Behavioral Impulsivity in Obsessive–Compulsive Disorder

Abstract

BackgroundGrassi et al. (2015) collected data to examine impulsivity in individuals with obsessive–compulsive disorder (OCD) compared to nonpsychiatric controls. Their aim was to examine whether OCD may be fully captured by the behavioral addiction model, using the prototypical mechanism underlying drug addiction as their framework. Based on their findings, Grassi et al. concluded that OCD shares behavioral components with addictions, particularly behavioral impulsivity and risky decision making. Furthermore, the authors suggested that this model may be superior to the prevailing psychological model of OCD.FindingsWe argue that based on the nature of their data as well as the current dominant conceptualization of OCD in the literature, this conclusion is untenable. The authors inferred behavioral impulsivity, whereas their main finding was concerning cognitive impulsivity or difficulties in planning. Such items on the Barratt impulsiveness scale have been shown in other research to overpredict behavioral impulsive tendencies in OCD, where the nature of the condition involves doubting of action and a conservative estimate of how one’s cognitions may impact behavior.ConclusionsWe conclude that similar to drug addiction, compulsive rituals in OCD may be governed by a negative reinforcement mechanism; the available data indicate that OCD does not share the two main components seen in addiction, namely, behavioral impulsivity and risky decision making.

Avoid jumping to conclusions under uncertainty in Obsessive Compulsive Disorder

“…OCD patients here, despite being largely free of any comorbidities, had significantly higher BIS attention-related impulsivity, consistent with previous findings [22,23,57]. Nevertheless, there was no evidence of a JTC reasoning style, or any association between impulsivity and task performance.…”

The link between ADHD-like inattention and obsessions and compulsions during treatment of youth with OCD

“…At the end of treatment then, upon completion of an intensive multimodal outpatient treatment protocol, these more significantly impaired comorbid children who had poorer treatment outcomes were also the patients still exhibiting secondary symptoms such as inattention, impulsivity, etc. The finding that hyperactivity-impulsivity was correlated with obsessions and compulsions at the end of treatment comes in contrast with many studies that have shown that adults with OCD are generally less impulsive than healthy controls (Abramovitch & McKay, 2016). Children with OCD may present with different challenges, as agitation from chronic obsessional distress may contribute to related problems like emotional dysregulation (McGuire et al, 2013; McNamara et al, 2014) and oppositionality (Lebowitz, Omer, & Leckman, 2011) which can also contribute to secondary symptoms like hyperactivity and impulsivity.…”

“…Indeed, Abramovitch and colleagues (2012; Abramovitch, Dar, Mittelman, & Schweiger 2013) found that while obsessions and compulsions may be linked with ADHD symptoms and executive dysfunction among individuals with OCD, the two constructs seem to be unrelated in people with subclinical levels of obsessive-compulsive symptoms. Finally, numerous studies have demonstrated that adults with OCD are less behaviorally impulsive than healthy controls (Abramovitch & McKay, 2016), though these results have not been replicated with children and adolescents. The frequency of hyperactive-impulsive symptoms in children with OCD may be different; obsessive-compulsive symptom severity has been linked with other externalizing behaviors like oppositionality and defiance (Lebowitz, Omer, and Leckman, 2011) and emotional dysregulation (McGuire et al, 2013; McNamara et al, 2014), which may in turn be associated with impulsive, hyperactive behavior.…”

Response to Cognitive impulsivity and the behavioral addiction model of obsessive–compulsive disorder: Abramovitch and McKay (2016)

“…Second, Abramovitch and McKay (2016) argued that higher scores on the BIS-11 cognitive subscales in our OCD group could be simply explained by excessive doubting, and therefore contradict the behavioral addiction model of OCD. However, we also found increased cognitive impulsivity on the Beads Task, which could not be explained by excessive doubting as patients accumulated significantly fewer evidence prior to decision than controls, reflecting overconfidence rather than excessive doubting.…”

“…Abramovitch and McKay (2016) argued that this conclusion is untenable by suggesting that (a) our finding of increased cognitive impulsivity and non-planning impulsivity on the Barratt impulsiveness scale (BIS-11) in OCD patients may support cognitive impulsivity, but not behavioral impulsivity that is typical for addiction and (b) risky decision-making on the Iowa gambling task (IGT) and fewer draws to decision on the Beads Task in our OCD patients may be accounted for by doubting and risk avoidance, rather than the typical risk-taking behaviors of addiction.…”