Compulsive behaviour in psychiatric disorders
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Compulsive Behaviour in Psychiatric Disorders: Definition and Core Features
Compulsive behaviour is a central feature in several psychiatric disorders, including obsessive-compulsive disorder (OCD), addiction, and compulsive sexual behaviour disorder (CSBD) Hollander2016Luigjes2019Ballester-Arnal2020+1 MORE. It is generally defined as repetitive acts that individuals feel compelled to perform, even when they recognize these actions are not aligned with their overall goals . This sense of being driven to act, despite awareness of the behaviour’s irrationality or maladaptiveness, is a key characteristic across different diagnoses Luigjes2019Robbins2024.
Compulsivity Across Psychiatric Disorders: Prevalence and Comorbidity
Compulsivity is not limited to a single disorder but is observed across a spectrum of psychiatric conditions, often co-occurring with other mental health issues. For example, individuals with CSBD frequently meet criteria for additional Axis I disorders such as mood and anxiety disorders, substance abuse, and major depressive disorder Ballester-Arnal2020Raymond2003. Similarly, compulsive traits are common in OCD and addiction, and these disorders often present with high rates of comorbidity and misdiagnosis, complicating treatment and increasing the burden on individuals and society Hollander2016Ballester-Arnal2020Raymond2003.
Neurobiological and Psychological Mechanisms of Compulsivity
Research highlights that compulsive behaviours are linked to dysfunctions in brain circuits responsible for goal-directed control and habit formation. Specifically, an imbalance between goal-directed and habitual systems in the brain is thought to underlie compulsivity, with excessive reliance on habits and reduced ability to control actions in line with long-term goals Gillan2016Robbins2024Robbins2019+2 MORE. Key brain regions involved include the orbitofrontal cortex, prefrontal cortex, anterior cingulate cortex, insular cortex, and their connections with the basal ganglia Robbins2024Robbins2019Van Den Heuvel2016. Recent studies also implicate the basolateral amygdala-dorsomedial striatum (BLA-DMS) circuit in the development of compulsive-like behaviours, especially under stress .
Dimensional and Transdiagnostic Approaches to Compulsivity
Traditional diagnostic categories may not fully capture the complexity of compulsive behaviours, as deficits in goal-directed control and compulsivity are present across multiple disorders, not just those classically defined as compulsive Gillan2016Robbins2024. A dimensional approach, focusing on symptom dimensions rather than categorical diagnoses, may better reflect the underlying biology and clinical manifestations of compulsivity Gillan2016Robbins2024Gillan2016. This approach can facilitate earlier diagnosis and more targeted treatments Hollander2016Gillan2016.
Societal and Clinical Impact of Compulsive Disorders
Compulsive disorders are often chronic, disabling, and associated with significant socioeconomic costs due to early onset, high comorbidity, and delays in treatment . The persistent nature of compulsive behaviours and their impact on daily functioning highlight the need for improved understanding, early intervention, and more effective treatment strategies Hollander2016Ballester-Arnal2020Raymond2003.
Conclusion
Compulsive behaviour is a core symptom across a range of psychiatric disorders, characterized by repetitive, hard-to-control actions that conflict with personal goals. It is underpinned by neurobiological dysfunctions in brain circuits governing habits and goal-directed behaviour, and is frequently accompanied by other psychiatric conditions. A dimensional, transdiagnostic perspective may improve diagnosis and treatment, ultimately reducing the burden of compulsive disorders on individuals and society Hollander2016Luigjes2019Gillan2016+7 MORE.
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Most relevant research papers on this topic
The cost and impact of compulsivity: A research perspective.
Compulsive disorders cause significant socioeconomic burden and require earlier diagnosis and targeted treatments to improve outcomes.
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Characterizing a psychiatric symptom dimension related to deficits in goal-directed control
Deficits in goal-directed control are strongly associated with a symptom dimension encompassing compulsive behavior and intrusive thoughts, providing a more specific understanding of psychiatric disorders.
Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD).
Compulsive Sexual Behavior Disorder (CSBD) is significantly associated with increased prevalence of various psychiatric conditions, highlighting the need for improved assessment and treatment approaches.
Obsessive-Compulsive Disorder: Puzzles and Prospects
Recent advances in genetic and developmental causation, neuropsychological basis, and treatment options for obsessive-compulsive disorder (OCD) reveal mixed results and potential for new animal models and integrated understanding of its pathophysiology.
Brain circuitry of compulsivity.
Compulsivity is linked to alterations in brain circuits involved in emotional processing, cognitive control, and motor functioning, with neuroplastic changes occurring during chronicity.
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