Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-21T08:35:31.783Z Has data issue: false hasContentIssue false
  • English
  • Français

Unpacking the role of self-reported compulsivity and impulsivity in obsessive-compulsive disorder

Published online by Cambridge University Press:  10 May 2017

Luisa Prochazkova ,
Linden Parkes Open the ORCID record for Linden Parkes [Opens in a new window] ,
Andrew Dawson ,
George Youssef ,
Gabriela M. Ferreira ,
Valentina Lorenzetti ,
Rebecca A. Segrave ,
Leonardo F. Fontenelle  and
Murat Yücel
Luisa Prochazkova
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
Linden Parkes
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
Andrew Dawson
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
George Youssef
Affiliation:
Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
Gabriela M. Ferreira
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia D'Or Institute for Research and Education, Rio de Janeiro, Brazil
Valentina Lorenzetti
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
Rebecca A. Segrave
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
Leonardo F. Fontenelle
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil D'Or Institute for Research and Education, Rio de Janeiro, Brazil
Murat Yücel*
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
*
*Address correspondence to Murat Yücel, Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, c/o 770 Blackburn Road, Clayton, Victoria 3800, Australia. (Email: murat.yucel@monash.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We aimed to determine whether individuals with obsessive-compulsive disorder (OCD) and demographically matched healthy individuals can be clustered into distinct clinical subtypes based on dimensional measures of their self-reported compulsivity (OBQ–44 and IUS–12) and impulsivity (UPPS–P).

Methods

Participants (n=217) were 103 patients with a clinical diagnosis of OCD; 79 individuals from the community who were “OCD-likely” according to self-report (Obsessive-Compulsive Inventory–Revised scores equal or greater than 21); and 35 healthy controls. All data were collected between 2013 and 2015 using self-report measures that assessed different aspects of compulsivity and impulsivity. Principal component analysis revealed two components broadly representing an individual's level of compulsivity and impulsivity. Unsupervised clustering grouped participants into four subgroups, each representing one part of an orthogonal compulsive-impulsive phenotype.

Results

Clustering converged to yield four subgroups: one group low on both compulsivity and impulsivity, comprised mostly of healthy controls and demonstrating the lowest OCD symptom severity; two groups showing roughly equal clinical severity, but with opposing drivers (i.e., high compulsivity and low impulsivity, and vice versa); and a final group high on both compulsivity and impulsivity and recording the highest clinical severity. Notably, the largest cluster of individuals with OCD was characterized by high impulsivity and low compulsivity. Our results suggest that both impulsivity and compulsivity mediate obsessive-compulsive symptomatology.

Conclusions

Individuals with OCD can be clustered into distinct subtypes based on measures of compulsivity and impulsivity, with the latter being found to be one of the more defining characteristics of the disorder. These dimensions may serve as viable and novel treatment targets.

Keywords

CompulsivityimpulsivityOCDmachine learningsubtypes
Type
Original Research
Information
CNS Spectrums , Volume 23 , Issue 1 , February 2018 , pp. 51 - 58
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

These authors contributed equally.

References

1. Fontenelle, LF, Mendlowicz, MV, Versiani, M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(3): 327–337; Epub ahead of print Jan 18.Google Scholar
2. Hollander, E, Doernberg, E, Shavitt, R, et al. The cost and impact of compulsivity: a research perspective. Eur Neuropsychopharmacol. 2016; 26(5): 800–809; Epub ahead of print Feb 10.CrossRefGoogle ScholarPubMed
3. Fineberg, NA, Brown, A, Reghunandanan, S, Pampaloni, I. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Int J Neuropsychopharmacol. 2012; 15(8): 1173–1191; Epub ahead of print Jan 9. Available at: https://academic.oup.com/ijnp/article-lookup/doi/10.1017/S1461145711001829.CrossRefGoogle Scholar
4. Pauls, DL, Abramovitch, A, Rauch, SL, Geller, DA. Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective. Nat Rev Neurosci. 2014; 15(6): 410–424.CrossRefGoogle ScholarPubMed
5. Gottesman, II, Gould, TD. The endophenotype concept in psychiatry: etymology and strategic intentions. Am J Psychiatry. 2003; 160(4): 636–645; Available at: http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.160.4.636.CrossRefGoogle ScholarPubMed
6. Cuthbert, BN, Insel, TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med. 2013; 11(1): 126 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653747/pdf/1741-7015-11-126.pdf.Google Scholar
7. Fineberg, NA, Chamberlain, SR, Goudriaan, AE, et al. New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr. 2014; 19(1): 69–89; Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113335/pdf/nihms605414.pdf.Google Scholar
8. Gillan, CM, Kosinski, M, Whelan, R, Phelps, EA, Daw, ND. Characterizing a psychiatric symptom dimension related to deficits in goal-directed control. Elife. 2016; 5: 1–24; Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786435/.Google Scholar
9. Robbins, TW, Gillan, CM, Smith, DG, de Wit, S, Ersche, KD. Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends Cogn Sci. 2012; 16(1): 81–91; Epub ahead of print Dec 10, 2011.Google Scholar
10. Grassi, G, Pallanti, S, Righi, L, et al. Think twice: impulsivity and decision making in obsessive-compulsive disorder. J Behav Addict. 2015; 4(4): 263–272; Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712760/.Google Scholar
11. Fontenelle, LF, Oostermeijer, S, Harrison, BJ, Pantelis, C, Yücel, M. Obsessive-compulsive disorder, impulse control disorders and drug addiction: common features and potential treatments. Drugs. 2011; 71(7): 827–840.Google Scholar
12. Chamberlain, SR, Leppink, EW, Redden, SA, Grant, JE. Are obsessive-compulsive symptoms impulsive, compulsive or both? Compr Psychiatry. 2016; 68: 111–118; Epub ahead of print Apr 15.CrossRefGoogle ScholarPubMed
13. Tavares, H, Gentil, V. Pathological gambling and obsessive-compulsive disorder: towards a spectrum of disorders of volition. Rev Bras Psiquiatr. 2007; 29(2): 107–117; Available at: http://www.scielo.br/pdf/rbp/v29n2/a05v29n2.pdf.Google Scholar
14. Chamberlain, SR, Leppink, EW, Redden, SA, Grant, JE. Are obsessive-compulsive symptoms impulsive, compulsive or both? Compr Psychiatry. 2016; 68: 111–118; Epub ahead of print Apr 15.Google Scholar
15. Benatti, B, Dell'Osso, B, Arici, C, Hollander, E, Altamura, AC. Characterizing impulsivity profile in patients with obsessive-compulsive disorder. Int J Psychiatry Clin Pract. 2014; 18(3): 156–160.CrossRefGoogle ScholarPubMed
16. Boisseau, CL, Thompson-Brenner, H, Caldwell-Harris, C, Pratt, E, Farchione, T, Barlow, DH. Behavioral and cognitive impulsivity in obsessive-compulsive disorder and eating disorders. Psychiatry Res. 2012; 200(2–3): 1062–1066.CrossRefGoogle ScholarPubMed
17. Ettelt, S, Ruhrmann, S, Barnow, S, et al. Impulsiveness in obsessive-compulsive disorder: results from a family study. Acta Psychiatr Scand. 2007; 115(1): 41–47.CrossRefGoogle ScholarPubMed
18. Sohn, SY, Kang, JI, Namkoong, K, Kim, SJ. Multidimensional measures of impulsivity in obsessive-compulsive disorder: cannot wait and stop. PLoS One. 2014; 9(11): e111739 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221112/pdf/pone.0111739.pdf.CrossRefGoogle ScholarPubMed
19. Summerfeldt, LJ, Hood, K, Antony, MM, Richter, MA, Swinson, RP. Impulsivity in obsessive-compulsive disorder: comparisons with other anxiety disorders and within tic-related subgroups. Pers Individ Dif. 2004; 36(3): 539–553.CrossRefGoogle Scholar
20. Zermatten, A, Van der Linden, M. Impulsivity in non-clinical persons with obsessive-compulsive symptoms. Pers Individ Dif. 2008; 44(8): 1824–1830.Google Scholar
21. Cavedini, P, Riboldi, G, D'Annucci, A, Belotti, P, Cisima, M, Bellodi, L. Decision-making heterogeneity in obsessive-compulsive disorder: ventromedial prefrontal cortex function predicts different treatment outcomes. Neuropsychologia. 2002; 40(2): 205–211.Google Scholar
22. Cavedini, P, Zorzi, C, Piccinni, M, Cavallini, MC, Bellodi, L. Executive dysfunctions in obsessive-compulsive patients and unaffected relatives: searching for a new intermediate phenotype. Biol Psychiatry. 2010; 67(12): 1178–1184; Epub ahead of print Apr 8.Google Scholar
23. da Rocha, FF, Alvarenga, NB, Malloy-Diniz, L, Corrêa, H. Decision-making impairment in obsessive-compulsive disorder as measured by the Iowa Gambling Task. Arq Neuropsiquiatr. 2011; 69(4): 642–647; Available at: http://www.scielo.br/pdf/anp/v69n4/a13v69n4.pdf.CrossRefGoogle ScholarPubMed
24. Kashyap, H, Fontenelle, LF, Miguel, EC, et al. “Impulsive compulsivity” in obsessive-compulsive disorder: a phenotypic marker of patients with poor clinical outcome. J Psychiatr Res. 2012; 46(9): 1146–1152.Google Scholar
25. Kim, HW, Kang, JI, Namkoong, K, Jhung, K, Ha, RY, Kim, SJ. Further evidence of a dissociation between decision-making under ambiguity and decision-making under risk in obsessive-compulsive disorder. J Affect Disord. 2015; 176: 118–124.Google Scholar
26. Kodaira, M, Iwadare, Y, Ushijima, H, et al. Poor performance on the Iowa Gambling Task in children with obsessive-compulsive disorder. Ann Gen Psychiatry. 2012; 11(1): 1–7; Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508952/pdf/1744-859X-11-25.pdf.Google Scholar
27. Starcke, K, Tuschen-Caffier, B, Markowitsch, HJ, Brand, M. Dissociation of decisions in ambiguous and risky situations in obsessive-compulsive disorder. Psychiatry Res. 2010; 175(1–2): 114–120.Google Scholar
28. Zhang, L, Dong, Y, Ji, Y, et al. Trait-related decision making impairment in obsessive-compulsive disorder: evidence from decision making under ambiguity but not decision making under risk. Sci Rep. 2015; 5: 17312 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658550/.Google Scholar
29. Fontenelle, LF, Oostermeijer, S, Ferreira, GM, Lorenzetti, V, Luigjes, J, Yücel, M. Anticipated reward in obsessive-compulsive disorder. J Clin Psychiatry. 2015; 76(9): e1134–e1135; Available at: http://www.psychiatrist.com/jcp/article/Pages/2015/v76n09/v76n0908.aspx.Google Scholar
30. Cavedini, P, Zorzi, C, Baraldi, C, et al. The somatic marker affecting decisional processes in obsessive-compulsive disorder. Cogn Neuropsychiatry. 2012; 17(2): 177–190.Google Scholar
31. Wright, L, Lipszyc, J, Dupuis, A, Thayapararajah, SW, Schachar, R. Response inhibition and psychopathology: a meta-analysis of go/no-go task performance. J Abnorm Psychol. 2014; 123(2): 429–439.Google Scholar
32. Lei, H, Zhu, X, Fan, J, et al. Is impaired response inhibition independent of symptom dimensions in obsessive-compulsive disorder? Evidence from ERPs. Sci Rep. 2015; 5: 10413 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438428/.Google Scholar
33. Bannon, S, Gonsalvez, CJ, Croft, RJ, Boyce, PM. Response inhibition deficits in obsessive-compulsive disorder. Psychiatry Res. 2002; 110(2): 165–174.CrossRefGoogle ScholarPubMed
34. Chamberlain, SR, Fineberg, NA, Blackwell, AD, Robbins, TW, Sahakian, BJ. Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. Am J Psychiatry. 2006; 163(7): 1282–1284.CrossRefGoogle ScholarPubMed
35. Figee, M, van den Munckhof, P, Schuurman, R, Denys, D. Neuroimaging deep brain stimulation in psychiatric disorders. In Denys D et al eds. Deep Brain Stimulation: A New Frontier in Psychiatry. New York: Springer Science; 2012: 225–236.CrossRefGoogle Scholar
36. Basar, K, Sesia, T, Groenewegen, H, Steinbusch, HWM, Visser-Vandewalle, V, Temel, Y. Nucleus accumbens and impulsivity. Prog Neurobiol. 2010; 92(4): 533–557.CrossRefGoogle ScholarPubMed
37. Knutson, B, Adams, CM, Fong, GW, Hommer, D. Anticipation of increasing monetary reward selectively recruits nucleus accumbens. J Neurosci. 2001; 21(16): 1–5; Available at: http://www.jneurosci.org/content/jneuro/21/16/RC159.full.pdf.Google Scholar
38. Foa, EB, Huppert, JD, Leiberg, S, et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess. 2002; 14(4): 485–495.Google Scholar
39. Carleton, RN, Norton, MA, Asmundson, GJ. Fearing the unknown: a short version of the Intolerance of Uncertainty Scale. J Anxiety Disord. 2007; 21(1): 105–117; Epub ahead of print May 2, 2006.Google Scholar
40. Obsessive-Compulsive Cognitions Working Group. Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory, part 2: factor analyses and testing of a brief version. Behav Res Ther. 2005; 43(11): 1527–1542.Google Scholar
41. Tolin, DF, Abramowitz, JS, Brigidi, BD, Foa, EB. Intolerance of uncertainty in obsessive-compulsive disorder. J Anxiety Disord. 2003; 17(2): 233–242.Google Scholar
42. Gentes, EL, Ruscio, AM. A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorder. Clin Psychol Rev. 2011; 31(6): 923–933.Google Scholar
43. Cyders, MA, Smith, GT, Spillane, NS, Fischer, S, Annus, AM, Peterson, C. Integration of impulsivity and positive mood to predict risky behavior: development and validation of a measure of positive urgency. Psychol Assess. 2007; 19(1): 107–118.Google Scholar
44. Whiteside, SP, Lynam, DR, Miller, JD, Reynolds, SK. Validation of the UPPS impulsive behaviour scale: a four-factor model of impulsivity. Eur J Pers. 2005; 19(7): 559–574.CrossRefGoogle Scholar
45. Beck, AT, Steer, RA, Brown, GK. Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation; 1996.Google Scholar
46. Hastie, T, Tibshirani, R, Friedman, J. The Elements of Statistical Learning: Data Mining, Inference, and Prediction Springer Series in Statistics New York: Springer Science; 2009. Available at: http://statweb.stanford.edu/~tibs/ElemStatLearn/printings/ESLII_print10.pdf.Google Scholar
47. Cuthbert, BN, Kozak, MJ. Constructing constructs for psychopathology: the NIMH research domain criteria. J Abnorm Psychol. 2013; 122(3): 928–937.Google Scholar
48. Zhang, T, Ramakrishnan, R, Livny, M. BIRCH: an efficient data clustering method for very large databases. In: Proceedings of the 1996 ACM SIGMOD International Conference on Management of Data. New York: Association for Computing Machinery; 1996: 103–114. Available at: https://www.cs.sfu.ca/CourseCentral/459/han/papers/zhang96.pdf.Google Scholar
49. Fineberg, NA, Potenza, MN, Chamberlain, SR, et al. Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review. Neuropsychopharmacology. 2010; 35(3): 591–604; Epub ahead of print Nov 25, 2009. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055606/pdf/npp2009185a.pdf.Google Scholar
50. Abramovitch, A, McKay, D. Behavioral impulsivity in obsessive-compulsive disorder. J Behav Addict. 2016; 5(3): 395–387; Epub ahead of print May 9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264405/.Google Scholar
51. Stein, DJ, Hollander, E, Simeon, D, Cohen, L. Impulsivity scores in patients with obsessive-compulsive disorder. J Nerv Ment Dis. 1994; 182(4): 240–241.CrossRefGoogle ScholarPubMed
52. Visser, HA, van Oppen, P, van Megen, HJ, Eikelenboom, M, van Balkom, AJ. Obsessive-compulsive disorder; chronic versus non-chronic symptoms. J Affect Disord. 2014; 152–154(1): 169–174; Epub ahead of print Sep 13, 2013.Google Scholar
53. Sandyk, R. Naloxone abolishes obsessive-compulsive behavior in Tourette's syndrome. Int J Neurosci. 1987; 35(1–2): 93–94.Google Scholar
54. Berlin, HA, Koran, LM, Jenike, MA, et al. Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2011; 72(5): 716–721; Epub ahead of print Aug 10, 2010.Google Scholar
55. Amiaz, R, Fostick, L, Gershon, A, Zohar, J. Naltrexone augmentation in OCD: a double-blind placebo-controlled cross-over study. Eur Neuropsychopharmacol. 2008; 18(6): 455–461; Epub ahead of print Mar 18.Google Scholar
56. Insel, TR, Pickar, D. Naloxone administration in obsessive-compulsive disorder: report of two cases. Am J Psychiatry. 1983; 140(9): 1219–1220.Google Scholar
57. Grant, JE, Kim, SW. Brain circuitry of compulsivity and impulsivity. CNS Spectr . 2014; 19(1): 21–27; Epub ahead of print May 10, 2013.Google Scholar
Supplementary material: File

Prochazkova supplementary material

Prochazkova supplementary material

Download Prochazkova supplementary material(File)
File 76.8 KB