Similarities among Disorders of Motivation and Arousal

Among the various disorders of motivation and arousal discussed in this section there are obvious differences, but also underlying similarities. Dys-thymia and depression both involve a significant reduction in motivation and arousal associated with chronic feelings of hopelessness, as though an unsatisfying outcome to one's efforts were already determined. Anxiety disorders are characterized by an intensification of arousal often combined with avoidance of what is assumed to be an inevitably dangerous outcome. Bipolar disorder, in the manic phase, is marked by intense exaggeration of arousal and an often pathological intensity of certain motivations; the depressive aspect, whether phasic or mixed, falls to the opposite extreme.

Comparison of these comorbid disorders with the characteristics of ADD syndrome shows considerable overlap as well as differences. Management of arousal, ability to activate for tasks, ability to sustain effort for tasks, management of emotions, ability to effectively utilize working memory, ability to size up and regulate actions in social situations—these interacting executive functions tend to be impaired in each of these comorbid disorders. Yet each of the comorbid disorders of arousal and motivation is also characterized by more extreme intensity or absence of arousal, and/or by motivation that is more extreme in its variability or fixity, than is usually found in ADD syndrome itself. These extremes of arousal and motivation, combined with specific related impairments of these various disorders, occur among persons with ADHD more often than in most others without ADHD. The high rates of comorbidity between ADHD and these various disorders of motivation and arousal may be seen as another example of concurrent impairments in the conductor of the orchestra and in specific components of the orchestra itself.

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