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PubMed2001

Sexual misconduct by health care providers.

1. Just as in society in general, health care providers can engage in compulsive sexual behaviors that jeopardize their health, careers, and relationships, both personal and professional. 2. Sex addicts not only deny and rationalize their acts but also resist accepting any feedback about their sexually inappropriate behaviors. 3. To protect patients from sexual misconduct, health care providers who exhibit sexually inappropriate behaviors must be confronted, and consistent limits must be set, including terminating patient contact, if necessary. 4. Treatment for sexually compulsive behaviors is multifaceted, and signs that a person is cooperating with treatment are ceasing the compulsive behaviors, experiencing feelings of remorse, expressing regret, accepting personal responsibility, and abiding by guidelines for reinstatement.

Behavior, Addictive↗
PubMed1989

Invited case transcript. Obsessive-compulsive disorder: a behavioral case formulation.

The interviewing skills of many behavior therapists are inadequate and several possible reasons are discussed. The present manuscript focuses on construction of initial clinical hypotheses. A strategy for developing and testing initial hypotheses is presented and illustrated by transcripts from a complex case. The transcript is taken from the initial interviews with a 26 year old woman presenting the problems of emotional distress related to thoughts of harming others, and anxiety concerning her difficulty in controlling physical aggression. A behavioral analysis of the origins and maintaining factors indicated that while the patient's compulsions were a vehicle to manage anxiety, the wellspring of her attempts to exert control over her thoughts was a fear of anger, loss of control, negative evaluation, criticism, and rejection. Distal and proximal predisposing events were examined in order to help explain the development of this maladaptive behavioral pattern, and to plan therapeutic strategy.

Adult↗
PubMed2000

Compulsive buying and risky behavior among adolescents.

Using a scale designed to measure compulsive buying of adolescents, a survey was conducted to assess the relationships of compulsive buying with several risky behaviors among 111 adolescents between the ages of 12 to 19 years. The correlations suggest that self-report measures of cigarette smoking, alcohol use, drug use, and likelihood of engaging in premarital sex were all significantly associated (rs = .30 to .32) with compulsive buying among teenagers. Implications of the results are discussed, and directions for research are offered.

Adolescent↗
PubMed2002

Magical beliefs and rituals in young children.

Thirty-one children were administered a structured interview that assessed their beliefs about magic, tricks and wishes. Children were also presented with demonstrations of magic tricks/illusions, and asked to offer explanations as to how they worked. Parents completed the Childhood Routines Inventory (CRI), a 19-item parent report measure that assesses children's rituals, habits and sensory-perceptual experiences that we have termed "compulsive-like" behavior. Results indicated that children's rituals and compulsions were positively related to their magical beliefs, and inversely related to their uses of concrete, physical explanations to describe various phenomena. In particular, children's beliefs about the effects of wishing were most consistently correlated with their compulsive-like rituals and routines. The findings extended the work on magical beliefs and obsessive-compulsive phenomena to the normative manifestation of compulsive behaviors found in typical development.

Child↗
PubMed2005

Psychostimulant-induced behavior as an animal model of obsessive-compulsive disorder: an ethological approach to the form of compulsive rituals.

Rats treated chronically with the D2/D3 dopamine receptor agonist quinpirole show a pattern of behavior that meets a set of ethologically derived criteria of compulsive behavior in obsessive-compulsive disorder (OCD). Moreover, in both quinpirole-treated rats and OCD patients, the structure of compulsive rituals appear similar in being composed of relatively few motor acts that are organized in a flexible yet recurrent manner. In addition, the development of compulsive behavior in quinpirole-treated rats is attenuated by the OCD pharmacotherapeutic drug clomipramine. These similarities support the validity of quinpirole-treated rats as a psychostimulant-induced animal model of OCD. Considering that the induction of compulsive behavior in the rat model involves chronic hyperstimulation of dopamine receptors, this raises the possibility that dopaminergic mechanisms may play a role in OCD, at least in some subtypes of this disorder.

Animals↗
PubMed2003

Patterns of substance abuse among treatment-seeking pathological gamblers.

Substance abuse patterns were reviewed for a group of patients admitted to the Gambling Treatment Program at the Brecksville Veterans Administration Medical Center. A retrospective chart review of 113 consecutively admitted patients between September 2000 and September 2001 found that 66.4% of pathological gamblers had a lifetime history of substance abuse or dependence at some point in their lives. A history of substance abuse or dependence was less common among gamblers aged 60 and above. In the year prior to admission, 58.1% of those with a history of substance abuse or dependence were actively using substances. Alcohol was the most commonly used substance, followed by marijuana and cocaine. In most gamblers with comorbid disorders, the onset of substance dependence preceded the onset of problem gambling. Pathological gamblers engaged in multiple impulsive and dysfunctional behaviors including suicide attempts, compulsive shopping and spending, and compulsive sexual behavior, and the presence of comorbid substance abuse disorders may influence the degree to which pathological gamblers engage in these additional problematic behaviors. These factors have important implications for treatment and prevention of relapse, as well as for theories of addictions.

Adult↗
PubMed1999

The rituals, fears and phobias of young children: insights from development, psychopathology and neurobiology.

This study examined the relationship between ritualistic, compulsive-like behaviors and normative fears and phobias in 61 children ranging from 1 to 7 years of age. Parents reported on their children's ritualistic habits, and perfectionistic behaviors that reflect what we have previously called "compulsive-like" behaviors. Parents also reported on their children's fears and phobias. Results indicated that various aspects of children's ritualistic and compulsive-like behaviors are correlated with children's fears and phobias. Developmental differences existed such that younger children's (< 4 years) repetitive, compulsive-like behaviors were related to "prepotent" fears such as stranger and separation anxieties, whereas the compulsive-like behaviors of older children (> 4 years) were correlated with more specific, "contextual" fears such as fears of contamination, death, and fears often associated with concerns of the inner city such as burglars, assault, etc. These findings are discussed in terms of the phenomenologic and possible neurobiological continuities between normative and pathologic rituals, fears and phobias.

Ceremonial Behavior↗
PubMed1986

Successful treatment of obsessive-compulsive disorders.

Behavioral therapy and drugs have significantly improved obsessive-compulsive disorder (OCD) symptoms. A variety of behavioral therapy methods have been employed, but exposure and prevention of response, particularly, have reduced ritualistic actions of many OCD patients. Many psychoactive drugs have been tried; the tricyclic antidepressant drugs (clomipramine or Anafranel), especially in research outside the United States, have alleviated OCD symptoms as well as depression. Compulsive rituals have responded more often than obsessive actions to both behavioral and psychopharmacological therapy. Recent research has suggested that psychophysiological as well as traditional psychogenic factors may contribute to the etiology, course, and alleviation of OCD.

Anti-Anxiety Agents↗
PubMed1994

Behavior therapy for obsessive compulsive disorder.

Exposure in vivo and ritual or response prevention are the essential elements of behavior therapy for obsessive compulsive disorder. Naturalistic behavior therapy helped a fortunate few before the effective elements of behavior therapy were identified and systematically applied. Homework exposure and response prevention are essential and therapist accompaniment is seldom necessary. Homework sessions are planned by patient and clinician and written records facilitate treatment modifications during homework sessions. About a quarter of patients refuse behavior therapy, but 90% of the remainder achieve worthwhile gains with exposure and response prevention. Limited availability of behavior therapy is a substantial public health problem.

Behavior Therapy↗
PubMed1989

Bilateral tectal projection of single nigrostriatal dopamine cells in the rat.

Employing fluorescent retrograde double/triple labeling techniques, we found that a substantial population of substantia nigra pars reticulata cells send divergent axon collaterals to both the ipsilateral striatum and bilateral superior colliculi in the rat. These multi-collateralized neurons were localized predominantly in the ventrolateral portion of the substantia nigra pars reticulata at its rostral level. Furthermore, tyrosine hydroxylase immunofluorescence histochemistry combined with fluorescent retrograde tracing techniques showed that the vast majority (more than 85%) of such specifically branched cells are dopaminergic. This novel nigral cell population seems to be in a strategic position to evoke dopamine-mediated motor impairments (i.e. abnormal saccadic eye movements in Parkinsonism) and/or behavioral syndromes (i.e. compulsive turning behavior) through the GABA-containing nigrotectal pathway.

Animals↗
PubMed2002

Drug addiction as drive satisfaction ("antidrive") dysfunction.

Drug addiction is a complex brain disorder, characterized by the loss of control over drug seeking and drug taking behavior, and by the risk of relapse, even after a prolonged period of abstinence. This disorder may have its source in a disturbed balance of drive-related behaviors, which control appetitive reactions aimed at seeking contact with an addictive substance. The act of consumption becomes more and more attractive, and the behavior takes on compulsive character. We suppose that drug addiction may involve a change in the mechanism of satisfaction of drives and states of satiation as well. To understand how the motivational processes are changed with the development of dependence, one must consider the mechanism of drive satisfaction and satiation states that occur in relation to the consumatory reflex. When a given drive is satisfied a state of fulfillment occurs. This state may be a result of a so-called "antidrive" mechanism (Konorski 1967). While a drive activity is characterized by general activation and tension, the drive satisfaction state ("antidrive") is characterized by relaxation and relief. When a particular drive is satisfied, the operation of other drives become possible. Therefore, we postulate that dysfunction of drive satisfaction leads to the sustained activation related to the current drug-related drive, which blocks the operation of other drives. In effect, uncontrolled compulsive appetitive behavior is released, and the operation of other drives is restrained, thus forcing the organism to focus on drug-related drive. The reason for an "antidrive" dysfunction may be related to adaptive changes which develop during a contact with an addictive substance.

Drive↗
PubMed1998

Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates.

A specific link between self-injurious behavior and bulimia nervosa has been observed. In affective spectrum disorders, some authors propose a distinction between impulsive and compulsive self-injurious behavior. One of the aims of the present study is to examine how different kinds of self-injurious behavior, including purging behavior, may be classified in bulimia nervosa. The clinical impact of the different types of self-injury will be studied. The subjects of the study were 125 consecutive patients with bulimia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-report questionnaires (Eating Disorders Inventory and Hopkins Symptom Checklist). In our sample, the distinction between compulsive and impulsive self-injurious behavior appeared to be confirmed by a principal component analysis. Self-induced vomiting loaded on the compulsive dimension and laxative abuse on the impulsive dimension. To study the clinical impact of the two kinds of behavior, bulimic subjects were divided according to their position in the two dimensions. The presence of impulsive self-injurious behavior is associated with a history of sexual abuse and with higher scores on the Symptom Checklist. The presence of both impulsive and compulsive behavior is associated with greater depression, whereas the presence of impulsive features in the absence of compulsive ones seems to be linked to a longer duration of illness and to a higher dropout rate. Both compulsive and impulsive self-injurious behaviors are associated with a greater lack of interoceptive awareness.

Adolescent↗