Kenneth Blum, Kai Uwe-Lewandrowski, Richard Green, Morgan P. Lorio, Alireza Sharafshah, Kavya Mohankumar,
Sergio Luis Schmidt, Rossano Kepler Alvim Fiorelli, Frank Forari, Igor Elman, Mark S. Gold, Panayotis K.
Thanos, Albert Pinhasov, Abdalla Bowirrat, David Baron, Edward J. Modestino, Brian Fuehrlein, Jag Khalsa,
Keerthy Sunder, Marco Lindenau, Anand Swaroop, Debasis Bagchi, Álvaro Dowling, Rafaela Dowling, João Bergamaschi,
Margaret A. Madigan and Rajendra D. Badgaiyan
Reward Deficiency Syndrome (RDS) is a neurogenetically influenced phenotype marked by impaired dopaminergic signaling and mesocorticolimbic reward-circuit dysfunction, leading to reduced reward sensitivity, motivational anhedonia, heightened stress reactivity, and increased vulnerability to compulsive, impulsive, and addictive behaviors. Evidence from molecular genetics, neuroimaging, behavioral neuroscience, and clinical outcomes research supports reward dysregulation as a shared mechanism underlying substance use disorders (SUD), behavioral addictions, mood and anxiety disorders, trauma-related conditions, and pain amplification syndromes. Despite more than five decades of investigation, RDS is not recognized as a discrete diagnosis in diagnostic and statistical manual of mental disorders (DSM) or international classification of diseases (ICD) systems. As a result, affected individuals are dispersed across symptom-based categories, obscuring shared biological vulnerability, fragmenting care, and limiting effective risk stratification, particularly in high-risk settings such as chronic pain management, postoperative opioid exposure, and relapse prevention. This perspective proposes recognizing RDS as a mechanism-informed clinical construct for descriptive documentation under existing codes such as F09 or F99 until formal classification is established. We present descriptive criteria integrating genetic vulnerability, assessed by the genetic addiction risk score (GARS®), with core symptom domains of reward and motivational dysfunction, stress dysregulation, compulsive or addictive behaviors, and neuropsychiatric comorbidity. Acknowledging RDS within contemporary diagnostic frameworks may enhance clinical utility, support personalized treatment planning, and improve epidemiologic surveillance and outcomes research. Recognition of reward dysregulation as a unifying mechanism is consistent with ICD-11’s emphasis on etiological coherence and dimensional models of psychopathology and represents an important step toward integrating neuroscience and precision medicine into psychiatric nosology and advancing more durable approaches to mental health and addiction care.
Published on: March 04, 2026
doi: 10.17756/jap.2026-053
Citation: Blum K, Lewandrowski KU, Green R, Lorio MP, Sharafshah A, et al. 2026. Reward Deficiency Syndrome: Criteria Unspecified Mental Disorder J Addict Psychiatry 10(1): 1-12.
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