On the other hand, data suggest many commonalities with the substance use disorders. PG and CB are both associated with cravings that are not unlike those reported by substance abusers; PG is noted to produce “withdrawal” symptoms when the gambler is abstinent,119 though this has not been studied in CB. Research shows that persons with PG or CB often have Inhibitors,research,lifescience,medical comorbid substance use disorders. Conversely, substance abusers have high rates of PG; there are no comparable data for CB. Family studies show that relatives of probands with PG or CB have high rates of

psychiatric illness, particularly alcohol and drug use disorders. Further, Slutske et al94 have reported that, based on twin data, PG appears to be related to the substance-use disorders and antisocial personality

disorder. Finally, as noted earlier, the neuroimaging studies, and both neurotransmitters Inhibitors,research,lifescience,medical and molecular genetic research on PG suggest a relationship with the substance-use disorders.116 These data support the inclusion of PG and perhaps CB in a category for “behavioral addictions,” possibly comprising a subset of the substance-use disorders, but they do not support a relationship with OCD. Conclusions The review suggests that CB and PG are probably not candidates for inclusion in an OC spectrum. The review was not meant to judge the merit of the OC spectrum concept. In fact, we have suggested that there appears to be sufficient Inhibitors,research,lifescience,medical evidence to support the existence of a limited OC spectrum that might include body dysmorphic disorder, Tourette’s disorder, trichotillomania, subclinical OCD, and Inhibitors,research,lifescience,medical perhaps the grooming disorders.8,120 While there are superficial phenomenologic similarities between CB/PG and OCD, other evidence suggests they are not associated: gender distribution, age at onset, and course; comorbidity studies; neuroimaging, neurotransmitter, and neuropsychological studies; and treatment response. We believe that PG and CB are likely related, despite Inhibitors,research,lifescience,medical their much different

gender distribution. Further, we believe that in the absence of new and convincing evidence, PG ought to remain within the ICD category. Lastly, we believe that CB is an identifiable and distinct disorder that ought to be included in DSM-5, and should be included with the ICDs. Selected abbreviations and acronyms CB compulsive buying ICD impulse-control disorder OC obsessive-compulsive OCD obsessive-compulsive disorder Carnitine palmitoyltransferase II PG pathological gambling SSRI selective serotonin reuptake E7080 clinical trial inhibitor
Obsessive-compulsive disorder (OCD) is a major public health problem. OCD is a severe and chronically debilitating disorder, affecting over 3 million people in the United States alone. People afflicted with OCD have distressing obsessions and compulsions that cripple their functioning in everyday life.1,2 According to the World Health Organization, OCD is among the ten most disabling medical conditions worldwide.