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

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.