive-compulsive disorders including aggressive as kleptomania, pyromania, pathologic gambling, trichillomania.

Characteristics of behavioural addictions include: 1) The behaviour is exhibited over a long period of time (at least 12 months) in an excessive, aberrant form, deviating from the norm or extravagant (e.g., regarding its frequency and intensity) 2) Loss of control over the excessive behaviour (duration, frequency, intensity, risk) when the behaviour started 3) Reward effect (the excessive behaviour is instantly considered to be rewarding) 4) Development of tolerance (the behaviour is conducted longer, more often and more intensively in order to achieve the desired effect; in unvaried form, intensity and frequency the desired effect fails to appear) 5) The behaviour that was initially perceived as pleasant, positive and rewarding is increasingly considered to be unpleasant in the course of the addiction 6) Irresistible urge/craving to execute the behaviour 7) Function (the behaviour is primarily employed as a way to regulate emotions/mood) 8) Expectancy of effect (expectancy of pleasant/positive effects by carrying out the excessive behaviour) 9) Limited pattern of behaviour (also applies to buildup and follow-up activities) 10) Cognitive occupation with the build-up, execution and follow-up activities of the excessive behaviour and possibly the anticipated effects of the excessively executed behaviour 11) Irrational, contorted perception of different aspects of the excessive behaviour 12) Withdrawal symptoms (psychological and physical) 13) Continued execution of the excessive behaviour despite negative consequences (health-related, occupational, social) 14) Conditioned/learned reactions (resulting from the confrontation with internal and external stimuli associated with the excessive behaviour as well as from cognitive occupation with the excessive behaviour) 15) Suffering (desire to alleviate perceived suffering)

Common origin may be shared between non pharmacologic and pharmacologic addictions, as (to investigate especially with neurofunctionnal imaging) 1) biological in the disturbance of reward system; 2) Genetic disorders (to explore); 3) Psychologic diorders by oversimulation of neuro-system in emotionnally difficult situations; 4) Social by exposition and behavioral induction.

Pathological gambling (PG) is a prevalent and highly disabling impulse-control disorder. 2 dominant phenomenological models for PG have been presented in the literature. According to one model, PG is included as an obsessive-compulsive spectrum disorder, while according to the second model, PG represents a form of nonpharmacologic addiction. A crucial task regrading the diagnostics of excessive gambling lies in the precise assessment of the different, clinically relevant grades of risky, problematic and pathologic gambling. The most commonly used and thoroughly evaluated screening instruments in assessing pathological gambling is the “South Oaks Gambling Screen“ (SOGS). Pathological gambling appears to be associated with other psychiatric disorders, most notably mood disorders, anxiety disorders, personality disorders, other impulse control disorders, and alcohol and other substance abuse and dependence. Emerging data in the field show that PG may be responsive to a range of psychopharmacologic agents including SSRIs, mood stabilizers, opioid antagonists, and the psychostimulant bupropion. We note that there is also preliminary evidence that combination pharmacotherapy has a role in the treatment of impulse-control disorders. PG may represent a heterogeneous disorder with different subtypes. Studies of psychiatric comorbidity, family studies, demographic information, and psychological profiles (i.e., attentional deficits and impulsivity) are useful in building models of PG subtypes.

Compulsive buying: one of the first instruments aimed at diagnosing excessive buying was the"Compulsive Buying Measurement Scale". Its items reflect the 4 dimensions of pathological buying: a tendency to spend, feeling an urge to buy or shop, post-purchase guilt, and family environment. While its evaluation showed a good reliability and validity, it was noticed that high scores also corresponded to heightened anxiety levels and frequent occurrence of comorbid disorders such as bulimia nervosa, depression or alcoholism within the family.

Compulsive exercising is a process forcing individuals to engage in exercise despite any obstacles or to exhibit withdrawal symptoms in case that exercising cannot be conducted ("addicition"), commitment constitutes an engagement in physical activity out of pleasure and expected satisfaction. According to the assumptions that addictions can be classified into positive and negative ones (e.g., excessive running is positive, drugs are negative). Prequels to diagnostic instruments used to assess exercise addiction were a psychoanalytically oriented interview and the "Commitment to Running Scale" (CR).The "Exercise Beliefs Questionnaire" assesses individual assumptions regarding exercise based on four factors: "social desirability", "physical appearance", "mental and emotional functioning", and "vulnerability to disease and aging".

Varying definitions of workaholism exist, its operationalizations also differ. Accordingly, the corresponding checklists and questionnaires have very distinct approaches and few of these instruments possess the minimally recommended characteristics regarding scale assessment to estimate distinct aspects of behaviour. In addition, most of these instruments are not based on theory and propose different dimensions. In general, there is a lack in the evaluation of psychometric characteristics and empirical analysis. Some authors equates workaholism with alcoholism and utilizes Jellinek's diagnostic criteria for alcoholism. Others consider is not derived from the extent of qualitative and quantitative subjective focus on work, but from the attitudes and behaviours regarding mental health. “Workaholism Battery“ consists of three scales: “work involvement“, “drive“ as well as “enjoyment of work“. It shows satisfactory reliability, adequate internal consistency and reasonable convergent validity with organizational and personal variables. Also there are to measure it via the “tendency to engage in non-required work activities” (typically, spending time thinking of ways to perform work better) and “to intrude actively on the work of others” (typically, time and energy spent on taking responsibility for others).

Computer addiction assessments are mostly based on the diagnostic criteria of pathological gambling and substance-related addictions, respectively. Since the symptom complex of computer addiction was initially reported in children and teenagers that excessively played video games, most of the instruments focus on video gaming behaviour in adolescence. About internet, in practice, it is a common experience that computer and internet addiction are difficult to differentiate, adequate diagnostics should involve the consideration of the two symptom complexes and, therefore, the use of instruments assessing both internet and computer addiction as well.

Excessive sexual behaviour has hardly been examined until now and valid instruments in its assessment are scarce. The establishment of the quantity of sexual engagement or the estimation of the frequency of risky sexual activities neglects the complexity of the disorder and does not contribute to obtaining relevant addiction-related aspects, such as loss of control and development of tolerance. So far, the screening test of sexual addiction is the only available instrument in estimating sexual addiction.

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