DISORDERS INVOLVING MOTIVATION AND BEHAVIOR

A. The Relationship Between Motivation and Behavior
1. What we do versus why we do it
   a. The behaviorist tradition in psychology
   b. The dangers of “mentalism”
2. Distinguishing normal from abnormal
   a. Quantitative aspects
      (1) Intensity, frequency and duration
      (2) “Surplus” and “deficit” behaviors
   b. Qualitative aspects
      (1) The four Ds
      (2) Socially unacceptable behavior
      (3) Behavior with negative consequences
      (4) Distress and denial
   c. Addiction, dependence and compulsion
      (1) What are they? (physical or psychological, maladaptive behavior or disease – see Lilienfeld Chapter 7)
      (2) Can any behavior become an addiction?

B. Substance-related Disorders in DSM
1. Psychoactive chemical substances and their effects
   a. Depressants
      (1) Alcohol
      (2) Prescription drugs
   b. Stimulants
      (1) Cocaine
      (2) Amphetamines
      (3) Caffeine and nicotine
   c. Opiates (narcotics)
   d. Hallucinogens
2. Distinguishing normal from abnormal use
   a. Quantitative aspects (how much, how often, how long)
   b. Qualitative aspects: negative consequences and loss of control
   c. The controlled substances issue
3. Substance-induced disorders
   a. Intoxication
   b. Withdrawal
   c. Substance-induced mental disorders (classified under their respective caregories)
4. Substance use disorders
   a. Substance abuse
   b. Substance dependence (“addiction”)
      (1) With or without physiological dependence
      (2) Early or sustained and partial or full remission
      (3) Type 1 and Type 2
   c. Comorbidity and complications
      (1) Anxiety, depression and the ”six-week rule”
      (2) Dual diagnosis
      (3) Correlations with social problems and with antisocial behavior
   d. The “progression:” substance use disorder as “chronic incurable disease”
      (1) Use to misuse to abuse to dependence (“addiction”)
      (2) Is the “progression” inevitable?
   e. Statistics

C. Other “Impulse Control” Disorders in DSM
1. Paraphilias
   a. Sexual deviance and perversion: what is normal?
      (1) Cultural disapproval: deviance is not disorder
      (2) Dysfunction: the four Ds
   b. The interplay of fantasy and behavior
   c. Obligatory (addiction) versus preferred
   d. Non-violent paraphilias
      (1) Fetishism and transvestic fetishism
      (2) Voyeurism and exhibitionism
      (3) Frotteurism
      (4) Other
   e. Violent paraphilias
      (1) Sexual sadism and masochism
      (2) Pedophilia and incest
   f. Do all rapists and child molesters suffer from a paraphilia?
   g. Course and statistics
      (1) The concept of escalation
      (2) Epidemiology
2. Impulse-control disorders not elsewhere classified
   a. In DSM
      (1) Pathological gambling
      (2) Kleptomania and pyromania
      (3) Intermittent explosive disorder
      (4) Trichotillomania
   b. Other possibilities
      (1) “Internet addictive disorder”
      (2) Shopping, spending, food, exercise, work and other “addictions”

D. Etiology of Disorders Involving Motivation and Behavior
1. Is there a common core to all “addictions”?
   a. The expansion of twelve-step models
   b. The concept of “cross-addiction”
2. The biomedical perspective
   a. Genetic influences
      (1) What is the evidence?
      (2) What is inherited?
   b. Neurobiological factors
      (1) Opioid receptors in the brain
      (2) Pleasure and the serotonin hyptothesis
      (3) Physiological differences in tolerance and withdrawal
      (4) The “flushing” phenomenon
      (5) The role of sex hormones in paraphilias
3. The intrapsychic perspective
   a. The self-medication hypothesis and other motivational theories
   b. The addictive personality and negative affectivity
   c. Fixation, regression and id-ego-superego
   d. John Money’s “lovemap”
4. The cognitive-behavioral perspective
   a. Maladaptive learning and behavior
      (1) Positive reinforcement (e.g. the ‘high,’ peer acceptance)
      (2) Negative reinforcement (e.g. tension reduction, avoiding withdrawal)
      (3) Observational learning
      (4) Classical conditioning of sexual arousal
   b. Cognitive factors
      (1) Expectancies
      (2) Self-efficacy
      (3) Attitudes and beliefs
5. The socio-cultural perspective
   a. Peer pressure
   b. Family, peer and media models
   c. Family conflict and other life stresses
   d. Inadequate development of self-esteem, social skills, etc.
6. Integrated and developmental models
   a. Distinguishing initiation, maintenance, and relapse
   b. Diathesis-stress

Copyright ©1998 Beverly J. Volicer and Steven F. Tello, UMass Lowell.  You may freely edit these pages for use in a non-profit, educational setting.  Please include this copyright notice on all pages.