Adicción al tarot: a propósito de un caso / Tarot addiction: about a case

Las denominadas adicciones psicológicas, conductuales o sin sustancia han despertado un interés creciente en los últimos años debido a los problemas que el uso de las nuevas tecnologías plantea en nuestra sociedad. En la actualidad el DSM-5 sólo reconoce el "Juego Patológico", pero cada vez son más los autores que defienden el reconocimiento de otros comportamientos abusivos como el uso de Internet, la telefonía móvil, los juegos online, el sexo, las compras o el ejercicio físico entre otras. En este sentido, la OMS ha propuesto en el borrador de la CIE-11 el reconocimiento del trastorno por juego digital o video juego (gaming disorder). El caso que presentamos trata de una adicción menos conocida: la adicción a consultas del tarot, a través de líneas telefónicas de pago, en una paciente con diagnóstico de trastorno límite de la personalidad y con antecedentes de abuso a sustancias (benzodiazepinas). La escasez de datos publicados en la bibliografía acerca de este tipo de comportamiento nos ha motivado a publicar el caso que les presentamos

So-called psychological, behavioral or substance-free addictions have aroused growing interest in recent years due to the problems posed by the use of new technologies in our society. Currently the DSM-5 only recognizes the Gambling Disorder, but more and more authors defend the recognition of other abusive behaviors such as the use of the Internet, mobile telephony, online games, shopping, sex, exercise and physical exercise, among others. In this respect, in the draft of the ICD-11 the WHO has proposed the recognition of digital games or video-games disorder (Gaming Disorder). The case we present deals with a lesser-known addiction: fortune-telling addiction or addiction to tarot, consulting through calls to pay-telephone lines, in a patient with a diagnosis of borderline personality disorder and with a history of substance abuse (benzodiazepines). The scarcity of data published in the literature about this type of behavior encouraged us to publish the case now being presented

Personality profiles of substance and behavioral addictions.

Substance-related and behavioral addictions are extremely prevalent and represent a major public health concern. In the ongoing attempt to understand the addictive personality, contradictory results have arisen from studies that have explored personality traits in different addiction populations. The diversity across addiction types suggests that some of these inconsistencies stem from distinct personalities underlying each addiction. The present study compares the personality profiles of several addictions, representing both substance (drugs and alcohol) and behavioral (gambling and sex) subtypes. 216 addicted individuals and 78 controls completed personality and sociodemographic questionnaires. Notable personality distinctions were found among different types of addiction. Whereas impulsivity and neuroticism were higher across all addiction populations, as compared to controls, people with alcohol use disorders also scored significantly lower on the traits of extraversion, agreeableness, and openness to experience. People with drug use disorders and those with compulsive sexual behavior were surprisingly similar, scoring lowest on the traits of agreeableness and conscientiousness. Finally, people with gambling disorder demonstrated a personality profile similar to that of the control group. Of note, personality profiles were also related to several demographic characteristics, including socioeconomic status and religiosity. Our findings support a potential role for personality in distinguishing among different types of addiction. This study suggests that different addictions may, to some extent, stem from distinct processes that are involved in personality development. These findings may provide a useful framework for understanding why different people develop different addictions.

Compulsive sexual behavior: a review of the literature.

BACKGROUND AND AIMS: Compulsive sexual behavior (CSB) is a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual's life. This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options. METHODS: We reviewed the literature regarding the clinical aspects of CSB and treatment approaches. RESULTS: The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm. CONCLUSIONS: Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health. Further research needs to be completed to understand where CSB falls within the psychiatric nosology.

How and when to intervene in cases of severe domestic squalor.

BACKGROUND: Little has been published concerning how best to intervene in cases of severe domestic squalor. METHODS: Background literature and reports on how best to intervene in cases of severe domestic squalor were reviewed. RESULTS: Reports by groups in London (Ontario), and Sydney (Australia) have provided recommendations for development of coordinated services to intervene in cases of squalor. Guidelines have been issued. Treatments for compulsive hoarding may contribute to improvement in cases where squalor is attributable to restricted access due to clutter. CONCLUSIONS: Effective interventions in cases of severe domestic squalor are commonly expensive and require good inter-agency collaboration. Budgetary support must be available to enable appropriate services to take on cases and provide case management.

Features and management of compulsive exercising in eating disorders.

Compulsive exercising is a common feature of patients with eating disorders. It is reported more frequently by patients with restricting-type anorexia nervosa than with other eating disorders. It is associated with higher eating disorder psychopathology, dietary restraint, general psychopathology, and specific personality features (ie, higher levels of perfectionism, persistence, and lower novelty seeking). It is a potent maintaining mechanism of eating disorder psychopathology, and it increases the risk of overuse injuries, bone fractures, and cardiac complications. It also appears to be a predictor of poor treatment outcome. Literature are lacking regarding its treatment, but cognitive-behavioral therapy in its enhanced form appears to be a promising treatment in hospitalized patients.

Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome.

OBJECTIVE: The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome. METHOD: Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory. RESULTS: Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise. DISCUSSION: Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.

An examination of the phenomenology and the reliability of ratings of compulsive behavior in autism.

To clarify the nature of compulsive behavior in autism, staff reports of behavioral patterns of 17 young autistic adults living in a farmstead residential facility were analyzed. Three staff members, who had worked most closely with each resident for at least 3 months completed three questionnaires, including Quantitative and Qualitative compulsive behavior scales, and the Childhood Autism Rating Scale (CARS). The questionnaires were completed on two occasions with a 2-week interval between administrations. Test-retest and interrater consistencies were examined for each of the scales. Both the Qualitative and Quantitative questionnaires show promise as instruments that could be used as objective baselines or descriptors for compulsive behavior in autism. Information gathered from these scales could be utilized to determine how to intervene in the behavior, and to assess progress in treatment programs.

Gay men, sexual risk and therapy.

AIDS: Risk reduction must go beyond safe sex guidelines and encompass the ongoing process of sexual negotiation. Therapists can play a role in assisting clients to safely navigate sexual activity. Several case scenarios of therapy related to sexual risk, particularly among gay and bisexual men, are discussed. For the sexually compulsive client, sex often camouflages depression, hopelessness, anxiety, or rage. Alan, a 41-year old seronegative lawyer, presents with complaints about compulsive, high-risk sex. His therapist might negotiate a contract around sexual acting out, interpret and explore the specific meanings of acting out, and suggest the possibility of couples' counseling. The second case scenario involves an uninfected couple, Phil and Tom, who are exploring non-monogamy. The therapist can assist the couple in negotiating a relationship contract that requires the trust that partners will keep their agreements and disclose breaches in sexual behavior. Sam and Peter, a second couple, are having a problem with sexual negotiation. Sam wants to have unprotected sex with Peter. Peter is angry that unsafe sex is so important to Sam. Their therapist needs to explore individual and relationship issues, educate them about the meanings of sexual behaviors, and address the level and history of trust in the relationship. Overall, to help clients navigate sexual activity, therapists must blend together their clients' psychodynamic histories, the social meaning of sex for gay men, and the medical and ethical context in which particular behaviors take place.^ieng

Treatment of crack-cocaine-induced compulsive behavior with trazodone.

Foraging is a compulsive behavior of searching for pieces of crack cocaine that the individual believes might have been accidentally misplaced. Three clinical cases of compulsive foraging behavior associated with crack cocaine are described. Due to the development of side effects secondary to the antidepressant desipramine, the patients were switched to the antidepressant trazodone. The use of trazodone led to remission of the foraging behavior. The authors hypothesize this remission was due to trazodone serotonin reuptake inhibitory action. In all three cases, the patients did not relapse into abusing crack cocaine.

Polydipsia amongst adults with a learning disability in an institution.

A hospital-based adult learning disabled population (n = 371) was screened for polydipsia with the help of a purpose-designed questionnaire. Polydipsia was defined as excessive drinking of more than 3 l of non-alcoholic fluid over a 24-h period. Altogether, 23 (6.2%) subjects were found to have polydipsia. The polydipsic group was compared with the whole hospital population on variables such as age and IQ distribution. A matched group of 23 individuals without a history of polydipsia was drawn from the same hospital population. The polydipsic and the matched group were compared using various biochemical and psychological measures. Thirty-five per cent of polydipsic patients, compared to 13% of the matched group, showed evidence of compensated hyponatraemia. This difference was not significant. There was no significant difference between the polydipsic and the matched group in the frequency of psychiatric illness, behavioural problems or autism. There also was no significant difference in the IQ levels of the polydipsic patients and the total hospital population. Polydipsia in this population is largely seen as part of an abnormal behavioural repertoire without any evidence of possible organic cause, except unidentified diabetes mellitus. Klein Levin syndrome and pica were represented in the polydipsic group, but not amongst the matched group.

The ambulatory treatment of noncompulsive users of psychoactive substances.

This paper presents the experience of "La Casa" Programme, a center of the University of Los Andes (Bogotá, Colombia) aimed at prevention, treatment, and research in the fields of drug addiction and AIDS. The multimodal strategy at "La Casa", ambulatory and almost free of charge, has constituted a unique approach in Colombia. The country has a heavy and specific drug consumption problem: in the last ten years the number of regular consumers of a mixture of alcohol, coca paste ("basuco")/cocaine and marihuana has increased to almost 500,000 people; state facilities and human resources are scarce, thus the importance of an appropriate use of them and search for alternatives.

The Rotter I-E scale as a predictor of relapse in a population of compulsive gamblers.

Profile surveys, completed Rotter I-E scales, and questionnaires on past relapse behavior were collected from 108 New Jersey compulsive gamblers who attended Gamblers Anonymous, and an attempt was made, based on the findings, to predict incidence of compulsive gamblers' relapse. Relationships between I-E scores and extent of relapse-free periods, and I-E scores and relapse, with the variables of religious background, age, marital status, education, type of work, and childhood physical abuse were investigated. In every instance the relationship found was statistically non-significant.

16PF items discriminating recidivists and long-term recovered polyaddicts.

Responses to 65 of the 187 items on Cattell's 16PF test were skewed by 83 members of Alcoholics Anonymous. Seventeen of those items had significantly different distributions when the 18 recidivists were compared to the 8 who had remained clean of all addictive substances and compulsive behaviors during the 2-year period studied. Another 14 items had significantly different distributions when the recidivists were compared to all the others. Comparisons with non-drug-disadvantaged groups and non-AA recovering addicts are suggested in order to isolate empirical predictor items for "addictive" versus "cured" scales.

Management of compulsive shoplifting through covert sensitization.

A client with a shoplifting of 4 years' duration was treated by convert sensitization. To control for improvement attributable to demand characteristics alone, thought-stopping was utilized prior to the treatment period. Results indicated that the application of thought-stopping produced an increase in all dimensions (frequency, duration and intensity) of shoplifting urges which were brought under control and virtually eliminated by instituting covert sensitization. Follow-up assessments at 1, 2, 5 and 14 months showed maintenance of treatment gains. These findings are discussed from the viewpoint of a cognitively mediated model of compulsive shoplifting.

Juvenile firesetters: do the agencies help?

In an attempt to find out what was being done for juvenile firesetters in their metropolitan community the authors reviewed the records of the local fire marshal, juvenile court, and psychiatric clinic. They found that the various agencies involved with 69 juveniles over a 3-year period were unable to coordinate their efforts and were largely unsuccessful in controlling the firesetting. Because the families of firesetters seem to have many other social problems, the authors recommend early inpatient assessment and possible referral to foster homes or residential treatment settings for juvenile firesetters.