Gambling disorder and trichotillomania: case report and literature review
Gambling disorder includes frequent preoccupations with gambling, gambling with greater amounts of money to receive the same level of desired experience, repeated unsuccessful efforts to control or stop gambling, restlessness or irritability when trying to stop gambling, and the interference of gambling in major areas of life functioning. Trichotillomania is an often debilitating psychiatric condition characterized by recurrent pulling out of one’s own hair, leading to hair loss and marked functional impairment. Disordered gambling frequently co-occurs with various psychiatric conditions, including impulse-control disorders (ICDs), as trichotillomania. We report a case of a 38 year-old-man with diagnosis of both gambling disorder and trichotillomania and we aim to discuss the neurobiological patterns and psychopathological variables, highlighting the heightened possibility of such occurrence.
Description of clinical case and review of the literature on the subject.
J, a caucasian 38-year-old man, was presented to the psychiatric ward. He pulls hair from the head and beard since childhood, and this habit became a daily routine during all his life. He tends to pull hair during times of stress, and not always he is aware that he is doing it, and says that pulls “automatically”. On examination, J has a 2-inch-diamenter area of alopecia on the beard. Additionally, J plays casino-based online games 8 hours/ day; and also makes sports betting, spends 100 euros/week. He had maxed out his credit cards and emptied his saving account. He has debts with his girlfriend, mother, and friends, and has used their cards without permission. J senses lack of control and anxiety when he is gambling, with a sense of relieve and pleasure in the end.
J meets both the diagnostic criteria for trichotillomania and gambling disorder. Trichotillomania has been hypothesized to lie along an impulsive-compulsive spectrum, representing obsessive-compulsive (OC) spectrum disorders. Although individuals with this disorder engage in repetitive behaviors, often with strong associated urges, behaviors are often related as pleasurable or egosyntonic, whereas repetitive behaviors or rituals in OC disorder are generally egodystonic. Individuals with trichotillomania typically score high on measures of impulsivity and related constructs like sensation-seeking whereas individuals with OC typically score high on measures of harm avoidance. There are multiple neurobiological and genetic similarities between impulse control disorders and addictions, and emerging data on the neurobiology of impulsivity suggest parallels between these two. Although many fewer studies have investigated ICDs than gambling disorder, genetic, behavioral and treatment data implicate multiple neurotransmitter systems and neuronal circuits in the establishment and maintenance of behavioral addictions. Despite these advances, controversy remains regarding the nosology and underlying pathophysiology of specific ICDs.
