Goodman, A. (1993) - The Addictive Process.

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Goodman, A. (1993). The Addictive Process: A Psychoanalytic Understanding. J. Amer. Acad. Psychoanal., 21:89-105.
(1993). Journal of American Academy of Psy choanaly sis, 21:89-105
The Addictive Process: A Psychoanalytic Understanding
A. Goodman
A psychoanalytic formulation of the addictive process is likely to be of value only in the context of a clear and meaningful
definition of addiction, so the definition I introduced in earlier papers is repeated here (Goodman, 1990, 1991b). Addiction was
defined as a process whereby a behavior that functions both to produce pleasure and to provide relief from internal discomfort
is employed in a pattern characterized by recurrent failure to control the behavior and continuation of the behavior despite
significant harmful consequences. The definition was accompanied by a set of diagnostic criteria for addictive disorder,
arranged in a format similar to that of the DSM-III-R (see Appendix).
The definition of addiction and diagnostic criteria for addictive disorder are behaviorally nonspecific. A behavioral
syndrome is designated as an addictive disorder or an addiction, not on the basis of what the behavior is, but on the basis of
how the behavior relates to a person's life. Any behavior that can function both to produce gratification and to provide escape
from internal discomfort has the potential to be engaged in addictively, but constitutes an addiction only to the extent that it
occurs in a pattern that meets the diagnostic criteria or coincides with the definition. It is not the type of behavior, its object, its
frequency, or its social acceptability that determines whether a pattern of behavior qualifies as addiction: it is how this behavior
pattern relates to and
Director, Minnesota Institute of Psychiatry.

Presented at the 35th Annual Meeting of the American Academy of Psychoanalysis, May 1991.
Technically, this definition of addiction is not a true definition, a phrase that specifies the core of a concept or the essential nature of
a condition. It is a condensed list of diagnostic criteria or identifying properties, descriptive features by which a condition can be
recognized. (Morey and McNamara, 1987; Smith and Medin, 1981). A true definition of addiction, in the technical (philosophy of
science) sense, would more closely resemble my definition of the addictive process.
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affects the individual's life, as indicated in the definition and specified in the diagnostic criteria.
The pattern of symptomatic relationships that meets the diagnostic criteria is common to all addictive disorders, by
definition, whatever the behavior involved. The inference system of medical science suggests that disorders that share a
pattern of symptomatic relationships are likely to share an underlying pathological process. Accordingly, we may hypothesize
that the several addictive disorders have in common an underlying pathological process, an addictive disease process.
Addictive disorders differ in the specific types of behavior that characterize them, but they share an underlying disease
process that determines the pattern of symptomatic relationships that corresponds to the diagnostic criteria. From the
perspective provided by this hypothesis, the group of addictive disorders is most accurately described, not as a variety of
addictions, but as a basic underlying addictive disease process, which may be expressed in one or more of various behavioral
manifestations.
In earlier papers, I characterized the addictive process as a pattern of compulsive dependence on external actions as a
means of regulating the internal state. The present paper represents an attempt to formulate a psychoanalytic understanding of
the addictive process, the underlying pattern shared by all addictive disorders.
I will begin with a historical review of psychoanalytic theories of drug addiction, paying particular attention to
contemporary formulations. I will then present in condensed form a psychoanalytic theory of the addictive processa theory
of addiction generally, not specific to a particular behavior that is used addictively. Finally, I will address the etiology of the
addictive process.
Historical Overview
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Earlier Theories
The developmental path of psychoanalytic theories of drug addiction parallels the development of psychoanalytic theory
as a whole. Early theories emphasized libidinal aspects, primarily oral erotism and attempts to induce a regressive, narcissistic,
and pleasurable state (Abraham, 1908; Brill, 1922; Freud, 1905). Similar formulations informed by object relations theory
attributed addiction
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to archaic passive object dependency and a wish to replace a lost object (Hartmann, 1969). Other theories incorporating object
relations focused more on aggressive drives and associated drug addiction with expression of, enhancement of, and defense
against sadistic/destructive tendencies (Bergler, 1946; Glover, 1932; Rosenfeld, 1965). With the emergence of ego
psychology, more theories of addiction emphasized adaptive functions of the addictive drugs, which relieve dysphoric affects
as well as gratify or defend against drives (Fenichel, 1945; Glover, 1932; Rado, 1933).
Contemporary Theories
Contemporary psychoanalytic theories have associated development of drug addiction with ego impairments and
superego pathology. Ego impairments that have been said to predispose to drug addiction concern functions of self-care and
affect-regulation. Khantzian (1978, 1980; Khantzian and Mack, 1983) has been primarily responsible for explicating the
relationship between drug addiction and deficits in self-care function, which he described as the proper capacity to assess,
warn, and protect against danger. Impairment in this function leads the drug addict to engage in a variety of dangerous
activities, including but not limited to drug use.
Our understanding of affect-regulation and how its impairment predisposes to drug addiction owes the most to Krystal.
According to Krystal (1974; Krystal and Raskin, 1970), drug addicts have primary deficits in affect-regulation that include
affect regression tendencies, deficient ability to utilize anxiety or affect as a signal, and impaired tolerance of pain or painful
affect, especially the primitive unpleasure affect of undifferentiated anxiety-depression that is associated with affect regression.
These deficits leave addicts vulnerable to the psychic trauma of being overwhelmed with primitive unpleasure affect in
circumstances that would not be potentially traumatic to others. They then use drugs to ward off these intolerable affect states.
Krystal's discussion (1975, 1982) of affect development helps clarify the relationship among affect regression, deficient affect
signal function, and impaired affect tolerance. Early in infancy, prior to the establishment of self-representation and object-
representation as separate entities, affects are experienced in a primary undifferentiated state as either pleasure or unpleasure.
Affect at this stage is global, total (all or none), and primarily somatic with no differentiation yet between
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sensation and feeling, between pain and painful affect, or between environmental origin and internal origin. The development
of affects involves their differentiation, desomatization, and verbalization (or symbolization). These processes make possible
the use of affects as signals, which is the main component of affect tolerance the ability to experience affects as information,
not just as exigent states of the organism. Krystal and Raskin (1970) noted a general tendency among drug addicts for affects
to emerge in an undifferentiated, global, primarily somatic way, with particular prominence of an affect combining anxiety and
depression. These overwhelming feelings are usually preceded by a milder form of dysphoria a vague restlessness,
uneasiness, unpleasant sense of tension which is often experienced by the addict as an inclination, urge, or craving to use
drugs.
The relationship between drug addiction and superego pathology has been explored primarily by Wurmser (1977, 1978,
1984, 1987a, 1988). At the center of this relationship is a split in the superego, a condition in which there is not one integrated
set of values, standards, and commandments but two opposing sets. Ideals and expectations are polarized, and their
nonfulfillment is associated with exaggerated condemnation of an all-or-nothing, black/white nature. Contradictory but
absolute superego valuations and demands lead to split identity (self-representation) and split experiences of others (object-
representations). Wurmser attributed the development of the superego split to (1) inability to resolve the conflict between
separation guilt and dependency shame and (2) inability to resolve loyalty conflicts occasioned by parental figures'
irreconcilable claims for allegiance. The drug addict, unable to integrate the split superego, is able to survive the threat of self-
disintegration only by denial of the superego, which both promotes and is reinforced by use of drugs. Drug use is partly an
attempt to ward off affects associated with superego processes of condemnation and humiliation, but consequences of drug
use often evoke such feelings in the user or provoke the environment to respond like an external version of the denied
superego. Wurmser (1984) further observed that the addict's defense against the punitive, critical superego also neutralizes the
approving, caring, protective superego. The addict is then subject to pervasive feelings of unprotectedness and hurt, which
lead to a desperate search for external protectors and comforters.
Wurmser (1978, 1980b, 1981, 1982, 1987b; Wurmser and Zients, 1982)
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discussed two other characteristics of drug addiction, which he termed the phobic core and the essential defenses. At the core
of addiction is a traumatic anxiety that, probably because of physiological concomitants, becomes associated with the general
idea of confinement or smothering. Wurmser identified this anxiety as claustrophobia, a fear of being closed in, trapped, or
engulfed. It is generally displaced onto external structures, and addicts consequently tend to experience phobic anxiety when
faced by limitations of any kind, including obligations, commitments, expectations, and closeness. Wurmser described two
basic modes of counterphobic defense against this traumatic anxiety. One involves seeking a fantasied protector in an external
object or structure. The other entails acting out a fantasy of omnipotence through deliberate (symbolic) exposure to the
dreaded situation in order to achieve mastery over it. Drug use for the addict may represent a condensation of these two modes
of counterphobic defense.
Wurmser identified two defense mechanisms as essential to drug addiction: denial and externalization. Denial or disavowal
was defined by Trunnel and Holt (1974) as a failure to appreciate the significance or implications of what is perceived (p.
771). Wurmser (1981) stated that what is denied in addiction is painful feelings, awareness of inner conflict, and impulses
associated with severe trauma. He also emphasized the superego as major focus of denial, which is directed mainly at affects
that relate to superego functions and at affects or strivings that violate superego standards (Wurmser and Zients, 1982).
Externalization was described by Wurmser (1977, 1978, 1980b) as the defensive effort to resort to external action in order
to support the denial of internal conflict, and thereby to transform internal into external conflict. Elsewhere, he noted that
externalization converts anxiety about a vague, internal danger into anxiety about a tangible, external danger (Wurmser and
Zients, 1982). Anxiety about inner dangers can then be relieved through action that evades or defeats danger in the external
world. Externalization thus expresses a fantasy of taking magical, omnipotent control over the inner life and is hence not solely
a defense mechanism but also a wish fulfillment.
What Wurmser described as externalization is an essential process in addiction and merits a specific term by which to be
designated. His use of the term externalization, however, differs
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from customary usage, according to which it is practically a synonym of projection. I believe that externalization would be more
useful as a psychoanalytic concept if defined in a manner that is distinct from projection and that is consistent with Wurmser's
use. I suggest that externalization be distinguished as a process of action, whereas projection remains a process of perception.
Projection would be defined as attribution to an object (human or nonhuman) of a drive, affect, superego function, or other
aspect that in fact belongs to the self; that is, perceiving as part of one's internal representation of another person or thing
what properly belongs with one's self-representation. Externalization, then, would be defined as action that is based on
projection of a drive, affect, superego function, or other aspect of the self onto an object. The action may also express an
attempt to induce or compel the object to function in accordance with the projection.
A Psychoanalytic Theory of the Addictive Process
A complete psychoanalytic theory of addiction would address two sets of psychodynamic factors and predisposing
conditions: one that concerns the underlying addictive process, and another that relates to the selection of a particular form of
behavior (or, within the area of drug addiction, a particular type of drug) as the one preferred for addictive use. This essay will
address the former set, which I believe is the more important, both in terms of etiological significance and as a guide in
treatment.
I will begin with a brief statement of the theory: The addictive process originates in a disorder of the self-regulation
system, of which impairment in affect-regulation is the most salient component. The addictive process develops when the
defensive system employed to cope with the intense, disorganizing affects and conflicts that result is based on denial,
externalization (as defined in the preceding section), and counterphobic/narcissistic structures. We will now consider in more
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detail the disorder of self-regulation, the associated affects and conflicts, and the defensive system that characterizes
addiction.
This definition of externalization is also consistent with the definition offered by Sandler et al. (1962) in their Hampstead Index work.
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Disorder of Self-Regulation
Contemporary psychoanalytic theories of drug addiction have emphasized self-care deficits, defects in affect-regulation,
and superego pathology. I believe that these impairments are most usefully considered as various aspects of the same general
area of dysfunctionin other words, that self-care, affect-regulation, and (at least some) superego functions comprise one
functional system, which may be designated as the system of self-regulatory functions or the self-regulation system. My use of
these terms is consistent with Grotstein's (1987) description of self-regulation as comprising self-soothing capacity,
maintenance of a cohesive sense of a core self, ability to take care of one's needs, and regulation of affects, self-esteem,
psychic energy, and will. The theory that I am proposing identifies the core of the addictive process as a disorder of the self-
regulation system, with particular emphasis on impairment of affect-regulation.
Affects
Defects in affect-regulation leave individuals vulnerable to being overwhelmed by intense, disorganizing, primitive
unpleasure affect. Impaired affect-regulation involves affect regression, in which affects are experienced as amorphous, total,
global, somatic, and in effect continuous with basic unpleasure affect. In the context of deficient affect tolerance and signal
function, this regressive affect tends to be experienced as impending organismic catastrophe. Individuals with these
impairments are thus threatened with overwhelming affective trauma by emotional states that an intact individual does not
experience as potentially traumatic. Emotional states that are particularly threatening include disappointment, rage, shame,
loneliness, and grief; but almost any intense affect, including excitement and love, can be experienced by these individuals as
threatening.
Conflicts
The understanding of anxiety that emerges from the preceding discussion seems to imply a departure from the
psychoanalytic principle that anxiety is associated with psychic conflict. A closer look, however, reveals conflict at the deepest
level. This fundamental conflict is indicated by juxtaposing Wurmser's claustrophobia
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with Grotstein's (1980) characterization of dissolution or fragmentation anxiety as agoraphobia which is the experience of no
boundaries (p. 530). Primary anxiety thus has two antithetical components: fear of being engulfed (claustrophobia) and fear of
disintegrating (agoraphobia). Each represents a form of annihilation anxiety, or fear of loss of self. A complementary conflict
may also be identified, between the wish for merger or fusionin a sense, claustrophiliaand the (biologically determined)
drive for individuation and masterywhich can be called agoraphilia. We may thus recognize a basic conflict, claustrophilia
and agoraphobia versus agoraphilia and claustrophobia, which represents the first organization of conflictual forces within the
psyche. Subsequent development of conflicts is both diachronic (linear) and synchronic (concurrent): the basic conflict
evolves a succession of derivatives that reflect emerging developmental issues, whereas the basic conflict and each of its
successive derivatives continue to operate in their original forms.
The basic conflict and its derivatives are part of the human condition. They become particularly problematic when their
components remain apart instead of being integrated and resolved. According to current formulations, splitting first occurs as a
manifestation of impaired integrative capacity and then later is used as a defensive to prevent or to contain anxiety (Kernberg,
1967). In the addictive process, splitting is promoted by (1) a split superego with extreme and contradictory demands, (2)
intensification of the affective component of conflicts caused by affect-regulation deficits, and (3) reliance on a defensive
system that is based on denial and on counterphobic/narcissistic fantasies that are in fact antithetical.
Defensive System
The characteristic defense mechanisms of addiction are denial and externalization. Externalization is the most specific
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defense. The defensive organization in addiction, which Wurmser (1978, 1980b, 1981, 1982, 1987b; Wurmser and Zients,
1982) described as a counterphobic system, is equally well described as a manic defense system (Rosenfeld, 1965) and as a
system of narcissistic structures (Kohut, 1968, 1971). It functions to defend against basic unpleasure affect and its
derivatives, which are traumatically threatening because of deficits in affect-regulation. Development of the
counterphobic/narcissistic system can be traced from its
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origin in primary narcissism. Primary narcissism represents the subjective state of the human organism prior to any experience
of unpleasure affect. Fantasy of return to this state is a final recourse of the infant who is otherwise helpless when threatened
by overwhelming unpleasure affect. As self and object representations differentiate, the fantasy of primary narcissism similarly
differentiates, and its defensive function becomes distributed over the two emerging representational structures: a fantasy of
omnipotent mastery or grandiose self, and a fantasied protector or idealized selfobject. Denial, externalization, and
counterphobic defenses support, reinforce, and promote each other so that in effect they operate as one system.
The preceding analysis of the addictive process has, for purposes of clarity, discussed self-regulatory functions, affects,
conflicts, and defenses as though they were separate processes. Their operation in a person, though, is characterized by
dynamic, mutually determining relationships among all of them. They are thus most accurately conceptualized as comprising
one organic process that has different aspects that can be sharply abstracted from each other only in theory.
Further Thoughts
Although addictive behavior is external action, it is precipitated by internal sensations that are often experienced as states
of bodily need: as craving by a drug addict, as hunger by a bulimic, as lust by a sex addict. Addiction has been compared with
psychosomatic disorders and they have been noted to share features of alexithymia, particularly impaired capacity to
discriminate among different somatic and affective sensations (McDougall, 1986). As inquiry deepens, boundaries seem to
blur between externalization onto the body (Ritvo, 1984), conversion of affect into somatic function (Wurmser, 1981), and the
somatic quality of affect experience that characterizes affect regression. The idea that addicts are today's version of
conversion hysterics (Wurmser, 1980a, p. 71) is worthy of serious consideration.
An additional aspect of the addictive process is how it operates to perpetuate and reinforce itself. The addictive actions
that result from impairments in ego and superego functions have external and internal consequences that often lead to further
impairment of ego and superego functions, and thus to further potentiation of the addictive process. Addiction moreover
involves a high level
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of what Rangell (1968) termed tertiary gain: the process by which a chronic symptom comes to function as part of the self or
identity, even becoming the central organizing event in a person's life. This function further deepens the addict's dependence
on the addiction.
Addiction has been described as a compromise solution between affect defenses and gratification of libidinal and
aggressive drives (Wurmser, 1977). On another level, it can be seen as a noncompromise solution: an attempt (through
denial, externalization, and counterphobic defenses) to relieve the unpleasure of intense conflicts without having to confront
them. Addiction expresses a fantasy of preconflictual unity and wholeness, an illusion maintained through denial of conflicts
and hence sacrifice of opportunities to integrate and resolve them.
Etiology
Etiology is an area of psychiatry that is rife with misunderstanding. Misunderstandings arise primarily as results of errors
in one or both of two domains: (1) failure to recognize that physiological and psychological concepts designate the same set of
events but belong to different conceptual networks, and hence that reference to physiological causes of psychological effects
is not meaningful (Goodman, 1991a); and (2) failure to distinguish between specific preconditions, concurrent factors, and
precipitating events (Freud, 1895). Concerning addiction, concurrent factors include social and cultural conditions, whereas
precipitating events are adventitious contacts by predisposed individuals with substances or behaviors that relieve their
particular forms of distress. The specific preconditions of addiction are the hereditary and life-history factors that contribute to
the specific combination of self-regulation disorder and characteristic defenses.
Development of the Self-Regulation System
Approaches to formulating the development of disorders of the self-regulation system begin most productively with an
understanding of how the self-regulation system develops in healthy growth. An overview of the literature indicates that
gradual internalization of caregiver functions and their integration with unfolding constitutionally determined structures is the
essential process in development of all aspects of the self-regulation system,
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including self-care, affect-regulation, and superego function. Self-care functions become internalized in the context of
caregivers' nurturing and protective behavior, accompanied by internalization of the message that the child is valued and worth
taking care of (Khantzian and Mack, 1983). Affect-regulation functions develop through internalization of the mother's
container function (Bion, 1962; Grotstein, 1980) and of her responses to the infant's affective behavior, which comes to
operate as the infant's first mode of communicating with her (Krystal, 1974). The former is the basic matrix for affect tolerance,
whereas the latter is the template for development of affect signal function. These affect-regulation functions are ultimately
indistinguishable in their development and operation (Grotstein, 1984; Krystal, 1975). Superego functions are also generally
recognized to develop through internalization and introjection of parental functions (Beres, 1958; Brickman, 1983; Furer,
1967; Hammerman, 1965; Reich, 1954; Sandler, 1960; Spitz, 1958; Westen, 1986). The unifying concept in these processes
is transmuting internalization, a concept introduced by Kohut (1968, 1971) and described by Tolpin (1971, p. 318) as bit-by-
bit accretion of psychic structure from innumerable fractionated internalizations of specific maternal functions.
Development of Self-Regulation Disorders
Consistent with this understanding of self-regulatory function development is the principle that disorders of the self-
regulation system develop as a result of disturbances in the process of transmuting internalization. These disturbances have
been variously attributed to traumatic disappointments (Kohut, 1966, 1968, 1971), impingements or failures or empathic
response (Winnicott, 1965), faulty patterns of affective interchange with the caregiver (Emde, 1988), inadequacy of maternal
stimulus barrier function (Krystal and Raskin, 1970), failure of parental container function (Bion, 1962), and mismatch
between the infant's needs and the caregiver's capacities (Balint, 1968). Interference with internalization may also result when
the child's defenses against dangerous wishes or needs disrupt the accessibility on which internalization depends.
A number of theorists have emphasized the separation-individuation period, particularly the rapprochement subphase, as
critical in the development of addictive disorders. More probably, traumatic disappointments and empathic failures occur
during earlier periods as well, and are registered and held in sensorimotor
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memory until the developing symbolic capacity enables their coding in a form more accessible to consciousness. Significantly,
major advances in development of the capacity for symbolic representation approximately coincide with the beginning of the
rapprochement subphase, at about 18 months of age. The core conflicts of separation-individuation are derivatives of the basic
conflict of claustrophilia and agoraphobia versus agoraphilia and claustrophobia, and may function like screen memories for
them or may be intensified by condensation with these preverbal conflicts particularly in individuals who, because of affect
regression, experience loss of the love object as equivalent to annihilation (Krystal and Raskin, 1970). Meanwhile, the
development of self-regulatory functions continues through childhood and adolescence. The work of mourning the mother-
child relationship and the aspect of self it embodies is the major task of adolescence (as a developmental, not chronological,
phase), and failure to fulfill this task impairs tolerance of depression and predisposes to denial and to self-compensatory
compulsion (Krystal, 1975).
Theories in the popular literature often attribute the development of addictive disorders to traumatic events in childhood,
particularly sexual abuse, physical abuse, and abandonment. However, as Kohut (1971) observed, the effects of specific
traumatic events are a function of preexisting susceptibilities, which in turn are caused by the interaction between inherited
psychological propensities and the whole history of the child's relationship with the parents (especially the mother) prior to the
traumatic event. The primary mediating factor is disturbed internalization of self-regulatory functions. Impaired internalization
of affect-regulation constitutes a general vulnerability to psychic trauma, whereas inadequate internalization of self-soothing
and self-caring functions predisposes to desperate dependence on external objects, which may entail specific vulnerabilities to
sexual abuse and other forms of victimization. Abandonment by or loss of a parent early in life contributes to development of
addictive pathology in a negative sense, rather than directly, as children are then deprived of the gradual disillusionment
through which transmuting internalization occurs (Kohut, 1971).
Hereditary/Constitutional Components
Empirical studies clearly indicate a hereditary component in the development of addictive disorders. The preceding
discussion of
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the addictive process suggests that hereditary contributions to the addictive process operate primarily by influencing the
development of self-regulatory functions and of defenses. Constitutional factors are likely to include: endogenous
predispositions to affective disorders and to schizotypal traits (Grotstein, 1987); innate components of sensory processing,
integration, and differentiation (Greenspan, 1989); temperamental variables that influence the goodness of fit between infant
and caregiver (Chess and Thomas, 1986; Thomas and Chess, 1980); and the genetic basis of various ego functions, including
the process of internalization itself. Meanwhile, most current research on the genetics of addiction is concerned with factors
that determine the effects of exogenous substances. Such factors may affect the choice of which substances will be preferred
for addictive use, but contribute little to the addictive process.
Conclusion
Returning to individual psychopathology, the oft-repeated assertion that there is no pathology typical of addicts is true
only in the sense that there is no preexisting category of pathology into which all addicts fit. The premise of this article is that
there is a set of pathological features that tend to characterize addicts. These features constitute the addictive process, which
represents a level of analysis intermediate in specificity between symptom and personality disorder. This level of analysis
contains more psychoanalytic information than does the symptom level, and is more clinically specific than is the personality
disorder level. It also provides a framework for understanding the relationships among apparently discrete clinical syndromes,
which coincide with or follow one another in the same individual more frequently than would be predicted were they not
related.
In earlier papers (Goodman, 1990, 1991b), I proposed specific diagnostic criteria for addictive disorder or addiction. In the
present paper, I offer a psychoanalytic understanding of the underlying pathology the addictive process and a
psychoanalytic formulation of its etiology and pathogenesis. My understanding of the disease concept of addiction is based
on this theoretical system. Interestingly, it is consistent with the Alcoholics Anonymous approach to alcoholism and the
Narcotics Anonymous approach to drug addiction, as indicated by the following quotes:
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Our liquor was but a symptom. So we had to get down to causes and conditions. (Alcoholics Anonymous, 1976, p.
64)
his character defects, representing instincts gone astray, have been the primary cause of his drinking and his
failure at life unless he is now willing to work hard at the elimination of the worst of these defects, both sobriety
and peace of mind will still elude him. (Alcoholics Anonymous, 1952, p. 50)
In our recovery, we find it essential to accept reality. We learn that conflicts are a part of reality, and we learn
new ways to resolve them instead of running from them. (Narcotics Anonymous, 1986, p. 84)
Helping people to get down to causes and conditions, to work at the elimination of character defects, and to resolve
conflicts is what psychoanalysis is about. I believe that there is a great future for psychoanalysis in helping people recover
from addictive disorders.
Appendix
Diagnostic Criteria for Addictive Disorder or Addiction
A. Recurrent failure to resist impulses to engage in a specified behavior.
B. Increasing sense of tension immediately prior to initiating the behavior.
C. Pleasure or relief at the time of engaging in the behavior.
D. At least five of the following:
(1) frequent preoccupation with the behavior or with activity that is preparatory to the behavior
(2) frequent engaging in the behavior to a greater extent or over a longer period than intended
(3) repeated efforts to reduce, control, or stop the behavior
(4) a great deal of time spent in activities necessary for the behavior, engaging in the behavior, or recovering from
its effects
(5) frequent engaging in the behavior when expected to fulfill occupational, academic, domestic, or social
obligations
(6) important social, occupational, or recreational activities given up or reduced because of the behavior
(7) continuation of the behavior despite knowledge of having
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a persistent or recurrent social, financial, psychological, or physical problem that is caused or
exacerbated by the behavior
(8) tolerance: need to increase the intensity or frequency of the behavior in order to achieve the desired effect, or
diminished effect with continued behavior of the same intensity
(9) restlessness or irritability if unable to engage in the behavior
E. Some symptoms of the disturbance have persisted for at least one month, or have occurred repeatedly over a longer
period of time.
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Article Citation [Who Cited This?]
Goodman, A. (1993). The Addictive Process. J. Am. Acad. Psychoanal. Dyn. Psychiatr., 21:89-105

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