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Both compulsive buying (CB) and pathological gambling (PG) have been proposed as members of a spectrum of disorders related to obsessive-compulsive disorder (OCD). The spectrum hypothesis originated in the early 1990s and has gained considerable support, despite the lack of empirical evidence. Interest in this hypothesis has become critical because some investigators have recommended the creation of a new category that includes these disorders in DSM-5, now under development. In this article, the authors describe the origin of the obsessive-compulsive (OC) spectrum and its theoretical underpinnings, review both CB and PG, and discuss the data both in support of and against an OC spectrum. Both disorders are described in terms of their history, definition, classification, phenomenology, family history, pathophysiology, and clinical management. The authors conclude that: (i) CB and PG are probably not related to OCD, and there is insufficient evidence to place them within an OC spectrum in DSM-V; (ii) PG should stay with the impulse-control disorders (ICDs); and ( iii) a new diagnosis of CB should be created and be classified as an ICD.

In the early 1990s, interest began to grow around the concept of an obsessive-compulsive (OC) spectrum. Hollander and others - wrote of a spectrum of disorders related to obsessive-compulsive disorder (OCD).

Based on his experience as an OCD researcher, Hollander considered OCD to be at the center of the spectrum, and described its breadth and overlap with many other psychiatric disorders. These disorders were considered to lie along orthogonal axes of impulsivity vs compulsiveness, uncertainty vs certainty, and cognitive vs motoric (features). The OC spectrum concept was quickly embraced by other investigators because it offered a new way to think about the relationship among many neglected disorders, and it potentially offered new treatment options., Not all investigators have agreed, and several critical reviews have appeared. - Despite the criticism, the concept of a group of disorders being related to OCD remains of great theoretical interest. The idea that disorders are related is crucial to classification schemes, and why should a group of disorders not be related to OCD? This question is now of singular interest because those responsible for developing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) must decide whether to create a separate category for OCD and potentially related disorders, or to keep OCD with the anxiety disorders.

If they create a new category for the OC spectrum they will need to determine its breadth. The OC spectrum's boundaries have expanded or contracted according to the views of the investigator concerned. It has been described as including disorders of impulse control such as pathological gambling (PG), trichotillomania, and kleptomania; Tourette's and other tic disorders; impulsive personality disorders (eg, borderline personality disorder); hypochondriasis and body dysmorphic disorder; eating disorders; and several disorders not currently recognized in DSM-IV-TR such as compulsive buying (CB) and sexual addiction. - Few investigators have offered evidence to validate a relationship among the disorders.

Typically, such evidence might include comparisons of phenomenology, natural history, family history, biological markers, and treatment response. OCD holds an important place at the center of the spectrum. Currently classified in DSM-IV-TR as an anxiety disorder, OCD is independent of other anxiety disorders in the International Classification of Diseases (ICD) system, and a strong rationale has been presented by Zohar et al for its separation from these disorders. First, OCD often begins in childhood, whereas other anxiety disorders typically have a later age of onset. OCD has a nearly equal gender distribution, unlike the other anxiety disorders, which are more common in women. Studies of psychiatric comorbidity show that, unlike the other anxiety disorders, persons with OCD generally tend not to have elevated rates of substance misuse.