Behavioral Addictions _ _______________________________________________________________________
Surgical Interventions Bariatric surgery is a treatment option for binge eating disor- der with severe obesity (BMI ≥40 or BMI ≥35 with comorbid conditions). In the past, an eating disorder diagnosis was a contraindication to bariatric surgery, but this restriction has been relaxed. The disability and difficulty achieving stable weight loss with standard behavioral interventions has increas- ingly led to surgery candidates with binge eating disorder [245; 274]. Bariatric surgery can be suitable for selected patients with binge eating disorder, but the extent of weight loss depends on post-surgery binge episode reduction, and 20% to 40% fail to lose sufficient weight or regain significant weight post-surgery [275]. Patients may experience emergent post-bariatric surgery psychiatric comorbidities. Considering the demonstrable and durable behavioral and neuroplastic changes associated with addictive eating behavior, obesity treatment is not realistic for some of these patients [276]. Overeaters Anonymous Overeaters Anonymous (OA) is a 12-step program for compul- sive overeaters. Binge eating is viewed as a physical, spiritual, and emotional disorder, and OA proposes recovery through change that promotes physical, spiritual, and emotional well- being. Members have stated the tools for spiritual and emo- tional work provided in OA were essential to recovery. Secure attachment experiences are very likely to occur within OA, in which safe ground is provided and positive attachment figures are accessible. These factors facilitate a corrective emotional experience that compensates for childhood rejection and time spent with a caregiver who lacked the emotional availability required for the creation of a secure attachment [277]. The contribution of secure attachment figures to binge-eating recovery is consistent with other research that connects emo- tional overeating in women to attachment-related themes of relationship history, addiction as coping mechanism for insecure attachment, emotional eating as reminiscent of ambivalent attachment, and emotional hunger [278]. COMPULSIVE BUYING DISORDER Compulsive buying disorder, also termed shopping addiction, pathologic buying, or compulsive buying, is characterized by excessive or poorly controlled preoccupations and urges to spend. The excessive, impulsive, and uncontrollable purchase of products persists despite severe psychological, social, occu- pational, or financial consequences [279; 280]. EPIDEMIOLOGY AND RISK FACTORS The prevalence of compulsive buying disorder in the United States is 5.8% to 8.9% [281; 282]. However, estimating compulsive buying disorder prevalence is difficult because standardized diagnostic criteria are lacking. Current defini- tions are based on similarities between compulsive buying disorder and substance/behavioral addictions, OCD, and eating disorders [280].
The prevalence of compulsive buying has increased worldwide in the past two last decades. The pooled results of 40 compul- sive buying prevalence studies from 16 countries found rates of 4.9% in adults, 8.3% in university students, and 12.3% in shopping-specific samples (e.g., shopping mall visitors). Younger age and female sex were associated with increased risk, but prevalence rates in the United States and other studied countries did not differ [283]. In one study, among 1,441 shopping mall visitors, the rate of compulsive buying disorder was 8.7% [283]. Compared with non-compulsive buyers, compulsive buyers were younger, less educated, more likely female, and more likely to have used licit and illicit substances. They also showed higher levels of impulsivity and obsessive-compulsive symptoms, lower levels of well-being and self-esteem, and greater psychological distress. Patients identified as compulsive buyers were five times more likely to meet diagnostic criteria for borderline personality disorder. These findings suggest that, among shopping mall visitors, compulsive buyers are prevalent and have high rates of important indicators for psychopathology [283]. COMORBIDITY Comorbidities associated with compulsive buying disorder include [281; 284]: • Mood disorders (21% to 100%) • Personality disorders (60%) • Anxiety disorders (40%) • Substance use disorders (24% to 46%)
• Eating disorders (8% to 85%) • Impulse control disorders (35%)
Patient samples show positive associations between compulsive buying disorder and bulimia nervosa, substance use disorders, gambling disorder, and impulse control disorders (e.g., inter- mittent explosive disorder). Compulsive buying disorder and ADHD are highly comorbid in both community and clinical samples. Patients with compulsive buying disorder also suffer high comorbidity with depressive and anxiety disorders, OCD, and hoarding disorder [285]. In a comparison of outpatients with compulsive buying dis- order, inpatients without compulsive buying disorder, and healthy controls, the patients with and without compulsive buying disorder did not differ in borderline personality disor- der symptoms, ADHD symptoms, or self-harming behaviors. Current impulse control disorder diagnosis was three times greater in patients with compulsive buying disorder than those without or control groups, despite patients with compulsive buying disorder perceiving themselves as being no more impul- sive than either comparison groups [285].
58
EliteLearning.com/Social-Work
Powered by FlippingBook