Obsessive Compulsive Spectrum Disorders

Although seemingly unrelated, many disorders involving repetitive behaviors may actually be part of the same family of ailments. These disorders are referred to as the obsessive-compulsive spectrum, and researchers have classified the disorders into three subgroups. The first groups involves excessive preoccupation with body appearance or sensations, seen with eating disorders such as anorexia nervosa. The second group refers to neurologic disorders that involve repetitive behaviors, such as obsessive-compulsive disorder, Tourette's syndrome, and autistic disorder. The third group involves repetitive behaviors driven by pleasure or arousal, such as sexual compulsions, kleptomania, and pathological gambling — high-risk impulse control disorders.

Body Obsessions

Individuals with body obsessions are preoccupied with imagined defects in their appearance. They may have cosmetic surgery or perform other rituals to try to change their appearance. Body dysmorphic disorder is the irrational preoccupation with a defect in one's physical appearance. This is related to the less common olfactory reference syndrome, the obsessive fear that one's body is emitting an unpleasant odor. This category also includes eating disorders: anorexia nervosa, bulimia nervosa, and muscle dysphoria -- a male body image problem sometimes called "bigorexia."

The Brain Keeps Going

Neurologic disorders that are charicterized by repetitive behaviors represent a part of the spectrum. These include disorders then occur as a result of neurological damage, such as obsessive-compulsive disorder, as it can be triggered by strep infection (P.A.N.D.A. -- pediatric autoimmune neuropsychiatirc disorders associated with streptococcal infections). In these cases, strep antibodies attack the basal ganglia area of the brain, (caudate nucleus, putamen, globis pallidus), resulting in sudden onset of the disorder. A similar mechanism can cause Syndenham's Chorea. Related conditions include hypochondriasis, the irrational fear of having a serious disease or medical condition, and Tourette's Syndrome which involves compulsive body tics and often swearing. The pervasive developmental disorders Autism and Asberger's Syndrome, also fall into the category.

Impulse Control Disorders

Repetitive behaviors driven by pleasure or arousal, such as impulse control disorders, are also part of the spectrum. These patients have a hard time controlling their impulses, which leads them to pursue risky activities. The impulsive behaviors relieve tension and result in feelings of pleasure, gratification, and/or relief. These type of impulse control disorders include compulsive gambling, kleptomania or compulsive stealing, pyromania or the deliberate setting of fires, intermittent explosive disorder, and sexual compulsions. Other related disorders are trichotillomania (compulsive hair-pulling), dermatillomania (compulsive skin picking) and onychophagia (nail biting). Impulsive behaviors are not to be confused with compulsive behaviors. Impulsive behaviors are momentarily enjoyed by the patient (egosyntonic), whereas compulsive behaviors cause distress when performed (egodystonic).