Heightened Negative Affects Associated With Neurotic Personality in Behavioral Addiction

Abstract

Although studies have demonstrated that negative affects are critical attributes of drug addiction, this has remained less clear in behavioral addiction. In this preliminary study with a relatively small number of samples, we investigated negative affects in patients diagnosed with behavioral addiction, particularly paraphilia and kleptomania. Negative affects were examined using self-rating questionnaire and further evaluated by objective assessments in behavioral addicts and normal subjects. Explicit, self-referential negative affects, such as anxiety, stress, and depression, were higher in behavioral addicts than control subjects. Such self-referential negative affects were, although not entirely, consistent with objective evaluations by others and blood stress hormone concentrations. Further investigation of personality traits in behavioral addicts unveiled that heightened negative affects were associated with stronger neurotic personality in behavioral addicts than normal subjects. These results suggest that behavioral addiction, such as paraphilia and kleptomania, may be characterized by heightened negative affects attributable to stronger neurotic personality.

Keywords: anxiety; cortisol; depression; impulse control disorder; kleptomania; paraphilia; personality; stress.

Figure 1

Self-assessment of negative affects with 21-item version of depression anxiety stress scale (DASS21). (A) A stacked bar graph showing scores in stress, anxiety, and depression scales of DASS21, respectively, in behavioral addiction (BA) patients and control (CT) subjects. Error bars indicate s.e.m. *p < 0.05. (B) A bar graph similar to (A) but showing those in kleptomania (KM) and paraphilia (PP) patients.

Figure 2

Objective assessment of anxiety with Hamilton anxiety rating scale (HAM-A) and correlations with self-assessment of negative effects. (A) A bar graph showing HAM-A scores in between behavioral addiction (BA) patients and control (CT) subjects. Error bars indicate s.e.m. *p < 0.05. (B) A graph similar to (A) but showing those in kleptomania (KM) and paraphilia (PP) patients. (C) Graphs showing correlations between HAM-A and 21-item version of depression anxiety stress scale (DASS21) scores in CT subjects (left) and BA patients (right). Each line indicates a linear correlation for stress, anxiety, and depression scales of DASS21, respectively.

Figure 3

Blood cortisol concentrations and correlations with self-assessment of negative effects. (A) A bar graph showing cortisol concentrations in blood samples from behavioral addiction (BA) patients and control (CT) subjects. Error bars indicate s.e.m. *p < 0.05. (B) A graph similar to (A) but showing those in kleptomania (KM) and paraphilia (PP) patients. (C) Graphs showing correlations between cortisol concentrations and 21-item version of depression anxiety stress scale (DASS21) scores in CT subjects (left) and BA patients (right). Dashed lines with r’ and p’ indicate person’s r and p-values, respectively, excluding the outlier.

Figure 4

Personality traits and correlations with negative effects. (A, B) Rader charts comparing big five personality traits between behavioral addiction (BA) patients and control (CT) subjects (A) and between kleptomania (KM) and paraphilia (PP) patients (B). Error bars indicate s.e.m. p = 0.080 in BA vs. CT at neuroticism. (C) A graph showing color-coded correlations (Pearson’s r) between each personality trait and negative affect assessments in BA patients and CT subjects. (D) A rader chart illustrating self-rating shown in (A) and objective rating made by others. *p < 0.05 in BA self vs. other in each trait.