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Background: The heterogeneity of gambling disorder (GD) has led to the identification of different subtypes, mostly including phenotypic features, with distinctive implications on the GD severity and treatment outcome. However, clustering analyses based on potential endophenotypic features, such as neuropsychological and neuroendocrine factors, are scarce so far. Aims: This study firstly aimed to identify empirical clusters in individuals with GD based on sociodemographic (i.e., age and sex), neuropsychological (i.e., cognitive flexibility, inhibitory control, decision making, working memory, attention, and set-shifting), and neuroendocrine factors regulating energy homeostasis (i.e., leptin, ghrelin, adiponectin, and liver-expressed antimicrobial peptide 2, LEAP-2). The second objective was to compare the profiles between clusters, considering the variables used for the clustering procedure and other different sociodemographic, clinical, and psychological features. Methods: 297 seeking-treatment adult outpatients with GD (93.6% males, mean age of 39.58 years old) were evaluated through a semi-structured clinical interview, self-reported psychometric assessments, and a protocolized neuropsychological battery. Plasma concentrations of neuroendocrine factors were assessed in peripheral blood after an overnight fast. Agglomerative hierarchical clustering was applied using sociodemographic, neuropsychological, and neuroendocrine variables as indicators for the grouping procedure. Comparisons between the empirical groups were performed using Chi-square tests (χ2) for categorical variables, and analysis of variance (ANOVA) for quantitative measures. Results: Three-mutually-exclusive groups were obtained, being neuropsychological features those with the greatest weight in differentiating groups. The largest cluster (Cluster 1, 65.3%) was composed by younger males with strategic and online gambling preferences, scoring higher on self-reported impulsivity traits, but with a lower cognitive impairment. Cluster 2 (18.2%) and 3 (16.5%) were characterized by a significantly higher proportion of females and older patients with non-strategic gambling preferences and a worse neuropsychological performance. Particularly, Cluster 3 had the poorest neuropsychological performance, especially in cognitive flexibility, while Cluster 2 reported the poorest inhibitory control. This latter cluster was also distinguished by a poorer self-reported emotion regulation, the highest prevalence of food addiction, as well as a metabolic profile characterized by the highest mean concentrations of leptin, adiponectin, and LEAP-2. Conclusions: To the best of our knowledge, this is the first study to identify well-differentiated GD clusters using neuropsychological and neuroendocrine features. Our findings reinforce the heterogeneous nature of the disorder and emphasize a role of potential endophenotypic features in GD subtyping. This more comprehensive characterization of GD profiles could contribute to optimize therapeutic interventions based on a medicine of precision.

Abstract Introduction Different components of the endocannabinoid (eCB) system such as their most well-known endogenous ligands, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), have been implicated in brain reward pathways. While shared neurobiological substrates have been described among addiction-related disorders, information regarding the role of this system in behavioral addictions such as gambling disorder (GD) is scarce. Aims Fasting plasma concentrations of AEA and 2-AG were analyzed in individuals with GD at baseline, compared with healthy control subjects (HC). Through structural equation modeling, we evaluated associations between endocannabinoids and GD severity, exploring the potentially mediating role of clinical and neuropsychological variables. Methods The sample included 166 adult outpatients with GD (95.8% male, mean age 39 years old) and 41 HC. Peripheral blood samples were collected after overnight fasting to assess AEA and 2-AG concentrations (ng/ml). Clinical (i.e., general psychopathology, emotion regulation, impulsivity, personality) and neuropsychological variables were evaluated through a semi-structured clinical interview and psychometric assessments. Results Plasma AEA concentrations were higher in patients with GD compared with HC (p = .002), without differences in 2-AG. AEA and 2-AG concentrations were related to GD severity, with novelty-seeking mediating relationships. Conclusions This study points to differences in fasting plasma concentrations of endocannabinoids between individuals with GD and HC. In the clinical group, the pathway defined by the association between the concentrations of endocannabinoids and novelty-seeking predicted GD severity. Although exploratory, these results could contribute to the identification of potential endophenotypic features that help optimize personalized approaches to prevent and treat GD.

Abstract Background Anandamide (AEA) and 2-arachidonoylglycerol (2-AG) play a pivotal role in stimulating motivational behavior toward food and energy metabolism. Aberrant functioning of the endocannabinoid system has been observed in extreme weight conditions (EWCs), suggesting it may influence pathophysiology. Then, we aimed to analyze fasting AEA and 2-AG plasma concentrations among individuals with EWC (i.e., anorexia nervosa [AN] and obesity with and without eating disorders [EDs]) compared with healthy controls (HCs), and its association with clinical variables and body mass index (BMI). Methods The sample included 113 adult women. Fifty-seven belonged to the obesity group, 37 without EDs (OB-ED) and 20 with ED (OB+ED classified within the binge spectrum disorders), 27 individuals from the AN group, and 29 from the HC group. Peripheral blood samples, several clinical variables, and BMI were evaluated. Results Unlike 2-AG, AEA concentrations showed significant differences between groups (p

Background and AimsCompulsive sexual behavior (CSB) is characterized by a persistent pattern of failure to control sexual impulses, resulting in repetitive sexual behavior over a prolonged period that causes marked discomfort in personal, family, social, school, work or in other functional areas. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the characteristics of the affected people. The purpose of this study was to compare online compulsive sexual behavior (when the problematic sexual practices were online) and non-online compulsive sexual behavior (when the problematic sexual practices were in-person) patients (OCSB and non-OCSB, respectively), and healthy controls in terms of sexual behavior, sociodemographic variables and psychopathology and personality characteristics.MethodA sample of 80 CSB male patients consecutively admitted to our Behavioral Addictions Unit and 25 healthy male controls, participated in the study. The CSB group was comprised by 36 online CSB patients (mean age 42.25, SD: 10.0) and 44 non-online CSB patients (mean age 43.5, SD: 11.9). Scores on the Sexual Compulsivity Scale, Temperament and Character Inventory-Revised, Symptom CheckList-90 Items-Revised, State-Trait Anxiety Index, and additional demographic, clinical, and social/family variables related to sexual behaviors between the three groups were compared.ResultsWhen compared with healthy controls, both clinical groups showed higher psychopathology in all measures as well as higher harm avoidance and self-transcendence and lower self-directness and cooperativeness. When comparing OCSB and non-OCSB patients, results showed that non-OCSB patients exhibited higher prevalence of sexually transmitted diseases, higher percentage of homosexual and bisexual orientation and higher scores in anxiety and in sexual impulse control failure.ConclusionBoth online and non-online CSB patients may experience a variety of comorbid psychological and medical problems. Patients with non-OCSB may suffer more consequences that are negative. Therefore, these results should be considered when designing the most convenient therapeutic approach. Whether sexual orientation plays a role in treatment needs and treatment response in CSB, should be further explored in future studies.

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p

Gambling disorder (GD) is a modestly prevalent and severe condition for which neurobiology is not yet fully understood. Although alterations in signals involved in energy homeostasis have been studied in substance use disorders, they have yet to be examined in detail in GD. The aims of the present study were to compare different endocrine and neuropsychological factors between individuals with GD and healthy controls (HC) and to explore endocrine interactions with neuropsychological and clinical variables. A case–control design was performed in 297 individuals with GD and 41 individuals without (healthy controls; HCs), assessed through a semi-structured clinical interview and a psychometric battery. For the evaluation of endocrine and anthropometric variables, 38 HCs were added to the 41 HCs initially evaluated. Individuals with GD presented higher fasting plasma ghrelin (p < 0.001) and lower LEAP2 and adiponectin concentrations (p < 0.001) than HCs, after adjusting for body mass index (BMI). The GD group reported higher cognitive impairment regarding cognitive flexibility and decision-making strategies, a worse psychological state, higher impulsivity levels, and a more dysfunctional personality profile. Despite failing to find significant associations between endocrine factors and either neuropsychological or clinical aspects in the GD group, some impaired cognitive dimensions (i.e., WAIS Vocabulary test and WCST Perseverative errors) and lower LEAP2 concentrations statistically predicted GD presence. The findings from the present study suggest that distinctive neuropsychological and endocrine dysfunctions may operate in individuals with GD and predict GD presence. Further exploration of endophenotypic vulnerability pathways in GD appear warranted, especially with respect to etiological and therapeutic potentials.

Introduction Anandamide (AEA) and 2-Arachidonoylglycerol (2-AG) play a pivotal role in food intake and reward aspects of feeding. Aberrant functioning in the endocannabinoid system has been observed in patients with eating disorders (EDs). This dysfunction may influence the incentive processes stimulating behaviors towards food acquisition or the hedonic evaluation of ingested food. Objectives The aims of this study are to compare fasting peripheral levels of AEA and 2-AG in ED patients, obese subjects (OB) and healthy controls (HCs), and to explore their association with clinical and anthropometric variables. Methods The sample included a total of 63 adult women. Peripheral blood samples were collected to investigate fasting levels of AEA and 2-AG in 31 ED patients: 22 Anorexia Nervosa (AN) and 9 Binge Eating Disorder (BED), compared to 21 OB and 11 HCs. Several clinical and anthropometric variables were also assessed. Results Comparing groups, significant differences in AEA levels were found (p=0.001). Specifically, individuals with AN exhibited lower AEA than OB (p

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games.Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported.Method: A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and SD = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia.Results and Discussion: e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, SD = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men.

Background and ObjectivesThe Internet provides easy access to multiple types of gambling and has led to changes in betting habits. A severe rise in problematic gambling has been predicted among all sectors of the population, and studies are required to assess the emerging phenotypes related to the new structures of gambling activities. This study aimed to explore the existence of latent classes associated with gambling habits among treatment-seeking gamblers due to Online Sports Betting (OSB).MethodInitial sample included n = 4,516 patients consecutively admitted for treatment in a hospital unit specialized in behavioral addictions. Two-step clustering analysis was used within the subsample of n = 323 patients who reported problems related with OSB, within a set of indicators including sociodemographics, psychopathological distress, personality, and severity of the gambling activity.ResultsThe prevalence of OSB as a main type of gambling problem in the study was 7.2% (95% confidence interval: 6.4 to 7.9%). Two latent clusters were identified, with differences in sociodemographics and clinical status. Cluster 1 (n = 247, 76.5%) grouped patients that were more affected due to the OSB behaviors, and it was characterized by non-married patients, lower socioeconomic position index, higher comorbidity with other substance related addictions, younger age, and early onset of the gambling activity, as well as higher debts due to the OSB, higher psychopathological distress, and a more dysfunctional personality profile. Cluster 2 (n = 76, 23.5%) grouped patients that were less affected by OSB, mostly married (or living with a stable partner), with higher social position levels, older age and older onset of the gambling activity, as well as a more functional psychopathological and personality profile.ConclusionThe increasing understanding of latent classes underlying OSB phenotypes is essential in guiding the development of reliable screening tools to identify individuals highly vulnerable to addictive behaviors among Internet gamblers, as well as in planning prevention and treatment initiatives focused on the precise profiles of these patients.

The use of instruments originally developed for measuring gambling activity in younger populations may not be appropriate in older age individuals. The aim of this study was to examine the presence of problematic and disordered gambling in seniors aged 50 or over, and study the reliability and validity properties of the SOGS (a screening measure to identify gambling related problems). Two independent samples were recruited: a clinical group of n = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit, and a population-based group of n = 361 participants recruited from the same geographical area. Confirmatory factor analysis verified the bifactor structure for the SOGS with two correlated underlying dimensions [measuring the impact of gambling on the self primarily (Cronbach's alpha α = 0.87) or on both the self and others also (α = 0.82)], and a global dimension of gambling severity (also with excellent internal consistency, α = 0.90). The SOG obtained excellent accuracy/validity for identifying gambling severity based on the DSM-5 criteria (area under the ROC curve AUC = 0.97 for discriminating disordered gambling and AUC = 0.91 for discriminating problem gambling), and good convergent validity with external measures of gambling (Pearson's correlation R = 0.91 with the total number of DSM-5 criteria for gambling disorder, and R = 0.55 with the debts accumulated due to gambling) and psychopathology (R = 0.50, 0.43 and 0.44 with the SCL-90R depression, anxiety and GSI scales). The optimal cutoff point for identifying gambling disorder was 4 (sensitivity Se = 92.3% and specificity Sp = 98.6%) and 2 for identifying problem gambling (Se = 78.8% and Sp = 96.7%). This study provides empirical support for the reliability and validity of the SOGS for assessing problem gambling in elders, and identifies two specific factors that could help both research and clinical decision-making, based on the severity and consequences of the gambling activity.

Introduction: Impairments in emotion regulation are understood to be a transdiagnostic risk factor of suffering from compulsive and addictive behaviors. The aim of this study was to investigate the role of emotion regulation deficits in gambling disorder and to analyze these differences taking gender, age, and gambling activity preferences into account. Methods: The sample included n = 484 patients seeking treatment for gambling disorder at a specialized outpatient service. Main outcomes were sociodemographic variables, emotion regulation, and gambling severity. Results: Differences between sexes were found in non-acceptance of emotions. Older patients obtained higher levels in non-acceptance of emotions, lack of emotion regulation strategies, emotional clarity, and global emotion regulation scores. No differences were found in emotion scores considering gambling preferences (non-strategic versus strategic). Path analysis showed that emotion regulation scores and age had a direct effect on gambling disorder severity, while emotion regulation and gambling preference were not mediational variables in the relationships of gender and age with gambling severity. Conclusions: Emotion regulation impairments differ in patients seeking treatment for gambling problems. Early prevention and intervention programs should incorporate the different dimensions of this process, taking into account clinical phenotypes.

Background and Aims: Gambling-related crimes are known to be associated with gambling disorder (GD). Due to a lack of consensus in the scientific community regarding the relevance of this diagnostic criterion, it was removed from the DSM-5. The primary aim of this study was to investigate through structural equation modeling (SEM) whether higher GD severity in treatment-seeking GD patients with a criminal record is mediated through the illegal acts criterion itself, or whether it can be better explained by other related clinical factors.Methods: An initial sample of 2,081 patients seeking treatment for gambling problems was included in the sample. SEM was used to evaluate the mediational role of the illegal acts criterion between the sex, age and personality traits, gambling severity, and comorbid depression levels. Comparisons between patients with coinciding and divergent DSM criterion for GD diagnosis were carried out.Results: Illegal acts mediated the relationship between personality traits and GD severity: younger age, high levels of novelty seeking, and low levels of self-transcendence increased the risk of endorsing the illegal acts criterion. No differences between coincident-divergent groups in terms of DSM-IV and DSM-5 diagnosis were found with regards to sex (p = 0.878), education level (p = 0.387), or civil status (p = 0.792).Discussion and Conclusion: The results obtained in the present study offer new insights into the utility of using a history of illegal acts, their different personality characteristics, and psychopathology to categorize GD patients. Our findings suggest that patients who engage in criminal behavior may require a more comprehensive intervention.

Background: Gambling disorder (GD) is a heterogeneous disorder which has clinical manifestations that vary according to variables in each individual. Considering the importance of the application of specific therapeutic interventions, it is essential to obtain clinical classifications based on differentiated phenotypes for patients diagnosed with GD.Objectives: To identify gambling profiles in a large clinical sample of n = 2,570 patients seeking treatment for GD.Methods: An agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used, considering a large set of variables including sociodemographic, gambling, psychopathological, and personality measures as indicators.Results: Three-mutually-exclusive groups were obtained. Cluster 1 (n = 908 participants, 35.5%), labeled as “high emotional distress,” included the oldest patients with the longest illness duration, the highest GD severity, and the most severe levels of psychopathology. Cluster 2 (n = 1,555, 60.5%), labeled as “mild emotional distress,” included patients with the lowest levels of GD severity and the lowest levels of psychopathology. Cluster 3 (n = 107, 4.2%), labeled as “moderate emotional distress,” included the youngest patients with the shortest illness duration, the highest level of education and moderate levels of psychopathology.Conclusion: In this study, the general psychopathological state obtained the highest importance for clustering.

Background and aims: Increases in the prevalence of behavioral addictions worldwide have led to a growth in the etiological research of the specific contribution of risk/protective factors to these disorders. The objective of this study was to assess the relative role of patients' sex, age of disorder onset and disorder duration on the clinical profile of behavioral addictions.Methods: Our sample included treatment-seeking patients diagnosed with gambling disorder (GD, n = 3,174), internet gambling disorder (IGD, n = 45), compulsive buying (CB, n = 113), and sex addiction (SA, n = 34).Results: The pattern of associations between the independent variables and the outcomes were strongly related to the behavioral addiction subtype: (a) for GD-men early onset of the disorder was related to GD severity, while for GD-women early onset was linked to novelty seeking; (b) for IGD-men, late onset correlated with addiction severity, worse psychopathological state, and high harm avoidance and self-transcendence levels; (c) for CB-women, early onset was related to higher reward-dependence scores and lower self-transcendence levels, and longer duration predicted higher cumulate debts; for CB-men, early onset and long duration correlated with high scores in harm-avoidance, self-directedness, self-transcendence, and cooperativeness; and (d) for SA-men, late onset and longer duration correlated with high disorder severity.Discussion and Conclusions: These findings are relevant for developing prevention and treatment programs specific to different behavioral addictions.

Internet Gaming Disorder is an increasingly prevalent disorder, which can have severe consequences in affected young people and in their families. There is an urgent need to improve existing treatment programs; these are currently hampered by the lack of research in this area. It is necessary to more carefully define the symptomatic, psychosocial and personality characterization of these patients and the interaction between treatment and relevant variables. The objectives of this study were three: (1) to analyze the symptomatic and personality profiles of young patients with Internet Gaming Disorder in comparison with healthy controls; (2) to analyze the effectiveness of a cognitive behavioral treatment on reducing symptomatology; and (3) to compare the results of that treatment with or without the addition of a psychoeducational group offered to the parents. The final sample consisted of 30 patients consecutively admitted to a specialized mental health unit in Spain, and 30 healthy controls. The experimental group received individual cognitive-behavioral therapy. The experimental group was divided into two subgroups (N = 15), depending on the addition or not of a psychoeducational group for their parents (consecutively admitted). Scores on the Millon Adolescent Personality Inventory (MACI), the Symptom Checklist-Revised (SCL-90-R), the State-Trait Anxiety Index (STAI), and other clinical and psychopathological measures were recorded. The patients were re-assessed post treatment (except for the MACI questionnaire). Compared with healthy controls, patients did not differ in symptomatology at baseline, but scored significantly higher in the personality scales: Introversive and Inhibited, and in the expressed concerns scales: Identity Confusion, Self-Devaluation, and Peer Insecurity and scored significantly lower in the Histrionic and Egotistic scale. In the experimental group, pre-post changes differed statistically on SCL-90-R scales Hostility, Psychoticism, and Global Severity Index and on the diagnostic criteria for Internet Gaming Disorder, regardless of the addition of a psychoeducational group for parents. Pre-post changes did not differ between experimental subgroups. However, the subgroup without psychoeducation for parents presented statistically higher drop-out rates during treatment. The results of this study are based on a sample of patients seeking treatment related to problems with online gaming, therefore, they may be of value for similar patients.

Gambling disorder (GD) is a psychiatric condition that was recently recategorized as a non-substance-related addiction in the Diagnostic and Statistical Manual of Mental Health Disorders. Criminal activity is commonly associated with gambling; however, few empirical studies to date have examined sociodemographic and psychological variables in this population. In this study, we explored criminal behavior history in a sample of consecutively recruited treatment-seeking gamblers (n = 382) and compared subjects with a history of illegal acts (n = 103, 26.9%) to those with no criminal record (n = 279, 73.1%). Impulsivity and personality traits were specifically explored, along with other gambling-related severity factors. We found that gamblers who engaged in illegal activity were more likely to endorse high levels of urgency (i.e., the tendency to act out when experiencing heightened emotional states) and increased lack of premeditation. Gamblers with a history of criminal behavior also had greater GD severity levels and gambling-related debts. Additionally, these gamblers reported lower levels of self-directedness, which is characterized by difficulty in establishing and redirecting behavior toward one’s goals. Likewise, gamblers who had conducted criminal acts showed a tendency to engage in greater risk-taking behavior. These results shed new light on this understudied population and provide insights for developing targeted harm-prevention interventions and treatment protocols.