Studyholism: A New Obsessive-Compulsive Disorder PDF

fpsyg-12-734116 January 20, 2022 Time: 11:24 # 1 ORIGINAL RESEARCH published: 24 January 2022 doi: 10.3389/fpsyg.2021.734116 Edited by: Antoine Bechara, University of Southern California, United States Reviewed by: Vasilios G. Masdrakis, National and Kapodistrian University of Athens, Greece Clariss...

fpsyg-12-734116 January 20, 2022 Time: 11:24 # 1 ORIGINAL RESEARCH published: 24 January 2022 doi: 10.3389/fpsyg.2021.734116 Edited by: Antoine Bechara, University of Southern California, United States Reviewed by: Vasilios G. Masdrakis, National and Kapodistrian University of Athens, Greece Clarissa Richardson, Illinois College, United States *Correspondence:Yura Loscalzo [email protected] Specialty section: This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology Received: 30 June 2021 Accepted: 03 December 2021 Published: 24 January 2022 Citation: Loscalzo Y and Giannini M (2022) Studyholism: A New Obsessive-Compulsive Related Disorder? An Analysis of Its Association With Internalizing and Externalizing Features. Front. Psychol. 12:734116. doi:10.3389/fpsyg.2021.734116 Studyholism: A New Obsessive-Compulsive Related Disorder? An Analysis of Its Association With Internalizing and Externalizing Features Yura Loscalzo *and Marco Giannini Department of Health Sciences, School of Psychology, University of Florence, Florence, Italy Studyholism (or obsession toward study) is a new potential obsessive-compulsive (OCD)-related disorder recently introduced in the literature. According to its theorization, there are two types of Studyholic: Engaged and Disengaged Studyholics, which are characterized, respectively, by high and low levels of Study Engagement. This study aims to shed light on the role of internalizing and externalizing features as antecedents and outcomes of Studyholism and Study Engagement. Moreover, it aims to analyze the differences in psychopathology and sensation seeking between students demonstrating Disengaged and Engaged Studyholism. We performed four path analyses, MANOVAs, and Mann–Whitney tests on 1,223 Italian college students ( M age = 22.56 3.53). Among the main ndings, Studyholism is associated with psychological and academic impairment, while Study Engagement predicts better mental health and academic functioning; though, the bvalues are lower for Study Engagement. Moreover, Studyholism is positively predicted by internalizing symptoms and negatively predicted by externalizing variables. Finally, students showing Engaged Studyholism have lower levels of obsessive-compulsive symptoms than those demonstrating Disengaged Studyholism. In conclusion, this study shows the critical importance of implementing preventive interventions aimed at reducing Studyholism levels in college students. Moreover, it provides support to the conceptualization of problematic overstudying as a new potential OCD-related disorder and to the value of distinguishing between Engaged and Disengaged Studyholics for tailored clinical interventions. Finally, it highlights the need to use two different theorizations and operationalizations for problematic overworking and overstudying. However, the literature on problematic overstudying is too scant to reach any rm conclusion. Hence, future studies should deepen the analysis of problematic overstudying, possibly using longitudinal designs, to unveil its internalizing and/or externalizing nature. Keywords: heavy study investment, obsession, OCD, study, study addiction, study engagement, work addiction, workaholism Frontiers in Psychology|www.frontiersin.org 1January2022|Volume 12|Article 734116 fpsyg-12-734116 January 20, 2022 Time: 11:24 # 2 Loscalzo and Giannini Studyholism: An OCD-Related Disorder?INTRODUCTION Fifty years ago,Oates(1971)introduced the term “Workaholism” to describe people who feel a compulsion to work for a long time and face adverse consequences due to this problem behavior. Since then, many scholars have analyzed Workaholism and its negative outcomes, such as depressive mood, work-family conict, and poor performance (Sussman,2012;Clark et al., 2016). Despite the vast literature on the topic,Loscalzo and Giannini(2017a)highlighted the lack of a denition shared by the scientic community; hence, they reviewed the studies on Workaholism and suggested a comprehensive model enclosing all the main features highlighted by dierent scholars. Therefore, they dened Workaholism as being characterized by both addiction and obsessive-compulsive symptoms, and by either high or low levels of work engagement (hence distinguishing between engaged and disengaged workaholics). In other words, Loscalzo and Giannini(2017a)suggested that Workaholism is made up of both externalizing and internalizing symptoms. Externalizing disorders are characterized by symptoms addressed toward others and low self-control. The feature of internalizing disorders is that symptoms are not shown to others, and there is excessive self-control (Strepparava and Iacchia,2012). Hence, addiction symptoms might be classied as externalizing, while obsessive-compulsive symptoms might be classied as internalizing. Finally, based on a thorough review of the literature,Loscalzo and Giannini(2017a)listed some potential antecedents and outcomes of Workaholism, distinguishing between individual and situational ones. Next, in line withAtroszko et al.(2015),Loscalzo and Giannini(2017b)suggested that a problem behavior similar to Workaholism might be evident in the school context too since studying is the main work activity of students. Though, as highlighted in a subsequent paper,Loscalzo and Giannini (2020a)believed that there is a critical dierence between work and study. While working is a paid activity, studying (despite a few exceptions) is not rewarded with money. Hence, in their view, it is not appropriate to straightforwardly use the Workaholism construct in the school context; a specic construct for students should be suggested. Therefore, they introduced in the literature a new potentialclinical condition specically related to study behavior, namely Studyholism (or obsession toward studying). More specically, when theorizing this new construct – based on their comprehensive workaholism model (Loscalzo and Giannini,2017a) –Loscalzo and Giannini (2017b)rst dened it as a potential new clinical condition that might include both addiction and obsessive symptoms, and either high or low study engagement. Though, based on the psychometric analyses performed on a pool of 68 items covering addiction symptoms, obsessive symptoms, and study engagement (Loscalzo et al.,2018),Loscalzo and Giannini(2017b)next proposed a two-factor denition, not including addiction items. Hence, they dened Studyholism as characterized by obsessive-compulsive symptoms and either high or low Study Engagement. Moreover, they suggested that the clinical form of Studyholism is the one associated with low Study Engagement (or Disengaged Studyholism). Loscalzo and Giannini(2017b)adopted the Heavy Study Investment (HSI) framework. More specically, referring to the heavy work investment model (Snir and Harpaz,2012), they dened HSI as a heavy investment of time and eort in studying that might take three dierent forms (based on the high/low levels of Studyholism and Study Engagement): Disengaged Studyholics (i.e., students with high levels of Studyholism and low levels of Study Engagement), Engaged Studyholics (i.e., students with high Studyholism but also high Study Engagement), and Engaged students (i.e., students with low Studyholism and high Study Engagement). Figure 1shows graphically the four types of student who arise by crossing the levels of Studyholism and Study Engagement, hence also including Detached students (or students with low levels of both Studyholism and Study Engagement). InLoscalzo and Giannini's(2017b)perspective, it is vital to adopt the HSI framework for two main reasons: (i) To avoid over-pathologizing a common behavior such as studying (in line withBillieux et al.,2015); (ii) To detect potential dierences between dierent types of Studyholics with regard to the same antecedents/outcomes, with critical implications for preventive and clinical interventions. Loscalzo and Giannini(2017b), in their rst theoretical paper, specied that they chose to name this new potential clinical condition as “Studyholism” since they aimed to maintain continuity with the construct of Workaholism, as they hypothesized that Studyholism could be an antecedent of it. Also, using a term that does not include the word “addiction” is vital forLoscalzo and Giannini(2017b), as it helps avoid a reduction of the construct to the addiction component, giving the possibility to consider the copresence of a positive dimension (namely, study engagement).Loscalzo and Giannini (2017b)introduced Studyholism as a construct dierent from Study Addiction (Atroszko et al.,2015), even if they are both related to problematic overstudying. “Problematic overstudying” FIGURE 1 | The four types of student accordingly toLoscalzo and Giannini's (2017b) conceptualization. Frontiers in Psychology|www.frontiersin.org 2January2022|Volume 12|Article 734116 fpsyg-12-734116 January 20, 2022 Time: 11:24 # 3 Loscalzo and Giannini Studyholism: An OCD-Related Disorder?is a general term coined byLoscalzo and Giannini(2018a)to refer to the analysis of this problematic behavior regardless of its theorization. Instead, Studyholism (Loscalzo and Giannini, 2017b) and Study Addiction (Atroszko et al.,2015) refer to problematic overstudying in the context of a specic model: the obsessive-compulsive (OCD)-related disorder and the behavioral addiction model, respectively.Atroszko et al.(2015)dened Study Addiction as a behavioral addiction characterized by seven core components of substance addictions (i.e., salience, tolerance, mood modication, relapse, withdrawal, conict, and problems). Concerning terminology, it should also be considered that when referring to Studyholism (without specifying if it is Engaged or Disengaged Studyholism), we consider only study-related obsessive symptoms, without taking into account the levels of Study Engagement. After the rst publication byLoscalzo and Giannini(2017b), the denition of problematic overstudying as a condition more similar to an obsession—or Studyholism (e.g.,Loscalzo and Giannini,2017b,2018a,b)—than to addiction (i.e., Study Addiction;Atroszko et al.,2015), or as an OCD-related disorder, has been substantiated by a thorough comparison of DSM- 5 (American Psychiatric Association [APA],2013) diagnostic criteria for OCD, substance-use disorder, and obsessive- compulsive personality disorder (Loscalzo and Giannini,2018a). Moreover, worry, an internalizing feature contributing to OCD (Comer et al.,2004), proved to be a strong predictor of Studyholism both in college (Loscalzo and Giannini,2019a) and adolescent (Loscalzo,2021) students. Though, the authors concluded these papers by underlining that the literature concerning problematic overstudying is too scant to reach any rm conclusion and that more studies are needed to uncover its real internalizing and/or externalizing nature. In line with this, since Loscalzo and Giannini believed that unveiling the real nature of a new potential clinical condition requires avoiding a conrmatory approach [refer to Kardefelt-Winther(2015)concerning the need to avoid an a priori assumption of addiction when analyzing new potential behavioral addictions], they reviewed some elements of their preliminary denition (Loscalzo and Giannini,2017b) based on their empirical ndings. In fact, the results of the outcomes associated with Engaged and Disengaged Studyholism showed that students demonstrating Disengaged Studyholism are not the most impaired type of students in all the functional areas (Loscalzo and Giannini,2019a;Loscalzo,2021). Hence,Loscalzo and Giannini(2019a)suggested conceptualizing both Disengaged and Engaged Studyholics as clinical types of Studyholism and using the following two speciers: (i) Level of study engagement (high, average, or low); (ii) Area of functional impairment (academic, social, or both). In conclusion,Loscalzo and Giannini(2020a)suggested these tentative DSM-like Studyholism criteria: Studyholism is characterized by persistent and recurrent problematic studying behaviors that produce clinically signicant impairment/distress and, more specically, by study-related obsessions and/or study-related compulsions during the last 6 months. Also, Loscalzo and Giannini included the usual DSM- 5 (American Psychiatric Association [APA],2013) exclusion criteria (i.e., physiological eects of a substance or medical condition and other mental disorders). Finally, they foresaw two speciers: (i) Study engagement level (high, average, or low); (ii) Main area of impairment (academic, social, or both: academic and social). However,Loscalzo and Giannini (2020a)stated that future quantitative and qualitative studies should analyze if these tentative criteria are suitable for an accurate denition of Studyholism and delete or add criteria, if needed. Therefore, a comprehensive analysis of the relationship between Studyholism, Study Engagement, psychopathology, and sensation seeking constitutes a critical step in providing evidence concerning the internalizing and/or externalizing nature of problematic overstudying. Even if Studyholism is not recognized as a clinical disorder, it is critical to analyze it further since previous studies showed that it is widespread in Italian youths, preadolescents, and adolescents (Loscalzo,2019;Loscalzo et al.,2021) and that it is associated with negative outcomes in the psychological, physical, academic, and social areas (Loscalzo and Giannini,2019a;Loscalzo,2021). Moreover, since 2000, mental health of college students received increasing interest, as many scholars were captivated by the high prevalence of psychopathology in this population. More specically, previous studies highlighted that mental disorders and high distress are common among university students, even if the onset generally occurs before the beginning of college (e.g.,Megivern et al.,2003;Rosenthal and Wilson,2008;Storrie et al.,2010;Auerbach et al.,2016). Depression, anxiety, suicidal ideation, and self-injury are widespread clinical diagnoses in college students (e.g.,Blanco et al.,2008;Gallagher,2008; Drum et al.,2009;Eisenberg et al.,2013;Ibrahim et al.,2013). Hence, professionals should be aware of the high prevalence of mental disorders in college students, including high levels of Studyholism, as this population might eciently receive preventive and treatment interventions. In line with this,Regehr et al.(2013)urged universities to oer students interventions aimed at reducing stress (such as cognitive, behavioral, and mindfulness programs), also considering the negative outcomes associated with mental issues, including lower Grade Point Average (GPA) and lower rates of graduations, compared to peers not suering from mental health disorders (e.g.,Keyes et al.,2012; Salzer,2012). Though, the literature specically related to problematic overstudying is scant, and the studies about its relationships with clinical diagnoses are almost absent. To the best of the authors' knowledge, there is only one study byLawendowski et al.(2020). This study analyzed the relationships between study addiction and social anxiety on a sample of 132 students of Polish music academies. Through a regression analysis, they concluded that social anxiety is a predictor of study addiction ( b = 0.24, p= 0.017). Hence, this study has the merit of shedding light on the role of an internalizing disorder as a contributing factor of problematic overstudying. However, the sample is small and representative of a particular type of student (musicians). Moreover, the theoretical framework is that of behavioral addictions. Given the lack of literature concerning problematic overstudying, it might be helpful to ground on the literature about problematic overworking.Loscalzo and Giannini(2020b) recently analyzed the role of psychopathology (evaluated through Frontiers in Psychology|www.frontiersin.org 3January2022|Volume 12|Article 734116 fpsyg-12-734116 January 20, 2022 Time: 11:24 # 4 Loscalzo and Giannini Studyholism: An OCD-Related Disorder?the Symptom Check List-90-R;Derogatis,1994) as an antecedent and outcome of Workaholism and Work Engagement, as well as the role of sensation seeking as an antecedent.Zuckerman (1994)dened sensation seeking as a personality trait whose main features are as follows: (i) The seeking of experiences and situations which are varied, novel, complex, and intense; (ii) The willingness to face the issues which might be associated with these experiences, such as physical, social, nancial, and legal issues. This personality trait characterizes people who use (and abuse) drugs, alcohol, and marijuana (e.g.,Linden-Carmichael et al.,2016;Meil et al.,2016;Rogers et al.,2018). Therefore, aiming to shed light on the internalizing and/or externalizing nature of Workaholism,Loscalzo and Giannini(2020b)included sensation seeking among the externalizing variables that could predict Workaholism. Their results showed that Workaholism predicts higher internalizing and externalizing symptoms (while Work Engagement is a negative predictor of all the SCL-90-R scales). Moreover, the predictors of Work Engagement are depression and boredom susceptibility (negative predictors) and somatization (positive predictor). Workaholism, instead, is positively predicted only by psychoticism. Based on these results, Loscalzo and Giannini(2020b)suggested that Workaholism might be dened as a declination at work of a personality disorder (like the Schizoid or Obsessive-Compulsive) and the importance to analyze other explanations besides addiction, also taking into account that sensation seeking, a feature of externalizing disorders, including substance addictions (e.g., Linden-Carmichael et al.,2016;Meil et al.,2016;Rogers et al., 2018), does not predict Workaholism. About Work Engagement, the authors suggested that it might be a coping strategy with somatization symptoms. Besides this comprehensive study, there are a few others that addressed some psychological symptoms (mostly somatization, depression, anxiety, or generic mental health) and usually did not address psychopathology as an antecedent of Workaholism (e.g.,Bartcazk and Ogi ´ nska-Bulik,2012;Nie and Sun,2016; Andreassen et al.,2018). Moreover, only a few studies included Work Engagement in the analyses (e.g.,Andreassen et al.,2007;Haar and Roche,2013). In sum, as previously reviewed byLoscalzo and Giannini(2020b), (i) There are a few studies supporting the association between Workaholism and somatization, anxiety, depression, attention decit and hyperactivity disorder (ADHD), and OCD symptoms; (ii) There is preliminary evidence for ADHD and anxiety as predictors of Workaholism, in contrast with depression and OCD symptoms; (iii) Work Engagement is associated with lower somatization, anxiety, and depression, even ifShimazu et al.(2018)found that higher levels of Work Engagement may harm mental health in the short-term (though this negative eect disappears, and it becomes positive, in the long-term). Given the scant literature addressing the internalizing and/or externalizing nature of problematic overstudying and overworking, and the directionality of the relationships between various psychopathology symptoms and problematic overstudying, the present study is of critical importance. First, Study 1 will shed light on the role of Studyholism and Study Engagement in predicting psychopathology. Second, Study 2 will give information about the internalizing and/or externalizing nature of problematic overstudying. Third, employing the same scales used byLoscalzo and Giannini(2020b)with workers, it will allow for comparing the results on workers and students. Hence, it will give further insight into the assertion ofLoscalzo and Giannini(2017b,2019b)that Workaholism and Studyholism are two dierent constructs that, despite having some similarities, have their features, and hence must be conceptualized through dierent theories [instead of using a straightforward application of the theoretical and empirical framework of work addiction, as done byAtroszko et al.(2015)]. In sum, this study focuses on the role of internalizing and externalizing psychopathology as both an antecedent and an outcome of Studyholism and Study Engagement; moreover, it aims to analyze the role of sensation seeking as an antecedent of Studyholism and Study Engagement. Finally, in line with Loscalzo and Giannini(2020b), we included a performance variable among the outcomes: the number of exams given (regardless of their outcome). Previous studies showed that Studyholism is not a predictor of GPA (or has a low value of negative correlation), in contrast with Study Engagement (Loscalzo and Giannini,2019a,2020a,c;Loscalzo,2021). Hence, it is interesting to analyze how the two types of HSI predict a dierent academic indicator. Finally, we explore dierences in psychopathology and sensation seeking between students with high/low levels of Studyholism/Study Engagement and between students showing Disengaged and Engaged Studyholism. Since the literature concerning the variables under analysis is very meager, we did not posit hypotheses regarding each specic internalizing and externalizing variable included in the model. Though, based on the comprehensive model ofLoscalzo and Giannini(2017b), which suggests psychopathology as both an antecedent and an outcome of Studyholism, and based on the few previous studies about Studyholism and Study Engagement (Loscalzo and Giannini,2019a;Loscalzo,2021), we expect that Studyholism is a positive predictor of internalizing and externalizing psychopathology, while Study Engagement predicts lower levels of psychological symptoms. About sensation seeking, in line withLoscalzo and Giannini(2020b)and with the previous studies supporting the denition of Studyholism as an OCD-related disorder (Loscalzo and Giannini,2019a;Loscalzo, 2021), we expect that it will not be a statistically signicant predictor of Studyholism. MATERIALS AND METHODS Participants We got the participation of 1,223 Italian college students aged between 18 and 50 years ( M= 22.56 3.53). Most of the participants were women (70.4%), lived in Tuscany (65.2%), and were not involved in a job besides studying (77.3%). Considering the length of the instruments selected for comprehensively evaluating psychopathology and sensation seeking, we designed two studies. For Study 1, we administered only the psychopathology scale ( n= 506). Next, for Study 2, we administered both the psychopathology scale and the scale Frontiers in Psychology|www.frontiersin.org 4January2022|Volume 12|Article 734116 fpsyg-12-734116 January 20, 2022 Time: 11:24 # 5 Loscalzo and Giannini Studyholism: An OCD-Related Disorder?assessing sensation seeking ( n= 717). For both the studies, we also administered two scales aimed at evaluating Studyholism and Study Engagement. The rst sample of participants comprises 506 students (70.6% women) aged between 18 and 49 ( M= 21.24 3.08). All the students lived in Tuscany and attended a course at the University of Florence. Regarding their professional status, most participants did not work besides studying (84%). Concerning their civil status, most of them were engaged (49.8%) or single (45.5%). There were also some cohabitants (2.4%) and just a few married (0.6%) (there were some missing cases). Concerning the study area, most participants were students of Psychology (37.7%) or students of Health Professions (19.8%). However, other areas of study are represented, such as Social and Political Sciences (17.4%) and Engineering (12.5%). Finally, with regard to the year of study, most of the sample was made up of rst-year (48.8%) and third-year (42.9%) students. We used this rst sample to analyze psychopathology as an outcome of Studyholism and Study Engagement. The second sample of participants comprises 717 students (70.2% women) aged between 18 and 50 ( M= 23.50 3.52). The 40.6% of participants lived in Tuscany, while the others lived across other Italian regions. Regarding their professional status, most participants did not work besides studying (72.5%). Finally, concerning their civil status, singles (47.8%) and engaged (43.7%) are the categories most represented, followed by cohabitant (6.6%), married (1.7%), and a few separated (0.1%) or divorced (0.1%). Concerning the area and year of study, this sample is more heterogeneous compared to the rst sample. Among the areas of study most represented, there were Engineering (18.1%), Medical studies (13.2%), Literature and Languages (11.4%), Economy (8.8%), Psychology (8.1%), Law (6.6%), and Educational studies (4.2%). Though, there were also students from other courses, such as Health Professions (3.3%), Social and Political Sciences (3.1%), History and Philosophy (2.1%), Maths, Physics and Natural Sciences (2.1%), Chemical studies (2.0%), and Biology (1.3%). Finally, concerning the year of study, the following were the percentages, respectively, from the rst to the sixth (for medical students only) years: 11.3, 19.7, 25.7, 15.2, 24.4, and 3.8%. We used this second sample for the analysis concerning psychopathology and sensation seeking as antecedents of Studyholism and Study Engagement. Materials Studyholism Inventory (SI-10) The SI-10 is a brief screening instrument created byLoscalzo et al. (2018)from a pool of 68 items. It comprises two scales, each one comprehending four items plus one ller: Studyholism and Study Engagement. The response format is a 5-point Likert scale ranging between 1 ( Strongly Disagree) and 5 (Strongly Agree ). The SI-10 also has a head-sheet with some questions about study habits (e.g., GPA, time spent studying daily and weekly generally and before exams). Currently, the SI-10 is available in Italian, English, Polish, Spanish, and Croatian translations. In this study, we administered the Italian version, which proved to have good psychometric properties (Loscalzo et al.,2018;Loscalzo and Giannini,2020c). Studyholism Inventory – Extended Version (SI-15) Loscalzo and Giannini(2020a)created, from a pool of 45 items, an extended version of the SI-10 Studyholism scale, aiming to deepen the measurement of Studyholism. In fact, in its 15-item and 3-factor nal version, the SI-15 evaluates Studyholism through three scales: Obsessions (also addressed by the SI-10), Compulsions, and Social Impairment. The Obsessions scale is made up of the four SI-10 Studyholism scale items plus an additional item. The response format is a 5-point Likert scale ranging from 1 ( Strongly Disagree) to 5 (Strongly Agree ). The SI-15 is currently available in Italian, English, Polish, and Spanish versions. We administered the Italian version for this study, which has good psychometric properties (Loscalzo and Giannini,2020a). Symptom Check List-90-R (SCL-90-R) The SCL-90-R (Derogatis,1994) is a 90-item self-report instrument that allows for evaluating both internalizing and externalizing symptoms through nine scales: Somatization (the distress arising from bodily perceptions), obsessive- compulsive (the typical obsessive-compulsive symptoms), interpersonal sensitivity (feeling inadequate and inferior to others), depression (including the lack of motivation), anxiety (evaluating both anxiety symptoms and tension), hostility (negative aect, irritability, and aggressiveness), phobic anxiety (persistent fears of specic situations), paranoid ideation (hostility, suspiciousness, projection, and fear of loss of autonomy), and psychoticism (symptoms ranging from mild interpersonal alienation to psychosis). The Italian version foresees a 5-point Likert scale ranging from 1 ( not at all) to 5 ( extremely ). Sensation Seeking Scale Form V (SSS-V) The SSS-V (Zuckerman et al.,1978;Zuckerman,1994) is a 40-item self-report scale for the evaluation of sensation seeking. It is made up of four scales: thrill and adventure- seeking (the desire to engage in dangerous sport or physical activities), experience seeking (looking for new experiences involving mind and senses and having a non-conformist lifestyle), disinhibition (the interest in disinhibited social and sexual activities), and boredom susceptibility (the repulsion for routine and repetitive activities). Each scale comprises 10 items, and each item presents two sentences (A and B); hence, the participants answer by choosing the sentence that applies the best to them. The scoring foresees to give a “1” if the sentence represents sensation seeking and a “0” to the other sentence. There is not an Italian validation of the SSS-V on an adult population; though, it has been previously used byTonetti et al.(2010)for a study on Italian youths and byLoscalzo and Giannini(2020b)for their Italian study on sensation seeking as an antecedent of Workaholism and Work Engagement. Hence, we decided to use the SSS-V since it allows us to evaluate sensation seeking in its four dimensions and compare the current Frontiers in Psychology|www.frontiersin.org 5January2022|Volume 12|Article 734116 fpsyg-12-734116 January 20, 2022 Time: 11:24 # 6 Loscalzo and Giannini Studyholism: An OCD-Related Disorder?study results with the one conducted byLoscalzo and Giannini (2020b)on workers. Procedure First, we asked the approval from the Ethical Committee of the University of Florence. Then, the participants of Study 1 were requested to ll out the paper-and-pencil questionnaire, including the SI-10, the SI-15, and the SCL-90-R, as well as the rst page with demographic variables (e.g., gender and age). The health professionals and psychology students lled out the questionnaire during a class. They were free to decline participation in the research, and no credit was given for participation. The other students involved in Study 1 were contacted at their universities, in common spaces, such as libraries and University rooms outside classes. Each participant signed the Informed Consent form before lling out the questionnaire. For Study 2, we created an online questionnaire containing the SI-10, the SI-15, the SCL-90-R, and SSS-V (besides demographic data). We recruited participants through the spread of the invitation to the research in social networks (the questionnaire itself has not been spread in social networks), aiming to reach participants outside Tuscany and across dierent areas of study. Since the questionnaire was lled online, we wrote all the information required by the Informed Consent on the rst page of the questionnaire, and we asked the participants to check the box stating that by lling the questionnaire on the following pages, they agreed to take part in the research. All the data have been gathered before the COVID- 19 outbreak. Data Analysis We performed the analyses using SPSS 27 and AMOS 22. First, we analyzed the zero-order correlations of the variables included in the models on the total sample ( n= 1223). Then, we conducted four Structural Equation Models (SEMs), and more specically, path analyses (Maximum Likelihood estimate method). For Study 1 ( n= 506): (i) We performed a path analysis model with the nine psychopathology scales and the number of exams given as outcomes of Studyholism and Study Engagement; (ii) We performed a second path analysis in which the antecedents of psychopathology and the number of exams given were the three SI-15 subscales, namely obsessions, compulsions, and social impairment. Then, for Study 2 ( n= 717), (iii) We performed a path analysis model with psychopathology and sensation seeking as predictors of Studyholism and Study Engagement; (iv) We performed a last path analysis model with psychopathology and sensation seeking as predictors of the three SI-15 subscales. To evaluate the t of the models, we used the following indices and cut-o values: $2 /df ratio, which indicates a good t if its value is less than 3 (Byrne,2001); goodness of t index (GFI) and comparative t index (CFI), whose cut-os were as follows: less than 0.90 lack of t, 0.90–0.95 good t, greater than 0.95 excellent t (Hu and Bentler,1999); and Root Mean Square Error of Approximation (RMSEA), where a value below 0.05 indicates excellent t, while values between 0.05 and 0.08 indicate an acceptable t (Reeve et al.,2007). Then, we analyzed dierences between high and low Studyholism/Study Engagement in the psychopathology and sensation seeking scales through four MANOVAs. Finally, we analyzed dierences between students demonstrating Disengaged and Engaged Studyholism in the psychopathology and sensation seeking scales through two Mann–Whitney tests (with Yates' continuity correction). The two types of Studyholics (and the high/low levels of Studyholism/Study Engagement) have been created referring to the SI-10 cut-o values for Italian College students (Loscalzo and Giannini,2020c). RESULTS Correlations Among the Study Variables First, we analyzed the zero-order correlations among all the variables included in the path analysis models ( Table 1shows the results of these analyses). We found that the SI-10 Studyholism scale and the SI-15 scales (obsessions, compulsions, and social impairment) have positive values of correlation with internalizing and externalizing symptoms, though the SI-15 obsessions scale has higher values of correlation compared to the other SI-15 scales. Instead, the SI- 10 Study Engagement scale has just a few statistically signicant (negative) correlations with the SCL-90-R scales, and the values are generally low. About sensation seeking, both Studyholism scales and Study Engagement correlate negatively with the SSS- V subscales and total score (even if the rvalues are low). There is just a negative correlation that is not statistically signicant, even if negative. Finally, the number of exams given does not correlate with the Studyholism scales (except for a low correlation with the SI-15 Compulsion scale), while it positively correlates with Study Engagement. Path Analysis Models—Internalizing and Externalizing Symptoms as Outcomes of Heavy Study Investment First, we tested a model in which the SCL-90-R scales and the number of exams given (regardless of the result) were the outcomes of both Studyholism and Study Engagement (as evaluated through the SI-10 scales; n= 506). The model showed an excellent t to the data: $2 /df = 2.32, p= 0.013; GFI = 0.99; CFI = 1.00; RMSEA = 0.05, 90% CI = (0.02–0.08). Figure 2depicts the structural model with standardized path estimates. In sum, Studyholism is a positive predictor of all the internalizing and externalizing scales, while Study Engagement is a negative predictor of these symptoms (except for somatization and anxiety), even if its bvalues are lower compared to Studyholism. The number of exams given, instead, is positively predicted only by Study Engagement. The highest bvalues belong to Studyholism on obsessive-compulsive, depression, and anxiety. The psychopathology scales whose variance is explained the most by Studyholism and Study Engagement include obsessive-compulsive (23.8% of the variance), depression (22.3% Frontiers in Psychology|www.frontiersin.org 6January2022|Volume 12|Article 734116 fpsyg-12-734116 January 20, 2022 Time: 11:24 # 7 Loscalzo and Giannini Studyholism: An OCD-Related Disorder?TABLE 1 | Zero-order correlations among study variables ( n= 1223 for SCL-90-R scale; n= 717 for SSS-V scales). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1. SH – 2. SE 0 :14 *** – 3. Obs 0 :80 *** 0:15 *** – 4. Comp 0 :31 *** 0:43 *** 0:43 *** – 5. Soc.Imp 0 :34 *** 0:36 *** 0:46 *** 0:68 *** – 6. SI-15 Tot 0 :61 *** 0:37 *** 0:79 *** 0:84 *** 0:85 *** – 7. SOM 0 :38 *** 0:003 0 :43 *** 0:19 *** 0:24 *** 0:36 *** – 8. O-C 0 :49 ***