Trichotieromania and Alopecia Areata Triggered by Aripiprazole- Methylphenidate Combo in an Autistic Child: The Nexus of Impulsivity-Compulsivity

Traditionally, compulsive disorders and impulsive disorders were regarded at opposite polarities—the former driven by harm-avoidance and the latter by reward-seeking. Convergent evidence from translational studies now suggests a shared tendency toward behavioural disinhibition, from failures in top-down cortical control of fronto-striatal circuits or overactivity within the striatal circuitry. Neurocognitive models posit the existence of separate yet intercommunicating compulsive and impulsive cortico-striatal circuits differentially modulated by neurotransmitters. Anatomical overlap between these functional systems does exist, so that what starts out as a problem in the impulsive circuit may end up as a problem in the compulsive circuit and vice versa.1