Latest developments in causes and treatments



Understanding the Compulsive Disorder Cycle

In a paper published in the journal Chronic Stress, authors Laura A. Kwako and George F. Koob explain the role of stress in addiction. They describe two disorder cycles: the Impulse Control Disorder Cycle and the Compulsive Disorder Cycle.

The Impulse Control Disorder Cycle is a loop that moves from Tension/Arousal to Impulsive Acts to Pleasure/Relief/Gratification and finally to Regret/Guilt/Self-Reproach which leads back to Tension/Arousal as the cycle of addiction takes hold. The Impulse Control Disorder Cycle is a good way to describe non-substance addictions, including behavioral addictions.

Impulse Control Disorder Cycle and Compulsive Disorder Cycle

The Compulsive Disorder Cycle described by Kwako and Koob begins with Anxiety/Stress leading to Repetitive Behavior which leads to Relief of Anxiety or Stress leading to Obsessions and closing the loop back to Anxiety/Stress. This is a cycle we have described in previous posts on AddictionNews. The authors explain the connection between stress and compulsion: 

Individuals who suffer from compulsions often recognize that the behaviors are harmful, but they nonetheless feel emotionally compelled to perform them. Performance of these behaviors reduces tension, stress, or anxiety.

The authors lament that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include stress as a causal factor in addiction. “These [DSM-5] criteria are largely not based on the neurobiology of addiction but rather on patient-reported symptoms,” say the authors. “[A]n emphasis on stress and negative affective states in addictive disorders, as discussed herein, could lead to the inclusion of these in future iterations of addiction diagnoses.” They conclude with:

Given the significant public health costs associated with addictions, these improvements would be well worth the time and effort to further explore the role of stress and negative affect in addictions.

Written by Steve O’Keefe. First published December 7, 2023.


“Neuroclinical Framework for the Role of Stress in Addiction,” Chronic Stress, January 2017.

Image of Impulse Control Disorder Cycle and Compulsive Disorder Cycle by Laura A. Kwako and George F. Koob used under Fair Use – Critical Analysis.

Image Copyright: imagehitevo, 123RF Free Images.


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