Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

13. Pathological Gambling and Other “Behavioral” Addictions 307lifetime prevalence of compulsive buying have ranged from 1.1 to 5.9%(Christenson et al., 1994; McElroy, Keck, Pope, Smith, & Strakowski, 1994).ETIOLOGYA growing body of literature implicates multiple neurotransmitter systems (e.g.,serotonergic, dopaminergic, noradrenergic, opioidergic), as well as familial andinherited factors, in the pathophysiology of ICDs (Potenza & Hollander, 2002).The most consistent findings involve the serotonin (5-hydroxyindole or 5-HT) system, believed to underlie impulse control (Potenza & Hollander, 2002).Evidence for serotonergic involvement in ICDs comes in part from studiesof platelet monoamine oxidase B (MAO-B) activity, which correlates withcerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA, ametabolite of 5-HT) and is considered a peripheral marker of 5-HT function(Potenza & Hollander, 2002). Low CSF 5-HIAA levels have been found tocorrelate with high levels of impulsivity and sensation seeking (Potenza &Hollander, 2002). Pharmacological challenge studies that measure hormonalresponse after administration of serotonergic drugs also provide evidence for serotonergicdysfunction in ICDs (Potenza & Hollander, 2002).Dopaminergic systems influencing rewarding and reinforcing behaviorshave also been implicated in ICDs. “Reward deficiency syndrome,” a hypothesizedhypodopaminergic state involving multiple genes and environmentalstimuli that puts an individual at high risk for multiple addictive, impulsive,and compulsive behaviors, is one proposed mechanism (Blum et al., 2000).Alterations in dopaminergic pathways have been proposed as underlying theseeking of rewards (gambling, drugs) that trigger the release of dopamine andproduce feelings of pleasure (Blum et al., 2000).Noradrenergic systems, believed to underlie arousal, excitement, and sensationseeking, have been implicated in impulsive behaviors (Potenza & Hollander,2002). Anticipation of or engagement in seemingly impulsive behaviorscan activate the autonomic nervous system. Correlations between scores on theextroversion scale of the Eysenck Personality Questionnaire and markers ofnoradrenergic functioning (e.g., CSF or plasma 3-methoxy-4-hydroxyphenylglycol[MHPG] levels, urinary outputs of norepinephrine and its major metabolites)suggest a disturbance in central noradrenergic system functioning in PG(Roy, De Jong, & Linnoila, 1989).The mu opioid system is believed to underlie urge regulation through theprocessing of reward, pleasure, and pain, at least in part via modulation ofdopamine neurons in mesolimbic pathway through gamma-aminobutyric acid(GABA) interneurons (Potenza & Hollander, 2002). Opioidergic involvementin ICDs comes from studies of naltrexone, a mu opioid receptor antagonist with