Dr. Aboujaoude is a Clinical Professor, researcher and writer at Stanford University's Department of Psychiatry, where he is Chief of the Anxiety Disorders Section and Director of the OCD Clinic and the Impulse Control Disorders Clinic. Besides the compulsivity-impulsivity spectrum, his work has focused on the intersection of technology and psychology, with an emphasis on the problematic use of Internet-related technologies, mental health in a post-privacy world, and the potential for telemedicine interventions such as virtual reality and video-based therapy to increase access to care and advance global health. His books include "Virtually You: The Dangerous Powers of the e-Personality" and "Mental Heath in the Digital Age: Grave Dangers, Great Promise". Dr. Aboujaoude also teaches psychology on the main Stanford campus and at UC Berkeley. Scholarly and media platforms that have featured his work include The New York Times, The Wall Street Journal, The Washington Post, Congressional Quarterly, The Harvard Business Review, The Chronicle of Higher Education, BBC, PBS, and CNN.

Academic Appointments

  • Clinical Professor, Psychiatry and Behavioral Sciences

All Publications

  • How much online pornography is too much? A comparison of two theoretically distinct assessment scales. Archives of public health = Archives belges de sante publique Vera Cruz, G., Aboujaoude, E., Liberacka-Dwojak, M., Wiłkość-Dębczyńska, M., Rochat, L., Khan, R., Khazaal, Y. 2024; 82 (1): 79


    Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools.The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria.An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data.Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk.Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.

    View details for DOI 10.1186/s13690-024-01294-5

    View details for PubMedID 38816773

    View details for PubMedCentralID PMC11137999

  • Online dating: predictors of problematic tinder use. BMC psychology Vera Cruz, G., Aboujaoude, E., Rochat, L., Bianchi-Demicheli, F., Khazaal, Y. 2024; 12 (1): 106


    Geolocation apps have radically transformed dating practices around the world, with profound sociocultural implications. Few studies, however, have explored their addictive potential or factors that are associated with their misuse.The present study aimed to assess the level of problematic Tinder use (PTU) in an adult sample, using a machine learning algorithm to determine, among 29 relevant variables, the most important predictors of PTU.1,387 users of Tinder (18-74 years-old; male = 50.3%; female = 49.1%) completed an online questionnaire, and a machine learning tool was used to analyze their responses.On 5-point scale, participants' mean PTU score was 1.91 (SD = 0.70), indicating a relatively low overall level of problematic app use. Among the most important predictors of Problematic use were the use of Tinder for enhancement (reduce boredom and increase positive emotions), coping with psychological problems, and increasing social connectedness. The number of "matches" (when two users show mutual interest), the number of online contacts on Tinder, and the number of resulting offline dates were also among the top predictors of PTU. Depressive mood and loneliness were among the middle-ranked predictors of PTU.In accordance with the Interaction of Person-Affect-Cognition-Execution model of problematic internet use, the results suggest that PTU relates to how individual experience on the app interacts with dispositional and situational characteristics. However, variables that seemed to relate to PTU, including lack of self-esteem, negative mood states and loneliness, are not problems that online dating services as currently designed can be expected to resolve. This argues for increased digital services to identify and address potential problems helping drive the popularity of dating apps.

    View details for DOI 10.1186/s40359-024-01566-3

    View details for PubMedID 38424651

    View details for PubMedCentralID 7773176

  • Finding Intimacy Online: A Machine Learning Analysis of Predictors of Success. Cyberpsychology, behavior and social networking Vera Cruz, G., Aboujaoude, E., Rochat, L., Bianchi-Demichelli, F., Khazaal, Y. 2023


    While an extensive scientific literature now exists on the use of online dating services, there are very few studies on user satisfaction with dating apps and with the resulting offline dates. This study aimed to assess the level of satisfaction with Tinder use (STU) and the level of satisfaction with Tinder offline dates (STOD) in a sample of adult users of the app. The study also aimed to examine, among 28 variables, those that are the most important in predicting STU and STOD. Overall, 1,387 Tinder users completed an online questionnaire. A machine learning model was used to rank order predictors from most to least important. On a 4-point scale, participants' mean STU score was 2.39, and, on a 5-point scale, mean STOD score was 3.05. The results indicate that satisfaction with dating apps and with resulting offline dates is strongly predicted by participants' age and by their motives for using Tinder (enhancement, emotional coping, socialization, finding "true love," or casual sexual partners), whereas the variables negatively associated with satisfaction were those related to psychopathology. Interestingly, 65.3 percent of app users were married or "in a relationship," and only 50.3 percent of app users were using it to meet someone offline. Generally, participants who engage with the app to cope with personal difficulties seem more likely to report higher levels of dissatisfaction, suggesting that dating apps are a poor coping mechanism and highlighting the need to address underlying problems or pathologies that may be driving their use.

    View details for DOI 10.1089/cyber.2022.0367

    View details for PubMedID 37352415

  • Privacy, bias and the clinical use of facial recognition technology: A survey of genetics professionals. American journal of medical genetics. Part C, Seminars in medical genetics Aboujaoude, E., Light, J., Brown, J. E., Boscardin, W. J., Hallgrimsson, B., Klein, O. D. 2023


    Facial recognition technology (FRT) has been adopted as a precision medicine tool. The medical genetics field highlights both the clinical potential and privacy risks of this technology, putting the discipline at the forefront of a new digital privacy debate. Investigating how geneticists perceive the privacy concerns surrounding FRT can help shape the evolution and regulation of the field, and provide lessons for medicine and research more broadly. Five hundred and sixty-two genetics clinicians and researchers were approached to fill out a survey, 105 responded, and 80% of these completed. The survey consisted of 48 questions covering demographics, relationship to new technologies, views on privacy, views on FRT, and views on regulation. Genetics professionals generally placed a high value on privacy, although specific views differed, were context-specific, and covaried with demographic factors. Most respondents (88%) agreed that privacy is a basic human right, but only 37% placed greater weight on it than other values such as freedom of speech. Most respondents (80%) supported FRT use in genetics, but not necessarily for broader clinical use. A sizeable percentage (39%) were unaware of FRT's lower accuracy rates in marginalized communities and of the mental health effects of privacy violations (62%), but most (76% and 75%, respectively) expressed concern when informed. Overall, women and those who self-identified as politically progressive were more concerned about the lower accuracy rates in marginalized groups (88% vs. 64% and 83% vs. 63%, respectively). Younger geneticists were more wary than older geneticists about using FRT in genetics (28% compared to 56% "strongly" supported such use). There was an overall preference for more regulation, but respondents had low confidence in governments' or technology companies' ability to accomplish this. Privacy views are nuanced and context-dependent. Support for privacy was high but not absolute, and clear deficits existed in awareness of crucial FRT-related discrimination potential and mental health impacts. Education and professional guidelines may help to evolve views and practices within the field.

    View details for DOI 10.1002/ajmg.c.32035

    View details for PubMedID 36751120

  • Cyberbullying: next-generation research. World psychiatry : official journal of the World Psychiatric Association (WPA) Aboujaoude, E., Savage, M. W. 2023; 22 (1): 45-46

    View details for DOI 10.1002/wps.21040

    View details for PubMedID 36640381

  • Smartphone apps for mental health and wellbeing: A usage survey and machine learning analysis of psychological and behavioral predictors. Digital health Vera Cruz, G., Aboujaoude, E., Khan, R., Rochat, L., Ben Brahim, F., Courtois, R., Khazaal, Y. 2023; 9: 20552076231152164


    Objective: Despite the availability of thousands of mental health applications, the extent to which they are used and the factors associated with their use remain largely unknown. The present study aims to (a) assess in a representative US-based population sample the use of smartphone apps for mental health and wellbeing (SAMHW), (b) determine the variables predicting the use of SAMHW, and (c) explore how a set of variables related to mental health, smartphone use, and smartphone "addiction" may be associated with the use of SAMHW.Methods: Data was collected via online questionnaire from 1989 adults. The data gathered included information on smartphone use behavior, mental health, and the use of SAMHW. Latent class analysis was used to categorize participants. Machine learning and logistic regression analyses were used to determine the most important predictors of SAMHW use and associations between predictors and outcome variables.Results: While two-thirds of participants had a statistically high probability for using SAMHW, nearly twice more had high probability for using them to improve wellbeing compared to using them to address mental health problems (43% vs. 18%). In both groups, these participants were more likely to be female and in the younger adult age bracket than male and in the adult or older adult age bracket. According to the machine learning model, the most important predictors for using the relevant smartphone apps were variables associated with smartphone problematic use, COVID-19 impact, and mental health problems.Conclusion: Findings from the present study confirm that the use of SAMHW is growing, particularly among younger adult and female individuals who are negatively impacted by problematic smartphone use, COVID-19, and mental health problems. These individuals tend to bypass traditional care via psychotherapy or psychopharmacology, relying instead on smartphones to address mental health conditions or improve wellbeing. Advising users of these apps to also seek professional help and promoting efforts to prove the efficacy and safety of SAMHW would seem necessary.

    View details for DOI 10.1177/20552076231152164

    View details for PubMedID 36714544

  • Treatment-resistant OCD: Pharmacotherapies in adults. Comprehensive psychiatry van Roessel, P. J., Grassi, G., Aboujaoude, E. N., Menchon, J. M., Van Ameringen, M., Rodriguez, C. I. 2022; 120: 152352


    Serotonin reuptake inhibitor (SRI) medications are well established as first-line pharmacotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). However, despite the excellent safety profile and demonstrated efficacy of these medications, a substantial proportion of individuals with OCD fail to attain sufficient benefit from SRIs. In this narrative review, we discuss clinical features of OCD that have been associated with poorer response to SRIs, and we present pharmacotherapeutic interventions that have been explored as augmenting or alternative treatments for treatment-resistant OCD. We additionally highlight non-SRI interventions for OCD that are currently under investigation. Pharmacotherapeutic interventions were identified via expert consensus. To assess the evidence base for individual pharmacotherapies, targeted searches for relevant English-language publications were performed on standard biomedical research databases, including MEDLINE. Information relevant to ongoing registered clinical trials in OCD was obtained by search of Pharmacotherapies are grouped for review in accordance with the general principles of Neuroscience-based Nomenclature (NbN). Clinical features of OCD that may suggest poorer response to SRI treatment include early age of onset, severity of illness, duration of untreated illness, and the presence of symmetry/ordering or hoarding-related symptoms. Based on evolving pathophysiologic models of OCD, diverse agents engaging serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Medications with dopamine antagonist activity remain the most robustly evidence-based of augmenting interventions, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Interventions targeting glutamatergic and anti-inflammatory pathways are less well evidenced, but may offer more favorable benefit to risk profiles. Ongoing research should explore whether specific interventions may benefit individuals with particular features of treatment-resistant OCD.

    View details for DOI 10.1016/j.comppsych.2022.152352

    View details for PubMedID 36368186

  • Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis. Journal of medical Internet research Aboujaoude, E., Vera Cruz, G., Rochat, L., Courtois, R., Ben Brahim, F., Khan, R., Khazaal, Y. 2022; 24 (10): e38963


    BACKGROUND: Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field.OBJECTIVE: We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools.METHODS: First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions.RESULTS: Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use.CONCLUSIONS: If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non-smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential.

    View details for DOI 10.2196/38963

    View details for PubMedID 36264627

  • Editorial Perspective: Missing the forest for the trees - how the focus on digital addiction and gaming diverted attention away from wider online risks. Child and adolescent mental health Aboujaoude, E., Gega, L. 2021


    Despite the many ways in which Internet-related technologies can affect psychology, research into the Internet's mental health consequences has disproportionately focussed on the narrow topics of online addiction and the closely related Internet gaming disorder. Over two decades into the online revolution, the Internet is being blamed for dramatic transformations, including a rise in extremism, social polarization and weakened democracies. In trying to understand how these shifts could have happened, or how they might be contained, society looks to mental health experts - after all, it is the interaction between technology and human psychology that is encouraging certain behaviours online and discouraging others. The field, however, has precious little to offer by way of explanations. To no small degree, this is due to the tendency to approach online psychological problems primarily through the addiction framework. The result has been to blind us to other important traits and phenomena that are playing out online and on social media, including impulsivity, aggression, inattention, narcissism and the psychological meaning of living in a postprivacy world. The article covers historical aspects of how the addiction model came to dominate the field; some insufficiently heeded early warning signals about other online ills and the big price society is paying today for this approach. We end with a call for a significant broadening of the focus of research when it comes to online psychopathology.

    View details for DOI 10.1111/camh.12503

    View details for PubMedID 34448531

  • Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical psychology & psychotherapy Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., Aboujaoude, E. 2021


    In-person psychotherapy (IPP) has a long and storied past but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP vs IPP or other comparison groups. A literature search identified k=56 within-group studies (N= 1681 participants) and 47 between-group studies (N=3564). The pre-post effect size of VDP was large and highly significant, g=+0.99 95% CI [0.67; 0.31]. VDP was significantly better in outcome than wait list controls (g=0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and PTSD (each with k> 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT, and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g=0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.

    View details for DOI 10.1002/cpp.2594

    View details for PubMedID 33826190

  • The retention challenge in remote therapy and learning seen through the lens of the COVID-19 pandemic. World psychiatry : official journal of the World Psychiatric Association (WPA) Aboujaoude, E. n., Gega, L. n., Saltarelli, A. J. 2021; 20 (1): 138–39

    View details for DOI 10.1002/wps.20828

    View details for PubMedID 33432753

  • How Digital Technology Mediated the Effects of the COVID-19 Pandemic on Mental Health: The Good, the Bad, and the Indifferent. Frontiers in digital health Gega, L., Aboujaoude, E. 2021; 3: 733151

    View details for DOI 10.3389/fdgth.2021.733151

    View details for PubMedID 34713202

  • Editorial: Online Psychology Beyond Addiction and Gaming: A Global Look at Mental Health and Internet-Related Technologies. Frontiers in psychology Aboujaoude, E., Kuss, D. J., Yao, M. Z., Leung, L. W. 1800; 12: 815013

    View details for DOI 10.3389/fpsyg.2021.815013

    View details for PubMedID 34975704

  • Where Life Coaching Ends and Therapy Begins: Toward a Less Confusing Treatment Landscape. Perspectives on psychological science : a journal of the Association for Psychological Science Aboujaoude, E. 2020: 1745691620904962


    "Life coaching" is a rapidly expanding profession born out of an unmet need for help effecting change, frustration with traditional models, the stigma attached to seeking care, and the online "Uberization" of many new services. But the distinctions often drawn between life coaching and psychotherapy are increasingly blurry, raise important questions about where coaching ends and therapy begins, and risk confusion between the two helping professions among vulnerable patients. This is potentially serious, in part because life coaching operates in a regulatory vacuum, with no education, training, licensing, or supervision requirements for coaches and no specific legal protections for any harmed clients. Although increased access to new forms of help is a positive development, the risk that mentally ill patients may undergo life coaching rather than receive proven psychotherapy treatments raises concerns about patient safety. It can also trigger fears of professional replacement among mental health providers whose education, preparation, and practice parameters are rigorously defined and closely scrutinized. More research is needed to prove the efficacy and safety of life-coaching modalities, and meaningful action is required at the level of training, oversight, and legislation to help protect patients and clarify roles.

    View details for DOI 10.1177/1745691620904962

    View details for PubMedID 32316831

  • Automated syndrome diagnosis by three-dimensional facial imaging. Genetics in medicine : official journal of the American College of Medical Genetics Hallgrímsson, B. n., Aponte, J. D., Katz, D. C., Bannister, J. J., Riccardi, S. L., Mahasuwan, N. n., McInnes, B. L., Ferrara, T. M., Lipman, D. M., Neves, A. B., Spitzmacher, J. A., Larson, J. R., Bellus, G. A., Pham, A. M., Aboujaoude, E. n., Benke, T. A., Chatfield, K. C., Davis, S. M., Elias, E. R., Enzenauer, R. W., French, B. M., Pickler, L. L., Shieh, J. T., Slavotinek, A. n., Harrop, A. R., Innes, A. M., McCandless, S. E., McCourt, E. A., Meeks, N. J., Tartaglia, N. R., Tsai, A. C., Wyse, J. P., Bernstein, J. A., Sanchez-Lara, P. A., Forkert, N. D., Bernier, F. P., Spritz, R. A., Klein, O. D. 2020


    Deep phenotyping is an emerging trend in precision medicine for genetic disease. The shape of the face is affected in 30-40% of known genetic syndromes. Here, we determine whether syndromes can be diagnosed from 3D images of human faces.We analyzed variation in three-dimensional (3D) facial images of 7057 subjects: 3327 with 396 different syndromes, 727 of their relatives, and 3003 unrelated, unaffected subjects. We developed and tested machine learning and parametric approaches to automated syndrome diagnosis using 3D facial images.Unrelated, unaffected subjects were correctly classified with 96% accuracy. Considering both syndromic and unrelated, unaffected subjects together, balanced accuracy was 73% and mean sensitivity 49%. Excluding unrelated, unaffected subjects substantially improved both balanced accuracy (78.1%) and sensitivity (56.9%) of syndrome diagnosis. The best predictors of classification accuracy were phenotypic severity and facial distinctiveness of syndromes. Surprisingly, unaffected relatives of syndromic subjects were frequently classified as syndromic, often to the syndrome of their affected relative.Deep phenotyping by quantitative 3D facial imaging has considerable potential to facilitate syndrome diagnosis. Furthermore, 3D facial imaging of "unaffected" relatives may identify unrecognized cases or may reveal novel examples of semidominant inheritance.

    View details for DOI 10.1038/s41436-020-0845-y

    View details for PubMedID 32475986

  • Editorial: Digital Interventions in Mental Health: Current Status and Future Directions. Frontiers in psychiatry Aboujaoude, E. n., Gega, L. n., Parish, M. B., Hilty, D. M. 2020; 11: 111

    View details for DOI 10.3389/fpsyt.2020.00111

    View details for PubMedID 32174858

    View details for PubMedCentralID PMC7056878

  • The psychology of "swiping": A cluster analysis of the mobile dating app Tinder. Journal of behavioral addictions Rochat, L., Bianchi-Demicheli, F., Aboujaoude, E., Khazaal, Y. 2019: 1–10


    BACKGROUND AND AIMS: The use of the smartphone dating application Tinder is increasingly popular and has received much media attention. However, no empirical study to date has investigated the psychological characteristics driving its adaptive or problematic use. The aim of this study is to determine whether reliable subtypes of users can be identified via a cluster analysis approach.METHODS: A total of 1,159 Tinder users were recruited. Survey questions investigated user characteristics, including: motives for app use, sexual desire, attachment styles, impulsivity traits, self-esteem, problematic use, depressive mood, and patterns of use.RESULTS: Four reliable clusters were identified: two with low levels of problematic use ("regulated" and "regulated with low sexual desire"), one with an intermediate level of problematic use ("unregulated-avoidants"), and one with a high level of problematic use ("unregulated-highly motivated"). The clusters differed on gender, marital status, depressive mood, and use patterns.CONCLUSION: The findings provide insight into the dynamic relationships among key use-related factors and shed light on the mechanisms underlying the self-regulation difficulties that appear to characterize problematic Tinder use.

    View details for DOI 10.1556/2006.8.2019.58

    View details for PubMedID 31663372

  • Problematic Internet use two decades later: apps to wean us off apps CNS SPECTRUMS Aboujaoude, E. 2019; 24 (4): 371–73
  • Protecting privacy to protect mental health: the new ethical imperative. Journal of medical ethics Aboujaoude, E. 2019


    Confidentiality is a central bioethical principle governing the provider-patient relationship. Dating back to Hippocrates, new laws have interpreted it for the age of precision medicine and electronic medical records. This is where the discussion of privacy and technology often ends in the scientific health literature when Internet-related technologies have made privacy a much more complex challenge with broad psychological and clinical implications. Beyond the recognised moral duty to protect patients' health information, clinicians should now advocate a basic right to privacy as a means to safeguard psychological health. The article reviews empirical research into the functions of privacy, the implications for psychological development and the resigned sentiment taking hold regarding the ability to control personal data. The article concludes with a call for legislative, educational and research steps to readjust the equilibrium between the individual and 'Big Data'.

    View details for DOI 10.1136/medethics-2018-105313

    View details for PubMedID 31123190

  • From Digital Mental Health Interventions to Digital "Addiction": Where the Two Fields Converge. Frontiers in psychiatry Aboujaoude, E., Gega, L. 2019; 10: 1017


    Scientific literature from the last two decades indicates that, when it comes to mental health, technology is presented either as panacea or anathema. This is partly because researchers, too frequently, have planted themselves either in the field of digital mental health interventions (variably called "telepsychiatry", "digital therapeutics", "computerized therapy", etc.), or in that of the problems arising from technology, with little cross-fertilization between the two. Yet, a closer look at the two fields reveals unifying themes that underpin both the advantages and dangers of technology in mental health. This article discusses five such themes. First, the breakneck pace of technology evolution keeps digital mental health interventions updated and creates more potentially problematic activities, leaving researchers perennially behind, so new technologies become outdated by the time they are studied. Second, the freedom of creating and using technologies in a regulatory vacuum has led to proliferation and choice, but also to a Wild-West online environment. Third, technology is an open window to access information, but also to compromise privacy, with serious implications for online psychology and digital mental health interventions. Fourth, weak bonds characterize online interactions, including those between therapists and patients, contributing to high attrition from digital interventions. Finally, economic analyses of technology-enabled care may show good value for money, but often fail to capture the true costs of technology, a fact that is mirrored in other online activities. The article ends with a call for collaborations between two interrelated fields that have been-till now-mutually insular.

    View details for DOI 10.3389/fpsyt.2019.01017

    View details for PubMedID 32038336

  • Problematic Internet use two decades later: apps to wean us off apps. CNS spectrums Aboujaoude, E. 2018: 1–3


    Two decades of research into problematic Internet use have not yielded an established definition, much less an accepted treatment algorithm that is based on the psychopharmacological and psychotherapeutic interventions that have been tested. Meanwhile, technology-mediated tools that purport to curb unnecessary use of Internet-related technologies and the associated negative consequences are gaining in popularity, despite the lack of rigorous clinical trials into their efficacy and safety. Some popular new offerings that vary in browser, operating system and platform compatibility are reviewed. While they share similar goals as "traditional" treatments, they may be more efficient, scalable, and affordable. Using technology against itself may be counter-intuitive, but the popularity of these tools and their potential advantages make them worthy of researchers' attention. Telepsychiatry platforms, which are gaining a foothold in the treatment of established disorders, may, paradoxically, also prove beneficial for the management of problematic use of Internet-related technologies.

    View details for PubMedID 30507371

  • Telemental health: why the revolution has not arrived. World psychiatry : official journal of the World Psychiatric Association (WPA) Aboujaoude, E. 2018; 17 (3): 277–78

    View details for PubMedID 30192097

  • Telemental health: why the revolution has not arrived WORLD PSYCHIATRY Aboujaoude, E. 2018; 17 (3): 277–78

    View details for DOI 10.1002/wps.20551

    View details for Web of Science ID 000443949200005

  • Promising Treatments for Obsessive-Compulsive Disorder: A Call for Additional Research CURRENT MEDICINAL CHEMISTRY Koran, L. M., Aboujaoude, E. 2018; 25 (41): 5690–97
  • Suicidality, psychopathology, and the internet: Online time vs. online behaviors PSYCHIATRY RESEARCH Harris, K. M., Starcevic, V., Ma, J., Zhang, W., Aboujaoude, E. 2017; 255: 341–46


    This study investigated whether several psychopathology variables, including suicidality, could predict the time people spend using the internet (hours online). Next, we examined a specific at-risk population (suicidal individuals) by their online behaviors, comparing suicidal individuals who went online for suicide-related purposes with suicidal individuals who did not go online for suicide-related purposes. An anonymous online sample of 713 (aged 18-71) reported hours online, psychiatric histories, and completed several standardized scales. After accounting for age and education, hierarchical regression modeling showed that the assessed psychopathology variables, including suicidality, did not explain significant variance in hours online. Hours online were better predicted by younger age, greater willingness to develop online relationships, higher perceived social support, higher curiosity, and lower extraversion. Suicidal participants, who did or did not go online for suicide-related purposes, did not differ on hours online. Multiple regression modeling showed that those who went online for suicide-related purposes were likely to be younger, more suicidal, and more willing to seek help from online mental health professionals. These findings revealed that hours online are not a valid indicator of psychopathology. However, studying online behaviors of specific at-risk groups could be informative and useful, including for suicide prevention efforts.

    View details for PubMedID 28601719

  • Three decades of telemedicine in obsessive-compulsive disorder: A review across platforms JOURNAL OF OBSESSIVE-COMPULSIVE AND RELATED DISORDERS Aboujaoude, E. 2017; 14: 65–70
  • Promising Treatments for Obsessive-Compulsive Disorder: A Call for Additional Research. Current medicinal chemistry Koran, L. M., Aboujaoude, E. 2017


    Many patients with OCD respond partially or not at all to standard medications and cognitive behavioral therapy approaches, making alternate treatments necessary. We review the preliminary evidence that exists in support of the use of stimulants, high-dose caffeine, opiates, memantine, ondansetron, ketamine, and transcranial magnetic stimulation in some patients with OCD. Although limited by small or modest sample sizes, open-label study designs, and brief follow-up periods, studies suggest that each of these strategies can help some patients who have inadequately responded to first-line treatments. The existing data and the unmet needs of OCD patients justify research attention to further test these treatments' safety and efficacy. Previously untested drugs also deserve attention, especially as recent research has suggested new possible contributors to OCD pathophysiology. Similarly, psychotherapeutic interventions beyond CBT should be investigated, and treatments with preliminary evidence in OCD, including Acceptance Commitment Therapy, Danger Ideation Reduction Therapy, and technology-enabled interventions like computerized CBT and Virtual Reality Exposure Therapy, should be carefully tested.

    View details for DOI 10.2174/0929867324666170526120916

    View details for PubMedID 28552055

  • The Internet's effect on personality traits: An important casualty of the "Internet addiction" paradigm JOURNAL OF BEHAVIORAL ADDICTIONS Aboujaoude, E. 2017; 6 (1): 1–4


    Background and aims The "Internet addiction" paradigm has been criticized for several shortcomings, including inattention to specific online behaviors, not distinguishing the Internet from other media, insufficient focus on comorbidities, and definitions that do not take into account the constant access now possible. The paradigm's biggest casualty, however, may be that it has diverted attention away from subtle personality changes that seem to occur online, including in users who cannot be considered "addicted" under any definition. Methods A narrative assessment of the literature was conducted, focusing on the Internet's effects on personality traits as revealed in studies of Internet users. Results Impulsivity, narcissism, and aggression are some of the personality traits that seem to be nurtured by the Internet, with possible negative offline consequences. Discussion Ignoring the Internet's subtle effects on personality as we embrace an addiction model that implies severe pathology makes the majority of Internet users feel deceptively immune to the psychological effects of new technologies. It also limits our understanding of the big cultural shifts that are happening as a result. Conclusion The Internet's potentially negative effect on personality, and by extension on society at large, is a fundamental part of online psychology, one well worthy of further investigation.

    View details for PubMedID 28301969

    View details for PubMedCentralID PMC5573001

  • Internet addiction: reappraisal of an increasingly inadequate concept. CNS spectrums Starcevic, V., Aboujaoude, E. 2017; 22 (1): 7-13


    This article re-examines the popular concept of Internet addiction, discusses the key problems associated with it, and proposes possible alternatives. The concept of Internet addiction is inadequate for several reasons. Addiction may be a correct designation only for the minority of individuals who meet the general criteria for addiction, and it needs to be better demarcated from various patterns of excessive or abnormal use. Addiction to the Internet as a medium does not exist, although the Internet as a medium may play an important role in making some behaviors addictive. The Internet can no longer be separated from other potentially overused media, such as text messaging and gaming platforms. Internet addiction is conceptually too heterogeneous because it pertains to a variety of very different behaviors. Internet addiction should be replaced by terms that refer to the specific behaviors (eg, gaming, gambling, or sexual activity), regardless of whether these are performed online or offline.

    View details for DOI 10.1017/S1092852915000863

    View details for PubMedID 26831456

  • Theory-Based Formative Research on an Anti-Cyberbullying Victimization Intervention Message. Journal of health communication Savage, M. W., Deiss, D. M., Roberto, A. J., Aboujaoude, E. 2017; 22 (2): 124-134


    Cyberbullying is a common byproduct of the digital revolution with serious consequences to victims. Unfortunately, there is a dearth of empirically based methods to confront it. This study used social cognitive theory to design and test an intervention message aimed at persuading college students to abstain from retaliation, seek social support, save evidence, and notify authorities-important victim responses identified and recommended in previous research. Using a posttest-only control group design, this study tested the effectiveness of an intervention message in changing college students' perceived susceptibility to and perceived severity of cyberbullying as well as their self-efficacy, response efficacy, attitudes, and behavioral intentions toward each recommended response in future episodes of cyberbullying. Results indicated that the intervention message caused participants in the experimental condition to report significantly higher susceptibility, but not perceived severity, to cyberbullying than those in the control condition. The intervention message also caused expected changes in all outcomes except self-efficacy for not retaliating and in all outcomes for seeking social support, saving evidence, and notifying an authority. Implications for message design and future research supporting evidence-based anti-cyberbullying health communication campaigns are discussed.

    View details for DOI 10.1080/10810730.2016.1252818

    View details for PubMedID 28103179

  • Fluvoxamine AMERICAN PSYCHIATRIC ASSOCIATION PUBLISHING TEXTBOOK OF PSYCHOPHARMACOLOGY, 5TH EDITION Aboujaoude, E., Koran, L. M., Schatzberg, A. F., Nemeroff, C. B. 2017: 419–29
  • When Is a New Scale not a New Scale? The Case of the Bergen Shopping Addiction Scale and the Compulsive Online Shopping Scale INTERNATIONAL JOURNAL OF MENTAL HEALTH AND ADDICTION Griffiths, M. D., Andreassen, C. S., Pallesen, S., Bilder, R. M., Torsheim, T., Aboujaoude, E. 2016; 14 (6): 1107–10


    Manchiraju et al. (International Journal of Mental Health and Addiction, 1-15, 2016) published the Compulsive Online Shopping Scale (COSS) in the International Journal of Mental Health and Addiction (IJMHA). To develop their measure of compulsive online shopping, Manchiraju and colleagues adapted items from the seven-item Bergen Shopping Addiction Scale (BSAS) and its' original 28-item item pool. Manchiraju et al. did not add or remove any of the original seven items, and did not substantially change the content of any of the 28 items on which the BSAS was based. They simply added the word "online" to each existing item. Given that the BSAS was specifically developed to take into account the different ways in which people now shop and to include both online and offline shopping, there does not seem to be a good rationale for developing an online version of the BSAS. It is argued that the COSS is not really an adaptation of the BSAS but an almost identical instrument based on the original 28-item pool.

    View details for PubMedID 27942256

    View details for PubMedCentralID PMC5120053

  • The rise of online impulsivity: a public health issue. The lancet. Psychiatry Aboujaoude, E., Starcevic, V. 2016; 3 (11): 1014-1015

    View details for DOI 10.1016/S2215-0366(16)30231-0

    View details for PubMedID 27794366

  • Rising suicide rates: an under-recognized role for the Internet? WORLD PSYCHIATRY Aboujaoude, E. 2016; 15 (3): 225–27

    View details for PubMedID 27717270

    View details for PubMedCentralID PMC5032515

  • Naltrexone: A Pan-Addiction Treatment? CNS drugs Aboujaoude, E., Salame, W. O. 2016; 30 (8): 719-733


    Addiction is a major public health problem with few efficacious and safe treatments. The goal of this review is to provide an evidence-based assessment of the therapeutic role of the opioid antagonist naltrexone across the addiction spectrum-substance-based and behavioral. The PubMed database was searched for randomized, placebo-controlled clinical trials that investigated the oral or intramuscular long-acting formulation of naltrexone in substance use disorders or behavioral addictions such as pathological gambling, kleptomania, and trichotillomania. Thirty-nine efficacy studies were retrieved, covering alcohol use disorder (n = 22), opioid use disorder (n = 6), nicotine use disorder (n = 5), stimulant use disorder (n = 2), gambling disorder (n = 2), trichotillomania (n = 1), and kleptomania (n = 1). Despite the very different presentations within and between both addiction categories, the data, as a whole, show consistency in favor of naltrexone's relative efficacy and safety. Given the potential benefit and good tolerability revealed in the studies, the high morbidity associated with addiction, and the dearth of alternate treatments, naltrexone would seem like an underutilized treatment option. Further, naltrexone's seemingly broad anti-addiction efficacy supports a shared role for brain opioid pathways in the pathophysiology of addiction, broadly defined. More studies investigating the efficacy and tolerability of naltrexone and other opioid modulators are warranted. Studies should also further examine the effect of combining psychotherapy with naltrexone, as well as the potential role of naltrexone in treating comorbid addictions.

    View details for DOI 10.1007/s40263-016-0373-0

    View details for PubMedID 27401883

  • Technology at the Service of Pediatric Mental Health: Review and Assessment. journal of pediatrics Aboujaoude, E., Salame, W. 2016; 171: 20-24

    View details for DOI 10.1016/j.jpeds.2015.12.009

    View details for PubMedID 26743496

  • Working towards an international consensus on criteria for assessing internet gaming disorder: a critical commentary on Petry et al. (2014) ADDICTION Griffiths, M. D., van Rooij, A. J., Kardefelt-Winther, D., Starcevic, V., Kiraly, O., Pallesen, S., Mueller, K., Dreier, M., Carras, M., Prause, N., King, D. L., Aboujaoude, E., Kuss, D. J., Pontes, H. M., Fernandez, O. L., Nagygyorgy, K., Achab, S., Billieux, J., Quandt, T., Carbonell, X., Ferguson, C. J., Hoff, R. A., Derevensky, J., Haagsma, M. C., Delfabbro, P., Coulson, M., Hussain, Z., Demetrovics, Z. 2016; 111 (1): 167-175

    View details for DOI 10.1111/add.13057

    View details for PubMedID 26669530

  • The Bergen Shopping Addiction Scale: reliability and validity of a brief screening test FRONTIERS IN PSYCHOLOGY Andreassen, C. S., Griffiths, M. D., Pallesen, S., Bilder, R. M., Torsheim, T., Aboujaoude, E. 2015; 6


    Although excessive and compulsive shopping has been increasingly placed within the behavioral addiction paradigm in recent years, items in existing screens arguably do not assess the core criteria and components of addiction. To date, assessment screens for shopping disorders have primarily been rooted within the impulse-control or obsessive-compulsive disorder paradigms. Furthermore, existing screens use the terms 'shopping,' 'buying,' and 'spending' interchangeably, and do not necessarily reflect contemporary shopping habits. Consequently, a new screening tool for assessing shopping addiction was developed. Initially, 28 items, four for each of seven addiction criteria (salience, mood modification, conflict, tolerance, withdrawal, relapse, and problems), were constructed. These items and validated scales (i.e., Compulsive Buying Measurement Scale, Mini-International Personality Item Pool, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale) were then administered to 23,537 participants (M age = 35.8 years, SD age = 13.3). The highest loading item from each set of four pooled items reflecting the seven addiction criteria were retained in the final scale, The Bergen Shopping Addiction Scale (BSAS). The factor structure of the BSAS was good (RMSEA = 0.064, CFI = 0.983, TLI = 0.973) and coefficient alpha was 0.87. The scores on the BSAS converged with scores on the Compulsive Buying Measurement Scale (CBMS; 0.80), and were positively correlated with extroversion and neuroticism, and negatively with conscientiousness, agreeableness, and intellect/imagination. The scores of the BSAS were positively associated with anxiety, depression, and low self-esteem and inversely related to age. Females scored higher than males on the BSAS. The BSAS is the first scale to fully embed shopping addiction within an addiction paradigm. A recommended cutoff score for the new scale and future research directions are discussed.

    View details for DOI 10.3389/fpsyg.2015.01374

    View details for PubMedID 26441749

  • Cyberbullying: Review of an Old Problem Gone Viral JOURNAL OF ADOLESCENT HEALTH Aboujaoude, E., Savage, M. W., Starcevic, V., Salame, W. O. 2015; 57 (1): 10-18


    Despite being relatively new, cyberbullying is now well recognized as a serious public health problem affecting children and adolescents. Scientific exploration has lagged media attention, but a synthesis of studies across several disciplines permits an understanding of its epidemiology, phenomenology, mental health dimensions, and management tools.To assess current knowledge of cyberbullying, we searched the MEDLINE, PubMed and PsycINFO databases for articles on "cyberbullying" and related designations. The Google search engine was used to capture otherwise unpublished legislative, governmental, and community response data and to help identify relevant books and book chapters.A significant proportion of children and adolescents (20%-40%) have been victims of cyberbullying, with females and sexual minorities seemingly at higher risk. Perpetrators are more likely to be male. By nature of the electronic platform, there seems to be an easier path to the bully-victim phenomenon (victims who become bullies or vice versa) than that in traditional bullying. A nonlinear relationship with age is suggested, but demographic data overall are preliminary. Accompanying psychopathology, including an increasingly well-established link to suicidality, is common. Several prevention and management approaches have been proposed to help prevent cyberbullying or mitigate its effects.Cyberbullying's seeming ubiquity, its disproportionate toll on vulnerable populations (e.g., children and sexual minorities), the link with suicidality, and the expected continued rise in Internet penetrance and connectivity make confronting it an urgent matter. A multipronged approach is most likely to succeed and would include: educational media campaigns; school-based programs; parental oversight and involvement; legislative action; and screening and evidence-based interventions by health care providers, especially pediatricians and mental health professionals.More research is needed into cyberbullying, but available data suggest a serious problem whose consequences are real and should not be dismissed as a "virtual" by-product of an increasingly digitalized childhood and adolescence.

    View details for DOI 10.1016/j.jadohealth.2015.04.011

    View details for PubMedID 26095405

  • Telemental health: A status update WORLD PSYCHIATRY Aboujaoude, E., Salame, W., Naim, L. 2015; 14 (2): 223-230


    A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up-to-date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet-based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better-designed meta-analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis-specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology-mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the "therapeutic alliance", privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology-enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.

    View details for DOI 10.1002/wps.20218

    View details for PubMedID 26043340

  • Cyberchondria, cyberbullying, cybersuicide, cybersex: "new" psychopathologies for the 21st century? WORLD PSYCHIATRY Starcevic, V., Aboujaoude, E. 2015; 14 (1): 97–100

    View details for DOI 10.1002/wps.20195

    View details for Web of Science ID 000349300000024

    View details for PubMedID 25655165

    View details for PubMedCentralID PMC4329904

  • Online disinhibition and its resulting addictions Aboujaoude, E., Starcevic, V. AKADEMIAI KIADO RT. 2015: 6
  • Compulsive Buying Disorder: A Review and Update CURRENT PHARMACEUTICAL DESIGN Aboujaoude, E. 2014; 20 (25): 4021-4025


    Compulsive buying disorder (CBD) refers to the chronic purchasing of unneeded or unwanted items, causing significant negative consequences. There are no established criteria for CBD, and operational definitions have relied on similarities with OCD, substance use disorders, and impulse control disorders. Compulsive buying disorder is common, affecting 5.8% of the general population, according to one study. Typically, CBD has early onset, frequent comorbidities, and a chronic course. The etiology of CBD is unknown, with biological, psychological and sociocultural factors proposed as likely contributors. Treatment data are limited and suggest addressing comorbid conditions and considering cognitive behavioral therapy, financial and family counseling, selective serotonin reuptake inhibitors, and naltrexone, among other possible interventions, to target CBD. Beyond treatment, educational, legislative and family-based public policy initiatives can likely help individuals with CBD and other excessive spenders.

    View details for Web of Science ID 000338451800005

  • Compulsive buying disorder: a review and update. Current pharmaceutical design Aboujaoude, E. 2014; 20 (25): 4021-4025


    Compulsive buying disorder (CBD) refers to the chronic purchasing of unneeded or unwanted items, causing significant negative consequences. There are no established criteria for CBD, and operational definitions have relied on similarities with OCD, substance use disorders, and impulse control disorders. Compulsive buying disorder is common, affecting 5.8% of the general population, according to one study. Typically, CBD has early onset, frequent comorbidities, and a chronic course. The etiology of CBD is unknown, with biological, psychological and sociocultural factors proposed as likely contributors. Treatment data are limited and suggest addressing comorbid conditions and considering cognitive behavioral therapy, financial and family counseling, selective serotonin reuptake inhibitors, and naltrexone, among other possible interventions, to target CBD. Beyond treatment, educational, legislative and family-based public policy initiatives can likely help individuals with CBD and other excessive spenders.

    View details for PubMedID 24001296

  • Problematic Internet use: an overview WORLD PSYCHIATRY Aboujaoude, E. 2010; 9 (2): 85-90


    There is wide agreement that the Internet can serve as a tool that enhances well-being. It is more difficult, however, to find consensus around the issue of problematic Internet use. That may be in part because scientific investigation has lagged far behind technological advances and media attention. The diagnostic schemas that have been proposed since 1996, and the screening tools that have been developed, stress similarities with substance use, impulse control disorders, and obsessive-compulsive disorder. Prevalence figures vary as a function of the diagnostic definition used, the age group studied, and whether the surveys were conducted online. Studies suggest high comorbidity rates with mood disorders and, among younger individuals, attention-deficit/hyperactivity disorder. Treatment should address any comorbid conditions present, as those may be causing, or exacerbating, problematic Internet use. Interventions that may specifically target problematic Internet use include cognitive behavioral therapy and selective serotonin reuptake inhibitors, but detailed guidelines must await further studies. For a medium that has so radically changed how we conduct our lives, the Internet's effects on our psychology remain understudied. More research is needed into the pathophysiology, epidemiology, natural course, and treatment of problematic Internet use. In addition, the more subtle psychological changes, such as disinhibition, that seem to characterize people's online behavior also deserve attention, even if they cannot be seen as necessarily pathological.

    View details for PubMedID 20671890

  • The prevalence of pathologic skin picking in US adults COMPREHENSIVE PSYCHIATRY Keuthen, N. J., Koran, L. M., Aboujaoude, E., Large, M. D., Serpe, R. T. 2010; 51 (2): 183-186


    Despite increasing recognition of the potentially severe medical and psychosocial costs of pathologic skin picking (PSP), no large-sample, randomized investigation of its prevalence in a national population has been conducted.Two thousand five hundred and thirteen US adults were interviewed during the spring and summer of 2004 in a random-sample, national household computer-assisted phone survey of PSP phenomenology and associated functional impairment. Respondents were classified for subsequent analysis according to proposed diagnostic criteria.Of all respondents, 16.6% endorsed lifetime PSP with noticeable skin damage; 60.3% of these denied picking secondary to an inflammation or itch from a medical condition. One fifth to one quarter of those with lifetime PSP not related to a medical condition endorsed tension or nervousness before picking, tension or nervousness when attempting to resist picking, and pleasure or relief during or after picking. A total of 1.4% of our entire sample satisfied our criteria of picking with noticeable skin damage not attributable to another condition and with associated distress or psychosocial impairment. Pickers satisfying these latter criteria differed from other respondents in demographics (age, marital status) and both picking phenomenology and frequency.

    View details for DOI 10.1016/j.comppsych.2009.04.003

    View details for Web of Science ID 000285923000014

    View details for PubMedID 20152300

  • Double-Blind Study of Dextroamphetamine Versus Caffeine Augmentation for Treatment-Resistant Obsessive-Compulsive Disorder 15th Annual Obsessive Compulsive Foundation Conference Koran, L. M., Aboujaoude, E., Gamel, N. N. PHYSICIANS POSTGRADUATE PRESS. 2009: 1530–35


    Two small, double-blind, placebo-controlled, single-dose, crossover studies found dextroamphetamine (d-amphetamine) 30 mg clearly superior to placebo in relieving symptoms of obsessive-compulsive disorder (OCD). We conducted a 5-week, double-blind, caffeine-controlled study to test the hypothesis that d-amphetamine, added after an adequate selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) trial, would be more effective than caffeine in reducing residual OCD symptoms of moderate or greater severity.Between August 2006 and February 2008, we enrolled adults with DSM-IV OCD and a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of >or= 20 after >or= 12 weeks of adequate treatment with an SSRI or SNRI. Subjects were randomly assigned to double-blind d-amphetamine 30 mg/d or caffeine 300 mg/d added to their SSRI/SNRI and other medications. Responders (first week mean Y-BOCS score decrease of >or= 20%) entered the study's 4-week double-blind extension phase.We enrolled 24 subjects, 11 women and 13 men, with a mean (SD) age of 40 (13.2) years and mean baseline Y-BOCS scores of 26.5 (4.1) for the d-amphetamine group (n = 12) and 29.1 (4.0) for the caffeine group (n = 12). At the end of week 1, 6 of 12 d-amphetamine subjects (50%) and 7 of 12 caffeine subjects (58%) were responders. At week 5, the responders' mean Y-BOCS score decreases were, for the d-amphetamine group (last observation carried forward), 48% (range, 20%-80%); and, for the caffeine group, 55% (range, 27%-89%). Obsessive-compulsive disorder and depression improvement were independent. The double-blind remained intact. No subject discontinued the study due to side effects.Larger, double-blind, placebo-controlled trials of both d-amphetamine and caffeine augmentation are needed in OCD subjects inadequately responsive to adequate doses of an SSRI or Identifier: NCT00363298.

    View details for DOI 10.4088/JCP.08m04605

    View details for Web of Science ID 000272206200007

    View details for PubMedID 19573497

  • Memantine Augmentation in Treatment-Resistant Obsessive-Compulsive Disorder An Open-Label Trial JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Aboujaoude, E., Barry, J. J., Gamel, N. 2009; 29 (1): 51-55


    Data from the fields of genetics, neuroimaging, and animal studies, along with case reports and small clinical trials, point to a role for glutamatergic dysfunction in the pathophysiology of obsessive-compulsive disorder (OCD). We report on the first open-label study to test the hypothesis that memantine, a noncompetitive glutamate antagonist, will result in a clinically meaningful reduction in OCD symptoms in adults with treatment-resistant OCD.We recruited 15 adult subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined OCD and a baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of 18 or higher, who had failed to respond to treatment with a serotonin reuptake inhibitor (SRI), given at an adequate and stable dose for at least 12 weeks. The duration of memantine treatment was 12 weeks, and the dose was gradually increased to a target of 20 mg/d. Response was defined as a 25% or greater reduction in the Y-BOCS score at study end and a Clinical Global Impression-Improvement scale rating of "much" or "very much" improved.Data from 14 subjects were analyzable. Mean baseline Y-BOCS score was 27.4 (SD, 5.0). Subjects had failed an average of 2.8 (SD, 1.8) SRI trials; 6 subjects had failed augmentation with atypical antipsychotics. At study end, 6 subjects (42.9%) were responders, and response was achieved by EOW4. Responders had significantly lower baseline Y-BOCS scores (2-tailed t tests, P < 0.05, t = 2.2) and had failed fewer SRIs (P

    View details for DOI 10.1097/JCP.0b013e318192e9a4

    View details for PubMedID 19142108

  • Fluvoxamine AMERICAN PSYCHIATRIC PUBLISHING TEXTBOOK OF PSYCHOPHARMACOLOGY, 4TH EDITION Aboujaoude, E., Koran, L. M., Schatzberg, A. F., Nemeroff, C. B. 2009: 353–61
  • Duloxetine treatment of dysthymia and double depression: an open-label trial JOURNAL OF CLINICAL PSYCHIATRY Koran, L. M., Aboujaoude, E. N., Gamel, N. N. 2007; 68 (5): 761-765


    Although not as common as major depressive disorder, dysthymia is not rare and is associated with substantial impairment. Antidepressants and some psychotherapies are often effective. We explored the efficacy of the antidepressant duloxetine, a serotonin and norepinephrine reuptake inhibitor.Between February 2005 and April 2006, we recruited 24 adults with DSM-IV dysthymia or dysthymia and concurrent major depression ("double depression") who had an entry score of > or = 17 on the clinician-rated Inventory for Depressive Symptomatology (IDS-C). We excluded subjects with significant medical illnesses and those requiring other psychotropic agents or undergoing psychotherapy. Subjects received duloxetine 60 mg/day for 6 weeks, increased as tolerated to 120 mg/day for the remainder of the 12-week trial for those with an inadequate treatment response.The subjects' mean +/- SD IDS-C scores decreased significantly from baseline (27.3 +/- 6.3) to endpoint (7.8 +/- 7.4, Student t = 12.38, df = 23, p < or = .001). The IDS-C response rate (intent-to-treat [ITT]) was 83% (20/24); the remission rate (ITT) was 79% (19/24). Among study completers, these rates were 89% (17/19) and 84% (16/19). Five subjects (21%) discontinued for side effects.Duloxetine appears to be an effective and well-tolerated treatment for dysthymia and double depression. A double-blind, placebo-controlled study is under way. If duloxetine is found to be effective, studies powered to detect potential, clinically important differences between duloxetine and other antidepressants will be identifier NCT00185575.

    View details for PubMedID 17503986

  • Escitalopram for compulsive buying disorder - A double-blind discontinuation study JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Koran, L. M., Aboujaoude, E. N., Solvason, B., Gamel, N. N., Smith, E. H. 2007; 27 (2): 225-227

    View details for Web of Science ID 000245094300027

    View details for PubMedID 17414257

  • Escitalopram treatment of kleptomania: An open-label trial followed by double-blind discontinuation 18th Congress of the European-College-of-Neuropsychopharmacology Koran, L. M., Aboujaoude, E. N., Gamel, N. N. PHYSICIANS POSTGRADUATE PRESS. 2007: 422–27


    Kleptomania has no definitive treatment. Mixed reports of benefit from openly prescribed selective serotonin reuptake inhibitors led us to design a double-blind, placebo-controlled discontinuation trial of escitalopram.Between December 2002 and March 2005, we recruited 24 subjects aged >or=20 years with DSM-IV kleptomania of >or=1 year's duration. We excluded subjects with organic mental disorders, psychoses, substance or alcohol abuse, suicidal risk, bipolar I or II disorder, anorexia nervosa, or antisocial personality disorder and subjects requiring other psychotropic medications. Our primary outcome measure was theft episodes per week. A responder was defined as a subject having a > 50% decrease in theft episodes per week and a Clinical Global Impressions-Improvement scale score of "much improved" or "very much improved." Escitalopram was started at 10 mg/day and increased as necessary and tolerated after week 4 to 20 mg/day. At the end of week 7, responders were randomly assigned to a 1-week taper followed by 16 weeks of placebo or to continuation of treatment for 17 weeks at their week 7 escitalopram dose.Nineteen subjects (79%) were week 7 responders and 15 were randomly assigned. Five subjects (4 responders) withdrew early: 1 for unrelated illness, 1 for protocol deviation, 2 for side effects, and 1 for withdrawn consent. Three (43%) of 7 escitalopram subjects relapsed compared with 4 (50%) of 8 placebo subjects (Fisher exact test p = .38).The high response rate during open-label escitalopram treatment was not better maintained by double-blind escitalopram than by placebo. Kleptomania may be a heterogeneous pathological behavior better treated with pharma-cotherapy in some cases and psychologically or with combined treatment in others.

    View details for PubMedID 17388713

  • Potential markers for problematic Internet use: A telephone survey of 2,513 adults CNS SPECTRUMS Aboujaoude, E., Koran, L. M., Gamel, N., Large, M. D., Serpe, R. T. 2006; 11 (10): 750-755


    The Internet has positively altered many aspects of life. However, for a subset of users, the medium may have become a consuming problem that exhibits features of impulse control disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.This is the first large-scale epidemiological study of problematic Internet use through a random-digit-dial telephone survey of 2,513 adults in the United States. Given the lack of validated criteria, survey questions were extrapolated from established diagnostic criteria for impulse control disorders, obsessive-compulsive disorder, and substance abuse. Four possible diagnostic criteria sets were generated. The least restrictive set required the respondent to report an unsuccessful effort to reduce Internet use or a history of remaining online longer than intended, Internet use interfering with relationships, and a preoccupation with Internet use when offline.The response rate was 56.3%. Interviews averaged 11.3 minutes in duration. From 3.7% to 13% of respondents endorsed > or =1 markers consistent with problematic Internet use. The least restrictive proposed diagnostic criteria set yielded a prevalence of problematic Internet use of 0.7%.Potential markers of problematic Internet use seem present in a sizeable proportion of adults. Future studies should delineate whether problematic Internet use constitutes a pathological behavior that meets criteria for an independent disorder, or represents a symptom of other psychopathologies.

    View details for PubMedID 17008818

  • Estimated prevalence of compulsive buying behavior in the United States AMERICAN JOURNAL OF PSYCHIATRY Koran, L. M., Faber, R. J., Aboujaoude, E., Large, M. D., Serpe, R. T. 2006; 163 (10): 1806-1812


    Compulsive buying (uncontrolled urges to buy, with resulting significant adverse consequences) has been estimated to affect from 1.8% to 16% of the adult U.S. population. To the authors' knowledge, no study has used a large general population sample to estimate its prevalence.The authors conducted a random sample, national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults. The interviews addressed buying attitudes and behaviors, their consequences, and the respondents' financial and demographic data. The authors used a clinically validated screening instrument, the Compulsive Buying Scale, to classify respondents as either compulsive buyers or not.The rate of response was 56.3%, which compares favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people ages 55 and older than the U.S. adult population. The estimated point prevalence of compulsive buying among respondents was 5.8% (by gender: 6.0% for women, 5.5% for men). The gender-adjusted prevalence rate was 5.8%. Compared with other respondents, compulsive buyers were younger, and a greater proportion reported incomes under 50,000 US dollars. They exhibited more maladaptive responses on most consumer behavior measures and were more than four times less likely to pay off credit card balances in full.A study using clinically valid interviews is needed to evaluate these results. The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.

    View details for Web of Science ID 000240906800026

    View details for PubMedID 17012693

  • Pulse-loaded intravenous clomipramine in treatment-resistant obsessive-compulsive disorder JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Koran, L. M., Aboujaoude, E., Ward, H., Shapira, N. A., Sallee, F. R., Gamel, N., Elliott, M. 2006; 26 (1): 79-83


    Small studies have suggested that intravenous clomipramine (CMI) may be more effective and induce faster improvement in obsessive-compulsive disorder than do orally administered serotonin reuptake inhibitors.To test these hypotheses, we conducted a randomized, double-blind, double-dummy study of pulse-loaded intravenous versus oral CMI, followed by open-label oral CMI for 12 weeks.We enrolled a volunteer and referred group of 34 adults with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition obsessive-compulsive disorder of > or =1-year duration and Yale-Brown Obsessive Scale score of > or =20. Eligible subjects had failed > or =2 adequate serotonin reuptake inhibitor trials. Subjects received pulse loaded CMI 150 mg by vein or by mouth on day 1 and 200 mg on day 2. Oral CMI began on day 6 at 200 mg/d and was increased by 25 mg every 4 days to 250 mg/d, as tolerated, for 12 weeks.Adverse events led to one withdrawal during oral pulse loading and 5 during open-label oral treatment. Intravenous pulse loading did not induce a more rapid or greater Yale-Brown Obsessive Scale score decrease than oral pulse loading at day 6 or by week 12. Day 6 and week 12 improvement were unrelated to plasma drug or metabolite concentrations. Pulse loading itself seemed to induce more rapid and greater improvement than expected in treatment-resistant obsessive-compulsive disorder.Further investigation of oral pulse-loading regimens in treatment-resistant obsessive-compulsive disorder is warranted.

    View details for DOI 10.1097/

    View details for PubMedID 16415712

  • Mirtazapine for obsessive-compulsive disorder: An open trial followed by double-blind discontinuation JOURNAL OF CLINICAL PSYCHIATRY Koran, L. M., Gamel, N. N., Choung, H. W., Smith, E. H., Aboujaoude, E. N. 2005; 66 (4): 515-520


    Many patients with obsessive-compulsive disorder (OCD) experience little response to standard treatment with serotonin reuptake inhibitors. Mirtazapine enhances serotonergic function by a mechanism distinct from reuptake inhibition. Because a pilot study suggested effectiveness of mirtazapine in OCD, we conducted a controlled trial.We recruited 30 subjects, 15 treatmentnaive and 15 treatment-experienced, with DSM-IV OCD of > or =1 year's duration and a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of > or =20. In the 12-week, open-label phase, subjects received mirtazapine starting at 30 mg/day and titrated over 2 weeks as tolerated to 60 mg/day. At week 12, responders (YBOCS score decrease > 25%) were randomly assigned, double-blind, to continue mirtazapine or switch to placebo for 8 weeks, including a 1-week, double-blind taper week for placebo subjects.In the open-label phase, the mean +/-SD YBOCS score fell from 28.3 +/-3.7 to 20.3 +/-8.5 (paired samples t = 4.81, p < .0001). Four subjects (13.3%) discontinued for side effects. Sixteen subjects (53.3%) (8 treatmentnaive, 8 treatment-experienced) were responders and 15 agreed to randomization. Response was independent of comorbid mood disorders. In the 8-week, double-blind, placebo-controlled discontinuation phase, the mirtazapine group's mean YBOCS score fell a mean +/-SD of 2.6 +/-8.7 points while the placebo group's mean score rose a mean +/-SD of 9.1 +/-7.5 points (Mann Whitney U = 6.5, p = .005, 1-tailed). All other outcome measures were consistent with mirtazapine's superiority versus placebo.Mirtazapine may be an effective pharmacotherapy for OCD. If our results are replicated, larger double-blind studies would be indicated.

    View details for PubMedID 15816795

  • Double-blind treatment with oral morphine in treatment-resistant obsessive-compulsive disorder JOURNAL OF CLINICAL PSYCHIATRY Koran, L. M., Aboujaoude, E., Bullock, K. D., Franz, B., Gamel, N., Elliott, M. 2005; 66 (3): 353-359


    Obsessive-compulsive disorder (OCD) often responds inadequately to serotonin reuptake inhibitors (SRIs). A case series reported substantial response to once-weekly oral morphine. We conducted a placebo-controlled, double-blind trial to investigate whether once-weekly oral morphine is effective in SRI-resistant OCD.Subjects with DSM-IV-defined OCD for > or =3 years who had failed > or =2 adequate SRI trials and had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of > or =20 were recruited. Current medications were continued. Subjects were randomly assigned to random-order, 2-week blocks of once-weekly morphine, lorazepam, and placebo. Week 2 dosage was increased, decreased, or maintained depending on response and side effects.We enrolled 23 subjects, who had failed 2 to 6 SRI trials. The median screening Y-BOCS score was 29. The median Y-BOCS score after morphine (highest dose) was 25 (median decrease = 13%). Seven subjects (30%) were responders (Y-BOCS decreases > or =25%). The median Y-BOCS score after lorazepam (highest dose) was 27 (median decrease = 6%). Four subjects (17%) responded to lorazepam; 1 was a morphine responder. The median Y-BOCS score after placebo (highest dose) was 27 (median decrease = 7%), and no subject responded. Responses differed significantly among the 3 conditions (Friedman 2-way analysis of variance, chir(2) = 13.92, df = 2, p = .01). Wilcoxon matched-pairs signed-rank tests (T = 56.5, p = .05) showed significance for morphine versus placebo but not lorazepam versus placebo.Our results support the hypothesis that once-weekly oral morphine can reduce symptoms in some treatment-resistant OCD patients. The mechanism of action is unknown. Further studies of mu-agonists and glutamate antagonists are warranted.

    View details for PubMedID 15766302

  • A case of kleptomania correlating with premenstrual dysphoria JOURNAL OF CLINICAL PSYCHIATRY Aboujaoude, E., Gamel, N., Koran, L. M. 2004; 65 (5): 725-726

    View details for Web of Science ID 000221887100025

    View details for PubMedID 15163267

  • Overview of Kleptomania and Phenomenological Description of 40 Patients. Primary care companion to the Journal of clinical psychiatry Aboujaoude, E., Gamel, N., Koran, L. M. 2004; 6 (6): 244-247


    BACKGROUND: Despite its considerable personal toll and its impact on the economy and the legal system, kleptomania is an understudied psychiatric disorder. METHOD: We review what is known about the epidemiology, course, and treatment of kleptomania and describe 40 patients meeting DSM-IV criteria for the disorder. RESULTS: Our data suggest a female preponderance, with an early age at onset and most often a continuous course. No other gender-based differences were seen. The majority of our subjects had not received treatment for kleptomania despite often having sought help for comorbid psychiatric conditions, most commonly major depressive disorder. Our data confirm kleptomania's devastating effects on personal and professional lives and serious legal consequences, reflected in high arrest and incarceration rates. Because patients with kleptomania rarely seek psychiatric help for the disorder, we indicate how other health care providers can screen for it, possibly as part of taking patients' legal and social histories, and suggest treatments. CONCLUSION: Awareness of kleptomania, empathy toward those afflicted, and rigorous research into treatment options are needed to mitigate kleptomania's personal and societal costs.

    View details for PubMedID 15614312

  • A 1-year naturalistic follow-up of patients with compulsive shopping disorder JOURNAL OF CLINICAL PSYCHIATRY Aboujaoude, E., Gamel, N., Koran, L. M. 2003; 64 (8): 946-950


    Compulsive shopping disorder is increasingly recognized as a treatable impulse-control disorder. We report the first long-term, naturalistic follow-up of patients with compulsive shopping disorder, which examined the course of illness over 1 year in a cohort that had completed up to 3 months of open-label treatment with citalopram, 20 mg/day to 60 mg/day. In that trial, 17 (71%) of 24 subjects who met McElroy and colleagues' diagnostic criteria for compulsive shopping disorder were responders (Clinical Global Impressions-Improvement scale rating of much or very much improved and Yale-Brown Obsessive Compulsive Scale-Shopping Version score decrease of >/= 50%).Follow-up interviews occurred 3, 6, 9, and 12 months after study end. Data gathered included comorbid conditions, estimated total debt, 2-week spending, whether the patient was taking citalopram, and illness versus remission status. Remission was defined as no longer meeting diagnostic criteria for compulsive shopping disorder. Data were gathered between March 2000 and January 2002.Of responders at trial end, 81% (13/16), 71% (10/14), 71% (10/14), and 73% (11/15) were in remission at 3, 6, 9, and 12 months. Mean 2-week compulsive shopping expenditures decreased from 773 US dollars (median = 500 US dollars) at baseline to 351 US dollars (median = 0 US dollars) at month 12, and mean total debt decreased from 17,833 US dollars (median = 20,000 US dollars) to 16,752 US dollars (median = 14,000 US dollars). No clear association was seen between taking citalopram and remission status (p =.55, p =.08, p =.58, and p =.60 at 3, 6, 9, and 12 months, respectively; Fisher exact test). The majority of trial nonresponders remained ill at each follow-up point.An acute response to citalopram predicts a greater likelihood of continued remission over 1 year, although the mechanisms that maintain remission require further investigation.

    View details for PubMedID 12927011

  • The psychiatric hospital of the cross: A sane asylum in the Middle East AMERICAN JOURNAL OF PSYCHIATRY Aboujaoude, E. 2002; 159 (12): 1982-1982

    View details for Web of Science ID 000179675000006

    View details for PubMedID 12450945



    High-performance liquid chromatography with electrochemical detection is a highly sensitive and selective method for detecting oxo8dG and oxo8Gua, biomarkers of oxidative DNA damage. When employed together with the DNA isolation and monoclonal antibody-based immunoaffinity purification methods described, oxo8dG and oxo8Gua in DNA and urine can be readily detected and quantitated, offering a powerful approach for assessing oxidative DNA damage in vivo. Application of the technique to the detection of oxo8dG from DNA permits quantitation of the steady-state levels of this oxidatively modified deoxynucleoside and overcomes the detection problems associated with the extremely low levels present in DNA. In addition, the selectivity gained by this detection method eliminates the problem of separating the signal for oxo8dG from those of normal deoxynucleosides. The quantitation of oxo8dG and oxo8Gua in biological fluids is noninvasive and complements the measurement of oxo8dG in DNA by estimating the rate of oxidative DNA damage occurring within the body or in a population of cells. This analytical approach may allow one to estimate oxidative DNA damage in an animal or individual exposed to prooxidant conditions associated with lifestyle, genetic predisposition, degenerative diseases, or environmental toxins. Furthermore, these assays may allow one to assess the potentially beneficial effects of intervention strategies that protect DNA from such damage.

    View details for Web of Science ID A1994BB09L00002

    View details for PubMedID 7808289