(PS7-10) Disentangling a Debate: A Systematic Review and Meta-analysis of Self-reported Impulsivity in OCD

Abstract Text:

Background: Obsessive-Compulsive Disorder (OCD) is a frequently debilitating disorder characterized by obsessions and compulsions. OCD is associated with preoccupation with the consequences of one’s actions, and avoidance of risk and accidental harm. Accordingly, OCD has been posited to lie on the compulsive end of an impulsive-compulsive continuum. However, some research has suggested that OCD is associated with behavioral impulsivity, defined as the tendency to act without forethought, often resulting in negative consequences. The aim of the present study was to disentangle this longstanding controversy by conducting a systematic review and meta-analysis of self-reported impulsivity in OCD versus controls.

Methods: Twenty-seven studies (nOCD = 1,547) comparing OCD to nonclinical controls on self-report measures of impulsivity, primarily the Barratt Impulsiveness Scale (BIS). A systematic review and several separate meta-analyses were conducted for total scores and subscale scores of impulsivity measures.

Results: Results from the systematic review indicated that while most studies did not identify significant differences in behavioral impulsivity between OCD and control participants, the majority reported significantly higher attentional impulsivity (difficulty controlling thoughts) scores in OCD compared to controls, which inflated the total impulsivity score. Meta-analytic analyses corroborated these findings. A small but significant effect size was found for total impulsivity scores (g = 0.39, p < .001), while a large significant effect size was observed for attentional impulsivity (g = 0.83, p < .001)) and a small, non-significant effect size was found for behavioral impulsivity (g = 0.17, p = .06). Additionally, a small significant effect size was identified for non-planning impulsivity (g = 0.38, p < .001).

Conclusion: OCD is not associated with elevated trait-level behavioral impulsivity. However, as expected, OCD is associated with significant problems controlling thoughts (i.e., BIS attention impulsivity). This echoes several reports that found that in OCD, the total impulsivity scores, particularly on the BIS, frequently result from high attentional impulsivity sub-scores, and the tendency for individuals with OCD to overstate self-reported levels of impulsivity. These findings may resolve the apparent discrepancy where some studies may erroneously imply or directly report elevated trait level self-reported behavioral impulsivity in OCD. Future research examining trait versus state impulsivity in OCD is warranted.