Mood disorder

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Mood_disorder 

 

A cartoon from the satirical magazine Punch encouraging those with depression to go into the countryside

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

Mood disorders fall into seven groups, including:

1. abnormally elevated mood, such as mania or hypomania
2. depressed mood, of which the best-known and most researched is major depressive disorder (MDD) (alternatively known as clinical depression, unipolar depression, or major depression)
3. moods which cycle between mania and depression, known as bipolar disorder (BD) (formerly known as manic depression).
4. several subtypes of depressive disorders or psychiatric syndromes featuring less severe symptoms such as dysthymic disorder (similar to MDD, but longer lasting and more persistent, though often milder) and cyclothymic disorder (similar to but milder than BD).

In some cases, more than one mood disorder can be present in an individual, like bipolar disorder and depressive disorder. Mood disorders may also be substance induced, or occur in response to a medical condition.

English psychiatrist Henry Maudsley proposed an overarching category of affective disorder. The term was then replaced by mood disorder, as the latter refers to the underlying or longitudinal emotional state, whereas the former refers to the external expression observed by others.

Classification

Depressive disorders

• Major depressive disorder (MDD), commonly called major depression, unipolar depression, or clinical depression, wherein a person has one or more major depressive episodes. After a single episode, Major Depressive Disorder (single episode) would be diagnosed. You must experience symptoms nearly all day for at least two weeks. After more than one episode, the diagnosis becomes Major Depressive Disorder (Recurrent). Depression without periods of mania is sometimes referred to as unipolar depression because the mood remains at the bottom "pole" and does not climb to the higher, manic "pole" as in bipolar disorder.

Individuals with a major depressive episode or major depressive disorder are at increased risk for suicide. Seeking help and treatment from a health professional dramatically reduces the individual's risk for suicide. Studies have demonstrated that asking if a depressed friend or family member has thought of committing suicide is an effective way of identifying those at risk, and it does not "plant" the idea or increase an individual's risk for suicide in any way. Epidemiological studies carried out in Europe suggest that, at this moment, roughly 8.5 percent of the world's population have a depressive disorder. No age group seems to be exempt from depression, and studies have found that depression appears in infants as young as 6 months old who have been separated from their mothers. However, there may be differences between cultures in prevalence of MDD due to cultural influences that "challenge the definition and diagnosis of psychiatric disorders", as seen in a study by Parker et al. that researched MDD in Chinese individuals. Depressive disorder (also known as depression) is a common mental disorder. It involves a depressed mood or loss of pleasure or interest in activities for long periods of time. Depression is different from regular mood changes and feelings about everyday life. It can affect all aspects of life. Depression can happen to anyone. People who have lived through abuse, severe losses, or other stressful events are more likely to develop depression.

• Depressive disorder is frequent in primary care and general hospital practice but is often undetected. Unrecognized depressive disorder may slow recovery and worsen prognosis in physical illness, therefore it is important that all doctors be able to recognize the condition, treat the less severe cases, and identify those requiring specialist care.

Diagnosticians recognize several subtypes or course specifiers:

• Atypical depression (AD) is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite ("comfort eating"), excessive sleep or somnolence (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection. Difficulties in measuring this subtype have led to questions of its validity and prevalence.

• Melancholic depression is characterized by a loss of pleasure (anhedonia) in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.

• Psychotic major depression (PMD), or simply psychotic depression, is the term for a major depressive episode, in particular of melancholic nature, wherein the patient experiences psychotic symptoms such as delusions or, less commonly, hallucinations. These are most commonly mood-congruent (content coincident with depressive themes).

• Catatonic depression is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here, the person is mute and almost stuporous, and either is immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms can also occur in schizophrenia or a manic episode, or can be due to neuroleptic malignant syndrome.

• Postpartum depression (PPD) is listed as a course specifier in DSM-IV-TR; it refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth. Postpartum depression, which affects 10–15% of women, typically sets in within three months of labor, and lasts as long as three months. It is quite common for women to experience a short-term feeling of tiredness and sadness in the first few weeks after giving birth; however, postpartum depression is different because it can cause significant hardship and impaired functioning at home, work, or school as well as, possibly, difficulty in relationships with family members, spouses, or friends, or even problems bonding with the newborn. In the treatment of postpartum major depressive disorders and other unipolar depressions in women who are breastfeeding, nortriptyline, paroxetine (Paxil), and sertraline (Zoloft) are in general considered to be the preferred medications. Women with personal or family histories of mood disorders are at particularly high risk of developing postpartum depression.

• Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 3–8% of menstruating women. The disorder consists of a "cluster of affective, behavioral and somatic symptoms" that recur monthly during the luteal phase of the menstrual cycle. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. The exact pathogenesis of the disorder is still unclear and is an active research topic. Treatment of PMDD relies largely on antidepressants that modulate serotonin levels in the brain via serotonin reuptake inhibitors as well as ovulation suppression using contraception.

• Seasonal affective disorder (SAD), also known as "winter depression" or "winter blues", is a specifier. Some people have a seasonal pattern, with depressive episodes coming on in the autumn or winter, and resolving in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times over a two-year period or longer. It is commonly hypothesised that people who live at higher latitudes tend to have less sunlight exposure in the winter and therefore experience higher rates of SAD, but the epidemiological support for this proposition is not strong (and latitude is not the only determinant of the amount of sunlight reaching the eyes in winter). It is said that this disorder can be treated by light therapy. SAD is also more prevalent in people who are younger and typically affects more females than males.

• Dysthymia is a condition related to unipolar depression, where the same physical and cognitive problems are evident, but they are not as severe and tend to last longer (usually at least 2 years). The treatment of dysthymia is largely the same as for major depression, including antidepressant medications and psychotherapy.

• Double depression can be defined as a fairly depressed mood (dysthymia) that lasts for at least two years and is punctuated by periods of major depression.

• Unspecified Depressive Disorder is designated by the code 311 for depressive disorders. In the DSM-5, Unspecified Depressive Disorder encompasses symptoms that are characteristic of depressive disorders and cause significant impairment in functioning, but do not meet the criteria for the diagnosis of any specified depressive disorders. In the DSM-IV, this was called Depressive Disorder Not Otherwise Specified.

• Depressive personality disorder (DPD) is a controversial psychiatric diagnosis that denotes a personality disorder with depressive features. Originally included in the DSM-II, depressive personality disorder was removed from the DSM-III and DSM-III-R. Recently, it has been reconsidered for reinstatement as a diagnosis. Depressive personality disorder is currently described in Appendix B in the DSM-IV-TR as worthy of further study.

• Recurrent brief depression (RBD), distinguished from major depressive disorder primarily by differences in duration. People with RBD have depressive episodes about once per month, with individual episodes lasting less than two weeks and typically less than 2–3 days. Diagnosis of RBD requires that the episodes occur over the span of at least one year and, in female patients, independently of the menstrual cycle. People with clinical depression can develop RBD, and vice versa and both illnesses have similar risks.

• Minor depressive disorder, or simply minor depression, which refers to a depression that does not meet full criteria for major depression but in which at least two symptoms are present for two weeks.

Bipolar disorders

• Bipolar disorder (BD) (also called "manic depression" or "manic-depressive disorder"), an unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression), which was formerly known as "manic depression" (and in some cases rapid cycling, mixed states, and psychotic symptoms). Subtypes include:

• Bipolar I is distinguished by the presence or history of one or more manic episodes or mixed episodes with or without major depressive episodes. A depressive episode is not required for the diagnosis of Bipolar I Disorder, but depressive episodes are usually part of the course of the illness.
• Bipolar II consisting of recurrent intermittent hypomanic and depressive episodes or mixed episodes.
• Cyclothymia is a form of bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes, but no full manic episodes or full major depressive episodes.
• Bipolar disorder not otherwise specified (BD-NOS), sometimes called "sub-threshold" bipolar, indicates that the patient has some symptoms in the bipolar spectrum (e.g., manic and depressive symptoms) but does not fully qualify for any of the three formal bipolar DSM-IV diagnoses mentioned above.

It is estimated that roughly 1% of the adult population has bipolar I, a further 1% has bipolar II or cyclothymia, and somewhere between 2% and 5% percent have "sub-threshold" forms of bipolar disorder. Furthermore, the possibility of getting bipolar disorder when one parent is diagnosed with it is 15–30%. Risk, when both parents have it, is 50–75%. Also, while with bipolar siblings the risk is 15–25%, with identical twins it is about 70%.

Substance-induced

A mood disorder can be classified as substance-induced if its etiology can be traced to the direct physiologic effects of a psychoactive drug or other chemical substance, or if the development of the mood disorder occurred contemporaneously with substance intoxication or withdrawal. Also, an individual may have a mood disorder coexisting with a substance abuse disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode. Most substances can induce a variety of mood disorders. For example, stimulants such as amphetamine, methamphetamine, and cocaine can cause manic, hypomanic, mixed, and depressive episodes.

Alcohol-induced

High rates of major depressive disorder occur in heavy drinkers and those with alcoholism. Controversy has previously surrounded whether those who abused alcohol and developed depression were self-medicating their pre-existing depression. Recent research has concluded that, while this may be true in some cases, alcohol misuse directly causes the development of depression in a significant number of heavy drinkers. Participants studied were also assessed during stressful events in their lives and measured on a Feeling Bad Scale. Likewise, they were also assessed on their affiliation with deviant peers, unemployment, and their partner's substance use and criminal offending. High rates of suicide also occur in those who have alcohol-related problems. It is usually possible to differentiate between alcohol-related depression and depression that is not related to alcohol intake by taking a careful history of the patient. Depression and other mental health problems associated with alcohol misuse may be due to distortion of brain chemistry, as they tend to improve on their own after a period of abstinence.

Benzodiazepine-induced

Benzodiazepines, such as alprazolam, clonazepam, lorazepam and diazepam, can cause both depression and mania.

Benzodiazepines are a class of medication commonly used to treat anxiety, panic attacks and insomnia, and are also commonly misused and abused. Those with anxiety, panic and sleep problems commonly have negative emotions and thoughts, depression, suicidal ideations, and often have comorbid depressive disorders. While the anxiolytic and hypnotic effects of benzodiazepines may disappear as tolerance develops, depression and impulsivity with high suicidal risk commonly persist. These symptoms are "often interpreted as an exacerbation or as a natural evolution of previous disorders and the chronic use of sedatives is overlooked". Benzodiazepines do not prevent the development of depression, can exacerbate preexisting depression, can cause depression in those with no history of it, and can lead to suicide attempts. Risk factors for suicide and suicide attempts while using benzodiazepines include high dose prescriptions (even in those not misusing the medications), benzodiazepine intoxication, and underlying depression.

The long-term use of benzodiazepines may have a similar effect on the brain as alcohol, and are also implicated in depression. As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of serotonin and norepinephrine, are believed to be responsible for the increased depression. Additionally, benzodiazepines can indirectly worsen mood by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Like alcohol, benzodiazepines can put people to sleep but, while asleep, they disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep sleep (the most restorative part of sleep for both energy and mood). Just as some antidepressants can cause or worsen anxiety in some patients due to being activating, benzodiazepines can cause or worsen depression due to being a central nervous system depressant—worsening thinking, concentration and problem solving (i.e., benzodiazepine-induced neurocognitive disorder). However, unlike antidepressants, in which the activating effects usually improve with continued treatment, benzodiazepine-induced depression is unlikely to improve until after stopping the medication.

In a long-term follow-up study of patients dependent on benzodiazepines, it was found that 10 people (20%) had taken drug overdoses while on chronic benzodiazepine medication despite only two people ever having had any pre-existing depressive disorder. A year after a gradual withdrawal program, no patients had taken any further overdoses.

Just as with intoxication and chronic use, benzodiazepine withdrawal can also cause depression. While benzodiazepine-induced depressive disorder may be exacerbated immediately after discontinuation of benzodiazepines, evidence suggests that mood significantly improves after the acute withdrawal period to levels better than during use. Depression resulting from withdrawal from benzodiazepines usually subsides after a few months but in some cases may persist for 6–12 months.

Due to another medical condition

"Mood disorder due to a general medical condition" is used to describe manic or depressive episodes which occur secondary to a medical condition. There are many medical conditions that can trigger mood episodes, including neurological disorders (e.g. dementias), hearing loss and associated disorders (e.g. tinnitus or hyperacusis), metabolic disorders (e.g. electrolyte disturbances), gastrointestinal diseases (e.g. cirrhosis), endocrine disease (e.g. thyroid abnormalities), cardiovascular disease (e.g. heart attack), pulmonary disease (e.g. chronic obstructive pulmonary disease), cancer, autoimmune diseases (e.g. multiple sclerosis), and pregnancy.

Not otherwise specified

See also: DSM-IV codes

Mood disorder not otherwise specified (MD-NOS) is a mood disorder that is impairing but does not fit in with any of the other officially specified diagnoses. In the DSM-IV MD-NOS is described as "any mood disorder that does not meet the criteria for a specific disorder." MD-NOS is not used as a clinical description but as a statistical concept for filing purposes. The diagnosis of MD-NOS does not exist in the DSM-5, however the diagnoses of unspecified depressive disorder and unspecified bipolar disorder are in the DSM-5.

Most cases of MD-NOS represent hybrids between mood and anxiety disorders, such as mixed anxiety-depressive disorder or atypical depression. An example of an instance of MD-NOS is being in minor depression frequently during various intervals, such as once every month or once in three days. There is a risk for MD-NOS not to get noticed, and for that reason not to get treated.

Causes

Meta-analyses show that high scores on the personality domain neuroticism are a strong predictor for the development of mood disorders.

A depressed mood is a predictable response to certain types of life occurrences, such as loss of status, divorce, or death of a child or spouse. These are events that signal a loss of reproductive ability or potential, or that did so in humans' ancestral environment. A depressed mood can be seen as an adaptive response, in the sense that it causes an individual to turn away from the earlier (and reproductively unsuccessful) modes of behavior.

A depressed mood is common during illnesses, such as influenza. It has been argued that this is an evolved mechanism that assists the individual in recovering by limiting their physical activity. The occurrence of low-level depression during the winter months, or seasonal affective disorder, may have been adaptive in the past, by limiting physical activity at times when food was scarce. It is argued that humans have retained the instinct to experience low mood during the winter months, even if the availability of food is no longer determined by the weather.

Much of what is known about the genetic influence of clinical depression is based upon research that has been done with identical twins. Identical twins have exactly the same genetic code. It has been found that when one identical twin becomes depressed the other will also develop clinical depression approximately 76% of the time. When identical twins are raised apart from each other, they will both become depressed about 67% of the time. Because both twins become depressed at such a high rate, the implication is that there is a strong genetic influence. If it happened that when one twin becomes clinically depressed the other always develops depression, then clinical depression would likely be entirely genetic.

Bipolar disorder is also considered a mood disorder and it is hypothesized that it might be caused by mitochondrial dysfunction.

Sex differences

Mood disorders, specifically stress-related mood disorders such as anxiety and depression, have been shown to have differing rates of diagnosis based on sex. In the United States, women are two times more likely than men to be diagnosed with a stress-related mood disorder. Underlying these sex differences, studies have shown a dysregulation of stress-responsive neuroendocrine function causing an increase in the likelihood of developing these affective disorders.

Overactivation of the hypothalamic-pituitary-adrenal (HPA) axis could provide potential insight into how these sex differences arise. Neuropeptide corticotropin-releasing factor (CRF) is released from the paraventricular nucleus (PVN) of the hypothalamus, stimulating adrenocorticotropic hormone (ACTH) release into the blood stream. From here ACTH triggers the release of glucocorticoids such as cortisol from the adrenal cortex. Cortisol, known as the main stress hormone, creates a negative feedback loop back to the hypothalamus to deactivate the stress response. When a constant stressor is present, the HPA axis remains overactivated and cortisol is constantly produced. This chronic stress is associated with sustained CRF release, resulting in the increased production of anxiety- and depressive-like behaviors and serving as a potential mechanism for differences in prevalence between men and women.

Diagnosis

DSM-5

The DSM-5, released in May 2013, separates the mood disorder chapter from the DSM-IV-TR into two sections: Depressive and related disorders and bipolar and related disorders. Bipolar disorders fall in between depressive disorders and schizophrenia spectrum and related disorders "in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history and genetics" (Ref. 1, p 123).

Bipolar disorders underwent a few changes in the DSM-5, most notably the addition of more specific symptomology related to hypomanic and mixed manic states. Depressive disorders underwent the most changes, the addition of three new disorders: disruptive mood dysregulation disorder, persistent depressive disorder (previously dysthymia), and premenstrual dysphoric disorder (previously in appendix B, the section for disorders needing further research). Disruptive mood dysregulation disorder is meant as a diagnosis for children and adolescents who would normally be diagnosed with bipolar disorder as a way to limit the bipolar diagnosis in this age cohort. Major depressive disorder (MDD) also underwent a notable change, in that the bereavement clause has been removed. Those previously exempt from a diagnosis of MDD due to bereavement are now candidates for the MDD diagnosis.

Treatment

There are different types of treatments available for mood disorders, such as therapy and medications. Behaviour therapy, cognitive behaviour therapy and interpersonal therapy have all shown to be potentially beneficial in depression. Major depressive disorder medications usually include antidepressants; a combination of antidepressants and cognitive behavioral therapy has shown to be more effective than one treatment alone. Bipolar disorder medications can consist of antipsychotics, mood stabilizers, anticonvulsants and/or lithium. Lithium specifically has been proven to reduce suicide and all causes of mortality in people with mood disorders.

If mitochondrial dysfunction or mitochondrial diseases are the cause of mood disorders like bipolar disorder, then it has been hypothesized that N-acetyl-cysteine (NAC), acetyl-L-carnitine (ALCAR), S-adenosylmethionine (SAMe), coenzyme Q10 (CoQ10), alpha-lipoic acid (ALA), creatine monohydrate (CM), and melatonin could be potential treatment options.

In determining treatment, there are many types of depression scales that are used. One of the depression scales is a self-report scale called Beck Depression Inventory (BDI). Another scale is the Hamilton Depression Rating Scale (HAMD). HAMD is a clinical rating scale in which the patient is rated based on clinician observation. The Center for Epidemiologic Studies Depression Scale (CES-D) is a scale for depression symptoms that applies to the general population. This scale is typically used in research and not for self-reports. The PHQ-9 which stands for Patient-Health Questionnaire-9 questions, is a self-report as well. Finally, the Mood Disorder Questionnaire (MDQ) evaluates bipolar disorder.

Epidemiology

According to a substantial number of epidemiology studies conducted, women are twice as likely to develop certain mood disorders, such as major depression. Although there is an equal number of men and women diagnosed with bipolar II disorder, women have a slightly higher frequency of the disorder.

In 2011, mood disorders were the most common reason for hospitalization among children aged 1–17 years in the United States, with approximately 112,000 stays. Mood disorders were top principal diagnosis for Medicaid super-utilizers in the United States in 2012. Further, a study of 18 states found that mood disorders accounted for the highest number of hospital readmissions among Medicaid patients and the uninsured, with 41,600 Medicaid patients and 12,200 uninsured patients being readmitted within 30 days of their index stay—a readmission rate of 19.8 per 100 admissions and 12.7 per 100 admissions, respectively. In 2012, mood and other behavioral health disorders were the most common diagnoses for Medicaid-covered and uninsured hospital stays in the United States (6.1% of Medicaid stays and 5.2% of uninsured stays).

A study conducted in 1988 to 1994 amongst young American adults involved a selection of demographic and health characteristics. A population-based sample of 8,602 men and women ages 17–39 years participated. Lifetime prevalence were estimated based on six mood measures:

• major depressive episode (MDE) 8.6%,
• major depressive disorder with severity (MDE-s) 7.7%,
• dysthymia 6.2%,
• MDE-s with dysthymia 3.4%,
• any bipolar disorder 1.6%, and
• any mood disorder 11.5%.

Research

Creativity and mood disorders

Main article: Creativity and mental health

Kay Redfield Jamison and others have explored the possible links between mood disorders – especially bipolar disorder – and creativity. It has been proposed that a "ruminating personality type may contribute to both [mood disorders] and art."

Jane Collingwood notes an Oregon State University study that:

looked at the occupational status of a large group of typical patients and found that 'those with bipolar illness appear to be disproportionately concentrated in the most creative occupational category.' They also found that the likelihood of 'engaging in creative activities on the job' is significantly higher for bipolar than nonbipolar workers.

In Liz Paterek's article "Bipolar Disorder and the Creative Mind" she wrote:

Memory and creativity are related to mania. Clinical studies have shown that those in a manic state will rhyme, find synonyms, and use alliteration more than controls. This mental fluidity could contribute to an increase in creativity. Moreover, mania creates increases in productivity and energy. Those in a manic state are more emotionally sensitive and show less inhibition about attitudes, which could create greater expression. Studies performed at Harvard looked into the amount of original thinking in solving creative tasks. Bipolar individuals, whose disorder was not severe, tended to show greater degrees of creativity.

The relationship between depression and creativity appears to be especially strong among poets.

Addictive personality

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Addictive_personality 

The term "addictive personality" refers to a proposed set of personality traits that may increase an individual's risk of developing addictive behaviors. While it is not formally recognized in diagnostic manuals like the DSM-5, this concept suggests that traits such as impulsivity, sensation-seeking, and emotional dysregulation may contribute to the development or maintenance of addiction. These behaviors extend beyond substance use to gambling, internet use, compulsive eating, and shopping.

The validity of addictive personality as a construct remains controversial, with some researchers arguing that these traits may emerge as a consequence of addiction rather than serve as predictors, and that the term itself lacks a consistent definition. Despite this controversial status, studies have found links between certain personality profiles and specific types of addiction, suggesting that a more nuanced relationship exists. Genetic factors are also recognized as significant contributors to addiction vulnerability, with research estimating that 40% to 70% of individual variation in addiction risk is heritable.

Etiology

The following factors are believed to influence addiction susceptibility.

Psychological factors

• Impulsivity
• Sensation seeking
• Nonconformity combined with weak commitment to socially valued goals for achievement
• Social alienation and tolerance for deviance
• Heightened stress coupled with lack of coping skills.

Some claim the existence of "addictive beliefs" in people more likely to develop addictions, such as "I cannot make an impact on my world" or "I am not good enough", which may lead to developing traits associated with addiction, such as depression and emotional insecurity. People who strongly believe that they control their own lives and are mostly self-reliant in learning information (rather than relying on others) are less likely to become addicted. However, it is unclear whether these traits are causes, results or merely associated coincidentally. For example, depression due to physical disease can cause feelings of hopelessness that are mitigated after successful treatment of the underlying condition, and addiction can increase dependence on others. Certain psychological disorders such as panic attacks, depressive disorders, and generalized anxiety disorder have been related to addiction. The addicted person, who struggles with reality and feels negative feelings, such as anxiety and depression, will seek out ways to help them avoid such feelings. A study based on social cognitive theories, included a personality-targeted intervention that was shown to help treat substance addiction. It is feasible that by changing certain elements of one's personality, one can gain a step in the right direction towards changing their addictive personality.

Genetic and biological factors

Research has explored possible biological and genetic contributions that are often linked to a vulnerability to addiction. Twin and adoption studies have shown that genetic factors may account for 40-60% of the risk for alcoholism and other substance-related disorders, with environmental influences playing a stronger role in early adolescence and diminishing over time.

Certain personality traits associated with addictive behaviors such as impulsivity, emotional dysregulation, and sensation-seeking have been linked to genes receptive of dopamine and nicotine, including DRD2 and CHRNA5. For example, the CHRNA5 gene has been associated with a reduced aversion to nicotine, possibly due to its impact on the brain's habenula region. This may reinforce the continued consumption of nicotine products by reducing the negative sensory experience of early use.

Biological factors have also been found through experimentation on rats. Rats with higher locomotor responses to novel environments were found to be more likely to self-administer stimulant drugs in laboratory settings, indicating a possible genetic predisposition toward drug reinforcement behaviors.

Recent research has further highlighted the role that genetic and biological factors play in traits such as impulsivity and reward sensitivity. A 2023 study by the National Institutes of Health identified shared genetic markers across a variety of substance use disorders, emphasizing how involved genes are in regulating dopamine signaling pathways. Further studies have implicated the CADM2 gene in impulsivity and reward-related behaviors. Variants in this gene have been associated with increased risk-taking and sensation-seeking traits, which are considered potential risk factors for developing addictive behaviors.

Environmental factors

Studies have found numerous environmental factors that correlate with addiction. Exposure to sustained stress in childhood, such as physical or sexual abuse, especially accompanied by unpredictable parental behavior strongly correlates with drug addiction and overeating in adulthood. Children who tend to react to distress in a more rash way have been linked to becoming more likely to drink and smoke in their adolescence. Results from this research found that this was because the reaction to distress affected psychosocial learning, which led to increased expectancy to drink or smoke. A lack of social interaction has also been shown to correlate with addictive tendencies; rats reared in isolation were quicker to develop a pattern of cocaine self-administration than rats reared in groups. There is a gene/environment connection in that individuals with particular personality traits may self-select into different environments, e.g., they may seek out work environments where addictive substances are more readily available.

Description

Addiction can be defined as an excessive amount of time and resources spent in engaging in an activity or an experience that somehow affects the person's quality of life. An addictive personality is when those addictive behaviors progress and change as the individual seeks to produce the desired mood.

People that face this issue are currently defined to have a brain disease as promoted by the National Institute on Drug Abuse and other authorities. People who experience addictive personality disorders typically act on impulses and cannot deal with delayed gratification. At the same time, people with this type of personality tend to believe that they do not fit into societal norms and therefore, acting on impulses, deviate from conformity to rebel. People with addictive personalities are very sensitive to emotional stress. They have trouble handling situations that they deem frustrating, even if the event is for a very short duration. The combination of low self-esteem, impulsivity and low tolerance for stress causes these individuals to have frequent mood swings and often struggle with depression. A coping mechanism to deal with their conflicting personality becomes their addiction and the addiction acts as something that the person can control when they find it difficult to control their personality traits.

People with addictive personalities typically switch from one addiction to the next. These individuals may show impulsive behavior such as excessive caffeine consumption, Internet use, eating chocolate or other sugar-laden foods, television watching, or even running.

Extraversion, self-monitoring, and loneliness are also common characteristics found in those who have addiction. Individuals who score high on self-monitoring are more prone to developing an addiction. High self-monitors are sensitive to social situations; they act how they think others expect them to act. They wish to fit in, hence they are very easily influenced by others. Likewise, those who have low self-esteem also seek peer approval; therefore, they participate in "attractive" activities such as smoking or drinking to try to fit in.

People with addictive personalities find it difficult to manage their stress levels. In fact, lack of stress tolerance is a telltale sign of the disorder. They find it difficult to face stressful situations and fight hard to get out of such conditions. Long-term goals prove difficult to achieve because people with addictive personalities usually focus on the stress that comes with getting through the short-term goals. Such personalities will often switch to other enjoyable activities the moment that they are deprived of enjoyment in their previous addiction.

Addictive individuals feel highly insecure when it comes to relationships. They may often find it difficult to make commitments in relationships or trust their beloved because of the difficulty they find in achieving long-term goals. They constantly seek approval of others and as a result, these misunderstandings may contribute to the destruction of relationships. People suffering from addictive personality disorder tend to also have depression and anxiety, managing their emotions by developing addiction to alcohol, other types of drugs, or other pleasurable activities.

An addict is more prone to depression, anxiety, and anger. Both the addict's environment, genetics and biological tendency contribute to their addiction. People with very severe personality disorders are more likely to become addicts. Addictive substances usually stop primary and secondary neuroses, meaning people with personality disorders like the relief from their pain.

Personality traits and addiction

Addiction is defined by scholars as "a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences". Substance-based addictions are those based upon the release of dopamine in the brain, upon which the range of sensations produced by the euphoric event in the brain changes the brain's immediate behavior, causing more susceptibility for future addictions. Behavior-based addictions, on the other hand, are those that are not linked to neurological behavior as much and are thus thought to be linked to personality traits; it is this type of addiction that combines a behavior with a mental state and the repeated routine is therefore associated with the mental state.

Drug addiction

A group of British forensic psychologists and data scientists analysed a new large database of users of psychoactive substances. To analyse the predisposition to drug use, they utilized 7 psychological traits, the Five Factor Model supplemented by Impulsivity and Sensation seeking:

• N Neuroticism is a long-term tendency to experience negative emotions such as nervousness, tension, anxiety and depression (associated adjectives: anxious, self-pitying, tense, touchy, unstable, and worrying);
• E Extraversion is manifested in outgoing, warm, active, assertive, talkative, cheerful characters, often in search of stimulation (associated adjectives: active, assertive, energetic, enthusiastic, outgoing, and talkative);
• O Openness to experience is a general appreciation for art, unusual ideas, and imaginative, creative, unconventional, and wide interests (associated adjectives: artistic, curious, imaginative, insightful, original, and wide interest);
• A Agreeableness is a dimension of interpersonal relations, characterized by altruism, trust, modesty, kindness, compassion and cooperativeness (associated adjectives: appreciative, forgiving, generous, kind, sympathetic, and trusting);
• C Conscientiousness is a tendency to be organized and dependable, strong-willed, persistent, reliable, and efficient (associated adjectives: efficient, organized, reliable, responsible, and thorough);
• Imp Impulsivity is defined as a tendency to act without adequate forethought;
• SS Sensation Seeking is defined by the search for experiences and feelings, that are varied, novel, complex and intense, and by the readiness to take risks for the sake of such experiences.

These factors are not statistically independent but the condition number of the correlation matrix is less than 10 and the multicollinearity effects are not expected to be strong.

The results of the detailed analysis of modern data support partially the hypothesis about psychological predisposition to addiction. The group of users of illicit drugs differs from the group of non-users for N, O, A, C, Imp, and SS. Symbolically, this difference can be illustrated as follows:

${\displaystyle \mathrm{N}\Uparrow ,\mathrm{O}\Uparrow ,\mathrm{A}\Downarrow ,\mathrm{C}\Downarrow ,\mathrm{I}\mathrm{m}\mathrm{p}\Uparrow ,\mathrm{S}\mathrm{S}\Uparrow }$

(N, O, Imp, and SS scores are higher for users; A and C scores are lower for users).

The hypothesis about importance of E for addiction was not supported by this aggregated analysis of use of all illicit drugs.

Analysis of consumption of different drugs separately demonstrated that predisposition to use of different drugs is different. For all illicit drugs groups of their users have the following common properties:

${\displaystyle \mathrm{O}\Uparrow ,\mathrm{C}\Downarrow ,\mathrm{I}\mathrm{m}\mathrm{p}\Uparrow ,\mathrm{S}\mathrm{S}\Uparrow }$

(O, Imp, and SS scores are higher for users and C score is lower for users).

Deviation of N, E, and A scores for users of different drugs can be different. For example, heroin users have average profile

${\displaystyle \mathrm{N}\Uparrow ,\mathrm{E}\Downarrow ,\mathrm{O}\Uparrow ,\mathrm{A}\Downarrow ,\mathrm{C}\Downarrow ,\mathrm{I}\mathrm{m}\mathrm{p}\Uparrow ,\mathrm{S}\mathrm{S}\Uparrow ,}$

whereas for LSD and Ecstasy (the latter being a so-called "Party drug") users N has no significant deviation from the population level and E can be higher.

Several personality profiles of risky behaviour were identified by various researchers, for example ${\displaystyle \mathrm{N}\Uparrow ,\mathrm{C}\Downarrow }$ (Insecures) and ${\displaystyle \mathrm{E}\Uparrow ,\mathrm{C}\Downarrow }$(Impulsives, Hedonists). Various types of addictive personality have in common low C.

Internet addiction

Internet addiction is associated with higher scores in neuroticism and lower scores in extraversion and conscientiousness. One explanation for this association is that virtual environments may feel safer and more comfortable for individuals with lower self-esteem and increased emotional sensitivity compared to real-life environments. Similarly, individuals with low extraversion that desire social interaction but are averse to face-to-face interaction may find the opportunity for online communication attractive. Research indicates that social media platforms utilize algorithmic designs such as infinite scrolling and personalized content recommendations to maximize user engagement, fostering an environment where compulsive usage patterns form among users.

Social media addiction is currently not recognized as a formal psychiatric disorder; however, with over 5 billion people spending an average of 2 hours and 29 minutes a day on social media in 2024, there are many concerns about the impact that social media has on mental health and the daily lives of people. Several mental health consequences have been linked to excessive social media usage, such as increased social media usage being linked to increased levels of stress, insomnia, and suicide-related outcomes.

Traits associated with addictive personality, such as impulsivity and emotional dysregulation, have been proposed as potential risk factors for problematic internet use. The compulsive nature of digital engagement, reinforced by algorithmic content delivery, is thought to contribute to patterns similar to those seen in substance-related addictions.

Personality theories of addiction

Personality theories of addiction are psychological models that associate personality traits or modes of thinking (i.e., affective states) with an individual's proclivity for developing an addiction. Models of addiction risk that have been proposed in psychology literature include an affect dysregulation model of positive and negative psychological affects, the reinforcement sensitivity theory model of impulsiveness and behavioral inhibition, and an impulsivity model of reward sensitization and impulsiveness.

Food addiction

While food addiction is widely considered not to be a medical disorder, there is still controversy as to whether food can be addictive as it is necessary for survival. Research has shown that foods can have the same chemical reactions in the brain as addictive chemicals or drugs (e.g. brain reward pathways). Furthermore, certain foods that have a higher level of sweeteners or fats have been found to demonstrate a higher addictive potential. More research is needed to determine the relation between food and addiction. Recent studies have attempted to find correlations between humans and animals, but no general consensus has been reached.

Cultural correlates of personality

The concept of enduring personality traits that predispose individuals to addictive behaviors, which is often referred to as the "addictive personality", has been examined not only in clinical psychology but increasingly through a cross-cultural lens. Although not formally recognized in diagnostic manuals like the DSM-5, traits such as impulsivity, sensation-seeking, and high neuroticism have consistently been associated with increased vulnerability to addiction. Cross-cultural studies using the Five-Factor Model of personality have found that these traits, especially neuroticism and low conscientiousness, are predictive of substance use disorders across diverse populations. This suggests a level of universality in the personality–addiction link, even as cultural norms and expressions of addiction vary widely.

Recent work in cultural psychology and behavioral genetics has further emphasized that while the core traits may be consistent, cultural factors shape how addictive behaviors manifest and are treated. For example, societal attitudes toward alcohol, coping mechanisms, and stress vary across countries, influencing how personality traits interact with environmental factors. As research becomes more data-driven and global in scope, scholars are moving away from older psychoanalytic models toward integrated frameworks that consider both individual personality traits and cultural dimensions. These new approaches provide a richer understanding of addiction risk that respects both universal psychological patterns and culturally specific contexts.

Co-occurring disorders

Traits commonly associated with addictive personality, such as high impulsivity, emotional dysregulation, and sensation-seeking, have been proposed as underlying vulnerabilities contributing to both addictive behaviors and other psychiatric conditions. Research has also linked these traits to increased risks for anxiety disorders, depressive disorders, and impulse control disorders. Additionally, related neurobiological mechanisms, specifically pertaining to emotional regulation and impulsivity, have been noted across addictive behaviors and other forms of psychopathology.

The prevalence of co-occurrences between substance use disorders and various other mental health disorders does not necessarily point to a specific directionality. The risk of developing both substance use disorders and other mental disorders can increase with similar external factors, such as exposure to trauma or stress. While pre-existing mental disorders can lead to substance use, substance use disorders can also lead to the onset of mental health issue, making it hard to determine causality.

The National Institute of Mental Health highlights that co-occurring mental disorders, such as depression and anxiety, are common among those with substance use disorders, underscoring the need for integrated treatment approaches . Furthermore, the concept of "dual diagnosis" refers to the coexistence of substance use disorders and mental illnesses, emphasizing the complexity of treatment and the necessity for comprehensive care strategies.

Treatments and intervention methods

Individuals exhibiting traits associated with an "addictive personality," such as impulsivity, sensation-seeking, and emotional instability, can benefit from a range of evidence-based therapeutic approaches and prevention strategies. Cognitive Behavioral Therapy (CBT) is one of the most commonly used treatments, helping individuals recognize and change maladaptive thought patterns and behaviors related to addiction. Dialectical Behavior Therapy (DBT), which focuses on improving emotional regulation and interpersonal skills, has also shown effectiveness in treating individuals with high emotional dysregulation, often present in those with addictive behaviors. Another approach, Motivational Interviewing (MI), targets uncertainty and enhances motivation to change, making it particularly useful in the early stages of treatment.

Prevention strategies often focus on fostering resilience and emotional regulation skills to reduce the risk of developing addictive behaviors. Programs that teach coping mechanisms for stress, as well as the development of strong social support networks, have been shown to be effective in preventing substance use disorders. Additionally, community-based programs like those focused on improving self-regulation and peer support have shown positive outcomes in reducing harmful behaviors related to addiction.

These therapeutic interventions and prevention strategies collectively address the complex relationship between personality traits and addictive behaviors, supporting individuals in achieving recovery and maintaining long-term abstinence.

Community support groups

The community aspect of peer run groups can reduce stigma and help those in recovery feel less alone. Community-based programs may follow a 12 step spiritual based protocol, encouraging abstinence from all substances, or be non-spiritual and encourage utilization of therapeutic coping skills and harm reduction. Self-Management Recovery Training (SMART Recovery), is one example of a non-spiritual program. SMART Recovery meetings are run by trained facilitators and incorporate aspects of Cognitive Behavioral Therapy. Alcoholics Anonymous (AA), founded in 1935, is a 12 step spiritual program that facilitated by fellow members. The 12 step modality encourages community, sponsorship, total abstinence from substances, and completion of the 12 steps. Another 12 step option is Narcotics Anonymous (NA), which was founded in 1953 as an offshoot of AA for those struggling with drugs addiction. Both NA and AA have similar models of encouraging total abstinence, fellowship, sponsorship, and step completion.

Criticism

There is an ongoing debate about the question of whether an addictive personality really exists. The assumption that personality might be to blame for an addicted person, who is in need of rehabilitation due to drug and alcohol addictions, can have great negative impacts from its supporting a homogeneous answer to a heterogeneous issue in question. These people run the risk of being stigmatized and incorrectly marginalized, and these misjudgments of personality may then lead to poor mental, medical, and social health practices. There are two sides of this argument, each with many levels and variations. One side believes that there are certain traits and dimensions of personality that, if existent in a person, cause the person to be more prone to developing addictions throughout their life. The other side argues that addiction is in chemistry, as in how the brain's synapses respond to neurotransmitters and is therefore not affected by personality. A major argument in favor of defining and labeling an addictive personality has to do with the human ability to make decisions and the notion of free will. This argument suggests human beings are aware of their actions and what the consequences of their own actions are and many choose against certain things because of this. This can be seen in that people are not forced to drink excessively or smoke every day, but it is within the reach of their own free will that some may choose to do so. Therefore, those with addictive personalities are high in neuroticism and hence choose to engage in riskier behaviors. The theory of addictive personalities agrees that there are two types of people: risk-takers and risk-averse. Risk-takers enjoy challenges, new experiences and want instant gratification. These people enjoy the excitement of danger and trying new things. On the other hand, risk-averse are those who are by nature cautious in what they do and the activities they involve themselves in. It is the personality traits of individuals that combine to create either a risk-taker or risk-averse person.

Another important concern is the lack of evidence supporting the addictive personality label and the possibility of stigma. While there is a medical consensus surrounding the genetic components of addiction, there is no such consensus supporting the idea that specific personality types have a tendency towards addictive behaviors. In fact, continued use of this term in the absence of clear evidence could be damaging to the people who believe they have an addictive personality.