Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •.

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

Contradicting classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) and future directions •.

Building on the conclusions of the debate papers by Gola et al. (2022) and Sassover and Weinstein (2022), the present commentary further addressed the contradictions between the current classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) with elaborating on the potential roles impulsivity and compulsivity may play in CSBD, and how these characteristics may relate to addictive behaviors in particular. Moreover, it briefly discussed how the classification of CSBD might impact research and clinical practice and proposed potential future research directions that may help to reach a consensus on the classification and core symptoms of CSBD.

Assessment of compulsive sexual behavior disorder among lesbian, gay, bisexual, transgender, and queer clients •.

Numerous debates surround the recent inclusion of compulsive sexual behavior disorder (CSBD) in the International Classification of Diseases (11th ed.), such as the appropriate classification of this construct and what symptom criteria best capture this syndrome. Although controversy surrounding CSBD abounds, there is general agreement that researchers should examine this syndrome in diverse groups, such as lesbian, gay, bisexual, and transgender populations. However, there have been few investigations into how diverse sociocultural contexts may influence the assessment and treatment of CSBD. Therefore, we propose several differential diagnosis considerations when working with sexual and gender diverse clients to avoid CSBD misdiagnosis.

Where to put Compulsive Sexual Behavior Disorder (CSBD)? Phenomenology matters •.

In this commentary paper, it is discussed if Compulsive Sexual Behavior Disorder (CSBD) is best categorized as an Impulse Control Disorder, an Obsessive-Compulsive Disorder or in light of the overlap of characteristics with both Gaming and Gambling Disorder as an addictive behavior. The overlapping features are: loss of control over the respective excessive behavior, giving increasing priority to the excessive behavior under investigation and upholding such a behavior despite negative consequences. Besides empirical evidence regarding underlying mechanisms, phenomenology also plays an important role to correctly classify CSBD. The phenomenological aspects of CSBD clearly speak in favor of classifying CSBD under the umbrella of addictive behaviors.

Mental Contamination in Obsessive-Compulsive Disorder: Associations With Contamination Symptoms and Treatment Response.

The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.

Bupropion Augmentation in a Case of Compulsive Buying Disorder.

BACKGROUND: Compulsive buying disorder (CBD) is a condition characterized by excessive preoccupations, impulses, and behaviors regarding buying, resulting in serious psychological, social, and financial problems. Even though it has not been included in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, "behavioral addictions" section, CBD is a hot topic in current clinical psychiatry, because of its relevant prevalence (at least 5% in adult populations) and severe effect on quality of life.The CBD shares some clinical features with substance-related and behavioral addictions, impulse control disorders, and obsessive compulsive disorder, and it is often comorbid with other psychiatric illnesses (especially depressive and anxiety disorders). The treatment of CBD is therefore difficult, and clear therapeutic guidelines are not yet available. Treating the comorbid disorders as the first-line approach, or combining drugs with different pharmacodynamic profiles, has been suggested to address this challenging condition. CASE: A 60-year-old woman affected by a severe form of CBD with comorbid major depressive disorder, resistant/intolerant to previous selective serotonin reuptake inhibitor treatments and only partially responder to mirtazapine, achieved a good clinical improvement adding bupropion. CONCLUSIONS: Combining 2 agents with different pharmacological profiles and mechanisms of action, such as bupropion and mirtazapine, could be a useful strategy in the management of complex CBD cases.

Pathological Overeating: Emerging Evidence for a Compulsivity Construct.

Compulsive eating behavior is a transdiagnostic construct that is characteristic of medical and psychiatric conditions such as forms of obesity and eating disorders. Although feeding research is moving toward a better understanding of the proposed addictive properties of food, the components and the mechanisms contributing to compulsive eating are not yet clearly defined or understood. Current understanding highlights three elements of compulsive behavior as it applies to pathological overeating: (1) habitual overeating; (2) overeating to relieve a negative emotional state; and (3) overeating despite aversive consequences. These elements emerge through mechanisms involving pathological habit formation through an aberrant learning process, the emergence of a negative emotional state, and dysfunctions in behavioral control. Dysfunctions in systems within neurocircuitries that comprise the basal ganglia, the extended amygdala, and the prefrontal cortex result in compulsive eating behaviors. Here, we present evidence to relate compulsive eating behavior and addiction and to characterize their underlying neurobiological mechanisms. A major need to improve understanding of compulsive eating through the integration of complex motivational, emotional, and cognitive constructs is warranted.

Disordered eating attitudes and exercise in women undergoing fertility treatment.

BACKGROUND: Previous research has found a higher lifetime prevalence of eating disorders in women undergoing fertility treatment. AIMS: This study aimed to gauge the prevalence of eating disorders in women attending a fertility clinic and to compare current disordered eating attitudes and exercise amongst different infertility categories. MATERIALS AND METHODS: Three hundred and eighty-five women were grouped according to infertility diagnosis: male factor, unexplained infertility, ovulatory disorders, polycystic ovarian syndrome (PCOS) and heterogeneous causations. Participants anonymously completed the Eating Disorder Examination Questionnaire (EDE-Q), the International Physical Activity Questionnaire (IPAQ) and a Demographics questionnaire. RESULTS: The lifetime history of self-reported eating disorders for women in the sample was similar to Australian community rates. Profile analysis revealed on the EDE-Q that women with ovulatory disorders were not significantly different from women with PCOS; however, they were significantly different to women with other infertility diagnoses (all P < 0.05), suggesting increased vulnerability to disordered eating. There were no between-group differences in exercise quantity (IPAQ, P = 0.625) although women with ovulatory disorders and PCOS had a significantly higher risk of engaging in compulsive, 'driven' exercise (OR = 6.98, CI = 1.39, 34.90, P = 0.018) as a means to control weight or shape. CONCLUSIONS: Contrary to previous research, our findings do not confirm a greater lifetime prevalence rate of eating disorders in women attending an infertility clinic. This study does highlight the importance of screening women with forms of an ovulatory disorder for features of disordered eating attitudes and driven exercise behaviours.

Avaliação da equivalência semântica da versão em português (Brasil) da Online Cognition Scale / Semantic equivalence of the Brazilian Portuguese-language version of the Online Cognition Scale / Evaluación de equivalencia semántica de la versión portuguesa (Brasil) de la Online Cognition Scale

Este estudo teve por objetivo realizar a avaliação da equivalência semântica da Online Cognition Scale para o português (Brasil). O processo consistiu em cinco etapas: tradução; retrotradução; revisão técnica e avaliação da equivalência semântica por profissionais capacitados; avaliação do instrumento quanto à compreensão verbal por uma amostra de profissionais (n = 10) e estudantes (n = 37). O instrumento foi traduzido e adaptado para o português, apresentando, ao final, excelente nível de compreensão verbal pela população alvo. A versão do instrumento adaptada para uso em nosso meio resultou em um instrumento equivalente do ponto de vista da equivalência semântica e de conteúdo, estando pronto para iniciar o estudo de suas qualidades psicométricas no contexto cultural brasileiro.

This study evaluated the semantic equivalence of the Online Cognition Scale in Brazilian Portuguese. The process included five steps: translation, back-translation, technical review, evaluation of semantic equivalence by trained professionals, and evaluation of the instrument for content understanding by a group of professionals (n = 10) and students (n = 37). The instrument was translated and adapted to Portuguese, showing a high level of verbal comprehension by the target population. The adapted version for use in Brazil resulted in an equivalent instrument from the semantic and content point of view, ready for evaluation of its psychometric qualities in the Brazilian cultural context.

El objetivo de este estudio fue llevar a cabo la evaluación de la equivalencia semántica de la Online Cognition Scale en portugués (Brasil). El proceso consistió en cinco etapas: traducción, retrotraducción, revisión técnica y evaluación de la equivalencia semántica de los profesionales; habilitación de instrumentos como la comprensión verbal por una muestra de profesionales (n = 10) y estudiantes (n = 37). El instrumento fue traducido y adaptado al portugués, con un excelente nivel final de comprensión verbal por parte de la población objetivo. La versión adaptada del instrumento para su uso en nuestro contexto, que dio como resultado un instrumento equivalente desde el punto de vista semántico y del contenido, está lista para que comience el estudio de sus propiedades psicométricas en el contexto cultural brasileño.

Hoarding disorder: a new diagnostic category in ICD-11?

Despite the long-held view that hoarding is a symptom of both obsessive-compulsive disorder and obsessive-compulsive personality disorder, increased evidence has emerged during the last 20 years suggesting that hoarding represents a distinct form of psychopathology. This study reflects the discussions on the nosological status of hoarding carried out by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. The distinctiveness of hoarding is based on its having core symptoms that differ from those of other disorders, as well as distinctive neurobiological correlates and treatment responses. Furthermore, data showing the clinical utility, global applicability, and appropriateness of the concept of hoarding disorder outside specialty mental health settings suggest that this condition should be included in ICD-11. Finally, given the focus of ICD-11 on primary care and public health, the Working Group suggests that poor insight and severe domestic squalor may be considered as specifiers for hoarding disorder in ICD-11.

Cross-cultural adaptation, validation and reliability of the brazilian version of the Richmond Compulsive Buying Scale

OBJECTIVE: To present the process of transcultural adaptation of the Richmond Compulsive Buying Scale to Brazilian Portuguese. METHODS: For the semantic adaptation step, the scale was translated to Portuguese and then back-translated to English by two professional translators and one psychologist, without any communication between them. The scale was then applied to 20 participants from the general population for language adjustments. For the construct validation step, an exploratory factor analysis was performed, using the scree plot test, principal component analysis for factor extraction, and Varimax rotation. For convergent validity, the correlation matrix was analyzed through Pearson's coefficient. RESULTS: The scale showed easy applicability, satisfactory internal consistency (Cronbach's alpha=.87), and a high correlation with other rating scales for compulsive buying disorder, indicating that it is suitable to be used in the assessment and diagnosis of compulsive buying disorder, as it presents psychometric validity. CONCLUSION: The Brazilian Portuguese version of the Richmond Compulsive Buying Scale has good validity and reliability.

Cannabinoid hyperemesis syndrome: a case series and review of previous reports.

BACKGROUND: Cannabis is the most commonly used illicit substance worldwide. Cannabinoids or cannabinoid receptor agonists are often used to treat nausea, vomiting, and anorexia. However, in recent years, several medical journals have published reports of patients with nausea and vomiting thought to be induced by chronic cannabis use. OBJECTIVE: The authors seek to inform readers about Cannabinoid Hyperemesis Syndrome (CHS). METHOD: The authors describe four patients with chronic cannabis abuse, episodic, intractable nausea and vomiting, and compulsive hot water bathing. Previous cases of CHS are reviewed, pathophysiology is hypothesized, and difficulties with making the diagnosis are discussed. CONCLUSION: CHS should be strongly considered in the differential diagnosis of patients with intractable vomiting and/or compulsive hot water bathing.

A cytokine study of adult patients with obsessive-compulsive disorder.

OBJECTIVES: We aimed to determine the plasma levels of cytokines in patients with obsessive-compulsive disorder (OCD) as compared with healthy controls and to investigate whether there is any association between their concentrations and OCD clinical and therapeutic features. METHODS: Forty patients with OCD and 40 healthy controls had their plasmas assessed for a range of cytokines (tumor necrosis factor-α, or TNF-α), chemokines (CCL2, CCL3, CCL11, CCL24, CXCL8, CXCL9, CXCL10), and other mediators (TNF soluble receptors sTNFR1 and sTNFR2 and interleukin-1 receptor antagonist) by enzyme-linked immunosorbent assay. Patients with OCD were further examined with the Mini-International Neuropsychiatric Interview, the Obsessive-Compulsive Inventory-Revised, and the Beck Depression Inventory. RESULTS: Compared with healthy controls, patients with OCD exhibited significantly increased plasma levels of CCL3, CXCL8, sTNFR1, and sTNFR2. Among patients with OCD, there was a positive correlation between relative antidepressant dose and sTNFr2 levels. Furthermore, although the levels of sTNFR1 correlated positively with the severity of washing symptoms, CCL24 levels correlated negatively with the severity of hoarding. CONCLUSIONS: The levels of certain immune markers are increased in adult patients with OCD and seem to vary according to predominant symptoms dimensions. Other studies are required to establish whether our findings truly reflect immunologic dysfunction in OCD or are the result of other hidden confounding factors.

Validação e aferição de fidedignidade da versão brasileira da Compulsive Buying Scale / Validation and reliability of the Brazilian version of Compulsive Buying Scale

INTRODUÇÃO: A Escala de Compras Compulsivas (CBS) é um instrumento breve e de fácil aplicação, que visa avaliar as principais dimensões do transtorno das compras compulsivas, centrando-se no controle dos impulsos. OBJETIVO: O presente estudo tem como objetivo validar e aferir a fidedignidade da versão brasileira da Escala de Compras Compulsivas (CBS). MÉTODOS: Para validade de construto, foi realizada análise fatorial com extração dos componentes principais e rotação Varimax. A correlação entre a escala CBS e as medidas de depressão e ansiedade, assim como do transtorno obsessivo-compulsivo, foi avaliada por meio do coeficiente de Pearson, para estudo da validade convergente e divergente. A consistência interna foi aferida por meio do coeficiente alfa de Cronbach. RESULTADO: A CBS apresentou bons parâmetros psicométricos, sendo considerada válida e fidedigna em sua versão brasileira. No que concerne às correlações, a CBS apresenta uma correlação inversamente proporcional com outras escalas diagnósticas para o transtorno das compras compulsivas, indicando, portanto, ser um excelente instrumento de aferição dessa desordem. A CBS apresentou alto coeficiente alfa de Cronbach (0,86), demonstrando boa confiabilidade. CONCLUSÃO: Embora seja uma escala curta, com poucos itens, a versão brasileira da escala de compras compulsivas apresenta boas propriedades psicométricas, apresentando-se como um importante instrumento para avaliação desse construto.

BACKGROUND: The Compulsive Buying Scale is a short and easy-to-apply instrument, which comprises the main dimensions of the compulsive buying disorder, focusing on impulse control. OBJECTIVE: This study aims to validate and assess the reliability of the Brazilian version of the Compulsive Buying Scale. METHODS: To assess construct validity, a factor analysis with principal components extraction and Varimax rotation was conducted. The correlations between the CBS and measures for depression, anxiety, and obsessive-compulsive disorder were assessed with the Pearson coefficient, evaluating convergent and divergent validity. The internal consistency was measured using Cronbach's alpha coefficient. RESULT: The psychometric parameters of the Brazilian version of the CBS were satisfactory and the instrument was considered valid and reliable. The CBS showed an inversely correlation with other diagnostic scales for the compulsive buying disorder. Cronbach's alpha coefficient (0.86) was high, demonstrating a satisfactory reliability of the Portuguese CBS. DISCUSSION: Although the Brazilian version of the Compulsive Buying Scale is a short version with just a few items, the scale has excellent psychometric properties, presenting itself as an important tool to detect and evaluate compulsive buying disorder.

Tradução e adaptação semântica da Compulsive Buying Scale para o português brasileiro / Translation and semantic adaptation of the Compulsive Buying Scale for Brazilian Portuguese

OBJETIVO: A Compulsive Buying Scale (Escala de Compras Compulsivas), instrumento breve e de fácil aplicação, apresenta como vantagem abarcar as principais dimensões do transtorno, sendo elas a compulsão pelas compras e o comportamento impulsivo. O presente estudo tem como objetivo a adaptação transcultural para o português do Brasil da Escala de Compras Compulsivas. MÉTODOS: Para a etapa de adaptação semântica, dois psicólogos bilíngues e um tradutor fluente em português e inglês traduziram a escala de seu idioma de origem, o inglês, para o português. Em um segundo momento, foi realizada a retrotradução da escala por dois tradutores e um psicólogo. Finalmente, a escala foi aplicada em 20 participantes, de modo que pudessem ser feitos ajustes semânticos no instrumento em questão. RESULTADOS: A colaboração entre profissionais especialistas em tradução bilíngue fluentes nos idiomas inglês e português brasileiro, e psicólogos clínicos capacitados à avaliação sobre o constructo a ser mensurado, possibilitou o ajuste dos termos utilizados na versão final da escala para o idioma português, assegurando adequação semântica do instrumento. Assim, todos os itens obtiveram aprovação superior a 90 por cento em sua aplicação experimental. CONCLUSÃO: A versão da escala de compras compulsivas adaptada para o idioma português foi elaborada com êxito.

OBJECTIVE: The Compulsive Buying Scale, a short and easy-to-apply instrument, has the advantage of comprising the main dimensions of the disorder, which are the compulsion for buying and the impulsive behavior. The present work aimed to adapt the scale transculturally to Brazilian Portuguese. METHODS: To the step of semantic adaptation, a Portuguese-English Translator and two bilingual Psychologists translated the scale from English to Portuguese. Secondly, it was translated back to English for validation by two translators and a Psychologist. Finally, the scale was applied to 20 participants in order to perform semantic adjustments to the instrument. RESULTS: The collaboration of professional translators and clinical psychologists, able to evaluate the quality of the material, made possible the adjustment of the text used in the final version of the scale in Portuguese, thus assuring semantic adequation. All items had approval of over 90 percent in the experimental application. CONCLUSION: The Brazilian Portuguese version of the Compulsive Buying Scale was successfully created.

Screening for Internet dependence: do the proposed diagnostic criteria differentiate normal from dependent Internet use?

There is continued discussion of including Internet dependence as a diagnosis in future editions of the Diagnostic and Statistical Manual of Mental Disorders. The primary aim of the study was to evaluate the utility of the proposed diagnostic criteria for Internet dependence as measured by Young's Diagnostic Questionnaire (YDQ). Although the YDQ does not provide any measure of severity, there is emerging recognition that some Internet users may display less severe or at risk Internet dependence. The degree to which the cutoff of 5 out of 8 criteria is appropriate to differentiate nondependent from dependent Internet use was evaluated by comparing the Internet usage and psychological dysfunction of 424 university students endorsing 3 and 4 diagnostic criteria (at-risk Internet dependence) to those endorsing less than 3 criteria (nondependent) and those endorsing 5 or more criteria (Internet dependence). The findings suggest that the proposed diagnostic criteria do not adequately discriminate individuals scoring 3 or 4 from those currently classified as Internet dependent. The implications of the findings for the assessment, diagnosis, and treatment of Internet dependence are discussed.

[Compulsive buying and psychiatric comorbidity]. / Pathologisches Kaufen und psychische Komorbidität.

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

Pharmacology of sexually compulsive behavior.

In a meta-analysis on controlled outcomes evaluations of 22,000 sex offenders, Losel and Schmucker found 80 comparisons between treatment and control groups. The recidivism rate averaged 19% in treated groups, and 27% in controls. Most other reviews reported a lower rate of sexual recidivism in treated sexual offenders. Of 2039 citations in this study (including literature in five languages), 60 studies held independent comparisons. Problematic issues included the control groups; various hormonal, surgical, cognitive behavioral, and psychotherapeutic treatments; and sample sizes. In the 80 studies compared after the year 2000, 32% were reported after 2000, 45% originated in the United States, 45% were reported in journals, and 36% were unpublished. Treatment characteristics showed a significant lack of pharmacologic treatment (7.5%), whereas use cognitive and classical behavioral therapy was 64%. In 68% of the studies, no information was available on the integrity of the treatment implementation; 36% of the treatment settings were outpatient only, 31% were prison settings, and 12% were mixed settings (prison, hospital, and outpatient). Integrating research interpretations is complicated by the heterogeneity of sex offenders, with only 56% being adult men and 17.5% adolescents. Offense types reported included 74% child molestation, 48% incest, and 30% exhibitionism. Pedophilia was not singled out. Follow-up periods varied from 12 months to greater than 84 months. The definition of recidivism ran the gamut from arrest (24%), conviction (30%), charges (19%), and no indication (16%). Results were difficult to interpret because of the methodological problems with this type of study. Overall, a positive outcome was noted with sex offender treatment. Cognitive-behavioral and hormonal treatment were the most promising. Voluntary treatment led to a slightly better outcome than mandatory participation. When accounting for a low base rate of sexual recidivism, the reduction was 37%, which included psychological and medical modes of treatment. Which treatments will reduce recidivism rates in sex offenders is extremely difficult to conclude. Some treatment effects are determined from small studies; however, recidivism rates may be based on different criteria. Larger studies tend to be published more frequently than small studies, negative results may be less likely to be reported in published studies, and differences in mandatory versus voluntary treatment may occur. Clearly more high-quality outcome studies are needed to determine which treatments work best for which individuals. One size is unlikely to fit all. However, pharmacologic intervention, although not always the perfect choice, has improved and will continue to advance the treatment of paraphilic, nonparaphilic, and compulsive sexual behaviors.

Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room.

AIM OF THE STUDY: Exercise dependence is an inadequate pattern of exercise leading to clinically significant negative consequences. Subjects present loss of control of their physical activity, tolerance, and withdrawal symptoms when they do not practice sport. We studied the prevalence of exercise dependence among clients of a Parisian fitness room. We also assessed alcohol and nicotine use disorders, 2 other "socially tolerated" behavioral addictions (compulsive buying and Internet addiction), and 2 disorders related to anxiety focused on the body (bulimia and hypochondria). METHOD: All clients of the fitness room 18 years and older were invited to participate in the study. Three hundred subjects were included; 125 (42%) presented diagnostic criteria of exercise dependence. Unsurprisingly, exercise dependents spent more hours each day in the fitness center practicing (2.1 vs 1.5 hours per day). They went to the fitness center more often each week (3.5 vs 2.9 days per week). Exercise addicts smoked less; alcohol consumption was equivalent in both groups. Compulsive buying was significantly more frequent in exercise dependents (63% vs 38%), which means they scored higher in the compulsive buying scale (5.4 vs 4.1). Prevalence of hypochondria was equivalent in both groups, but scores in the Whiteley Index of Hypochondria were higher (4.1 vs 3) in the exercise-dependent group. Bulimia was significantly more frequent among exercise dependents (70% vs 47%), who also presented a higher number of bulimic episodes each week (2.5 vs 1.3). Subjects with exercise dependence spent more time on their computer each day (3.9 vs 2.4 hours per day). We found no difference regarding time spent using Internet, the number of e-mails sent or received, and their time at speaking on a cellular phone. CONCLUSION: Our results lead to systematically study the addictive relation to exercise among regular clients of the fitness rooms. Exercise addicts are exposed to negative consequences for their excess of physical activity. Exercise addiction is also associated to compulsive buying, bulimia, and, in a lesser extent, hypochondria.