Descriptive Psychopathology: The Signs and Symptoms of ...

296 Section 3: Examination domainsabrasions) and their repeated checking to see if doors are locked, windows areshut, stovetops are unlit, and lights are turned off. They are compelled to placeobjects into special alignment to “straighten-up” the table settings, items on thedesk top, furniture in the room, and pictures on the wall. They automaticallyutter prayers without thought, count the number of incidental things they see(ceiling tiles, lines in the wall paper, chairs in the room, i.e. arithmomania), andsilently repeat trivial words or phrases. They are compelled to perform certainacts or touch certain objects in a specific way for a specified number of times(opening and closing locks, tapping the table setting objects in a specific order fora specific number of times). When the act is completed, they are seized by doubt,and must repeat the ritual again and again. 15 The overwhelming impulse to askperpetual questions, seeking explanations for the most mundane circumstance(folie du pourquoi) and the fear of uttering certain words (onomatomania) are rarecompulsions. Factor analytic studies of persons with OCD identify contamination/washing,symmetry/ordering/hoarding, and checking as common themesin adult and child sufferers. 16HoardingIn 15–20% of patients with OCD, the most prominent early feature of the illnessis hoarding. 17 Useless objects, debris and unneeded purchases are amassed despitethe awareness that the piles of old newspapers, stuffed trash bags, appliances, andeveryday objects serve no purpose and are consuming the sufferer’s living space,often leaving only narrow pathways to various parts of the house or apartment.Patients with chronic manic-depression similarly hoard. Some manic-depressivepatients use these items to decorate themselves or stuff materials into their nosesand ears. 18“Impulse control disorders” that are OCD variants 19Impulsivity is a personality trait that also occurs following traumatic brain injuryto frontal brain regions. 20 Most of the conditions listed in the DSM impulsecontrol disorder category, however, are best understood as compulsive behaviorassociated with OCD. 21 Trichotillomania, kleptomania, and pathological gamblingare compulsions. Obsessions do not define these behaviors, but manypatients with these compulsions have other OCD features. Associated anxietyoccurs when the compulsion is actively inhibited. Some authors consider theseconditions linked to addictive behaviors such as alcohol and substance abuse, 22 butalcoholics and abusers of illicit drugs do not have a greater risk for OCD oranxious–fearful personality traits.Trichotillomania is the compulsion to twirl and pull at one’s hair and can leadto spotty baldness. It is associated with chewing, biting, licking and eating the