Behavioral addictions by dr simran and dr shashank

Includes gambling disorder, internet addiction, sexual addiction, binge eating disorder, etc

1. BEHAVIOURAL ADDICTIONS PRESENTED BY:- GUIDED BY:- DR. SIMRAN SANDHU DR. ABHAY PALIWAL SIR DR. SHASHANK KUMAR

2. To be discussed… What is addiction? Neurobiology of addiction Addictive processes Gambling disorder Binge eating disorder Internet gaming disorder Sexual addiction Miscallaneous

3. What is addiction? ADDICTION : It is a condition in which a behaviour that can function both to produce pleasure and to reduce anxiety or other painful affects is employed in a pattern that is characterised by two features: Recurrent failure to control the behaviour and Continuation of the behaviour despite significant harmful consequences

4. What is ‘ behavioural ’ addiction? Several behaviours , besides psychoactive substance ingestion, produce short-term reward that may lead to persistent behaviour despite knowledge of adverse consequences. Diminished control is a core defining concept of psychoactive substance dependence or addiction. This similarity has given rise to the concept of non-substance or “ behavioural ” addictions, i.e., syndromes analogous to substance addiction, but with a behavioural focus other than ingestion of a psychoactive substance. 

5. What makes a behavior qualify as an addiction? (Griffith’s criteria) Salience E uphoria T olerance W ithdrawal Symptoms C onflict R elapse

6. Types of behavioral addiction

7. NEUROCIRCUITRY Reward pathway Impulsivity circuit Compulsivity circuit

8. Reward pathway

9. Impulsivity circuit Every behavior starts as an impulse. The circuit that drives impulsivity is a loop of projections This circuit is usually modulated "TOP DOWN" from the prefrontal cortex If top down response is inadequate or overcome by activity from the ventral striatum, impulsive behaviors may result.

10. Compulsivity circuit The circuit that drives compulsivity is a loop with projections from This circuit can be modulated "top down" from the OFC IF this "top down" inhibition system is inadequate or overcome by activity from dorsal striatum, this can lead to compulsive behaviors.

11. NEURO-CIRCUITRY Impulsivity is thus regulated by ventrally dependent learning system Whereas, compulsivity is controlled  dorsally That is behaviors start out as impulses mediated by the ventral loop , which reacts to reward and motivation . Overtime the locus of control for these behaviors migrate dorsally due to neuroadaptation and neuroplasticity that engages dorsal habit system by means of which impulsive act becomes compulsive. Hence behaviors like gambling, internet gaming , binge eating start out as an impulse overtime become compulsive.

12. Role of neurotransmitters Normally, Serotonin (5-HT) - involved with inhibition of behaviour Dopamine - involved with learning, motivation, and the salience of stimuli, including rewards Dopamine excess and serotonin deficiency can lead to addictive behaviours.

13. Evidence for dopaminergic involvement The ventral tegmental area contains neurons that release dopamine to the nucleus accumbens and orbital frontal cortex. Alterations in dopaminergic pathways have been proposed as underlying the seeking of rewards that trigger the release of dopamine and produce feelings of pleasure. Dopamine involvement in behavioral addictions is suggested by studies of medicated Parkinson’s disease patients. Two studies of patients with PD found that more than 6% experienced a new onset behavioral addiction or impulse control disorder (e.g., pathological gambling, sexual addiction), with substantially higher rates among those taking dopamine agonist medication. A higher levo-dopa dose equivalence was associated with greater likelihood of having a behavioral addiction.

14. Evidence for serotonergic involvement 5-HIAA, (a metabolite of 5-HT) - considered a peripheral marker of 5-HT function. Low CSF 5-HIAA levels correlate with high levels of impulsivity and sensation-seeking and have been found in pathological gambling and substance use disorders. Pharmacologic challenge studies that measure hormonal response after administration of serotonergic drugs also provide evidence for serotonergic dysfunction in both behavioural addictions and substance use disorders

15. Addictive processes

16. Addictive processes Develop prior to addictive patterns These are guided by two sets of factors: Factors contributing to underlying addictive process Factors that guide the selection of particular behavior as the one preferred for addictive use

17. Factors contributing to underlying addictive process Impairment in three interrelated functional systems: Impairment in all 3 result from interactions among genetics and environmental influences Motivation reward Affect regulation Behavioural inhibition Unsatisfied states of restless anhedonia, irritable tension and subjective emptiness Makes addicts vulnerable to painful affects, affective hyperresponsivity and emotional instability Increases the likelihood of short-term pleasure over long-term consequences

18. Genetics Motivation reward Affect regulation Behavioural inhibition Homozygous 11 genotype of D1 receptor Pathological gambling compulsive shopping compulsive eating Taq A1 allele Pathological gambling, eating disorder sexual addiction 5HTTLPR Pathological gambling binge eating disorder A allele of BDNF binge eating disorder Long allele of D4 receptor gene polymorphism pathological gambling binge eating cue elicited craving for heroin and food

19. Environmental factors Maternal gestational stress
Maternal factors during infancy like maternal separation and maternal care giving deficiency Adverse childhood events like history of sexual or physical abuse Abnormal baseline and stressor responsive cortisol levels Increase pituitary adrenal and autonomic responses to stress

20. Factors that guide the pattern of addictive behavior Impaired self regulation Assisted character pathology- Characteristic self protective processes Impaired ability to symbolise affects Impaired management of basic conflicts Reliance on the primal fantasy

21. Impaired self regulation Normally develops during the first years of life by the process of internalisation If impaired, May become dependent on external sources like substance, person, nonhuman object, bodily state etc May learn to ward off traumatic affects and self states by engaging in a rewarding activity External or internal cues associated with intense affects become conditioned to particular addictive behavioural responses. so, stress can trigger urge to engage in such behaviours.

22. Characteristic self protective processes Referred to as defense mechanisms Denial the unconscious or conscious refusal to acknowledge or accept the reality of a particular situation Externalisation Blaming outside forces or circumstances for addictive behavior and/or its related problems Narcissistic personality system Functions to preserve one’s sense of self from fragmentation and to sustain an artificial self-esteem that supports the dissociation of overwhelming shame, humiliation, vulnerability, sense of inadequacy and helplessness

23. Impaired ability to symbolise Affects Difficulty recognising, naming and verbalising their affects which are typically experienced as physical bodily states rather than meaningful emotions
Accompanied by lower capacity for empathy and diminished emotional involvement in interpersonal relationships
Addictive behaviour is precipitated by painful affects that addicts perceive as threatening to overwhelm them

24. The basic conflict Conflict between two fundamental sets of drives and fears that emerged during the first two years of life
If not effectively managed, it intensifies the inner conflict Drive for attachment, connection or merger with the caregiver Fear of being abandoned by, or isolated from the caregiver Drive for separation autonomy and mastery Fear of being controlled by the caregiver

25. Primal fantasy Externalisation of primal fantasy on to another person Sexualisation of the fantasy – Addictive involvement in romantic relationships or other kinds of sexual behaviour People unconsciously perceive drug or food or object of addictive behaviours as the fantasy object that will relieve their pain and meet their unmet needs Unconscious fantasy that can develop during first two years of life.

26. Gambling disorder

27. Gambling Disorder Gambling can be described as “ putting something of value at risk on an outcome that is due to chance ”. It may include casino games, sports betting, card playing and lotteries. It can be recreational or pathological .

28. Nosology Separate diagnostic entity first introduced in DSM III, termed pathological gambling Was previously placed in impulse control disorder NOS DSM V – new category ‘ non substance related disorder ’ New term - gambling disorder

29. DSM 5 diagnostic criteria 4 out of 9 for 12 months – Wagering increasing amount of money in order to achieve the peculiar excitement of the illness Restlessness and irritability accompanying efforts to decrease wagering or abstain from it altogether Repeated unsuccessful efforts to control, diminish or stop gambling Overwhelming preoccupation with past and future actual gambling activities and gambling related endeavors Gambling in the context of dysphoric affect, anxiety, depression, etc Attempts to get even by repeatedly returning to gamble Lying to Significant others in order to conceal the extent of gambling activity Gambling related jeopardizing or loss of significant family and social relationships, jobs, education or career opportunities Escalation of the search for sources of money to pay of gambling debts

30. Risk factors Poor minorities living in urban slums Adolescent and young adults History of gambling disorder in family Elderly Women History of verbal and sexual abuse in childhood History of ADHD in family members

31. Personality characteristics of a gambler Competitive
Intelligent
Independent
Overconfident
Keen interest in sports participation and viewing
Optimist
Has profound feeling of loneliness
Do not easily express feelings
Grandiose elitism

32. Epidemiology Life time gambling prevalence is as high as 46 % P roblem gambling prevalence is around 7.4%.

33. Psychoanalytic theories Simmel (1920) Pregenital and oedipal conflicts were implicated in the illness Stekel : classified pathological gambling as compulsive neurosis with latent homosexual tendencies Freud argued that pathological gambling stemmed from a displacement of childhood masturbatory urges Edmund Bergler driven by a desire to lose Gambler has grudges against parents for imposing reality principle which cause guilt and need for punishment. Kris Pleasure of pathological gamblers wagering articulates with guilt ridden oedipal sexual tensions.

34. Clinical features Spiralling Closure Exposure Bail out Relapse Usually begins in adolescence End stage gambling – Cease to derive pleasure, life only revolves around play 60% pathological gamblers commit illegal acts example bouncing cheques, financial scams, prostitution etc SOGS – South Oaks Gambling Screen NODS – National Opinion research centre DSM Screen for gambling problems

35. Differential diagnosis Recreational gamblers – usually play on designated occasions, don’t care if they win or lose, satisfaction of non-pathological competitive drive, Acute substance use (cocaine or alcohol) leads to temporary disinhibition which may lead to gambling Schizophrenia
Mania
Antisocial personality disorder Rarely due to compromise of cerebral function by injury, infection or neoplasm. In patients with Parkinson disease being treated with dopamine agonists

36. Treatment Tolerant non-critical attitude
Group, family and couples therapy can be helpful
Pharmacological management: SSRIs, mood stabilisers, Atypical antipsychotics, opioid antagonist such as naltrexone Gamblers anonymous – International self help organisation 12 step program
Administered by accident pathological gamblers
Analogous to Alcoholics Anonymous
Similar group for relatives High drop out rate

37. Binge eating disorder

38. Nosology In DSM-IV, it was classified under eating disorder not otherwise specified .. In DSM-V shifted to formally recognized eating disorder and diagnostic criteria were modified. In DSM-V to make a diagnosis of BED, an episode of binge eating at least once per week on average for 3 or more months is required.

39. DSM-V CRITERIA A . Recurrent episodes of binge eating. An episode of binge eating is characterized  by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour  period), an amount of food that is definitely larger than what  most people would eat in a similar period of time under    similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B . The binge-eating episodes are associated with three (or more) of the following:  1. Eating much more rapidly than normal.  2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. C . Marked distress regarding binge eating is present. D . The binge eating occurs, on average, at least once a week for 3 months. E . The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa .

40. Epidemiology

41. Etiology History of:- Childhood obesity Mood disorder Negative family dynamics May put individuals at higher risk of BED 42

42. Co-morbities

43. Physical clinical signs and features

44. Treatment PSYCHOTHERAPY CBT is the most effective psychological treatment for BED and should be considered a first-line treatment. CBT combined with psychological treatment such as SSRI shows better results than CBT and medications alone. PSYCHOPHARMACOTHERAPY Lisdexamfetamine has strong evidence for both weight loss and reduction of binge episodes. Antidepressant has also shown improvement in binge eating but not in weight loss , these includes – fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, duloxetine and bupropion.

45. Internet gaming addiction

46. Intro duction The DSM-5 work group reviewed more than 240 articles and found some behavioral similarities of internet gaming to gambling disorder and to substance use disorder and has proposed internet gaming addiction in DSM-5 under conditions for further study. However, literature suffers from lack of a standard definition from to which to derive prevalence data and understanding natural histories. Further, seemingly high prevalence in asian countries and, to a lesser extent in the west, justified inclusion of these disorder in this section of DSM-5

47. Proposed criteria for DSM-V Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12-month period: 1. Preoccupation with Internet games. 2. Withdrawal symptoms when Internet gaming is taken away. 3. Tolerance—the need to spend increasing amounts of time engaged in Internet games. 4. Unsuccessful attempts to control the participation in Internet games. 5. Loss of interests in previous hobbies and entertainment. 6. Continued excessive use of Internet games despite knowledge of psychosocial problems. 7. Has deceived family members, therapists, or others regarding the amount of Internet gaming. 8. Use of Internet games to escape or relieve a negative mood. 9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity.

48. Associated co-morbidities

49. Prevalance Gaming disorder appears to be most prevalent among adolescent and young adult males aged 12–20 years. Currently unclear due to varying questionaires , criteria and threshold employed It seems to be highest in Asian countries especially china and south korea but fewer from europe and north korea .

50. Treatment There are no evidence based study that provides efficacy of a certain treatment, such as CBT FAMILY THERAPY PHARMACOTHERAPY All treatment are considered experimental for now.

51. Sexual addiction

52. Sexual addiction Sexual compulsivity is the name given to this condition by investigators who argue that the symptomatic sexual behaviour is compulsive because it functions to reduce anxiety and other painful effects Definition of compulsion in DSM-V includes its function of providing relief from anxiety and other painful affects However, it also specifies that compulsions are not performed to produce pleasure. Addiction is a more suitable description because Feel driven Entails harmful or unpleasant consequences Functions to reduce anxiety or other painful affects Functions to produce pleasure or gratification

53. Nosology Not included in DSM Provisional criteria- Presence of 4 or more of the following for 12 months- Sexual behaviour is often engaged in over a longer period, in greater quantity, or at higher level of intensity than was intended Unsuccessful efforts to cut down or control the sexual behaviour Great deal of time is spent in activities n ecessary to prepare for the sexual behaviour, engage in it, or recover from its effects Craving to engage in the sexual behaviour Sexual behavior has resulted in failure to fulfil significant responsibilities at work school or home Reduction of social, occupational or recreational activities as a result of engaging in the sexual behavior Continues despite persistent or recurrent social or interpersonal problems that its effects have caused or exacerbated Continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behaviour It Is recurrently performed in situations in which doing so is physically hazardous Tolerance Withdrawal

54. Epidemiology Prevalence is 3 to 6% 80% are males ( paraphilic > non paraphilic ) Begins in teenage peaks between 20 to 40 years and then gradually declines

55. Comorbidities

56. Differential diagnosis Organicity – Temporal lobe epilepsy Seizure disorder Frontal lobe lesions Elderly with dementia Side-effect of Antiparkinsonian drugs Increased testosterone levels OCD – accompanied with anxiety, not arousal BPAD Schizophrenia Personality disorder Psychoactive substance use disorder Pointers for organicity Middle-age onset Change from previously normal sexuality Excessive aggression Reports of aura or seizure like symptoms prior to or during sexual behaviour Impaired perceptual or motor skills

57. Sexual addiction vs paraphilia 58 Sexual addiction Paraphilia Can be diagnosed when its diagnostic criteria are met whether the symptomatic behaviour is paraphilic or non paraphilic Limited to paraphilia Impaired ability to control the symptomatic behaviour is prominent in the diagnosis Neither mentioned in the definition of paraphilic disorder nor the diagnostic criteria for any of these paraphilic disorders Not for diagnosis of sex addiction Risk of harm to others as a result of symptomatic behaviour is sufficient to warrant a diagnosis of paraphilic disorder It is an objectively observable event DSM V describes it as an interest, not a behaviour

58. Prognosis Good prognosis Healing support factors- stable job and primary relationship Supportive social networks Availability of supportive sexual outlets Personality factors intelligence
Creativity Self observatory capacity
Sense of humour
Motivation for change Poor prognosis Illness factors early age of onset
Increased frequency of symptomatic sexual behaviour
Use of other substances
Absence of anxiety or guilt about the behaviour Comorbid psychiatric disorders
High degree of associated character pathology

59. Treatment 1. Symptomatic behavioral management Goals: to prevent the occurrence of symptomatic sexual behaviour If it occurs, to bring about its discontinuation before it leads to significant harmful consequences 2. Healing of the addictive process

60. Symptomatic behavioral management Cognitive behavioural techniques : Identifying and correcting disorder thoughts Example: behaviour mastery technique victim empathy training anger management, assertiveness training, etc Dialectical behaviour therapy Help patients develop skills that enhance emotional regulation and implement them in daily lives Support groups: Safe, non-Judgmental sanctuary anonymous to sex addiction

61. Healing of the addictive process Pharmacotherapy SSRI - Fluoxetine, Paroxetine, Fluvoxamine TCAs- Imipeamine , Desipramine , Clomipramine Lithium Anticonvulsants – Carbamazepine, Valproate, Topiramate Buspirone Naltrexone ECT Psychotherapy Psychodynamic psychotherapy Meditation Yoga

62. Miscellaneous Social media addiction Compulsive buying Compulsive exercise Love addiction Presentation Title

63. Social media addiction Social media addiction is characterized as being overly concerned about social media, driven by an uncontrollable urge to log on to or use social media, and devoting so much time and effort to social media that it impairs other important life areas. Social media platforms produce the same neural circuitry that is caused by gambling and recreational drugs.  when an individual gets a notification, such as a like the brain receives a rush of dopamine and sends it along r eward pathways , causing the individual to feel pleasure.   The brain rewires itself through this positive reinforcement, making people desire likes, retweets, and emoticon reactions.

64. COMPULSIVE BUYING DISORDER CBD is characterized by excessive shopping cognitions and buying behavior that leads to distress or impairment .  Some researchers have linked CBD to addictive disorders , while others have linked it to obsessive-compulsive disorder, and still others to mood disorders. CBD was included in DSM-III-R as an example of an " impulse control disorder” not otherwise specified.

65. gf COMPULSIVE exercise Exercise addiction are characterized by loss of control over the exercise behavior, which is performed as “ obligation ” rather than for enjoyment, and also have negative physical and psychosocial consequences for the individual.

66. Love addiction Love addiction refers to a pattern of behaviors characterized by an intense fixation on the sensation of being in love, prompting individuals to actively pursue love in a manner that can result in unwanted consequences.  Causes of love addiction Childhood experiences Low self-esteem Unmet emotional needs Biological factors Insecurity and fear of abandonment Unresolved trauma Co-occurring mental health conditions Social and cultural influences

67. Summary

68. REFERENCES Comprehensive textbook of psychiatry. Synopsis of psychiatry. DSM-5 Bhatia U, Bhat B, George S, Nadkarni A. The prevalence, patterns, and correlates of gambling behaviours in men: An exploratory study from Goa, India. Asian J Psychiatr . 2019 Jun;43:143-149. doi : 10.1016/j.ajp.2019.03.021. Epub 2019 Mar 26. PMID: 31151082; PMCID: PMC6712305. Kuss DJ, Griffiths MD. Online social networking and addiction--a review of the psychological literature. Int J Environ Res Public Health. 2011 Sep;8(9):3528-52. doi : 10.3390/ijerph8093528. Epub 2011 Aug 29. PMID: 22016701; PMCID: PMC3194102. Black DW. A review of compulsive buying disorder. World Psychiatry. 2007 Feb;6(1):14-8. PMID: 17342214; PMCID: PMC1805733. Lichtenstein MB, Hinze CJ, Emborg B, Thomsen F, Hemmingsen SD. Compulsive exercise: links, risks and challenges faced. Psychol Res Behav Manag. 2017 Mar 30;10:85-95. doi : 10.2147/PRBM.S113093. PMID: 28435339; PMCID: PMC5386595. Presentation Title 69

69. Thank You

70. mcq

71. Presentation Title 72 1.Addiction is often associated with behaviors that: ​ A) Always result in negative outcomes​ B) Provide pleasure and reduce anxiety ​ C) Are easy to stop without support​ D) Are always socially accepted​

72. Presentation Title 73 1.Addiction is often associated with behaviors that: ​ A) Always result in negative outcomes​ B) Provide pleasure and reduce anxiety ​ C) Are easy to stop without support​ D) Are always socially accepted​ Answer: B) Provide pleasure and reduce anxiety

73. Presentation Title 74 2.The process by which impulsive acts become compulsive is primarily influenced by: A) Emotional regulation B) Neuroadaptation and neuroplasticity C) Social learning D) Environmental changes

74. Presentation Title 75 2.The process by which impulsive acts become compulsive is primarily influenced by: A) Emotional regulation B) Neuroadaptation and neuroplasticity C) Social learning D) Environmental changes Correct Answer: B) Neuroadaptation and neuroplasticity

75. Presentation Title 76 3. What regulates impulsivity according to the provided information? A) Dorsal learning system B) Ventral learning system C) Limbic system D) Cerebellum

76. Presentation Title 77 3. What regulates impulsivity according to the provided information? A) Dorsal learning system B) Ventral learning system C) Limbic system D) Cerebellum Correct Answer: B) Ventral learning system

77. Presentation Title 78 4. In which disorders are low CSF 5-HIAA levels commonly found? A. Schizophrenia and bipolar disorder B. Pathological gambling and substance use disorders C. Anxiety and depression D. OCD and PTSD

78. Presentation Title 79 4. In which disorders are low CSF 5-HIAA levels commonly found? A. Schizophrenia and bipolar disorder B. Pathological gambling and substance use disorders C. Anxiety and depression D. OCD and PTSD Answer: B. Pathological gambling and substance use disorders

79. Presentation Title 80 5. What is 5-HIAA primarily used as a marker for? A. Dopaminergic function B. Adrenergic function C. Serotonergic (5-HT) function D. GABAergic function

80. Presentation Title 81 5. What is 5-HIAA primarily used as a marker for? A. Dopaminergic function B. Adrenergic function C. Serotonergic (5-HT) function D. GABAergic function Answer: C. Serotonergic (5-HT) function

81. Presentation Title 82 6. Which brain region is primarily involved in the reward system and plays a crucial role in addiction? A. Amygdala B. Hippocampus C. Prefrontal cortex D. Nucleus accumbens

82. Presentation Title 83 6. Which brain region is primarily involved in the reward system and plays a crucial role in addiction? A. Amygdala B. Hippocampus C. Prefrontal cortex D. Nucleus accumbens Answer: D. Nucleus accumbens

83. Presentation Title 84 7. Affect regulation in addiction makes individuals vulnerable to which of the following? A. Enhanced emotional stability B. Reduced sensitivity to pain C. Painful affects, affective hyperresponsivity, and emotional instability D. Improved decision-making skills

84. Presentation Title 85 7. Affect regulation in addiction makes individuals vulnerable to which of the following? A. Enhanced emotional stability B. Reduced sensitivity to pain C. Painful affects, affective hyperresponsivity, and emotional instability D. Improved decision-making skills Answer: C. Painful affects, affective hyperresponsivity, and emotional instability

85. Presentation Title 86 8. How does addiction affect the perception of reward values among different experiences? A. It enhances the value of non-addictive experiences. B. It does not alter the perception of rewards. C. It distorts the relative reward values, favoring addictive behaviors. D. It makes all experiences equally rewarding.

86. Presentation Title 87 8. How does addiction affect the perception of reward values among different experiences? A. It enhances the value of non-addictive experiences. B. It does not alter the perception of rewards. C. It distorts the relative reward values, favoring addictive behaviors. D. It makes all experiences equally rewarding. Answer: C. It distorts the relative reward values, favoring addictive behaviors

87. Presentation Title 88 9. According to DSM 5 , for diagnosis of gambling addiction how many criteria should be met for how long? A. 5 out of 9 for 6 months B. 4 out of 9 for 12 months c. 4 out of 9 for 6 months d. 6 out of 9 for 12 months B. 4 out of 9 for 12 months

88. Presentation Title 89 9. According to DSM 5 , for diagnosis of gambling addiction how many criteria should be met for how long? A. 5 out of 9 for 6 months B. 4 out of 9 for 12 months c. 4 out of 9 for 6 months d. 6 out of 9 for 12 months Answer: B. 4 out of 9 for 12 months

89. Presentation Title 90 10. Damage to the VMPFC and amygdala is associated with a preference for which type of decision-making? A) Long-term planning and risk assessment B) Immediate rewards while ignoring long-term consequences C) Rational decision-making based on past experiences D) Balanced consideration of pros and cons

90. Presentation Title 91 10. Damage to the VMPFC and amygdala is associated with a preference for which type of decision-making? A) Long-term planning and risk assessment B) Immediate rewards while ignoring long-term consequences C) Rational decision-making based on past experiences D) Balanced consideration of pros and cons Correct Answer: B) Immediate rewards while ignoring long-term consequences