Pathological gambling and compulsive buying: do they fall within an obsessive-compulsive spectrum?

Area of Science:

• Psychiatry
• Behavioral Science
• Clinical Psychology

Background:

• Compulsive buying (CB) and pathological gambling (PG) have been theorized to belong to a spectrum of disorders related to obsessive-compulsive disorder (OCD).
• This hypothesis, originating in the early 1990s, lacks substantial empirical support but has influenced diagnostic considerations for DSM-5.
• The classification of these behavioral conditions is critical for accurate diagnosis and treatment.

Purpose of the Study:

• To critically evaluate the obsessive-compulsive (OC) spectrum hypothesis for compulsive buying and pathological gambling.
• To review the existing evidence for and against the inclusion of CB and PG within an OC spectrum.
• To provide recommendations for the classification of CB and PG in future diagnostic manuals.

Main Methods:

• Review of the origin and theoretical basis of the OC spectrum.
• Comprehensive description of compulsive buying and pathological gambling, including history, definition, classification, phenomenology, family history, pathophysiology, and clinical management.
• Analysis of empirical data supporting or refuting the OC spectrum hypothesis for CB and PG.

Main Results:

• Current evidence does not support a relationship between compulsive buying, pathological gambling, and obsessive-compulsive disorder.
• Insufficient data exists to place CB and PG within an OC spectrum in the DSM-5.
• Pathological gambling is better classified within the impulse-control disorders (ICDs).

Conclusions:

• Compulsive buying and pathological gambling are likely not related to OCD and should not be placed within an OC spectrum.
• Pathological gambling should remain classified as an impulse-control disorder.
• A new diagnosis for compulsive buying should be established and classified as an impulse-control disorder.