Deborah Brauser

May 07, 2014

NEW YORK ― "Love addiction," a condition characterized by severe pervasive and excessive interest toward a romantic partner, may actually be a form of attachment disorder, new research suggests.

A new literature review of studies using the terms "love addiction," "pathological love," and "behavioral addiction" showed possible involvement of the brain reward dopaminergic system as well as attachment-related biological systems.

"We wondered where does love, a feeling of well-being, devolve into addiction? And what might be the criteria for love addiction and its destructive and dysfunctional behaviors?" asked Vineeth P. John, MD, associate professor of psychiatry and behavioral health at the University of Texas Health Science Center in Houston, during a press briefing here at the American Psychiatric Association 2014 Annual Meeting.

Still, he told Medscape Medical News that it is important not to medicalize normal, albeit deep, love. Instead, clinicians should be concerned if patients stay in a relationship despite danger or if have severe pining long after a breakup despite knowing the relationship is over.

"There is an urgent need for a better conceptualization of [love addiction] from a nosological and neurobiological perspective," the investigators note.

"This would be the first step in devising controlled studies aiming at properly assessing the efficacy of different psychosocial and pharmacological interventions in the treatment of this intriguing condition."

Lack of Control

Dr. John reported that the researchers wanted to question whether being addicted to love was possible and if so, whether it could be a diagnosable disorder.

Dr. Vineeth John

They defined love addiction as a pattern of maladaptive behaviors and intense interest toward 1 or even more romantic partners at the detriment of other interests and resulting in a lack of control and significant impact on functionality.

Although it can occur simultaneously with substance dependence or sex or gambling disorders, it can also be considered an addiction behavior itself, a part of a mood or obsessive-compulsive disorder, or even a part of erotomania.

"It is thought that it affects as many as 3% of the population. And in certain subsets of young adults, it may even go up to 25%," said Dr. John.

He added that individuals who are most at risk for the condition include those with an immature concept of love, a maladaptive social environment, or high levels of impulsivity and anxiety; are anxious-ambivalent or "seductive narcissists"; or have structural affective dependence.

Results from the analysis showed that a picture of a participant's "beloved" elicited activation in the brainstem, the right ventral tegmental area (VTA), and the caudate nucleus regions. These areas have been shown to be central to the brain's reward, memory, and learning functions and have been implicated in substance abuse.

In addition, addiction and attachment disorders share overlapping neural circuits, through the VTA to the nucleus accumbens.

"So basically, what we might be looking at is an attachment problem," he said.

Love Molecules

He also reported that 4 possible "molecules of love" include dopamine (which incites desire and facilitates repetition of love behavior), oxytocin (which mediates social behavior), the opioid hormone (which activates pleasure sensations), and vasopressin (which affects protective behaviors).

Interestingly, men who carried the "allele 334 for the gene coding for vasopressin receptor (AVP R1A)" showed less stable relationships.

"But the most plausible and practical aspect of love addiction would be to look at how to treat it," said Dr. John.

Because they found few studies examining benefits of psychotherapy and no studies assessing the efficacy of medications for this condition, the investigators came up with hypothetical guidelines for target symptom interventions.

For psychosocial treatments, they suggested self-help groups, cognitive-behavioral therapy, psychodynamic psychotherapy, or enrolling in Sex and Love Addicts Anonymous.

In addition, they suggested using selective serotonin reuptake inhibitors and/or antidepressants to treat obsessive thoughts about a romantic partner; mood stabilizers to treat mood instability or seeking out multiple partners; mood stabilizers, antipsychotics, naltrexone, or buprenorphine for treating impulsive seeking of romantic partners; and oxytocin or vasopressin for treating impaired attachments.

"It might be possible to devise drug-based therapies for the treatment of difficult love, based on neurobiological substrates," said Dr. John.

"But this is clearly a futuristic concept. We cannot medicalize noble human emotions. This particular addiction has to be harmful, disruptive, and destructive and cause significant psychological distress. And the treatment has to be totally voluntary," he added.

"Overall, it's time to think about our patients, or at least a small subset of them who are clearly suffering with what is probably an attachment problem."

Worth Pursuing

"I think this is a very important area of study," said Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City.

Dr. Jeffrey Borenstein

"The issue of attachment is extremely important because it relates to other conditions that we treat, including some of the personality disorders," he added.

Dr. Borenstein, who was not involved with this research, was moderator of the press briefing.

He noted that the investigators' approach of looking specifically at the question of love addiction was interesting.

"Obviously Dr. John is not saying that we have pills for this or even that we should be treating this. But I think it's an area of study worth learning more about," concluded Dr. Borenstein.

The study authors report no relevant financial relationships.

American Psychiatric Association's 2014 Annual Meeting. Abstract NR8-35. Poster presented May 6, 2014.

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