Presidential Address: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5’s New Category☆
Section snippets
Phenomenology of OCD
One cardinal feature of OCD is obsessions: persistent intrusive thoughts, ideas, images, and doubts that are experienced as unwanted, unacceptable, or senseless. Obsessions evoke distress (e.g., anxiety, guilt, doubt) concerning the possibility or uncertainty of unwanted consequences (e.g., illness, harming) and are not simply worries about everyday topics. Moreover, obsessions typically relate to a finite number of themes, including (a) contamination and illness; (b) responsibility for harm or
OCD as an Anxiety Disorder
Through DSM-IV-TR, OCD was included among the anxiety disorders along with social and specific phobias, panic disorder and agoraphobia, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). This grouping made sense on two levels. First, at a purely descriptive level, OCD symptoms are remarkably similar to the main features of anxiety disorders: excessive and irrational fear, anxious apprehension, and avoidance behavior. Although not mentioned in DSM, rituals such as
What Happened in DSM-5?
If OCD fit among the anxiety disorders, why was it moved in DSM-5? It turns out that some DSM-5 architects felt that OCD was incorrectly classified as an anxiety disorder because it bears greater similarity to other disorders (i.e., the OCRDs) that share “compulsive behavior and failures in behavioral inhibition” rather than anxiety (Fineberg, Saxena, Zohar, & Craig, 2011, p. 21). Ultimately, those who made decisions about the DSM-5 (e.g., Fineberg et al., 2011, Hollander et al., 2005) provided
Repetitive thoughts and behaviors in ocd and ocrds
The DSM-5 states that OCD and the other OCRDs are “characterized by preoccupations and by repetitive behaviors or mental acts in response to the preoccupations” and “recurrent body-focused repetitive behaviors (e.g., hair pulling, skin picking) and repeated attempts to decrease or stop the behaviors” (American Psychiatric Association, 2013, p. 235). To this end, the unifying factor among the OCRDs is the presence of repetitive thoughts and behaviors that the person seemingly cannot stop.
At this
Conclusions and Challenges
The DSM-5 has many limitations, extending well beyond problems with the new OCRD category. Indeed, the reliability and validity of the very conditions it describes are highly questionable. But in light of these problems, let me issue a call to arms for ABCT and offer some constructive suggestions for moving forward with research and clinical practice more generally in light of this year’s convention theme focusing on empirically supported psychological principles and mechanisms of
Conflict of Interest Statement
The author declares that there are no conflicts of interest.
References (66)
- et al.
The status of hoarding as a symptom of obsessive-compulsive disorder
Behaviour Research and Therapy
(2008) - et al.
The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study
Biological Psychiatry
(2000) - et al.
Age at onset and clinical correlates in body dysmorphic disorder
Comprehensive Psychiatry
(2013) - et al.
Systematic review: Pharmacological and behavioral treatment for trichotillomania
Biological Psychiatry
(2007) - et al.
Identification of trichotillomania cue profiles
Behaviour Research and Therapy
(1993) - et al.
Hoarding behaviors in a large college sample
Behaviour Research and Therapy
(2003) - et al.
Reply
Biological Psychiatry
(2008) - et al.
Affective correlates of trichotillomania
Behaviour Research and Therapy
(2002) - et al.
A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder
Clinical Psychology Review
(2004) - et al.
Age of onset of compulsive hoarding
Journal of Anxiety Disorders
(2006)
Obsessive-compulsive disorder and serotonin: Is there a connection?
Biological Psychiatry
The relationship of obsessive-compulsive disorder to putative spectrum disorders: Results from an Indian study
Comprehensive Psychiatry
Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin-pickers
Psychosomatics
Skin picking and trichotillomania in adults with obsessive-compulsive disorder
Comprehensive Psychiatry
Repetitive behaviors in chronically institutionalized schizophrenic patients
Schizophrenia Research
Separating hoarding from OCD
Behaviour Research and Therapy
A comparison of clinical features in trichotillomania and obsessive-compulsive disorder
Behaviour Research and Therapy
Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder
Behaviour Research and Therapy
A meta–analysis of functional neuroimaging in obsessive–compulsive disorder
Psychiatry Research: Neuroimaging
A meta-analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder
Behaviour Research and Therapy
Mirror gazing in body dysmorphic disorder and healthy controls: Effects of duration of gazing
Behaviour Research and Therapy
Non-selective Effects of Selective Serotonin Reuptake Inhibitors
Biological Psychiatry
Exposure Therapy for Anxiety: Principles and Practice
Diagnostic and statistical manual of mental disorders
Age of onset in obsessive–compulsive disorder: Admixture analysis with a large sample
Psychological Medicine
Diagnostic issues and epidemiology in obsessive–compulsive disorder
Efficacy of citalopram in treatment of pathological skin picking, a randomized double blind placebo controlled trial
Acta Medica Iranica
Psychogenic excoriation: Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment
CNS Drugs
Biological markers for anxiety disorders, OCD and PTSD – a consensus statement. Part I: Neuroimaging and genetics
The World Journal of Biological Psychiatry
Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition
The World Journal of Biological Psychiatry
Anxiety and its disorders: The nature and treatment of anxiety and panic
The serotonin hypothesis of obsessive compulsive disorder
International Clinical Psychopharmacology
Meta-analysis: Hoarding symptoms associated with poor treatment outcome in obsessive–compulsive disorder
Molecular Psychiatry
Cited by (0)
- ☆
This article is based on the Presidential Address delivered by Jonathan S. Abramowitz at the 49th Annual Association for Behavioral and Cognitive Therapies (ABCT) convention in Chicago on November 14, 2015. I would like to thank Ryan Jane Jacoby, Lillian Reuman, and Shannon Blakey for their helpful feedback in preparing this address.