Tanning Addiction Linked to Other Psychological Disorders

January 6, 2014

By Will Boggs MD

NEW YORK - Tanning dependence and problematic tanning may be associated with obsessive-compulsive and body dysmorphic disorders, researchers say.

"There is only a small (but growing) research literature available regarding the psychiatric correlates of excessive tanning, and more is needed in order to understand the mechanisms that might be involved," said Lisham Ashrafioun, a graduate student at Bowling Green State University in Ohio, and Dr. Erin E. Bonar from University of Michigan's Addiction Research Center in Ann Arbor.

"This may help clarify the extent to which excessive tanning may be best conceptualized as an addiction-related disorder or as a symptom of another class of psychiatric disorders, or as a distinct health risk behavior, which can help inform prevention and intervention," they told Reuters Health by email.

Ashrafioun and Dr. Bonar evaluated whether a variety of tanning-related, demographic, psychological, and substance use characteristics were associated with problematic tanning and/or tanning dependence in a cross-sectional study of 533 individuals who had tanned before.

Participants who endorsed at least three of the eight criteria on the Tanning-DSM were considered tanning dependent, and those who answered affirmatively two of the four questions on the tanning-specific version of the CAGE alcohol screener were considered to have problematic tanning.

Using these criteria, 31% (165)of participants were tanning dependent and 12% (65) had problematic tanning, according to the report, online December 27 in the Journal of the American Academy of Dermatology.

In logistic regression analyses, female sex and screening positive for body dysmorphic disorder and obsessive-compulsive disorder significantly predicted tanning dependence.

In the model for problematic tanning, only screening positive for obsessive-compulsive disorder was significantly predictive.

Frequency of tanning in the past 30 days most strongly correlated with problematic tanning and tanning dependence, and this association was strongest for participants who tanned at least 9 times in the past 30 days.

Excessive tanning did not appear to be associated with depression or substance abuse, the researchers found.

"We were also surprised about how commonly endorsed some of the symptoms of addiction-like tanning were for those who did not meet criteria for addiction-like tanning," the authors said. "For example, items that assess symptoms analogous to withdrawal (Do you feel unattractive or anxious to tan if you do not maintain your tan?) and tolerance (Do you feel that you need to spend more and more time in the sun or tanning bed in order to maintain your tan?) were endorsed by approximately one-fourth of the subsample who did not meet criteria for problematic tanning."

"A dermatologist or other physician who learns of frequent tanning by a patient may consider using some of the brief assessments we used in our study (e.g., GAD-7, PHQ-9, AUDIT, etc.) to see whether a patient meets the established cut-off that would suggest referral," Ashrafioun and Dr. Bonar added. "These screening instruments can be integrated into health history questionnaires that are already routine in many physicians' offices."

"We understand that physicians are very aware of the dangers of tanning and that preventive messages are one key approach for reducing risk for skin cancer," they told Reuters Health. "However, some of the young adults in our sample indicate continuing to tan despite knowledge that it can be harmful for them, or despite having a family history of skin cancer."

"Thus," they conclude, "in addition to prevention messages, additional psychiatric assessment and behavioral interventions may be appropriate for individuals who engage in frequent tanning. That there is a small subset of people who have tried to stop tanning, but still continue, and/or who think they should spend less time tanning, suggests that they may need some assistance with making some changes. Further, more research is needed to understand what other factors may be influencing excessive tanning behaviors which could further guide physicians' approach to reducing risk for skin cancer."

Dr. Bryon Adinoff, who was not involved in the research, said the link between problematic tanning, female gender and body dysmorphic syndrome are consistent with earlier findings.

"The relationship with OCD was unexpected," Dr. Adinoff, from VA North Texas Health Care System and UT Southwestern Medical Center in Dallas, told Reuters Health by email.

"At this point, there is no known treatment for this disorder, and even calling it a disorder remains tenuous," he said. "It is has not been recognized as a disorder, or addiction, by any formal organization. There are no known treatments. The best approach, at this point, is to use education -- advise the tanner of the dangers of tanning, particularly with a tanning bed (many users think that tanning beds are safe)."

"More research is necessary to understand the biology of this problem (e.g., how is UVR addictive? What are the biologic mechanisms involved that translate the UVR to the brain), and developing treatments is imperative," Dr. Adinoff concluded.

SOURCE: http://bit.ly/1bC6GXt

J Am Acad Dermatol 2013.

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