Like OCD, BDD also seems to respond to CBT, particularly exposure and response prevention, rather than other psychotherapeutic interventions. A number of studies and case reports of group78,79 and individual80-82 treatment

with CBT have shown promising results. Poor insight presents a challenge in terms of engaging patients in therapy, but does not preclude successful treatment. Indeed, correction of the misperception about their appearance does not seem to be SAR405838 mw necessary for successful treatment or to add to treatment success.83 Pathological gambling PG is a disorder of impulse control characterized by recurrent gambling behavior that is maladaptive (ie, loss of judgment or excessive gambling) and in which Inhibitors,research,lifescience,medical personal, family, and/or vocational endeavors are disrupted.62 PG shares many characteristics with other impulse control disorders such as kleptomania and pyromania in that individuals with these disorders have the irresistible impulse to perform harmful acts, have loss of control, may harm self or others, and engage in risky behavior. They share a pre-act arousal Inhibitors,research,lifescience,medical and/or tension, and the performance of the act results in relief

or gratification, sometimes followed by guilt. PG is characterized by an inability to resist Inhibitors,research,lifescience,medical the urge to gamble and is often progressive. Patients may show “tolerance” and thus need to gamble with increasing amounts of money. The course of PG tends to be chronic, although the pattern of gambling may be regular or episodic. During periods of gambling, the individuals often have hours of daily preoccupation with gambling, including planning future Inhibitors,research,lifescience,medical gambling, reliving past gambling experiences, and figuring

out how to obtain money for gambling. They may lie and defraud people to finance their gambling. Individuals with PG commonly experience tormenting and devastating distress over their gambling behavior. Chronicity is often associated with increases in frequency and amount gambled; additionally, gambling may increase during periods Inhibitors,research,lifescience,medical of heightened stress. Gambling thus leads to more and more severe consequences, and more gambling, and may spiral out of control. Thus, the combination of illness chronicity, severe interference with normal life activities, and unavailability MTMR9 of treatment frequently leads to severe personal, familial, financial, social, and occupational impairment. In 1998, 86% of adults in the USA were estimated to have participated in some type of gambling over their lifetime, up from 63% in 1975; the past-year figures increased only slightly, from 61 % to 68%.84 The past-year prevalence of PG among adults has been estimated to be between 0.9% and 2.0%, while the lifetime adult prevalence has been estimated to be between 1.5% and 2.3%.85 The prevalence rates are higher among adolescents and college students. As with OCD, demographic factors in treatment-seeking populations differ from those in epidemiological/general population surveys.