What is obsessive-impulsive disorder?
August 8, 2007 10:14 AM   Subscribe

I would like information on obsessive-impulsive disorder.

A few years ago, I was told that someone who used to be quite close to me had been diagnosed with something called obsessive-impulsive disorder. In that conversation, it was vaguely described to me as being similar to OCD but where, instead of set routines or regular obsessions, the person instead felt an overwhelming urge to act out whatever just came into their minds to do. I was also told that the person probably developed this disorder due to drug use. For the sake of clarity, allow me to emphasize: 1) my interlocutor would certainly know the details of this person's mental illness and had no reason to lie to me; 2) I am certain I didn't just mishear and misunderstand "obsessive-compulsive disorder."

Since then, I have occasionally tried searching for information on this disorder, and I have found nothing. Either it is not in the DSM-IV, or I do not know how to find good information about the DSM-IV. I have seen no references to this disorder or found anything about it.

So, has anyone heard of Obsessive-Impulsive Disorder? Does anyone know where I could find more information about it? If it isn't actually a disorder recognized by DSM or, really, anything, then does that say anything specific about either the person I was told suffered from it or my interlocutor who told me about it?
posted by Ms. Saint to Health & Fitness (9 answers total) 3 users marked this as a favorite
There's Obsessive-Compulsive Personality Disorder, which is separate from OCD.
posted by occhiblu at 10:17 AM on August 8, 2007

There are also various Impulse Control Disorders.

I know that different countries sometimes use different terms -- is everyone in this situation American?
posted by occhiblu at 10:20 AM on August 8, 2007

You might be able to find something out by asking the folks at the CrazyBoards. The people in the OCD subsection might be able to give you some information, anecdotal or otherwise, on the *difference in diagnosis between the two disorders.

*They can probably also tell you if such a differentiation exists.
posted by ElectricBlue at 10:25 AM on August 8, 2007

Oh, yes, everyone is American. Sorry -- I didn't realize that could make a difference.
posted by Ms. Saint at 10:27 AM on August 8, 2007

This interview with psychiatrist Eric Hollander, who is co-chair of the Planning Agenda for DSM-V, might be helpful. He talks about how they're considering reorganizing some of the OCD, anxiety, and impulse control disorders:

The second cluster [of OCD spectrum disorders] are the more impulsive disorders in which people initiate certain behaviors to obtain some element of pleasure, arousal, or gratification; however, over time a compulsively-driven component keeps these behaviors going. Within the impulse-control disorders, there are two groups: the first consists of the impulse-control disorders that currently exist in the DSM, including kleptomania, pyromania, intermittent explosive disorder, pathological gambling, and trichotillomania. In addition to that, there will probably be four newer disorders in the DSM-V, which we have started to call the impulsive-compulsive disorders. These are impulsive-compulsive shopping, impulsive-compulsive sexual behavior, impulsive-compulsive Internet use, and impulsive-compulsive psychogenic excoriation or skin picking. These behaviors have some element of pleasure, arousal, or gratification in the beginning, but a compulsively driven mechanism later causes the behavior to persist.

For example, we just finished a study on Internet addiction using escitalopram as a treatment, which we have not fully analyzed. These people get “stuck” on the Internet searching for information (ie, they constantly surf the Web with a “need-to-know” feeling of incompleteness) or they get stuck doing all kinds of impulsive things on the Internet, such as gambling, looking at sexual material, shopping, and trading stocks.

And later:
This idea [about OCD] has undergone refinement over the last 12 years; to some extent, this area is more complex than we originally thought. At first we thought that this whole area could be viewed from a dimensional standpoint: there are some disorders that are risk-aversive and harm-avoidant, such as OCD, and other disorders that are much more impulsive or novelty-seeking, such as the impulse-control disorders or the Cluster B personality disorders, including borderline personality disorder. Now we see that a lot of these disorders have both compulsive and impulsive features.

The four impulsive-compulsive disorders, for example (shopping, sexual behavior, Internet use, and skin picking) have compulsive and impulsive features, and are relatively complex. They can have features of both compulsively-driven behaviors to reduce anxiety, but also impulsive behaviors driven to obtain pleasure, arousal, or gratification. Patients with autism who have many rigid routines and rituals coupled with impulsive-aggressive behavior can also be included in this group, as can patients with Tourette’s syndrome who have compulsive rituals and impulsive-aggressive behavior. So these are not necessarily unitary disorders but are disorders made up by different symptom domains, one of them being repetitive thoughts and behaviors and others being, for example, inattention coupled with motor hyperactivity or affective instability. These associated symptom domains or comorbid conditions can influence phenomenology or how these behaviors are expressed and can certainly influence treatment response. The treatment response then becomes much more complex as well. We have to understand how repetitive thoughts and behaviors interact with these other symptom domains or other comorbid conditions.

It seems like he's basically saying that compulsions are things we do to avoid risk (so, hand washing to avoid germs) while impulses are things we do to gain pleasure. Someone with Obsessive-Compulsive Disorder would have intrusive repetitive thoughts (the obsessions) and would then act in a way designed to reduce anxiety about the thought (the compulsion); in my understanding of what Hollander is differentiating, that would mean someone described as "obsessive-impulsive" would, like someone with OCD, have obsessive thoughts, but then rather acting in a way designed to avoid negative consequences, would instead act in a way to seek out pleasure or gratification. My question would be whether that impulsive act was designed to fulfill the obsession (eg, the person would be thinking obsessively about the pleasurable activity and would finally act on it in order to make the thought go away), or derail the obsession (eg, the person is thinking obsessively about something bad happening, and uses the impulsive activity as a distraction from the thought).

(I'm working off a single class in psychopathology here (as well as being fueled by an ironic compulsion to know the answer to your question!), so I may not be getting the whole picture. I would say, through this interview and other bits I'm turning up, that it does look like our understanding of anxiety disorders, OCD, and related disorders is really changing, and so categories may be a bit more in flux than the DSM would lead one to believe.)
posted by occhiblu at 11:42 AM on August 8, 2007 [1 favorite]

It's not a disorder in the DSM-IV, which makes it unlikely that it was offered to someone as a "diagnosis" since psychiatric diagnosis is covered by the DSM in the USA. I've never heard of it (I'm a psychotherapist). It's possible that it was a label for behavior offered from within a particular treatment modality. The desire to have "a diagnosis" is present for many people for many different reasons, and it's hard to speculate without knowing the people involved.

None of which is an attempt to rob it of explanatory power. The concept of psychological diagnosis is fuzzy at best. The DSM, while the standard, is neither very valid nor very reliable. The general concepts can be quite useful, as occhiblu's extended (obsessive, intellectualized, highly defended ;) ) answer shows.

In general impulse control problems are those problems in which folks have trouble filtering their behavior and their actions. There are a bunch of theories for why this might be so, ranging from childhood lead poisoning to problems in the regulation of affect and the development of the superego (conscience).

Obsession is equally variously understood, but the concept is close enough to standard usage that it isn't hard for people to understand what it means. Ideas for why people develop obsessions similarly range from ill-defined ideas about "chemical imbalances" to more psychologically based notions that folks obsess about thing X so as to avoid ever even thinking about thing Z. Interestingly both concepts can be explored in Freud's Mourning and Melancholia where he talks about the problem of not completing the developmental task of getting over the (psychological) loss of one's parents as one gets older and grows away from them. In the healthy person getting over the loss (loss here used in the most general sense of loss of innocence) leads to the formation of the superego and kind of healthy progression, while the melancholic or depressive fails and becomes stuck, getting depressed as a refusal to accept the parents limitations.

Although I don't know obsessive-impulsive disorder as a diagnosis per se, I'd say that your working explanation of the concept works pretty well. I would point out, however, that there is a question raised by all the impulse control disorders about free will, particularly in someone who previously exhibited impulse control: does this diagnosis absolve this person of attempting to control themselves?
posted by OmieWise at 1:51 PM on August 8, 2007

FWIW, my friend is a psychiatrist and she told me that most doctors and anyone with a higher IQ (say >130) tends to have OCPD, as far as she has ever been ever to tell.
posted by acoutu at 2:14 PM on August 8, 2007

as occhiblu's extended (obsessive, intellectualized, highly defended ;) ) answer shows.

:-) I was about an hour into wading through PubMed abstracts on compulsions and obsessions, and had just skimmed through article number four on Compulsive-Impulsive Internet Use, before the irony struck me.

posted by occhiblu at 2:51 PM on August 8, 2007

Thanks, guys. This has given me some great information!
posted by Ms. Saint at 6:48 PM on August 8, 2007

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