“reward system” of the brain, is involved
in impulse control disorders.
There are no evidence-based treatment for
CBD. Treatment have generally followed
the same protocols as with other impulse
control disorders, namely, cognitive-
behavioral therapy (CBT)
pharmacotherapies. Pharmacotherapies
have included the use of
psrticularly fluoxetine and citalopram.
There is some evidence of improvements
with naltrexone suggesting that opiate
antagonist mught play a role in CBD.
Since the medication findings are mixed,
no empirically supported
recommedations can be made. CBD has
also been recommended and has been
shown to yield significant improvement
compared with a control group, and the
improvement attributed to CBT were
maintained during a 6-month follow-up.
EXCESSIVE TANNING
There is a subgroup of people for whom
tanning is clearly excessive and seems to
reflect frank psychopathology. Excessive
tanning is not disreet DSM-5 diagnosis,
nor is it mentioned as an example of a not
otherwise specified impulse
disorder. However, for this subgroup of
people who tan excessively,
presentation, symptomatology, psychiatric
comorbidity, consequences of behavior,
and overall course of illness resemble
significantly the trajectories of other
behavioral addictions and the substance
use disorders. One small study even
reported a group of regular sunbathers who
exhibited opioid withdrawal symptoms
upon administration of naltrexone, an
and opioid antagonist.
While most recent research has
SSRIs, adopted the addiction paradigm in
understanding excessive tanning, there are
other psychiatric disorders that may also
explain the manifestations of the illness.
The following three disorders have been
proposed as “possible underlying
treatment psychopathologies” for excessive tanning:
obsessive compulsive disorder (OCD),
body dysmorphic disorder (BDD), and
borderline personality disorder (BPD).
At this time , limited research has
been conducted to support or refute these
explanations. Furthemore, an alternative
formulation of the illnes could suggest that
excessive tanning may be a behavioral
addiction that is often found to be
comorbid with these disorders-OCD, BDD
and BPD.
The lack of research in this area
extends to treatments. However, if we
control
accept that excessive tanning is best
appreciated as a behavioral addiction, then
their
(1) addressing underlying or co occuriing
psychiatric conditions and (2) providing
CBT or motivational interviewing (MI)
seem to be the most reasonable approach
women who indoor tan very frequently
markedly reduced their behavior following
an MI session delivered by a trained peer
counselor. Interestingly, a comparison
group that was given identical information
but through the Internet with no person-to-
person contact failed to show
significant difference from the control
group.
A number of other psichosocial
interventions have been tried in small
samples of more normative populations,
including the following three, which have
shown some promising result, including
showing patients ultraviolet photos of skin
damage, showing patients “image norms of
aspirational peers” approving paleness,
and providing feedback on the patient’s
sun tanning behavioral patterns by a
physician.
In addition to treatments, prevention
has play a major role in addressing the
proposed illness, especially since there is
little evidence of safe and effective
therapeutic interventions. Current public
health efforts go beyond raising awareness
of the risk of suntanning. State, federal,
and international regulations are being
concidered and implemented to limit
indoor tanning by imposing higher taxes
and prohibiting minors from using such
facilities.
KLEPTOMANIA
The DSM-5 includes kleptomania in the
category of disruptive, impulse controln
and conduct disorders, which also includes
intermittent explosive disorders, conduct
disorder, and pyromania. The DSM-5
requires the following symptoms for a
any diagnosis of kleptomania:
 Reccurrent failure to resist impulse to
steal object that are not needed for
personal use or their monetary value.
 Increasing senseof tension immediately
before committing the theft.
 Pleasure, gratification, or relief at the
time of committing the theft.
 The stealing is not committed to
express anger or vengeance and is not
in response to delucion or a
hallunation.
 The stealing is not better explained by
conduct disorder, a manic episode, or
antisocial personality disorder.
Kleptomania is characterized by
recurrent episodes of compulsive stealing.
Often confused with shoplifting, it differs
in that those with kleptomania do not steal
for personal gain. They steal in response to
an overwhelming urgecauses fellings of
anxiety, tension, or arousal.stealing
soothes these feelings.however,following
this,there are often feelings of guilt,
remorse,and fear.these feelings frequently
serve as barriers to treatment seeking.
 Kleptomania is a psychiatric disorder examined the comorbidity of OCD in
that is poorly understood and the subject of subjects with kleptomania have been
only few empirical studies. While the inconsistent with some showing a
prevalence of the disorder in the US relativety high co- occurrence (45% to
general population is unknown, it has been 60%), while others show low rates (0% to
estimated at 6 per 1000 people. 6,5%). When rates of kleptomania have
While kleptomania meets criteria for been examined in subyeths with OCD , a
impulse control disorder (inability to similarly low co-occurrence was found
control one’s impulse to steal ,repeated (2,2% to 5,9%).
expression of impulsive acts that . lead to Kleptomania and subtance use
physical or financial damage),it shares disorders have central qualities in
many characteristics oof OCD.there is common. These include recurring or
evidence derived from studies of clinical compulsive participation in a behavior in
characteristics,familial transmission,and spite of undersirable consequences
treatment response that suggests that weakened control over the distrubing
kleptomania may have subtypes that are behavior an overwhelming need or desire
more lke OCD, addictive disorders, or experienced befor taking part of the
mood disorders. problematic behavior, and a positive
A correlational aspect lmined in pleasure-seeking condition throughout the
inking kleptomania to OCD is seen in the act of the disturbing behavior the anxiety,
biolgic perspective on OCD. Studies of tension, or arousal that those with
the brain using magnetic resonance kleptomania experience and the relief that
imaging showed that subjects with OCD they feel upon stealing, followed by guilt
has significantly less white matter than did or remorse are consistent with opponent
normal control subjects, suggesting a proces descptions and wanting-but-not-
widely distributed brain abnormality liking states described for subtance use
associated with OCD. OCD is considereda disordes. Similiar to subtance use disordes,
result of serotonin deficiency.the use of a higher percentage of cases of
SSRIs in the treatment of both OCD and kleptomania have been noted in
kleptomania and has been considered a adolescenes and young adults and a
link between the disorder. smaller number of cases among older
Prevalence rates between the two aduts. Family history also show a likely
disorder do not show a stroong common genetic input to subtance use and
relationship. The results of studiest,which kleptomania in the family members of
persons with kleptomania than in the
general population.
Tereatment for kleptomania has
many commonaties with treatmenth for
subtance use disordes and OCD.
Treatment usually consists of a
combination of therapies including
pharmacotherapy and talk therapy. While
there are no medications specifically
approved for the treatment of kleptomania,
the similarity and suggested biologic
dynamics of kleptomania and OCD and
impulse control disordes led to the theory
that similiar groups of medications could
be used for all of these conditions.
Fluexotine and other SSRIs have been
widely used to treat kleptomania , although
there has not been strong evidence
supporting the efficacy of SSRIs in
treating the disordes. There has been some
promising evidence supporting the use of
mood stabilizers, antiseizure,medication,
and opioid antagonesis, particularly
naltrezone. Opioid receptor antagonist
have been shown to lessen urge-related
symptoms, which is a central part of
impulse control disordes and subtance
depedence