Vol 5 n° 3 - Anxiety II
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bsessive-compulsive disorder (OCD) is char- acterized  by  obsessions  and  compulsions,  but  it  has become clear that there are a significant number of other disorders that have core obsessive and compulsive fea- tures. Disorders that include such features cross several diagnostic categories and can be grouped according to the focus of the symptoms: bodily preoccupation, impulse control, or neurological disorders (Table I). In addition to having obsessive and compulsive symptoms, all of these disorders also have some similarities in patient characteristics, course, comorbidities, neurobiology, or treatment response.Thus, an obsessive-compulsive (OC) spectrum has been proposed, for which all of these dis- orders are candidates.1-4 Each of these disorders can often be  chronic  and  devastating  in  terms  of  the  suffering caused, the interference with functioning in important areas of life, and the economic toll to individuals and society. Individuals with these disorders exhibit repetitive behav- iors because they have a defect in the mechanism that enables them to inhibit acting.2 The disorders vary in the extent to which they are characterized by compulsivity versus impulsivity, and this difference is often discussed in terms of a compulsive-impulsive spectrum.2-4 They vary in numerous ways beginning with the phenomenology of this inability to resist acting. Compulsive disorders include OCD, body dysmorphic disorder (BDD), hypochondria- sis, and anorexia nervosa. Individuals who act compul- sively are avoiding risk and seeking safety; these individ- uals appear to have an exaggerated sense of harm and are driven to avoid harm or reduce anxiety and distress by performing the compulsive behaviors.The impulsive dis- Keywords: obsessive-compulsive disorder; body dysmorphic disorder; pathological gambling; sexual compulsivity; autism; Asperger’s disorder; impulsivity Author   affiliations:   Department   of   Psychiatry,   Mount   Sinai   School   of Medicine, New York, NY, USA Address  for  correspondence:  Andrea  Allen,  PhD,  Department  of  Psychiatry, Mount Sinai School of Medicine, Box 1230, One Gustave L. Levy Place, New York, NY 10029-6574, USA (e-mail: andrea.allen@mssm.edu) C l i n i c a l   r e s e a r c h 2 5 9 Obsessive-compulsive spectrum disorders Andrea Allen, PhD; Audrey King, PhD; Eric Hollander, MD O The obsessive-compulsive spectrum is an important con- cept referring to a number of disorders drawn from sev- eral diagnostic categories that share core obsessive-com- pulsive features. These disorders can be grouped by the focus of their symptoms: bodily preoccupation, impulse control, or neurological disorders. Although the disorders are clearly distinct from one another, they have intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics, and treatment response. In com- bination with the knowledge gained through many years of research on obsessive-compulsive disorder (OCD), the concept  of  a  spectrum  has  generated  much  fruitful research on the spectrum disorders. It has become appar- ent that these disorders can also be viewed as being on a continuum of compulsivity to impulsivity, characterized by harm avoidance at the compulsive end and risk seeking at the impulsive end. The compulsive and impulsive disorders differ in systematic ways that are just beginning to be understood. Here, we review these concepts and several representative obsessive-compulsive spectrum disorders including both compulsive and impulsive disorders, as well as the three different symptom clusters: OCD, body dys- morphic disorder, pathological gambling, sexual compul- sivity, and autism spectrum disorders. © 2003, LLS SAS Dialogues Clin Neurosci. 2003;5:259-271. Copyright © 2003 LLS SAS.  All rights reserved www.dialogues-cns.org