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

OBJECTIVE: (DSM-5-TR) provides descriptive reliability and the Research Domain Criteria (RDoC) framework advances dimensional neurobiological insight, neither alone offers a clinically operational explanation for stress-triggered recurrence. METHODS: This discussion paper proposes the Imprinted Arousal Pattern (IAP) framework, a transdiagnostic clinical reasoning model conceptualizing compulsive behaviors as conditioned arousal-affect-meaning-behavior loops consolidated through reinforcement and stress sensitization. The framework draws from addiction science, conditioning theory, attachment research, and trauma-informed neurobiology and is mapped onto RDoC domains. RESULTS: IAP reframes compulsive behaviors as learned regulatory architectures-once adaptive solutions for managing threat, shame, or dysregulation, now rigid and self-perpetuating across contexts. The framework provides a structured explanation for intolerance of low-arousal states and predictable stress-reactive relapse and translates into practical assessment and treatment considerations for psychiatric-mental health nurse practitioners. CONCLUSIONS: By shifting focus from symptom suppression to restructuring maladaptive regulatory systems, IAP offers a coherent, dignity-preserving formulation for compulsive behaviors. As a portable explanatory framework, it provides structured language for patterns long recognized in psychiatric nursing practice but insufficiently named.