Impulsivity in obsessive-compulsive disorder: A systematic review and meta-analysis

There is an ongoing debate regarding the role of impulsivity in obsessive-compulsive disorder (OCD). Impulsivity is a complex multidimensional construct, generally defined as the tendency to act without forethought. OCD, in contrast, is associated with preoccupation with the consequences of one's actions, harm and risk avoidance, and was posited to lie on the opposite end of a proposed impulsive-compulsive continuum. The aim of the present study was to conduct a systematic review and meta-analysis of studies comparing OCD and non-clinical controls on self-report measures of impulsivity.

Twenty-seven studies were subjected to analyses (N_OCD = 1547). Separate meta-analyses were conducted on the total scores and the subscale scores of the impulsivity measures used in these studies, primarily the Barratt Impulsivity Scale (BIS).

Results from the meta-analyses showed large effect sizes for the BIS Attention subscale (g = 0.83; 95 % CI = 0.61-1.06), medium effect size for the Nonplanning subscale (g = 0.41; 95 % CI = 0.29-0.53), and very small effect sizes for the Motor subscale (g = 0.17; 95 % CI = 0.02-0.32). These results were complemented by a systematic review, where most studies found significantly elevated attention impulsivity in OCD compared to controls, whereas only a minority of studies reported significantly elevated motor impulsivity.

OCD is not associated with elevated trait-level impulsivity. Inflated total BIS scores frequently result from high Attentional Impulsivity scores on this measure. In addition, individuals with OCD tend to inflate self-reported impulsivity. A pathway toward resolution of the controversy surrounding impulsivity in OCD would be to differentiate between trait and state impulsivity.