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Imprinted Arousal Pattern (IAP): A Transdiagnostic Clinical Reasoning for Compulsive Behaviors.

Raymond Zakhari¹

¹Hunter College, The City University of New York, New York City, USA.

Journal of the American Psychiatric Nurses Association

|April 30, 2026

Summary

The Imprinted Arousal Pattern (IAP) framework explains compulsive behaviors as learned loops triggered by stress. This model helps clinicians understand and treat recurring addictive behaviors by focusing on regulatory systems, not just symptom suppression.

Keywords:

addiction anxiety borderline personality disorder cumpulsive behaviors paraphilias substance abuse

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Area of Science:

Psychiatry and Behavioral Science
Neuroscience
Clinical Psychology

Background:

Compulsive behaviors and addictions frequently recur despite treatment.
Patients often report an inability to tolerate stillness or emotional discomfort as a driver.
Current diagnostic (DSM-5-TR) and neurobiological (RDoC) frameworks lack operational explanations for stress-triggered relapse.

Purpose of the Study:

To propose the Imprinted Arousal Pattern (IAP) framework.
To offer a transdiagnostic clinical reasoning model for compulsive behaviors.
To explain stress-triggered recurrence and intolerance of low-arousal states.

Main Methods:

Conceptualizing compulsive behaviors as conditioned arousal-affect-meaning-behavior loops.
Integrating principles from addiction science, conditioning theory, attachment research, and trauma-informed neurobiology.
Mapping the IAP framework onto Research Domain Criteria (RDoC) domains.

Main Results:

IAP reframes compulsive behaviors as learned regulatory architectures, initially adaptive but becoming rigid.
The framework explains intolerance of low-arousal states and predictable stress-reactive relapse.
IAP offers practical assessment and treatment considerations for psychiatric-mental health nurse practitioners.

Conclusions:

IAP provides a coherent, dignity-preserving formulation for compulsive behaviors.
It shifts focus from symptom suppression to restructuring maladaptive regulatory systems.
The framework offers structured language for complex patterns in psychiatric nursing practice.