Should pathological gambling and obesity be considered addictive disorders? A factor analytic study in a nationally representative sample

Childhood psychosocial challenges and risk for obesity in U.S. men and women

Childhood psychosocial challenges (i.e., adversities, mental and substance use disorders, social challenges) may relate to the onset of obesity and extreme obesity. Identifying the types of psychosocial challenges most strongly associated with obesity could advance etiologic understanding and help target prevention efforts. Using a nationally representative sample of U.S. adults (N = 24,350), the present study evaluates relationships between childhood psychosocial challenges and development of obesity and extreme obesity. After mutually controlling, childhood poverty was a risk in men OR = 1.2 (1.0-1.4) and a significantly stronger one in women OR = 1.6 (1.4-1.8); maltreatment increased odds of obesity in both men and women OR = 1.3, 95% CI (1.1-1.4), and specifically increased odds of extreme obesity in women OR = 1.5 (1.3-1.9). Early childrearing (before age 18) was an independent risk factor in both men OR = 1.4 (1.0-1.9) and women OR = 1.3 (1.1-1.5); not finishing high school was the strongest childhood psychosocial challenge risk factor for extreme obesity in both men (OR = 1.6, 1.1-2.2) and women (OR = 2.0, 1.5-2.5). Psychiatric disorders (MDD, anxiety disorder, PTSD) before age 18 were not independently associated with adult obesity in men nor women, but substance use disorders (alcohol or drug) were inversely associated with adult obesity. Individuals who have experienced childhood adversities and social challenges are at increased risk for obesity. Previous findings also indicate that these individuals respond poorly to traditional weight management strategies. It is critical to identify the reasons for these elevated weight problems, and to develop interventions that are appropriately tailored to mitigate the obesity burden faced by this vulnerable population.

Problematic internet use in gamblers: impact on clinical and cognitive measures

OBJECTIVE

Gambling is a commonplace phenomenon, existing along a continuum from occasional gambling to functionally impairing gambling disorder. The internet may act as a conduit for some gambling behaviors. The impact of problematic internet use on clinical and cognitive features relevant to gambling has received little research attention.

METHODS

A total of 206 adults aged 18-30 years who gamble at least five times per year were recruited from the general community and undertook detailed clinical and cognitive assessments. Problematic internet use was defined using a total score of 5 or more on Young's Diagnostic Questionnaire (YDQ). Linear regression was employed to evaluate the relative contribution of addictive-related, impulsive-related, and compulsive-related measures in predicting YDQ total scores in gamblers.

RESULTS

Gamblers with problematic internet use (18% of the sample) reported lower quality of life, lower self-esteem, elevated rates of intermittent explosive disorder, gambling disorder symptoms, attention deficit hyperactivity disorder (ADHD) symptoms, antisocial personality disorder, and posttraumatic stress disorder (PTSD), as well as relative deficits in decision making and spatial working memory. In linear regression, the extent of problematic internet use was most significantly associated with increased gambling disorder symptoms and increased ADHD symptoms.

CONCLUSIONS

Problematic internet use in gamblers is associated with worse quality of life, more problem/pathological gambling symptoms, more psychiatric morbidities, and select cognitive impairment. Refinement of the definition of problematic internet use and exploration of its clinical and cognitive associations are likely to be highly relevant to the treatment of problematic gambling.

Cardiovascular disease and psychiatric disorders among Latinos in the United States

PURPOSE

Cardiovascular disease (CVD) is the leading cause of death among Latinos and disproportionately impacts people with psychiatric disorders. The aim of this study was to examine the relationships between CVD and psychiatric disorders among different Latino subgroups using a nationally representative sample.

METHODS

Latinos participants (N = 6359) were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. A structured diagnostic interview was used to determine psychiatric diagnoses for any past-year mood, anxiety, and substance use disorders. A self-reported measure of physician-confirmed CVD was used. The relationships between CVD and psychiatric disorders among Latino subgroups were examined with logistic regression models adjusting for sociodemographics, CVD-risk factors, and acculturation.

RESULTS

CVD were highest among Puerto Ricans (12%) and Cubans (11%), followed by Other Latinos (7%) and Mexicans (5%). The relationship between psychiatric disorders and CVD differed by Latino subgroups. Significantly increased odds of CVD were found among Mexicans with any past-year mood and anxiety disorders, Puerto Ricans with any past-year psychiatric disorders, Cubans with any past-year mood and substance abuse disorders, and Other Latinos with any past-year mood, anxiety, and lifetime schizophrenia/psychotic disorders.

CONCLUSIONS

The associations between CVD and psychiatric disorders are not uniform among Latinos. Efforts to address the need for health and mental health services must carefully consider this heterogeneity.

Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. On functional and compulsive aspects of reinforcement pathologies

BACKGROUND

This paper is a commentary to a debate article entitled: "Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research", by Billieux et al. (2015). METHODS AND AIM: This brief response focused on the necessity to better characterize psychological and related neurocognitive determinants of persistent deleterious actions associated or not with substance utilization.

RESULTS

A majority of addicted people could be driven by psychological functional reasons to keep using drugs, gambling or buying despite the growing number of related negative consequences. In addition, a non-negligible proportion of them would need assistance to restore profound disturbances in basic learning processes involved in compulsive actions.

CONCLUSIONS

The distinction between psychological functionality and compulsive aspects of addictive behaviors should represent a big step towards more efficient treatments.

Towards a comprehensive developmental model of pathological gambling

AIMS

To develop a comprehensive etiological model of pathological gambling (PG) for men and women based on Kendler's development model for major depression, which groups 22 risk factors into five developmental tiers (childhood, early adolescence, late adolescence, adulthood, last year). We hypothesized that: (1) all risk factors would be associated significantly with PG; (2) the effect of risk factors in earlier developmental tiers would be accounted for by later tiers; and (3) there would be few gender differences.

DESIGN

Separate models were built for life-time gambling and for 12-month PG among those with life-time gambling.

SETTING

Data drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the United States.

PARTICIPANTS

Respondents to NESARC wave 1 (n = 43 093).

MEASUREMENTS

Odds ratios (OR) and adjusted OR (AOR) were used to determine the risk factors in multiple models.

FINDINGS

After mutually adjusting for other risk factors, family history of substance use disorders (SUD) or depression, impulsivity, childhood-onset anxiety, number of Axis I and II disorders, history of SUD, nicotine dependence, social deviance in adulthood, and past-year history of SUD, nicotine dependence and independent stressful life events predicted life-time gambling. Past history of PG, number of personality disorders and past year nicotine dependence were associated significantly with 12-month PG (all P < 0.05). There were no significant gender interactions for 12-month PG.

CONCLUSIONS

A modification of Kendler's model for major depression provides a foundation for the development of a comprehensive developmental model of pathological gambling. Life-time history of gambling and 12-month pathological gambling appear to be determined by risk factors in several developmental levels, with the effect of earlier development tiers accounted for by later ones.