Obsessive–compulsive or addiction? Categorical diagnostic analysis of excoriation disorder compared to obsessive-compulsive disorder and gambling disorder

• Published in: Psychiatry research 2019-11, Vol.281, p.112518-112518, Article 112518
• Main Authors: Oliveirra, Elen Cristina Batista, Fitzpatrick, Chelsea L., Kim, Hyoun S., Gulassa, Daniel Carr Ribeiro, Amaral, Roberta Souza, Cristiana, Nicoli de Mattos, Hayashiuchi, Ana Yaemi, McGrath, Daniel S., Tavares, Hermano
• Format: Article
• Language: English
• Subjects: Adult; Aged; Behavior, Addictive - classification; Behavior, Addictive - diagnosis; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Disruptive, Impulse Control, and Conduct Disorders - classification; Disruptive, Impulse Control, and Conduct Disorders - diagnosis; DSM-5; Excoriation disorder; Female; Gambling - classification; Gambling - diagnosis; Gambling disorder; Humans; Impulse control disorders; Male; Middle Aged; Obsessive-Compulsive Disorder - classification; Obsessive-Compulsive Disorder - diagnosis; Obsessive–compulsive; Skin picking disorder; Young Adult
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2019.112518

•We compare excoriation disorder (ED), obsessive–compulsive disorder (OCD) and gambling disorder (GD) comorbidity profile with the goal to explore a categorical profile to ED.•Results suggest some ED association with addiction, impulsivity or both.•However, was found that ED share a ground with compulsivity justifying the definitive inclusion of ED within the realm of obsessive–compulsive related disorders spectrum. Excoriation disorder (ED) is currently classified in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders’ Obsessive–compulsive and Related Disorders section (OCRD). However, there remain debates regarding whether ED is related to obsessive–compulsive disorder (OCD) or whether it is better conceptualized as a behavioral addiction. The present research compared the diagnostic overlap and psychiatric comorbidities of 121 individuals seeking treatment for ED (n = 40), OCD (n = 41) and gambling disorder (GD) (n = 40). ED was more likely to overlap with OCD (n = 14) than GD (n = 3). Compared to OCD, ED had similar frequencies of other body focused repetitive behaviors (BFRBs), but higher frequency of addictive behaviors (Odds Ratio – OR = 11.82). In comparison to GD, ED had similar frequencies of addictive behaviors, but higher frequency of BFRBs (OR=19.67). The results support the recent classification of ED as an OCRD. However, ED presents an association with behavioral addictions that suggests a mixed impulsive-compulsive nature. A limitation of the present research was the use of a non-validated semi-structured clinical interview to diagnose impulse control disorders. Future research should examine other characteristics (e.g., epidemiology, neurobiology, genetics, treatment response) to further investigate whether ED should remain classified as an OCRD.