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Problems with cognitive flexibility have been associated with multiple psychiatric disorders, but there has been little understanding of how cognitive flexibility compares across these disorders. This study examined problems of cognitive flexibility in young adults across a range of psychiatric disorders using a validated computerized -diagnostic flexibility paradigm. We hypothesized that obsessive-compulsive spectrum disorders (eg, obsessive-compulsive disorder, trichotillomania, and skin-picking disorder) would be associated with pronounced flexibility problems as they are most often associated with irrational or purposeless repetitive behaviors. A total of 576 nontreatment seeking participants (aged 18-29 years) were enrolled from general community settings, provided demographic information, and underwent structured clinical assessments. Each participant undertook the intra-extra-dimensional task, a validated computerized test measuring set-shifting ability. The specific measures of interest were total errors on the task and performance on the extra-dimensional (ED) shift, which reflects the ability to inhibit and shift attention away from one stimulus dimension to another. Participants with depression and PTSD had elevated total errors on the task with moderate effect sizes; and those with the following had deficits of small effect size: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), antisocial personality disorder, and binge-eating disorder. For ED errors, participants with PTSD, GAD, and binge-eating disorder exhibited deficits with medium effect sizes; those with the following had small effect size deficits: depression, social anxiety disorder, OCD, substance dependence, antisocial personality disorder, and gambling disorder. These data indicate cognitive flexibility deficits occur across a range of mental disorders. Future work should explore whether these deficits can be ameliorated with novel treatment interventions.

\"Addictions to drugs or alcohol are usually apparent, but what about behavioral addictions? A person addicted to shoplifting or gambling, for example, or picking at their skin, may suffer in the shadows while their behavior consumes their time and energy--and disrupts their life. Legal, medical, and financial troubles are common for such a person and their loved ones, as are social and family conflicts. Behavioral addictions are serious illnesses and usually do not go away on their own--telling the loved one to simply stop doing the behavior will not work. This book is for anyone who has a behavioral addiction, and for their families and friends. It describes what a behavioral addiction is, what causes it, and how it can be diagnosed and treated. It takes an in-depth look at seven specific addictions: to gambling, stealing, sex, internet use, shopping and buying, hair pulling and skin picking, and food. Behavioral addictions have a physical basis in the brain and are addictive because, like alcohol and narcotics, they are rewarding. The addicted person spends enormous amounts of time preparing for or engaging in the habit, and in the process neglects other areas of life. He or she may also be convicted of a crime, put their sexual partner at risk of infection, lose their job due to negligence and their home due to debt. These repetitive habits persist despite negative consequences so that, ultimately, the person loses all conscious control over the behavior. The guidance provided here helps readers deal with the complicated issues surrounding these addictions, including how family members can help the addicted person while helping themselves. Dr. Grant has published many books and has appeared on CNN, BBC, GMA, The Early Show, and elsewhere\"-- Provided by publisher.

Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder. To conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings. A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest. The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities. PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder. S.R.C. consults for Cambridge Cognition and Shire. K.I.'s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work.

While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially “addictive” qualities of repetitive behaviors, and whether such behaviors constitute “behavioral addictions,” is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, compulsive sexual behavior, and problem Internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of “behavioral addictions” has been handled by latest revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.

Skin picking disorder (also known as excoriation disorder or dermatillomania) is a common mental health disorder currently classified as an obsessive-compulsive and related condition. Despite being first described in the 1800s, very little is known about its phenomenology and clinical presentation. Most information about this disorder to date is based on online surveys rather than in-person assessments. Clinical and demographic data were collected from individuals with skin-picking disorder taking part in research studies, using in-person assessments comprising validated instruments. Descriptive information was presented as to the nature of skin picking disorder. The sample comprised 262 individuals, mean age 32.5 years, being 87% female. The peak age of onset of symptoms was 12.9 years, and most affected individuals (>90%) had symptom onset before age of 20 years. Typically, individuals reported picking from multiple body sites (most common was the face), and the most frequent triggers were stress and the ‘feel’ (i.e. texture) of the skin. Comorbidities were common, including trichotillomania, depression, generalized anxiety disorder, and impulsive/compulsive disorders (especially attention-deficit hyperactivity disorder and obsessive-compulsive disorder). The majority of people with the disorder (87.1%) had never received treatment. Of those who had received treatment in the past, 87% reported that they found the treatment helpful for their symptoms. This study sheds new light on the clinical presentation and phenomenology of skin picking disorder. Results highlight the need for further research into its clinical presentation, longitudinal course, and treatment approaches. •Skin picking is common and usually begins before age 20 yrs.•Trichotillomania, depression, anxiety and ADHD are commonly comorbid with skin picking.•The majority of people with skin picking have never received treatment.

Background Participant discontinuation is a significant challenge in pharmacological trials for trichotillomania (hair-pulling disorder). Attrition in clinical trials reduces statistical power, introduces error, and potentially wastes financial and medical resources. Identifying predictors of discontinuation may help researchers enhance participant retention and improve study outcomes. Methods Data from five completed pharmacological trials for trichotillomania were aggregated, and participants were classified as either Discontinued or Completed. Differences in demographic and clinical variables between these groups were analyzed using a generalized linear mixed model. Results Of the 222 participants, 177 (80%) were categorized as the Completed group. Discontinued patients (20%) were more likely to have achieved higher levels of formal education and were more likely to have a history of depression. Conclusions This study is among the first to examine variables associated with discontinuation rates in trichotillomania trials. The results underscore the importance of addressing educational background and patient history of depression when assessing dropout risk. These findings can guide future research to better support participants at risk of discontinuing treatment.

Impulsivity is a common cognitive issue across several psychiatric illnesses but is most frequently associated with the DSM-5 Disruptive, Impulse Control and Conduct Disorders, ADHD, and addictive disorders. We hypothesized that a wide range of psychiatric disorders would be associated with elevated impulsivity, not just those commonly linked to impulsiveness. This study aimed to explore the relationship between impulsivity and various psychiatric disorders in young adults. 700 non-treatment seeking participants (aged 18–29 years) were enrolled from the general community, provided demographic information, and underwent a psychiatric evaluation to screen for various psychiatric disorders. Each participant then completed the Barratt Impulsiveness Scale (BIS), a self-report measure of impulsivity, followed by the Stop Signal Task (SST), a computerized stop-attention task that measures impulse control. Impulsivity levels across psychiatric disorders were examined by analyzing z-scores relative to controls. Patients with bulimia nervosa, comorbid panic disorder with agoraphobia, and borderline personality disorder showed the highest levels of attentional, motor, and non-planning impulsivity, respectively. The effect size of the difference in total BIS impulsivity was large (d > 0.8) for several conditions including eating, personality, addictive, and mood disorders. The effect size of the difference in impulsivity was not large for any of the measures of ADHD. As compared to other psychiatric disorders analyzed, trichotillomania showed the greatest levels of impulsivity as measured by SST. This data indicates that a wide range of psychiatric disorders exhibit heightened impulsivity with findings differing across various cognitive domains. Comorbidity resulted in unique findings of elevated impulsivity. This may suggest utility in viewing impulsivity as a transdiagnostic factor for a broad range of psychiatric disorders. Future studies should analyze comorbidities and whether patient psychiatric medication impacts these findings. •Impulsivity is common across many eating, personality, addictive, and mood disorders.•Impulsivity could be a transdiagnostic tool if integrated into classification systems.•Comorbid panic disorder with agoraphobia exhibits heightened levels of impulsivity.•Impulsivity is multidimensional such that deficiencies vary by cognitive domain.•Objective SSRT impulsivity measures are more conservative than the subjective BIS.

The COVID-19 pandemic (including lockdown) is likely to have had profound but diverse implications for mental health and well-being, yet little is known about individual experiences of the pandemic (positive and negative) and how this relates to mental health and well-being, as well as other important contextual variables. Here, we analyse data sampled in a large-scale manner from 379,875 people in the United Kingdom (UK) during 2020 to identify population variables associated with mood and mental health during the COVID-19 pandemic, and to investigate self-perceived pandemic impact in relation to those variables. We report that while there are relatively small population-level differences in mood assessment scores pre- to peak-UK lockdown, the size of the differences is larger for people from specific groups, e.g. older adults and people with lower incomes. Multiple dimensions underlie peoples’ perceptions, both positive and negative, of the pandemic’s impact on daily life. These dimensions explain variance in mental health and can be statistically predicted from age, demographics, home and work circumstances, pre-existing conditions, maladaptive technology use and personality traits (e.g., compulsivity). We conclude that a holistic view, incorporating the broad range of relevant population factors, can better characterise people whose mental health is most at risk during the COVID-19 pandemic. The COVID-19 pandemic has affected people’s health and well-being. Here, the authors characterize self-reported impact of the pandemic (positive and negative) at a large scale in the United Kingdom, and show variance among individual circumstances.

The existence of subtypes of trichotillomania (TTM) have long been hypothesized, and recent studies have further elucidated characteristic subtypes of TTM and possible ramifications of subtyping for treatment. In clinical applications of subtyping for treatment of TTM, family history (FH) of psychiatric disorders in patients may serve as a tool to differentiate disorder presentations and inform care. We compared prevalence of psychiatric illnesses in first-degree relatives of participants with TTM and healthy controls, respectively, in a large sample, and examined associations between those psychiatric disorders that were significantly different in the FH between groups and measures of disability, severity, and neuropsychological constructs. We compared FHs of 152 participants (mean age = 29.9) with TTM and 71 healthy controls (mean age = 29.6), utilizing chi-squared tests to determine which psychiatric illnesses were more prevalent in FHs of participants with TTM. We then used two-tailed t-tests to compare TTM participants with those more prevalent FHs to participants without those FHs on measures of disorder severity, disability, and neuropsychological constructs. Obsessive-compulsive disorder (OCD), TTM, skin picking disorder (SPD), and major depressive disorder (MDD) were significantly more frequent in first-degree relatives (p < 0.0033) of TTM participants than those of healthy controls. TTM participants with a FH of OCD scored significantly higher on measures of impulsivity and lower on measures of distress tolerance. Those with FH of TTM, SPD, and MDD did not differ significantly across measured variables. OCD, TTM, SPD, and MDD are more prevalent in the FHs of people with TTM, as compared to healthy controls. TTM participants with a family history of OCD may be more likely to demonstrate decreased distress tolerance and increased impulsivity. In all, as understanding of TTM subtypes develops, the FH may prove a useful tool in delineating subtypes and informing care. •Obsessive-comulsive disorder (OCD), Body-Focused Repetitive Behaviors (BFRBs), and Major Depressive Disorder (MDD) are common in the family history of people with trichotillomania (TTM)•TTM patients with a family history of OCD have increased impulsivity and decreased distress tolerance•Family history may potentially be clinically useful in the treatment of TTM•Results emphasize importance of subtyping in understanding TTM