Impulsivity and compulsivity in pathological gambling and obsessive-compulsive disorder.

Impulsividade e compulsividade no jogo patológico e no transtorno obsessivo-compulsivo The article by Tavares and Gentil represents an important contribution towards our understanding of the relationship between impulse control disorders (specifically here, pathological gambling PG) and obsessive compulsive disorder (OCD). The authors investigated the clinical characteristics and personality features of three groups, those with: 1) PG; 2) OCD; and 3) neither. Their findings that personality features of novelty seeking and impulsivity were related and elevated in PG, and harm avoidance was elevated in OCD are largely consistent with prior studies, as discussed in the manuscript. The examination of patterns of clinical courses of the disorders and patterns of co-occurring disorders are consistent with the personality findings and the literature on PG and OCD. For example, the data presented on the temporal progression of PG and OCD further suggest a similarity between PG and substance use disorders (i.e., the presence of a “telescoping” phenomenon that is present in women as compared to men) that is absent in OCD. The data presented on the episodic versus continuous nature of symptoms in PG and OCD indicate a more continuous pattern in OCD as compared with PG. The intermittent nature of symptom experience in PG is consistent with the “chronic, relapsing” pattern of behaviors typically ascribed to drug addiction. The high rate of cooccurrence between PG and substance use disorders is consistent with findings from prior studies of clinical and community samples and consistent with considering PG as a non-substance-related addiction. The high rate of co-occurrence between OCD and somatoform disorders and a substantially lower rate of cooccurrence between OCD and substance use disorders suggests that OCD clusters separately from substance use disorders in the structure of psychiatric disorders, although direct investigation of this notion is needed. These data are both useful and timely as considerations for how to classify PG and other impulse control disorders with respect to OCD and substance use disorders in psychiatric nomenclature systems are being discussed. Moreover, as the conceptualizations and categorizations of impulse control disorders have important implications for research, prevention and treatment efforts, the findings have substantial clinical relevance. As often occurs in research, the present study raises a number of important questions. For example, what is the nature of the difference in the shorter symptom consolidation period observed in PG as compared with OCD, and how do processes like denial or insight influence the consolidation periods? What is the nature of compulsivity? Specifically, the authors found that one measure of temperament [Harm Avoidance 2 (HA2) – Fear of Uncertainty vs. Confidence] distinguished individuals with OCD from healthy control subjects without the disorder. The authors then used this feature as a measure of compulsivity. In contrast, the authors used a scale to assess impulsivity and examine its relationship to the temperament features found to distinguish PG from control Editorial