Love addiction is a proposed disorder concept involving love relations characterized by severe distress and problematic passion-seeking despite adverse consequences.[1] Academics do not currently agree on a precise definition of love addiction or when it needs to be treated.[2] Love addiction can be contrasted with passionate love (the early stage of romantic love) which may be intense but still be prosocial and positive when reciprocated.[1][3][4] Research on the biology of romantic love indicates that passionate love resembles a behavioral addiction, but it has been evolved for the purpose of pair bonding.[3][5]
A 2010 medical inquiry concluded that medical evidence at the time did not have definitions or criteria to classify love addiction as a disorder. Furthermore, the authors state there is a risk of misunderstanding and "overmedicalizing" people who experience it.[1] There has never been a reference to love addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a compendium of mental disorders and diagnostic criteria published by the American Psychiatric Association.[6]
Definition
Defining an addictive disorder which revolves around love passion is difficult because passionate love (also called infatuation) normally has features which resemble addiction.[1][2][3] People in love experience salience, they yearn for their beloved and the amourous stage resembles "getting high".[3][1] One of the major differences between love and drug addiction is that the addictive aspects of passionate love tend to fade away in a relationship, whereas the condition of a drug addiction tends to worsen over time.[1][4]
A team of bioethicists including Brian Earp and Julian Savulescu have drawn a distinction between two views on how the relationship between love and addiction can be conceptualized:[2]
In a narrow view, love might be considered an addiction when it's the result of abnormal brain processes. This is similar to an emerging viewpoint on drug addiction that the brain processes which are responsible for addiction do not exist in the brains of non-addicted people. Drugs of abuse artificially 'co-opt' neurotransmitter systems to produce reward signals which are much higher than could be achieved by natural rewards or with normal functioning.[2][7] There is also some evidence that certain cases like binge eating and gambling addiction may elicit responses similar to drugs in some susceptible people.[2][8] In the narrow view of love addiction then, "only extreme, radical brain processes, attachment behaviors, or manifestations of love" could indicate addiction, and it may be a rare condition.[2]
In a broad view, all love might be considered addiction. In this case, addiction may be "a spectrum of motivation" for any type of reward, like an appetite one can develop via reward conditioning, which is an evolved mechanism. This includes drugs, but also food for example, given that the human appetite for food can sometimes be contrary to real nutritive needs. In this way, perhaps everyone is "addicted" to food, sex, etc., although not to the point of distress or needing treatment. In the broad view of love addiction then, "to love someone is literally to be addicted to them".[2]Helen Fisher, Arthur Aron and colleagues have proposed that romantic love is a "natural" addiction, evolved for pair bonding, which is a "positive addiction" (i.e. not harmful) when requited and a "negative addiction" when unrequited or inappropriate.[3]
In their 2010 proposal, Reynaud et al. defined addiction as "the stage where desire becomes a compulsive need, when suffering replaces pleasure, when one persists in the relationship despite knowledge of adverse consequences (including humiliation and shame)."[1] Others state that "Individuals addicted to love tend to experience negative moods and affects when away from their partners and have the strong urge and craving to see their partner as a way of coping with stressful situations."[9]
Some authors include rejected lovers as love addicts,[10] and the concept of limerence (i.e. all-absorbing infatuated love, commonly for an unreachable person) has also been compared to addiction or a type of love addiction.[11][12][13]
The modern history of the concept of the love addict – ignoring such precursors as Robert Burton's dictum that 'love extended is mere madness'[14][non-primary source needed] – extends to the early decades of the 20th century. Freud's study of the Wolf Man highlighted 'his liability to compulsive attacks of falling physically in love... a compulsive falling in love that came on and passed off by sudden fits';[15] but it was Sandor Rado who in 1928 first popularized the term "love addict" – 'a person whose needs for more love, more succor, more support grow as rapidly as the frustrated people around her try to fill up what is, in effect, a terrible and unsatisfiable inner emptiness.'[16] Even Søren Kierkegaard in Works of Love (1847) said "Spontaneous [romantic] love makes a man free and in the next moment dependent... spontaneous love can become unhappy, can reach the point of despair."[17]
In 1945, the psychoanalystOtto Fenichel defined "love addicts" as "persons in whom the affection or the confirmation they receive from external objects plays the same role as food in the case of food addicts. Although they are unable to return love, they absolutely need an object by whom they feel loved, but only as an instrument to procure the condensed oral gratification." Fenichel states that such people also constitute a high percentage of those he defines as hypersexual.[18] A case report by Fenichel described a married woman who was passionately in love with another man, but whom she could not leave despite feeling seriously conflicted. Fenichel interprets the affair as fulfilling a "narcissistic need" in the woman, which repelled anxiety and depression.[19]
However, it was not until the 1970s and 1980s that the concept came to the popular fore.[citation needed]Stanton Peele opened the door with his 1975 book Love and Addiction; but (as he later explained), while that work had been intended as 'a social commentary on how our society defines and patterns intimate relationships... all of this social dimension has been removed, and the attention to love addiction has been channeled in the direction of regarding it as an individual, treatable psychopathology'.[20] In 1976, the 12-Step program Sex and Love Addicts Anonymous (SLAA) started hosting weekly meetings based on Alcoholics Anonymous. They published their Basic Text, Sex and Love Addicts Anonymous, in 1986 discussing characteristics of and recovery from both love addiction and sex addiction.[21] As of late 2012, SLAA.'s membership had grown to an estimated 16,000 members in 43 countries.[22] In 1985, Robin Norwood's Women Who Love Too Much popularized the concept of love addiction for women. In 2004 a program just for love addicts was created--Love Addicts Anonymous. Since, variations on the dynamics of love addiction have become further popularized in the 1990s and 2000s by multiple authors.[citation needed] Reynaud et al. state in their 2010 review that most people who attend SLAA meetings may actually be there for sexual dependence (for men) or relationship dependence (for women), rather than for love addiction.[1]
The early stage of romantic love is being compared to a behavioral addiction (i.e. addiction to a non-substance) but the "substance" involved is the loved person.[23][24][25][26] Addiction involves a phenomenon known as incentive salience, also called "wanting" (in quotes).[27][28] This is the property by which cues in the environment stand out to a person and become attention-grabbing and attractive, like a "motivational magnet" which pulls a person towards a particular reward.[29][28] Incentive salience differs from craving in that craving is a conscious experience and incentive salience may or may not be. While incentive salience can give feelings of strong urgency to cravings, it can also motivate behavior unconsciously, as in an experiment where cocaine users were unaware of their own decisions to choose a low dose of cocaine (which they believed was placebo) more often than an actual placebo.[30] In the incentive-sensitization theory of addiction, repeated drug use renders the brain hypersensitive to drugs and drug cues, resulting in pathological levels of "wanting" to use drugs.[26][28] People in love are thought to experience incentive salience in response to their beloved. Lovers share other similarities with addicts as well, like tolerance, dependence, withdrawal, relapse, craving and mood modification.[25]
Incentive salience is mediated by dopamine projections in the mesocorticolimbic pathway of the brain, an area generally involved with reward, motivation and reinforcement learning.[27][28][31][32] Dopamine signaling for incentive salience originates in the ventral tegmental area (VTA) and projects to areas such as the nucleus accumbens (NAc) in the ventral striatum.[33][28] The VTA is one of two main areas of the brain with neurons which produce dopamine (the other being the substantia nigra pars compacta). Projections from the VTA innervate the NAc, where dopamine activity attaches motivational significance to stimuli associated with rewards.[34] Brain scans of people in love using fMRI (commonly while looking at a photograph of their beloved) show activations in these areas like the VTA and NAc.[25][26][35] Another dopamine-rich area of the reward system shown to be active in romantic love is the caudate nucleus, containing 80% of the brain's dopamine receptor sites, located in the dorsal striatum.[25][32][36][37] The caudate nucleus has shown activity in response to a monetary reward and cocaine.[36][38][39] This activity in reward and motivation areas suggests that early-stage intense romantic love is a motivation system or goal-oriented state (rather than a specific emotion), consistent with the description of romantic love as a desire or longing for union with another person.[36][26][32] These activations are also consistent with the similarity between romantic love and addiction.[25][26]
In addiction research, a distinction is drawn between "wanting" a reward (i.e. incentive salience, tied to mesocorticolimbic dopamine) and "liking" a reward (i.e. pleasure, tied to hedonic hotspots), aspects which are dissociable.[29][28] People can be addicted to drugs and compulsively seek them out, even when taking the drug no longer results in a high or the addiction is detrimental to one's life.[25] They can also "want" (i.e. feel compelled towards, in the sense of incentive salience) something which they do not cognitively wish for.[29] In a similar way, people who are in love may "want" a loved person even when interactions with them are not pleasurable. For example, they may want to contact an ex-partner after a rejection, even when the experience will only be painful.[25] It is also possible for a person to be "in love" with somebody they do not like, or who treats them poorly.[40]
Modern research is increasingly showing the importance of endogenous opioids in love and social attachment, particularly the β-endorphin (the most potent endogenous opioid) and the μ-opioid receptor system.[41][42][43][44] While opioids have their origin being the body's natural painkiller, they're also implicated in a variety of other systems, essentially like neurotransmitters.[42][45] Opioid receptors are located throughout the brain, including in the limbic system (affecting basic emotions) and neocortex (affecting more conscious decision-making).[46] Opioids are linked to the consummatory part of reward, or i.e. "liking" or pleasure, and released in areas of the brain called hedonic hotspots (or pleasure centers). Hedonic hotspots are located in the nucleus accumbens, the ventral pallidum and other areas.[42][43][33] This function includes social reward, or the pleasurable aspect of social interactions.[42] The brain opioid theory of social attachment (BOTSA) is a long-running theory summarizing this connection, originally conceived of in the 1970s, based on a proposal by the psychiatristMichael Liebowitz and research by the neuroscientistJaak Panksepp. Starting in the 1990s, opioids were overshadowed by the interest in oxytocin and largely overlooked until more recently, possibly because of the difficulty studying them (requiring e.g. a PET scan, which is expensive).[42] Opioids have been connected to a variety of social experiences, including the early stage of romantic love and attachment styles.[44][42][47] While the addictive aspects of love have been compared to cocaine or amphetamine addiction, other aspects may also resemble an opioid addiction.[41]
Cultural examples
In A Spy in the House of Love, the heroine Sabina is said to have seen her 'love anxieties as resembling those of a drug addict, of alcoholics, of gamblers. The same irresistible impulse, tension, compulsion and then depression following the yielding to the impulse'.[48] As a result, she has subsequently been described as 'feeling like a "love addict" enslaved to obsessive-compulsive patterns of behaviour'.[49]
P. G. Wodehouse features in The Inimitable Jeeves 'a character called Bingo who on about every third page meets a wonderful new woman who is going to save his life and is better than any woman he has ever met before, and then of course it flops... a new burst of life, but it does not last'.[50]
St. Augustine – 'to Carthage then I came, where a cauldron of unholy loves sang all about my ears'[51] – has been interpreted as being, 'fundamentally, what one might call a "love addict"', with a disturbing tendency 'to invest all of himself in relationships and to "forget himself" in the intensity of his affection'.[52]
↑ "Letter to Healthcare Professional" distributed at 2012 SASH Conference.
↑ Tallis 2004, pp.216–218, 235 harvnb error: no target: CITEREFTallis2004 (help): "There are certainly some striking similarities between love and addiction[.] [...] At first, addiction is maintained by pleasure, but the intensity of this pleasure gradually diminishes and the addiction is then maintained by the avoidance of pain. [...] The 'addiction' is to a person, or an experience, not a chemical. [...] [O]ne of the characteristics shared by addicts and lovers is that they both obsess. The addict is always preoccupied by the next 'fix' or 'hit', while the lover is always preoccupied by the beloved. Such obsessions are associated with compulsive urges to seek out what is desired [...]."
↑ Nestler, Hyman & Malenka 2010, p.147-148, 266, 364-367, 376 harvnb error: no target: CITEREFNestlerHymanMalenka2010 (help): "Most [neurons which produce dopamine] have their cell bodies in two contiguous regions of the midbrain, the substantia nigra pars compacta (SNc) and the ventral tegmental area (VTA). [...] Neurons from the VTA innervate the ventral striatum (nucleus accumbens), olfactory bulb, amygdala, hippocampus, orbital and medial prefrontal cortex, and cingulate cortex. [...] [D]opamine confers motivational salience ("wanting") on the reward itself or associated cues (nucleus accumbens shell region), updates the value placed on different goals in light of this new experience (orbital prefrontal cortex), helps consolidate multiple forms of memory (amygdala and hippocampus), and encodes new motor programs that will facilitate obtaining this reward in the future (nucleus accumbens core region and dorsal striatum). [...] Dopamine acts in the nucleus accumbens to attach motivational significance to stimuli associated with rewards (such as food). [...] The brain reward circuitry targeted by addictive drugs [...] includes the dopaminergic projections from the ventral tegmental area (VTA) of the mid-brain to the nucleus accumbens (NAc) and other forebrain structures. [...] A reward is a stimulus that the brain interprets as intrinsically positive or as something to be approached. A reinforcing stimulus is one that increases the probability that behaviors paired with it will be repeated. [...] The neural substrates that underlie the perception of reward and the phenomenon of positive reinforcement are a set of interconnected forebrain structures called brain reward pathways; these include the nucleus accumbens (NAc; the major component of the ventral striatum), the basal forebrain (components of which have been termed the extended amygdala [...]), hippocampus, hypothalamus, and frontal regions of cerebral cortex. These structures receive rich dopaminergic innervation from the ventral tegmental area (VTA) of the midbrain."
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