Love as an addiction

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The European Journal of Psychiatry is a quarterly publication founded in and directed by Professor A. Seva until his death in The journal is indexed in different bibliographic data bases, including the Social Sciences Citation Index. It is supported by the University of Zaragoza Spainhas been open to contributions from all over the world, and also has North American and Asian-Pacific co- editors.

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It will include basic studies and the growing application of clinical laboratory techniques in psychiatry. The European Journal of Psychiatry is determined to place particular emphasis on clinical issues related to a personalised medicine, including prevention and early intervention.

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Mental Health Abstracts DataBase. Psychological Abstracts PA. Sociological Abstracts Love as an addiction. The Impact Factor measures the average of citations received in a particular year by papers published in the journal during the two preceding years. SRJ is a prestige metric based on the idea that not all citations are the same.

SJR uses a similar algorithm as the Google rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total of citations in a subject field. Even though love addiction is not recognized by DSM-5 as a specific diagnosis, there is enough literature data to support its characterization as an independent mental disorder. Information on the treatment of love addiction is still scant. The currently available therapeutic strategies for love addiction are discussed, as well as some perspectives in the treatment of love addiction from a pharmacological standpoint.

There is scant evidence regarding the Love as an addiction of love addiction in the medical literature, specially with respect to pharmacological interventions, although several agents may hypothetically be of benefit in this condition. Psychotherapy is often cited as the cornerstone of the treatment of love addiction, but its efficacy has not been properly investigated. LA, also called pathological love, 4,5,6 can be defined as a pattern of behavior characterized by a maladaptive, pervasive and excessive interest towards one or more romantic partners, resulting in lack of control, the renounce of other interests and behaviors, and other negative consequences.

The current paper focuses on the clinical management of LA. Initially, some clinical and nosological considerations are addressed, followed by a review on the currently available therapeutic strategies for LA found in the literature.

Finally, the potential of pharmacological interventions in the treatment of LA are discussed, based on the putative mechanisms involved in the development of this condition. Despite its proposed inclusion among the behavioral addictions, hence its name, there is no consensus regarding the nosology of LA. Literature data suggest that different authors seem to utilize distinct criteria for its diagnosis, according to the clinical and phenomenological aspects emphasized in their descriptions.

Some authors propose a dimensional approach, according to which the differences between both conditions would be merely quantitative, given the several phenomenological similarities between addictive behaviors and the regular experience of being in love, including the grief associated with the end of a long-term romantic relationship.

From a nosological standpoint, based on the different descriptions found in the literature, LA can be characterized as: a a behavioral addictionwhich would share several hallmark criteria with classic substance dependence. The loss of or perspective of losing the partner is associated with important anxiety, depressive symptoms, and despair. When faced with the loss of the partner, these patients can either persist in trying to reinstate the relationship or quickly shift their focus to a new partner, replacing their source of dependence and perpetuating the dysfunctional relationship pattern.

Of notice, functional MRI studies suggest that romantic passion is associated with activation of areas belonging to the brain reward system, such as the ventral tegmental area, the striatum, the orbitofrontal cortex, and the cingulate cortex. Individuals rejected by their romantic partners displayed hyperactivation of the nucleus accumbens, an area known to be hyperactive during cocaine craving. This model emphasizes the characterization of LA as an impulse control disorder. Novelty seeking is strongly associated with impulse control disorders, such as pathological gambling and compulsive buying.

Therefore, some patients with LA would suffer from deficits in the attachment system and elevated rates of reward-seeking behaviors, with multiple romantic partners, excessive sexual interest, and poor impulse control. Others, on the other hand, would have elevated rates of both reward-seeking and attachment-related behaviors, resulting in excessive dependence from the romantic partner and obsessive features. Despite the different considerations mentioned above, there is some consensus in regard to the fact that LA, as a primary disorder of love, should be distinguished from other conditions, which show love-related dysfunctional behaviors as part of a broader spectrum Love as an addiction psychopathological findings, such as manic states and primary psychotic disorders.

For example, in the case of manic states, an excessive interest in establishing a romantic relationship can sometimes be observed, but usually subsides once the mood symptoms improve. Similarly, some personality disorders, such as borderline and dependent personality disorders often display patterns highly suggestive of LA, but those are not usually restricted to the romantic sphere, affecting their relationships as a whole, as well as other areas of their functioning. Moreover, even though some authors regard erotomania as a pathology of love, 18,20 that condition seems to be distinct from love addiction.

Patients with erotomania, in addition to romantic feelings towards the supposed partner, experience a delusional belief in regard to the reciprocity of their love, regardless the lack of evidence to support that belief and reassurances in contrary. In DSM-5, this condition is included as a subtype of delusional disorder. Impaired judgment is, to some extension, a common feature during romantic experiences and imaging studies point to deactivation of brain areas associated with critical judgment, such as the frontal lobes.

Finally, despite the similarities and the overlap between LA and sex addiction from an epidemiological perspective, there is enough evidence to consider both disorders as distinct. A detailed discussion on sex addiction and its treatment is beyond the scope of the present article. The search was complemented through manual search of cross-references. Articles addressing solely the treatment of sex addiction were excluded. Through the search strategy described above, twelve papers containing information on the clinical management of LA were identified.

However, only one original study specifically addressing the treatment of that condition could be found. Self-help groups are by far the most adopted intervention for the treatment of LA. Several Step groups are available in the United States for the treatment of love addiction, although most of them also address the treatment of sex addiction. Despite the popularity of self-help groups and the fact that they are often cited by experts as a cornerstone in the treatment of LA, we were not able to identify controlled studies assessing their efficacy.

Furthermore, admission criteria for inclusion into these groups are usually broad and, sometimes, based on the administration of screening questionnaires. Consequently, individuals who participate in these groups may suffer from other issues involving dysfunctional romantic relationships. Cognitive-behavioral therapy CBT has been cited by some authors as of potential benefit in the treatment of LA. The psychopathological features involved in love addiction point to a potential role of automatic thoughts and cognitive distortions such as generalization, catastrophizing, and arbitrary inference in the perpetuation of LA.

These distortions could be successfully addressed through CBT. Nevertheless, we were not able to identify any studies addressing the use of CBT in the treatment of LA. It has been advocated that the best in the treatment of LA are achieved through the use of rational self-counseling. Improvements in self-communication, as well as interventions aiming at enhancing the separation between feeling and facts related to the loss are some of the possible interventions that may be of benefit for patients with LA.

Since it has been hypothesized that, from a psychological standpoint, LA would result from disturbances in attachment during early childhood, psychodynamic psychotherapy has been advocated by some as the treatment of choice for LA. It has been suggested, though, that the treatment of patients with love addiction can be particularly prone to problematic transferential and counter-transferential reactions, due to the attachment and intimacy-related issues usually experienced by the patients.

Although many authors seem to believe that group therapy is the treatment of choice for LA, only one study analyzed the impact of this intervention in a systematic way. Eight subjects with a putative diagnosis of pathological love underwent 8 weekly therapy sessions. indicated statistically ificant increases in the mean scores of the LHS, after the intervention. Several methodological limitations limit the generalization of these findings, including the lack of a control group, the absence of a clear definition of LA as inclusion criteria, and the fact that five of the subjects also met criteria for major depressive disorder.

Whereas the pharmacological treatment of comorbid conditions associated with love addiction, such as depressive and anxiety disorders, would potentially be of benefit, no literature data specifically addressing the pharmacological treatment of LA without psychiatric comorbidities could be identified.

Nevertheless, given the phenomenological characteristics of this condition, as well as some of the neurobiological mechanisms possibly involved in its pathophysiology, several psychopharmacological interventions could, hypothetically, be of benefit for the management of LA. Some of them are outlined below. Again, it is important to emphasize that, to date, no scientific data is available in regard to the efficacy and safety of pharmacological agents in the treatment of LA and that the authors do not suggest or recommend their use in clinical practice, in light of the lack of available evidence.

The phenomenological similarity between obsessive-compulsive disorder OCD and some cases of LA suggests that antidepressants, especially selective serotonin reuptake inhibitors SSRI could be of potential benefit in the treatment of these patients.

Given the efficacy of SSRIs in the treatment of the latter, one can hypothesize that this class of medications may play a role in the treatment of LA. One open-label clinical trial analyzed the efficacy of Lhydroxytryptophan, a serotonin precursor, in the treatment of patients with high levels of romantic distress. Improvements in romantic distress were found to be, at least in part, correlated with increases in the levels of platelet serotonin BDNF.

The inexistence of a control group limits the interpretation of these findings. Further, the release of oxytocin, a neuropeptide that can enhance the experience of secure attachment, improving well-being, and Love as an addiction separation anxiety, seems to be modulated by serotonergic activity. Moreover, SSRIs seem to decrease the dopaminergic transmission at the ventral tegmental area, one of the key areas involved with reward and motivation. In consonance with this hypothesis, venlafaxine, a dual-action antidepressant that seems to increase dopaminergic transmission in higher doses, has been associated with induction of erotomania in a case report.

Finally, there is evidence suggesting that patients with love addiction have higher rates of harm avoidance and reward dependence, what would make them more susceptible to anxious patterns of attachment and more likely to persist in unsatisfactory relationships in order to prevent loneliness. The strong association between LA and impulsivity suggests that mood stabilizers may play a role in the treatment of this condition.

Although there is evidence suggesting that lithium and other mood stabilizers seem to be effective in the treatment of aggression and other behaviors secondary to poor impulse control, Love as an addiction we are not aware of any clinical evidence regarding the efficacy of these medications in LA. Given the putative association between dopaminergic activity and romantic feelings see aboveone could hypothesize that antipsychotics, due to their dopaminergic antagonism, may play a role in the treatment of LA.

Furthermore, patients with LA seem to show higher novelty seeking than healthy controls 13 and this temperament trait seems to be modulated by dopaminergic activity, 36 more specifically the D4 subtype dopamine receptor. Animal research indicates that the neuropeptides oxytocin and vasopressin are involved in several neurobiological mechanisms related to romantic attachment. It has been proposed that the release of these hormones during mating is responsible for linking social s to the dopamine reward systems in the brain, producing positive reinforcement, ultimately contributing to the establishment of bonding and attachment.

Moreover, classic research findings have demonstrated that differences in the expression of vasopressin receptor genes seem to explain the differences between two different species of male voles. Prairie voles, which show a higher of vasopressin receptor 1a in the amygdala and ventral pallidum, show more monogamous behavior when compared to mountain voles, which usually have multiple partners. Regardless of all the limitations that result from the extrapolation of animal research findings to the study of human behavior, the findings above suggest that, from a pathophysiological perspective, ministration of exogenous oxytocin and vasopressin might not be of benefit in the treatment of LA.

Yet, it has been demonstrated that exogenous oxytocin seems to reduce the amygdala response to social fear als. Imaging studies suggest that Love as an addiction romantic love is associated with hyperactivation of several reward brain systems, including the globus pallidus, an area rich in opiate receptors. For instance, naltrexone, a opioid mu receptor antagonist, is able to block the reward response associated with substance use, and is commonly utilized in the treatment of alcohol dependence.

Buprenorphine, a kappa-receptor antagonist, is able to decrease craving associated with substance withdrawal. Studies are necessary in order to investigate if these medications may play a role in the management of LA. Given the fact that LA seems to be a multifaceted condition, the different pharmacological agents that could, in theory, be of benefit for its management may be grouped according to the aimed symptoms, which might vary from patient to patient.

A summary of this approach can be found in Love as an addiction 1. Potential pharmacological targets for the treatment of love addiction. The present paper corresponds to a critical review of the current literature on LA and its treatment. While several authors highlight psychotherapy as a cornerstone in the management of LA, very little controlled evidence regarding these interventions is available. At this point, there is no evidence supporting the use of pharmacological agents in the treatment of LA, although several classes of medications might have a potential role in its management, considering the putative pathophysiological mechanisms involved in this condition.

There is a need for a better characterization of LA from a nosological standpoint, with the possible establishment of diagnostic criteria, facilitating the distinction between LA and normal romantic experiences. That would allow the formulation and implementation of controlled studies, aiming at examining the efficacy of therapeutic interventions in the treatment of LA.

Despite these reservations, the diagnosis and management of LA may be a promising area of research. Romantic love has always been and will continue to be strongly associated not only with rewarding feelings but also with marked suffering. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflict of interest to declare. ISSN: Indexed in: Social Sciences Citation Index.

article Next article. Issue 1. s January - March More article options. Treatment of love addiction: Current status and perspectives. Download PDF. Sanches ab. Corresponding author. This item has received. Article information.

Love as an addiction

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