In order to elucidate the relationship between impulse control disorders and obsessive-compulsive disorder (OCD), it is essential to study more clinically homogenous subgroups of patients with impulsive disorders. Using four cases of patients with OCD and comorbid paraphilias (transvestic fetishism, sadism, gynandromorphophilia, and exhibitionism) as reference-points, we discuss the concepts of compulsivity, impulsivity, and the temporal relationship between them. The case studies here described suggest that (1) patients with OCD and comorbid paraphilias tend to develop OCD first, (2) once developing paraphilic fantasies, desires, or behaviors, patients with OCD can exhibit typical compulsive behaviors in an attempt to keep these phenomena under control, (3) patients with OCD and ego-dystonic sexual obsessions can develop paraphilic fantasies, desires, or behaviors with similar content to the first phenomenon, (4) OCD and paraphilias can follow independent courses in the same patient, and (5) patients with OCD and paraphilias may not present obsessions with sexual content. The distress presented by patients with OCD and paraphilias give good reason for the continuous investigation of this association, aiming at clarifying the neurobiological mechanisms underlying this association.
Obsessive-compulsive disorder; paraphilia; impulse control disorder