Behavioral addictions: an overview.

By Dr. Reef Karim and Dr. Priya Chaudhri

The Journal of Psychoactive Drugs 

2012 Jan-Mar;44(1):5-17.

The legitimacy of nonsubstance addictions has received increased attention from clinicians, researchers and the general population as more and more individuals report symptoms consistent with impairment of impulse control. The clinical presentation of these disorders is varied, as compulsive activities may include: gambling, eating, sex, shopping, use of the Internet or videogames or even exercising, working or falling in love. As such, there is great controversy in diagnosing, treating or even naming these conditions, as many of these behaviors are daily rituals instrumental to our ultimate survival. Historically, the phrase "impulse control disorders" described these conditions but many researchers and clinicians also use the term "behavioral addictions," "process addictions" or "impulsive-compulsive behaviors" to report behavioral pathology. This review summarizes the data of each of these behavioral addictions from epidemiology to neurobiology to treatment options. Research suggests similarities between natural and drug reward processing but clinical evidence supports the utilization of treatment modalities for these behavioral conditions that can sometimes differ from traditional drug treatment.



By Rory C. Reid, PhD, Bruce N. Carpenter, PhD, Randy Gilliland, BS, and Reef Karim, DO

Journal of Addiction Medicine


Earlier evidence suggests comorbid attention-deficit disorder (ADHD) among those seeking treatment for hypersexual behavior. This article examines which facets of ADHD symptoms are most strongly associated with hypersexual behavior among a patient sample of men (N = 81).


ADHD diagnosis was made by 2 clinicians, and symptom characteristics were measured using the Conners' Adult ADHD Rating Scale and the Sexual Compulsivity Scale.


Among ADHD symptoms, inattentive features were most prevalent. A stepwise regression analysis revealed that the Problems with Self-Concept subscale of the Conners' Adult ADHD Rating Scale was the strongest predictor of scores on the Sexual Compulsivity Scale. Surprisingly, subscales that measured traits of impulsivity, inattention, memory problems, and hyperactive restlessness did not contribute additional predictive variance in the statistical model.


The results of these findings suggest that clinicians should exercise caution in assuming that common characteristics of ADHD, such as impulsivity and hyperactivity, exert the strongest influence on hypersexual behavior. Rather, our results provide evidence that the associated features of ADHD, such as problems with low self-esteem, might be more salient factors in influencing hypersexuality severity among patients with comorbid hypersexual behavior and ADHD.



Reliability, Validity, and Psychometric Development of the Pornography Consumption Inventory in a Sample of Hypersexual Men

Rory C. Reid, Desiree S. Li, Randy Gilliland, Judith A. Stein, Reef Karim

Journal of Sex and Marital Therapy

VOL 37, ISS 05



Exploring Facets of Personality and Escapism in Pathological Gamblers

Rory C. Reid, Ph.D., LCSW ; Desiree S. LI, B.S. ; Jean Lopez, B.A. ; Michael Collard, M.A. ; Iman Parhami, M.D. ; Reef Karim, D.O. ; Timothy Fong, M.D.

Journal of Social Work Practice in the Addictions

This study explored facets of personality between pathological gamblers (n = 69) and nonpathological gamblers (n = 55) in a convenience sample in Los Angeles, California. Pathological gamblers were more prone to mood disturbance, impulsivity, feelings of frustration, interpersonal sensitivity, vulnerability to distress, and distrust of others as measured by the NEO Personality Inventory–Revised. Pathological gamblers also reported diminished competence and self-discipline as well as tendencies toward hasty decision making when compared to nonpathological gamblers. A categorical analysis of subtypes revealed that those who gambled to escape experienced significantly greater levels of neuroticism and facets of impulsivity.



Self-Reported Differences on Measures of Executive Function and Hypersexual Behavior in a Patient and Community Sample of Men

Rory C. Reid, Reef Karim, Erin McCrory, and Bruce N. Carpenter

Journal of Social Work Practice in the Addictions

Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n = 87) and a non-hypersexual community sample (n = 92) of men using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and the Hypersexual Behavior Inventory (HBI). Significant differences between the groups emerged on eight subscales and all of the general indices of executive functioning with the most dramatic differences on BRIEF-A's Shift, Emotional Control, Initiate, and Plan/Organize subscales. Hypersexual behavior was positively correlated (r = .37, p < .01) with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.