Impulse control disorders: association with obsessive compulsive disorder, addiction and impulsivity

Abstract

This workshop will discuss several impulse-control disorders, such as pathological gambling (PG) and kleptomania, and present an expanded conceptualization of their phenomenology.

PG might be considered as an obsessive-compulsive spectrum disorder, a form of non-pharmacological addiction or an impulse control disorder. Accordingly, we will present three subypes of pathological gamblers: the ‘impulsive’ subtype, the ‘obsessive-compulsive’ subtype, and the ‘addictive’ subtype.

Kleptomania is an impulse control disorder, but may be a form of obsessive compulsive spectrum disorder. On the other hand some authors described the kleptomanic behaviour as an addiction.

Based on these considerations we will bring together knowledge from clinical experience, neuroimaging examination and neuro- psychological assessment, that might lead to better and wider understanding of these conditions. We will present a study that examined whether pathological gambling, a disorder belonging to the OC Spectrum, is characterized by dysfunctional cognitions as in OCD. OCD patients exhibited higher OCD cognitions than both panic patients and normal controls, but equal to PG patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC Spectrum theory for PG.

We will also present recent publications on reward sensitivity and decision making in addictive behaviours and discuss the importance of identification and clarification of the neural substrates involved in decision-making.

Finally, we will summarize the rapidly accumulating body of knowledge related to the neurobiology of impulsiveness from multi-disciplinary neuropsychological and neuroimaging studies.