Impulsive compulsivity in obsessive-compulsive disorder: A phenotypic marker of patients with poor clinical outcome


Although traditionally obsessive-compulsive disorder (OCD) and impulse control disorders (ICD) have represented opposing ends of a continuum, recent research has demonstrated a frequent co-occurrence of impulsive and compulsive behaviours, which may contribute to a worse clinical picture of some psychiatric disorders. We hypothesize that individuals with 'impulsive' OCD as characterized by poor insight, low resistance, and reduced control towards their compulsions will have a deteriorative course, greater severity of hoarding and/or symmetry/ordering symptoms, and comorbid ICD and/or substance use disorders (SUD). The sample consisted of 869 individuals with a minimum score of 16 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Of these, 65 had poor insight, low resistance, and reduced control towards compulsions ('poor IRC') and 444 had preserved insight, greater resistance and better control over compulsions ('good IRC'). These two groups were compared on a number of clinical and demographic variables. Individuals with poor IRC were significantly more likely to have a deteriorative course (p < 0.001), longer duration of obsessions (p = 0.017), greater severity of symmetry/ordering (p < 0.001), contamination/cleaning (p < 0.001) and hoarding (p = 0.002) symptoms, and comorbid intermittent explosive disorder (p = 0.026), trichotillomania (p = 0.014) and compulsive buying (p = 0.040). Regression analysis revealed that duration of obsessions (p = 0.037) and hoarding severity (p = 0.005) were significant predictors of poor IRC. In the absence of specific measures for impulsivity in OCD, the study highlights the utility of simple measures such as insight, resistance and control over compulsions as a phenotypic marker of a subgroup of OCD with impulsive features demonstrating poor clinical outcome. © 2012 Elsevier Ltd.



Impulse control disorders, Impulsive-compulsive spectrum, Impulsivity, Insight and resistance, Obsessive-compulsive disorder, adult, compulsion, demography, disease duration, human, impulse control disorder, impulsiveness, major clinical study, obsession, obsessive compulsive disorder, phenotype, priority journal, symptom, trichotillomania, Yale Brown Obsessive Compulsive Scale, Adult, Female, Humans, Impulse Control Disorders, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Questionnaires, Retrospective Studies, Severity of Illness Index, Statistics, Nonparametric, Young Adult

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Journal of Psychiatric Research, v. 46, n. 9, p. 1146-1152, 2012.