For those who read my posts up until now, it will have become clear that the general definition of OCD, as presented in the beginning of the blog, is an easily understandable concept when applied to the various dimensions shown in the diagramme. Simply put: the patient has a huge problem stopping something, be it worrisome thoughts that occur in repeating fashion, or compulsive acts that slwo are of a repetitive nature. It’s hard to end these by an effort of will; the clinician says: there is lack of inhibition.
Now, apart from the dimensions I showed there are other disorders of our psyche that have similar characteristics.
Think of a compulsive gambler. He or she can’t stop playing in a casino, for instance. Although that person may be highly intelligent, and know very well that ‘in the end the bank wins always’, ending a game is impossible, even (or especially) when experiencing a lucky streak. There must be a thrill in it all, or a feeling of reward to be active in such a situation of high risk. This may be compared to the feelings of relief a ‘pure’ OCD patient feels after having repeatedly washed or checked.
Think of a woman who thinks she is overweight, and afraid that her body does not answer currently fashionable standards. She may go fasting, may take medication like amphetamines, to slim down. The lure of being thin can be so strong that she eventually dies of her obsession.
Think of compulsive hair-pulling. This is an example of repetitive behaviour that never seems to lead to satisfaction; no, it leads to ungainly bald spots on the head. But the person in question ‘must’ pull his/her hair. With a posh word, this is called trichotillomania (TTM).
For these observations, namely that there is a wider array of disorders that are strongly reminding of ‘pure OCD’, but still more distant cousins so to speak, when observed and described in a clinical settings, the concept of OCD spectrum disorders was coined and defined.
The core of these spectrum disorders is constituted by:
- neurological/motoric disorders (e.g. tics and Tourette’s Disorder or TD);
- impulse control disorders, such as trichotillomania (see above), skin-picking, and gambling;
- bodily preoccupations (or somatoform disorders) (e.g. body dysmorphic disorder or BDD, anorexia nervosa (AN), boulimia, and types of hypochondriasis (excessive worrying about imagined abnormalities).
These primary categories were described by Wetterneck et al (2007), and Fornaro et al (2009). The group of Fornaro compiled a comprehensive diagramme of OCD spectrum disorders:
If you want to have a good look at this picture, please click on it and use the magnifying glass symbol to see the hi-resolution format.
Important note: it is not necessary that you learn all types of OCD-related disorders by heart. I want to present a scheme that allows the reader to understand the complexity of the vast group of disorders that forms the family of the OCD spectrum.
Please keep in mind the core idea here, as I defined above: lack of inhibition.