Compulsive washing may be more clearly characterized by problems in reward processing. In contrast, duration of checking, severity of OCD, and comorbidity with impulse control disorders shape compulsive behaviors by imparting them with habitual tendencies.

For the first time substance use will not be required for the diagnosis of addiction in diagnostic classification manuals, such as DSM and ICD. The DSM-5 has included gambling disorder, along with substance use disorders, as forms of addictions in a new chapter named "Substancerelated and addictive disorders", thus reflecting evidence that gambling behaviors activate reward systems similarly to drugs of abuse. However, there is still debate on whether other less recognized forms of impulsive behaviors, such as compulsive buying (oniomania), compulsive sex, and kleptomania can be conceptualized as addictions. In this review, we critically evaluate the literature on these behaviors with a focus on socio-demographic and clinical characteristics, underlying neurobiology and treatment response, and their potential overlap with substance use disorders. We were unable to find a substantial number of studies supporting a relationship of the aforementioned reward-based conditions to substance use disorders, thus supporting the contention not to include compulsive buying, compulsive sex, and kleptomania in DSM-5 as behavioral addictions.

Individuals with OCD can be clustered into distinct subtypes based on measures of compulsivity and impulsivity, with the latter being found to be one of the more defining characteristics of the disorder. These dimensions may serve as viable and novel treatment targets.

Background We assessed self-reported drives for alcohol use and their impact on clinical features of alcohol use disorder patients. Our prediction was that, in contrast to “affectively” (reward or fear) driven drinking, “habitual” drinking would be associated with worse clinical features in relation to alcohol use and higher occurrence of associated psychiatric symptoms. Methods Fifty-eight DSM-IV alcohol abuse patients were assessed with a comprehensive battery of reward- and fear-based behavioural tendencies. In addition, an 18-item self-report instrument (the Habit, Reward and Fear Scale, HRFS) was employed to quantify affective (fear or reward) and non-affective (habitual) motivations for alcohol use. To characterise clinical and demographic measures associated with habit, reward and fear, we conducted a partial least squares analysis. Results Habitual alcohol use was significantly associated with the severity of alcohol dependence reflected across a range of domains and with lower number of detoxifications across multiple settings. In contrast, reward-driven alcohol use was associated with a single domain of alcohol dependence, reward-related behavioural tendencies, and lower number of detoxifications. Conclusions These results seems to be consistent with a shift from goal-directed to habit-driven alcohol use with severity and progression of addiction, complementing preclinical work and informing biological models of addiction. Both reward-related and habit-driven alcohol use were associated with lower number of detoxifications, perhaps stemming from more benign course for the reward-related and lack of treatment engagement for the habit-related alcohol abuse group. Future work should further explore the role of habit in this and other addictive disorders, and in Obsessive-Compulsive Related Disorders.

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There seems to be a lack of relationship between animal hoarding and OCD. However, further studies with larger numbers of patients are needed to better define their psychopathological profile and more appropriate nosological insertion.

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Objectives: In this retrospective study of patients with obsessive-compulsive disorder (OCD), we assessed the relationship between different motivational drivers of compulsive behaviours and the response to naturalistic treatments (based mostly on high dose serotonin reuptake inhibitors [SRIs]).Methods: Seventy-six OCD patients were assessed with a structured diagnostic interview; the Habit, Reward and Fear Scale-Revised (HRFS-R); the Yale-BrownObsessive-Compulsive Scale (YBOCS); the Beck Depression Inventory (BDI); and the OCD Retrospective Assessment of Treatment Response (RATS), which includes information on SRIs administration (e.g., dose and duration of their use), augmentation strategies (such as antipsychotic use or exposure and response prevention intervention), and pre-treatment YBOCS scores. Patients were naturalistically followed up for a mean of 7.28 (SD 5.51) years.Results: Analysis revealed that the fear subscore of the HRFS was the only significant predictor (among a detailed battery of demographic, clinical and treatment factors) independently associated with greater delta (pre-treatment minus post-treatment) YBOCS scores.Conclusions: In contrast to predictions (based on existing models), poorer treatment response was not associated with increased habit scores in the HRFS. Future longitudinal studies are needed to confirm whether increased fear as a driver for ritualistic behaviours is able to predict worse outcomes in OCD samples. K E Y W O R D Sassessment, fear, habit, obsessive-compulsive disorder, reward, treatment