Medications for behavioral addictions

Abstract

This chapter discusses pharmacotherapy to treat behavioral addictions. Pathological gambling, kleptomania, trichotillomania (TTM), pyromania, and intermittent explosive disorder (lED) are all formally recognized by the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) as impulse control disorders (ICDs) Not Elsewhere Classified. Although compulsive buying, compulsive sexual behavior (CSB), Internet addiction. and pathological skin picking (PSP) are not formally recognized by the DSM, they are generally included as impulse control disorders, Not Otherwise Specified. Relatively little is known about behavioral addictions compared to other psychiatric illnesses. Most research has focused on pathological gambling (PG), but research concerning clinical and biological/genetic characteristics of all types of behavioral addictions is greatly needed to better inform researchers, clinicians, and the general public. Large, randomized, placebo-controlled studies are especially needed to gain knowledge about beneficial treatments. Taken as a whole, pharmacological treatment studies have suggested that opioid antagonists may be useful for some behavioral addictions, while serotonergic antidepressants may be useful for others however, the data are limited and results should be interpreted with caution. Data from glutamatergic agent studies warrant further research in their use for the treatment of PG and trichotillomania (TTM). Further exploration of atypical antipsychotics for the treatment of TTM is also needed. Data regarding lithium, antiepileptic, and stimulant medications are extremely limited and inadequate to reach any clinical judgments. Closer examination of the heterogeneity across and within these disorders and how that heterogeneity impacts pharmacological treatment is an area for further research. Advances in these areas will hopefully increase public awareness of these disorders, serving to improve the lives of those both directly and indirectly affected by behavioral addictions. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

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