Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis

Objectives: To evaluate the efficacy of a group therapy based on cognitive-behavioral techniques customized for intermittent explosive disorder (IED). The current report presents the preliminary results of a clinical trial comparing pre- and post-intervention scores in different anger dimensions. Methods: The studied sample consisted of 84 treatment-seeking subjects. The mean (standard deviation) age was 43.0 (11.9) years, and 78% were male. The therapeutic group program consisted of 15 weekly sessions plus three maintenance sessions. The sessions lasted approximately 90 minutes each. Results: No differences were found in demographic profile and pre-treatment status between subjects who completed treatment (n=59) and dropouts (n=25). Comparison of State-Trait Anger Expression Scale (STAXI) scores pre- and post-treatment showed statistically significant changes in all anger scales and subscales of the questionnaire. Conclusion: This preliminary report is a significant addition to currently scarce clinical data. Our findings provide further evidence that structured cognitive-behavioral group therapy, with a focus on anger management and cognitive coping, may be a promising approach to the treatment of IED.

A cross-cultural study of gambling disorder: a comparison between women from Brazil and the United States

Objective: To perform a cross-cultural comparison of gambling disorder (GD) in women from Brazil and the United States, two countries with pronounced social and cultural differences. We hoped to produce insight into the impact of cultural influences on the presentation of GD in women, which may be useful for the development of culturally-sensitive interventions. Method: We assessed 681 women with GD: 406 from a Brazilian sample and 275 from a U.S. sample. We assessed demographic and gambling behavior variables in addition to co-occurring psychiatric disorders. Results: Fewer Brazilian participants were Caucasian (73.3 vs. 91.3%; p = 0.022). Also, Brazilian women had lower levels of education (59.9% with high school or less vs. 44.4%; p < 0.001), and were more likely to have a current partner (54.9 vs. 43.4%; p = 0.003). Brazilian gamblers also reported lower urge scores (6.6±4.3 vs. 11.6±2.4; p < 0.001) and higher chasing rates (89.1 vs. 80.0%; p = 0.002). Brazilian gamblers reported higher rates of bingo gambling (19.2 vs. 5.7%; p < 0.001), but lower rates of card game gambling (5.8 vs. 23.1%; p < 0.001). Finally, Brazilian gamblers were more likely to endorse a history of major depressive disorder (36.9 vs. 24.4%; p = 0.001). Conclusions: This study reinforces the need for further general cross-cultural research on GD and particularly for studies investigating how gender mediates these differences. Finally, the differences noted in this analysis suggest that the findings of predominantly Anglo-Saxon cultures may not be generalizable to other world populations.

Hoarding disorder: a new diagnostic category in ICD-11?

Despite the long-held view that hoarding is a symptom of both obsessive-compulsive disorder and obsessive-compulsive personality disorder, increased evidence has emerged during the last 20 years suggesting that hoarding represents a distinct form of psychopathology. This study reflects the discussions on the nosological status of hoarding carried out by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. The distinctiveness of hoarding is based on its having core symptoms that differ from those of other disorders, as well as distinctive neurobiological correlates and treatment responses. Furthermore, data showing the clinical utility, global applicability, and appropriateness of the concept of hoarding disorder outside specialty mental health settings suggest that this condition should be included in ICD-11. Finally, given the focus of ICD-11 on primary care and public health, the Working Group suggests that poor insight and severe domestic squalor may be considered as specifiers for hoarding disorder in ICD-11.

Body-focused repetitive behavior disorders in ICD-11

This article addresses the question of how body-focused repetitive behavior disorders (e.g., trichotillomania and skin-picking disorder) should be characterized in ICD-11. The article reviews the historical nosology of the two disorders and the current approaches in DSM-5 and ICD-10. Although data are limited and mixed regarding the optimal relationship between body-focused repetitive behavior disorders and nosological categories, these conditions should be included within the obsessive-compulsive and related disorders category, as this is how most clinicians see these behaviors, and as this may optimize clinical utility. The descriptions of these disorders should largely mirror those in DSM-5, given the evidence from recent field surveys. The recommendations regarding ICD-11 and body-focused repetitive behavior disorders should promote the global identification and treatment of these conditions in primary care settings.

Cleptomania: características clínicas e tratamento / Kleptomania: clinical characteristics and treatment

OBJECTIVES: Kleptomania, a disabling impulse control disorder, is characterized by the repetitive and uncontrollable theft of items that are of little use to the afflicted person. Despite its relatively long history, kleptomania remains poorly understood to the general public, clinicians, and sufferers. METHOD: This article reviews the literature for what is known about the clinical characteristics, family history, neurobiology, and treatment options for individuals with kleptomania. RESULTS: Kleptomania generally has its onset in late adolescence or early adulthood and appears to be more common among women. Lifetime psychiatric comorbidity is frequent, mainly with other impulse control (20-46 percent), substance use (23-50 percent) and mood disorders (45-100 percent). Individuals with kleptomania suffer significant impairment in their ability to function socially and occupationally. Kleptomania may respond to cognitive behavioral therapy and various pharmacotherapies (lithium, anti-epileptics, and opioid antagonists). CONCLUSIONS: Kleptomania is a disabling disorder that results in intense shame, as well as legal, social, family, and occupational problems. Large scale treatment studies are needed.

OBJETIVOS: A cleptomania, um transtorno incapacitante do controle dos impulsos, caracteriza-se pelo furto repetitivo e incontrolável de itens que são de pequena utilidade para a pessoa acometida por esse transtorno. Apesar de seu histórico relativamente longo, a cleptomania continua sendo pouco entendida pelo público geral, pelos clínicos e pelos que dela sofrem. MÉTODO: Este artigo revisa a literatura sobre o que se sabe a respeito das características clínicas, histórico familiar, neurobiologia e opções de tratamento para indivíduos com cleptomania. RESULTADOS: A cleptomania geralmente tem seu início no final da adolescência ou no início da vida adulta, e parece ser mais comum em mulheres. A comorbidade psiquiátrica ao longo da vida com outros transtornos de controle de impulsos (20-46 por cento), de uso de substâncias (23-50 por cento) e de humor (45-100 por cento) é freqüente. Indivíduos com cleptomania sofrem de prejuízo significativo em sua capacidade de funcionamento social e ocupacional. A cleptomania pode responder ao tratamento com terapia cognitivo-comportamental e com várias farmacoterapias (lítio, antiepilépticos e antagonistas de opióides). CONCLUSÕES: A cleptomania é um transtorno incapacitante que resulta em uma vergonha intensa, bem como problemas legais, sociais, familiares e ocupacionais. São necessários estudos de tratamento em ampla escala.