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Heroin Addiction and Related Clinical Problems: 2005, 07, 3 (pages: 33 - 46)

Addictive disorders, bipolar spectrum and the impulsive link: The psychopathology of a self-regenerating pathway

Maremmani I., Pacini M., Perugi G.

Summary: Impulsiveness is a typical feature of mood elation states, with a double link: on one hand, impulsive behaviour is favoured by manic states, on the other manic states are accompanied by a drive towards pleasurable objects and situations, which are repeatedly sought after, and may become prominent in the life of the individual. Mood elation does not bring with it its own antidotes, but, conversely, brings exposure to increasing levels of pro-manic stimulation, in a self-regenerating circuit. On epidemiological grounds, some observations can be cited: 1) impulse control disorders can be viewed as closely linked with bipolar disorders, especially when minor excitement (hypomania) and the whole bipolar spectrum are taken into account, beyond full-blown bipolar I patterns; 2) impulse control disorders tend to cluster, suggesting common grounds of pleasure-seeking and reward, regardless of the specific objects that are craved for in different periods or moments. Substance abuse can be read as one kind of impulse control disorder, linked to others and to the bipolar spectrum by a self-regenerating dynamic. Addiction is an autonomous disorder which can be seen as the extreme degree of an impulse control disorder, with paroxysmal craving and a self-maintaining or relapse-inducing course. Impulse control disorders, the bipolar spectrum and substance abuse also share some distinctive symptoms displayed during depressive states or during protracted abstinence, described under the name “hypophoria” and probably underlying the impairment of the brain-rewarding system.