Psychiatry and Clinical Psychopharmacology

Obsessive compulsive disorder from the perspective of impulse control disorders

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S33-S34
Read: 2620 Published: 21 March 2021

Impulsivity is defined as a tendency to give quick and unplanned responses to internal or external stimuli, irrespective of adverse outcomes, and this is a key element of impulse-control disorders as well as many psychiatric disorders. ICDs are characterized by difficulty in resisting certain impulses or actions that arouse a desire but have the capacity to damage the individual or others, and by a feeling of increasing tension prior to the action and satisfaction, pleasure or relief during the action or once it is completed. Obsessive compulsive disorder (OCD) involves intrusive and persistent anxiety-creating thoughts (obsessions) and behavior (compulsions) performed in order to suppress that anxiety. OCD and ICDs have traditionally been conceptualized as being at opposite ends of a maladaptive behavior continuum, with high harm avoidance at one end and risk-seeking at the other. However, there is evidence that ICDs also have compulsive characteristics and OCD impulsive aspects. Impulsivity and compulsivity are therefore thought to share common psychopathological and neurobiological mechanisms. Although compulsivity and impulsivity are conceptualized as mutually opposed in appearance, the relationship seems to be more complex than that. Compulsivity and impulsivity may be present simultaneously in the same disorder, or they can be seen separately at different times. The uncontrolled behaviors that are characteristic features of ICDs bear similarities to the undesired, excessive and unnecessarily frequent rituals in OCD. Additionally, the high levels of impulsivity frequently reported in individuals with ICDs are also reported in OCD patients. However, there are some differences between OCD and ICDs. For example, individuals with ICDs are generally people with impulsive characteristics who constantly seek exciting and hedonic activities, while individuals with OCD tend to avoid harm and not take risks. In addition, impulsive disorders are generally perceived as ego-syntonic and compulsive disorders as ego-dystonic. Moreover, the repetitive behaviors in ICDs may change with time and, similarly to those in OCDs, may become less pleasure seeking/more anxiety relief focused. Studies to date show a high level of comorbidity between OCD and ICDs (particularly pathological skin picking and trichotillomania). The obsessive-compulsive (OC) spectrum concept is one that has been considered and discussed for the last 20 years. The O-C spectrum contains a disorder group characterized by repetitive thoughts and behaviors different from, but also related to OCD. Indeed, in DSM-V, OCD and some ICDs (compulsive skin picking and trichotillomania) are classified together on the basis of similar pathophysiology, etiology and comorbidity features (Obsessive-Compulsive and Related Disorders). This presentation will be considered OCD from a perspective of impulsivity and ICDs in the light of the information summarized above.

EISSN 2475-0581