Clinical Signs and Symptoms of Addictive Behaviors

By Korpa, Terpsichori N.; Papadopoulou, Pinelopi, V | International Journal of Child and Adolescent Health, October 1, 2013 | Go to article overview

Clinical Signs and Symptoms of Addictive Behaviors


Korpa, Terpsichori N., Papadopoulou, Pinelopi, V, International Journal of Child and Adolescent Health


Introduction

There exist a range of behavior patterns like pathological gambling, overeating, excessive Internet use, compulsive sex and buying, defined as addictive behaviors, which (including substance use-related addictive disorders) are associated with serious family, school/work and social problems. Many addicted individuals show clinical functional impairment as well. For this reason, addictive behaviors constitute major public health issues. Prevention, assessment and early intervention in this field are critical.

Clinical experts specialized in evaluating and treating addictive disorders support the view that patients, who give up alcohol or illicit drug use, usually transfer their addictive behavior to activities such as Internet, sex etc. Additionally, significant similarities can be recognized between biological and behavioral addictions. Adolescents exhibiting behavioral addictions often meet diagnostic criteria for substance use disorders (see table 1) (1).

Behavioral addictions represent clinical entities, not classified in Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) (2) (except pathological gambling), during which repetitive impulsive behaviors take place with a strong negative impact on the patient and his close environment.

Given the fact that the specific addictions are dangerous psychiatric conditions manifested in the developmental period of adolescence and that early onset of pathological gambling is connected to more psychiatric problems, family/social problems, substance use, cognitive problems and suicidal ideation, it is considered critical mental health professionals to be informed about the clinical symptomatology of these behaviors, so that they will able to identify the addiction and to manage it (3). In this review we will look at these main addictive behaviors.

Pathological gambling

Nowadays, adolescents and young people are grown up in a society, where gambling, pathological or not, is an accessible and a socially acceptable activity. The mean age onset for pathological gambling is 11.5 years worldwide. According to international studies, the prevalence of the disorder is estimated to be 2-4 higher in adolescents compared to adults. It is noteworthy that 3.5-8% of adolescents aged 12-17 years are diagnosed as "pathological gamblers". Gambling in adolescence is associated with poor school performance, criminal behavior and family conflicts. Moreover, not only recreational but also pathological gambling is connected to psychiatric comorbidity in adults and high-risk behaviors in adolescents (4).

As mentioned above, pathological gambling is the only behavioral addiction described in this chapter, which is encoded in both international classification systems. More specifically, it is incorporated in the section "impulse control disorders" with other clinical disorders (pyromania, trichotillomania) in DSM-IV (see table 2); while in ICD-10 it is included in the category "personality and behavior disorders in adults". In February 2010, the DSM-V task force suggested that the "substance-related disorders" should be renamed "addiction and associated disorders" and pathological gambling should be introduced as the only behavioral addiction in the diagnostic textbook (5,6).

As far as the main clinical symptoms of the disorder are concerned, it could be argued that the addictive behavior, which accounts for the pathological involvement in the activity, contains compulsive use, loss of control and continuous use despite adverse consequences (7). Finally, pathological gambling, as defined by DSM-IV, tends to be manifested along with further psychiatric disorders, including anxiety disorders, alcohol abuse and substance use disorders. Additionally, comorbid major depressive episode is relative common, as some researchers may claim that 2/3 of these patients could meet the diagnostic criteria for major depressive disorder (8). As a result, adolescents do represent a vulnerable social group, which is susceptible to present comorbid psychiatric disorders. …

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