Diferencias y similitudes clínicas, psicopatológicas y de personalidad en los transtornos del espectro impulsivo-compulsivo.

Abstract

Current empirical literature shows a growing interest in the dimensional models into the mental disorders research. This approach groups different psychopathological conditions based on the similarities in the symptoms, the onset and the progression of the problems, the comorbidities, the treatment outcomes and other multiple etiological conditions. One of the clinical groups of this approach, which is the object of study of this thesis dissertation, is the impulsive-compulsive spectrum disorders (ICSD), which includes a broad number of disorders characterized by persistent, excessive and uncontrollable behaviors. The evolution of these behaviors led to severe impairment at the psychological, social and occupational levels. Behavioral addictions (also named as substance-free addictions) are included within this spectrum, and two of the most prevalent conditions of this group are the Gambling Disorder (GD) and the Compulsive Buying (CB). But despite the large number of empirical studies published, new researches are needed on different issues related to the ICSD, such as the emotional expression profile (particularly in the field of implicit emotions), or the underlying mechanisms that lead to the onset and progression of concurrent comorbid conditions. Clinical studies with broad heterogeneous samples, consisting of patients with different diagnostic subtypes and different phenotypes, are also needed. This thesis dissertation has the next main objectives, which have been addressed through two independent studies: a) to know the underlying mechanisms of the comorbid presence of CB and GD, including as potential predictor variables (independent and mediating effects) sex, age of onset and personality traits; and b) to examine the implicit and explicit emotional expression in patients diagnosed with GD who are in different clinical states (acute versus remission), and compare their profile with a control group of participants without gambling problems. Data recruited at the Pathological Gambling and Other Behavioral Addictions Unit (Psychiatry Unit, Bellvitge University Hospital), have been analyzed. The samples of each study included participants according to the specific objectives. All the patients within the clinical groups met clinical criteria for CB and/or GD, and the control group included individuals from the same hospital without gambling and/or buying problems. An extensive clinical assessment based on standardized instruments was obtained. In the first study, structural equation models (SEM) were used to examine the underlying mechanisms associated with the concurrent presence of CB and GD. In the second study, a serious video game (Playmancer platform) was used as a therapeutic tool, and this system also allowed assessing the patients’ implicit emotional expression. The results indicated that some personality dimensions directly influenced the comorbid presence of CB with GD (particularly, the novelty seeking and harm avoidance traits), as well as the age of onset and male sex. Regarding the emotional assessment, the patients into the GD-acute state showed greater expression levels and implicit emotions, as well as higher emotional dysregulation, compared with patients into the GD-remission state and with the controls. The results of the first study provided empirical evidence on the underlying mechanisms related to the cross-sectional comorbidity of CB and GD, which can be useful for designing effective preventive and therapeutic programs focused on the specific characteristics of the patients. The results of the second study referred to the implicit emotional expression in patients with GD in different clinical state are also relevant to implement intervention strategies directly focused on the area of emotional control.

Date of Award	28 Nov 2019
Original language	Spanish
Supervisor	Susana Jiménez Murcia (Director), Fernando Fernández‐Aranda (Director), Roser Granero (Director) & Roser Granero (Tutor)