Subjective Perception of Impulsivity in Patients with Obsessive - Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is the fourth most common psychiatric disorder (Pigott 1998) affecting approximately 2-3% of general population (Abramowitz, Brigidi & Roche, 2000) with equal prevalence in men, women, and children (March & Mulle, 1998). The behavioral features of obsessive compulsiveness and impulsivity, as distinct from its primary disorder, are seen in many psychiatric conditions (McElroy, Phillips & Keck, 1994). The failure to 'resist an urge, drive, or temptation to commit an act that is harmful to the individual orto others' is classified as 'Impulse Control Disorder' (DSM-IV-TR, 2000) or as 'Habit and Impulse Disorders' (ICD-10, 1992). It is reported that 29 % of patients with OCD have co-morbid features of other impulse control conditions (Matsunaga et al. 2005). With respect to symptoms, OCD has been characterized as a disorder of impulse control with some patients exhibiting conduct and anger-control difficulties (Stein, Hollander, Simeon & Cohen, 1994). Furthermore, following successful treatment of OCD symptoms, reductions in impulsivity and anger have been noted (Lopez-Ibor, 1990). In personality literature, impulsivity has been conceptualized variedly (Cloninger, 1996). Most definitions have incorporated 'risk taking, instability, a lack of reflection and restraint, and proclivity to engage in behaviors associated with immediate gratification' as core features of impulsivity (Frost, Steketee, Cohn & Greiss, 1994). Impulsivity, as central feature of personality, has been invoked to understand and diagnose the psychopathology in OCD, mania, addictive disorders, or attention deficit-hyperactivity disorders. It has been characterized by 'underestimation of harm, non-reflective responses, difficult-to-control desires and repetitive behaviors to obtain pleasure and gratification' (Li & Chen, 2007). It is also defined as 'failure to evaluate a situation as risky, acting without thinking and inability to plan ahead' (Helmers, 2000). Gray, Owen, Davis, and Tsaltas (1983) proposed that impulsive individuals are 'insensitive to stimuli associated with punishment, display excessive sensitivity to stimuli associated with reward and display a deficit in passive avoidance learning'. Impulsivity can be regarded as 'predisposition to action without reflection or regard for consequences' (Moeller, Barratt, Dougherty, Schmitz, & Swann, 2001). Consequences of impulsivity include substance abuse (Swann, Dougherty, Pazzaglia, Pham, & Moeller, 2004), suicidal behavior (Swann et al. 2005) and other serious behavioral problems (Stanford & Barratt, 1992). Despite the growing acceptance for diagnostic heterogeneity, its nosological placement and the notion of spectrum (Oldham, Hollander & Skodol, 1996) rather than the earlier positions when specific types or traits were postulated to explain personality factors in OCD, there is disagreement regarding placement of impulsivity either as 'low' pole or central axis on this spectrum (Hollander & Wong, 1995), thereby, warranting further investigation. While some investigators highlight the phenomenological similarities between OCD and impulse control (Lopez-lbor, 1990), some maintain a distinction between impulsive and non-impulsive groups of OCD (Hoehn-Saric & Barksdale, 1983). Zermatten & Linden (2008) explored the relationship between obsessive-compulsive symptoms and four facets of impulsivity (Urgency, Lack of Premeditation, Lack of Perseverance and Sensation Seeking) in 220 non-clinical individuals. Their results revealed a strong link between 'Urgency' and obsessivecompulsive symptoms. In addition, 'Lack of Premeditation' negatively predicted the 'Checking and Ordering' subscales, while 'Lack of Perseverance' was positively linked with 'Obsessions' and negatively with 'Ordering'. Finally, no relation was found between obsessivecompulsive symptoms and 'Sensation Seeking'. Even as there are studies which have found individuals with obsessive compulsive symptoms scoring low, high, or differently from non-clinical controls on measures of impulsivity (Frost et al. …