Obsessive-compulsive disorder and related disorders: compulsivity vs impulsivity

Abstract

Obsessive-compulsive disorder (OCD) and its related disorders, including body-dysmorphic disorder (BDD), trichotillomania (hair pulling), and excoriation (skin picking) disorder, are characterised by repetitive thoughts and behaviours and the inability to inhibit these behaviours. On a continuum of compulsivity and impulsivity, OCD and BDD lie on the compulsive end, whereas trichotillomania and excoriation disorder lie on the impulsive end. Treatment is determined by the impulsive and compulsive characteristics of each disorder, and thus, thorough assessment is key to the treatment of these disorders. These disorders rely on some level of the following treatment modalities: exposure and response prevention (ERP), habit reversal training (HRT) and medication. With OCD and BDD, ERP is the first line of treatment. On the other hand, due to their more impulsive characteristics, the first line of treatment for trichotillomania and excoriation disorder is HRT and response prevention, followed by exposures.