Behavioral Addiction Under The Rubric Of Addiction Spectrum Disorders Ranging From Impulsive - Compulsive Disorders To Reward Deficiency Syndrome

The term addiction comes from the Latin word “addicere”, which translates as “bound to”, or “enslaved by”. Behavioral addictions also known as “process addictions” or “impulsive-compulsive behaviors” encompass a diverse group of behaviors right from compulsive shopping, gambling, internet use and gaming to pornography, sex, exercising and food addiction. Humans have been known to have non-substance addictive behaviors since time immemorial and evidence to this can be found in ancient literature across continents. However the diagnostic rubric for behavior addiction is a recent epoch with the addition of gambling disorder in the chapter substance-related and addictive disorders in DSM-5. Behavioral addictions share many features similar to substance addictions in the form of spending more and more time due to intense craving to repeatedly indulge in the behavior despite possible harm and symptoms like irritability and dysphoric mood when abstinent. Hence shows the phenomena of tolerance, craving and withdrawal symptoms. They also share many features similar to obsessive compulsive disorders in the form of obsessive thoughts about the behavior, a sense of tension and excitement before performing the behavior and compulsive engagement in the activity without having any control over its amount and time along with a sense of pleasure, gratification and relief when performing or shortly after it has been performed. There is also a significant association between addictions and impulsivity as evidenced by the comorbidity of impulse dyscontrol and attention deficit hyperactivity disorder with addictions. Further there is much evidence for the defects in impulsive choice and impulsive action in addictive disorders, especially behavior addictions. Further these behavioral addictions with impulsive spectrum and obsessive compulsive spectrum defects have been included under a superordinate category of impulsivecompulsive disorder. The reward deficiency syndrome has long been implicated in the pathophysiology of substance addictions as the reward deficit caused by the hypodopaminergic state predisposes the individual for multiple drug-seeking behaviors which have propensity to fix the dopamine deficit, setting right this genetic glitch. The same phenomenon is observed in many behavioral addictions. Hence behavioral addictions can be viewed as a spectrum ranging from impulsive compulsive disorders to reward deficiency syndrome[1]. It has been observed that persons with substance addictions have comorbid behavioral addictions as well, and this can be seen even before a person starts using any substance. Neurobiological, genetic and environmental predispositions underlying the development and maintenance of substance addictions is well elucidated. However the heterogeneity and lack of proper empirical criteria to classify the different behavioral addictions make it difficult to formulate paradigms of genetics and neurobiology. Gambling addiction was earlier classified under impulse control disorder but has now found its place rightfully in the addictive disorders. The brain areas involved in gambling addiction are vmPFC and the orbitofrontal along with neurotransmitter norepinephrine, serotonin and dopamine which are similar to impulsive and compulsive disorders. The defects seem to be associated more with impulsive choice defects than impulsive actions. In more severe cases of gambling disorder there is a role for compulsivity. Further there is hyperdopaminergia than hypo-dopaminergia in gambling disorder. Therefore this seems a highly impulsive compulsive disorder with little reward deficiency evidence[2]. Bleuler described impulsive in1Department of Psychiatry, MES Medical College, Perinthalmanna, India 2Department of Psychiatry, Government Medical College, Manjeri, India