Clinical and theoretical implications of a possible link between obsessive‐compulsive and impulse control disorders

Abstract

AbstractStudies examining the phenomenology, comorbidity, treatment response, family history, and biology of obsessive‐compulsive disorder (OCD) were compared with similar studies of DSM‐III‐R impulse control disorders (ICDs) (intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania) and other possible ICDs to examine the relationship of these disorders to one another and to other psychiatric disorders. These studies suggest that OCD and the ICDs share a number of features. These include: 1) phenomenologic similiarities between the obsessions and compulsions of OCD and the irresistible impulses and impulsive actions of ICDs; 2) a strong association with anxiety, psychoactive substance use, and eating disorders; 3) frequent co‐occurrence of OCD and ICDs; 4) apparent preferential response to thymoleptic agents and behavioral therapy; 5) high familial rates of mood disorders; and 6) probable abnormalities in central serotonergic neurotransmission. However, OCD and ICDs differ in some important respects: 1) OCD symptoms are more frequently associated with harm avoidance, insight, resistance, and lack of gratification, whereas ICD symptoms are more frequently associated with sensation seeking, lack of insight and resistance, and gratification; 2) certain ICDs may show stronger associations with bipolar disorders, alcohol and substance abuse, attention deficit hyperactivity disorder, and antisocial behavior; and 3) OCD responds preferentially to serotonin reuptake inhibitors whereas ICDs may respond to a wider variety of antidepressant and mood‐stabilizing agents. Although the differences between OCD and ICDs might be attributable to distinct etiologic mechanisms, many differences could be caused by variation along a bidimensional continuum of different combinations of compulsivity versus impulsivity, with “pure” compulsive states (prototypic OCD) at one extreme, pure impulsive states (the protoypic ICD) at the other extreme, and various combinations of these pure states (mixed compulsive‐impulsive conditions) located in between. Depression 1:121–132 (1993). © 1993 Wiley‐Liss, Inc.