Personality and Psychological Disorders by Claridge Gordon. Davis Caroline & Caroline Davis

Author:Claridge, Gordon.,Davis, Caroline & Caroline Davis [Gordon Claridge]
Language: eng
Format: epub
ISBN: 9781134635740
Publisher: Taylor & Francis (CAM)

Obsessive–Compulsive Spectrum Disorders

In recent years, there has been a growing trend to expand the boundaries of OCD classification – using the label Obsessive–Compulsive Spectrum Disorders (OCSD) – and to include a broad range of Axis I and Axis II disorders which are connected to OCD by virtue of loosely associated similarities in symptomatology, family history, neurobiology, comorbidity, clinical course, and treatment outcome. Among the plethora of syndromes included in the spectrum are those as diverse as somatoform disorders, tic disorders, epilepsy, autism, pathological gambling, borderline personality disorder, and the eating disorders (see Hollander & Wong, 1995 for a more comprehensive list). A common thread that seems to unite all these conditions is that each involves the difficulty, or the inability, to delay or inhibit repetitive behaviours. And, the principal reason investigators cohere these seemingly disparate syndromes is their collective responsiveness to the SRI drugs. However, owing to the obvious diversity among the spectrum disorders, a number of subgroups or clusters have been described within the broader category. These include the bodily appearance disorders, the impulse-control disorders, and the neurological disorders.

Whether this new classification represents a theoretical model with useful implications for improved treatment, or whether it simply obscures by overinclusion and simplification, has been disputed by those working in the field. Therefore, and in an effort to remain objective, we will try and give a balanced view of both positions in the remainder of this chapter. Eric Hollander, a leading proponent of the OCSD classification, has presented an interesting dimensional model of the spectrum disorders, proposing that they are appropriately conceptualized along a continuum of orientation to risk, with the compulsive disorders such as OCD, body dysmorphic disorder and anorexia nervosa, at the ‘risk-avoidance’ end of the continuum, and impulsive disorders such as borderline and antisocial personality disorders at the ‘risk-taking’ end. Psychologically, the two ends of the continuum are distinguished by differences in the motivation that drives the behaviours. In the case of compulsivity, the ritualized behaviours are carried out to reduce anxiety and discomfort, whereas the behaviours associated with impulsivity are seen to maximize pleasure and arousal. Hollander (1996) also described this spectrum within a conceptual biological framework, emphasizing the role of serotonergic dysfunction in all the disorders, though in different ways along the continuum – compulsivity being characterized by brain hyperfrontality and increased 5-HT sensitivity, and impulsivity by hypofrontality and low pre-synaptic 5-HT levels. Of interest, and rather puzzling however, is that some people seem to have both impulsive and compulsive features simultaneously, or at different times during the course of the same disorder.

Recent research suggests that a core feature of this risk-taking dimension is the varying ability to make good decisions, or to delay gratification, if doing so results in a better long-term outcome. The impulsive or high end of the dimension reflects a diminished capacity to do so, and the compulsive end of the spectrum displays a heightened tendency to inhibit reward. To illustrate, rats with a lesion in the core of the nucleus accumbens,

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