Cloninger's theory suggests that over
expression of the RD temperament could cause psychiatric illnesses, such as
addictive behaviors,
sociopathies, and
personality disorders. Low levels of norepinephrine cause an increase in reward dependence. When produced in normal levels, norepinephrine creates a sense of well-being, but low levels of norepinephrine cause symptoms of
depression, lack of
arousal and lack of
motivation. In humans, this leads to then a
negative feedback mechanism whereby we seek out pleasurable activities to remove the negative
affect caused by the low levels of norepinephrine, therefore increasing our reward dependence. An increase in the RD temperament leads us to seek out those behaviors or substances that will allow us to remain in a pleasant physical and/or mental state, attributing to the fact that we humans are
hedonistic individuals, seeking to avoid pain and embracing pleasurable stimuli. Our pleasure and reward systems in the brain are hyper-activated, which makes us display continuous approach behaviors to the reward in question. Our neuro-circuitry is as such that when we stop having access to such pleasurable objects of desire, we then experience negative consequences (
withdrawal symptoms). Addictive behaviors then arise to alleviate such negative consequences and the cycle continues.
Relationship to addictive behaviors People who have high reward dependent personalities but find themselves in situations where they are unable to find rewards and approval through family support or other types, will seek reward through other means e.g.
substance abuse or over-eating. It is then suggested that individuals with such predispositions should adopt preventive strategies or avoid such situations, where they seek such rewards that could potentially have adverse consequences. A study conducted using adolescents with Excessive Internet video Game Play (EIGP) showed that such addictive behaviors were correlated with higher RD scores on the TCI, whereas both low and high scores of RD were implicated in specific alcoholic and drug addictions. • Proposed
Type 1 Alcoholism is clinically characterized by a late onset (after the age of 25) of alcohol-related problems (usually after an extended period of drinking that is socially encouraged), strong psychological dependence (loss of control) with guilt and fear about alcohol dependence, and rare occurrence of fighting and arrests after drinking. Psychologically, it is proposed to be characterized by high reward-dependence (in both males and females). :Low reward dependence is then hypothesized to fit the psychological profile of
Type 2 Alcoholism (predominantly in males).
Type 2 Alcoholism is clinically characterized by an early onset of alcohol-related problems before the age of 25 (independent of external circumstances), drinking often associated with
antisocial behavior, spontaneous alcohol-seeking behavior (inability to abstain), low associated guilt and fear, and frequent fighting and arrests after drinking. This combination of traits also describes people with
Antisocial Personality Disorder (ASPD) and is consistent with findings that type 2 alcoholics frequently suffer from ASPD. Since the inception of these theories they have been tested in several investigations and the results have been consistent with the theories. The positive relation of gambling craving to
depression and negative relation to reward dependence suggests that, individuals who have a lesser disposition to experience positive emotions are the ones who most miss gambling when abstaining. Meanwhile, pathologic gamblers seem to turn to gambling as a way to cope with depressive feelings and lack of positive experiences in life. Pathologic gamblers would potentially benefit from interventions targeting early relief of depression symptoms and replacement of the activity and joy once prompted by gambling. :fMRI studies also show that brain systems involved in the processing of primary rewards, such as the striatum, may sub serve social rewards processing. Since higher RD scores are also correlated to the basal ganglia of the ventral striatum, this explains why
Parkinson's disease (PD) patients on medications indulge in impulsive gambling behaviors. Pathologic gamblers were shown to experience stronger cravings than did
Alcohol-Dependent Subjects (ADS).
Antisocial personality disorder (ASPD) is characterized in behavioral terms by childhood or adolescent onset of recurrent antisocial behavior. :Lower RD scores and decreased plasma oxytocin levels have also typically been associated with
paranoid,
schizoid and
schizotypal personality disorders. In this case a directional relationship was found in which the low reward dependence is a state-dependent characteristic of patients with AVP depression, and not vice versa. :Research has also found a low expression of reward dependence in
suicide attempters. These findings and the negative correlation between reward dependence and the number of suicide attempts may suggest the implication of the noradrenergic pathway in suicide behaviors. Low scores of RD have also been implicated in showing
criminality in adult age. At the 2010 Annual meeting of the
American Psychological Association (APA), a study looking at treatment methods of personality disorders was presented in which it was found, that panic disorder patients with higher RD scores were more resistant to
Escitalopram treatment. Since long-term
pharmacotherapy is needed for treatment of panic disorder, the present results suggest that development of therapeutic strategy for panic patients with high reward dependence is needed.
Other clinical disorders In response to
a lack of social reward, individuals with high reward dependence are more likely to have increased noradrenergic activity. These individuals experience feelings of depression,
agitation and extreme discontent, leading them to indulge in habits that reinforce reward-seeking, such as increased sexual activity or overeating. Whereas restricting
anorexia, in particular, tends to reflect low reward dependence. Reward dependence is not consistently associated with diagnosis but can also significantly affect treatment issues, such as
Therapeutic alliance. Persistence in completing
weight-loss programs were related to high RD scores during pre-treatment. This demonstrates that, having higher reward dependence enhances an individual's disposition to being more dedicated and sociable, making them increasingly respond to societal pressures, thereby reducing their risk of dropping out from weight-loss programs. Studies in
autistic disorder and
Asperger syndrome have shown results, where lower
oxytocin levels and lower RD scores were reported in these children leading to their abnormal social behaviors.{{Cite journal ==Other research==