Elsevier

Behavior Therapy

Volume 49, Issue 1, January 2018, Pages 1-11
Behavior Therapy

Presidential Address: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5’s New Category

https://doi.org/10.1016/j.beth.2017.06.002Get rights and content

Highlights

  • DSM-5s category of obsessive-compulsive related disorders is critically examined.

  • There are logical and scientific flaws in the arguments supporting the category.

  • An approach based on functional (behavioral) analysis is proposed.

Abstract

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) includes a new class of obsessive-compulsive and related disorders (OCRDs) that includes obsessive-compulsive disorder (OCD) and a handful of other putatively related conditions. Although this new category promises to raise awareness of underrecognized and understudied problems, the empirical validity and practical utility of this new DSM category is questionable. This article critically examines the arguments underlying the new OCRD class, illuminates a number of problems with this class, and then discusses implications for clinicians and researchers.

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)

  • T.R. Insel et al.

    Obsessive-compulsive disorder and serotonin: Is there a connection?

    Biological Psychiatry

    (1985)
  • T.S. Jaisoorya et al.

    The relationship of obsessive-compulsive disorder to putative spectrum disorders: Results from an Indian study

    Comprehensive Psychiatry

    (2003)
  • N.J. Keuthen et al.

    Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin-pickers

    Psychosomatics

    (2000)
  • L. Lovato et al.

    Skin picking and trichotillomania in adults with obsessive-compulsive disorder

    Comprehensive Psychiatry

    (2012)
  • D.J. Luchins et al.

    Repetitive behaviors in chronically institutionalized schizophrenic patients

    Schizophrenia Research

    (1992)
  • S.J. Rachman et al.

    Separating hoarding from OCD

    Behaviour Research and Therapy

    (2009)
  • M.A. Stanley et al.

    A comparison of clinical features in trichotillomania and obsessive-compulsive disorder

    Behaviour Research and Therapy

    (1992)
  • D. Veale et al.

    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

    (2001)
  • S.P. Whiteside et al.

    A meta–analysis of functional neuroimaging in obsessive–compulsive disorder

    Psychiatry Research: Neuroimaging

    (2004)
  • J. Williams et al.

    A meta-analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder

    Behaviour Research and Therapy

    (2006)
  • K. Windheim et al.

    Mirror gazing in body dysmorphic disorder and healthy controls: Effects of duration of gazing

    Behaviour Research and Therapy

    (2011)
  • B. Zurowski et al.

    Non-selective Effects of Selective Serotonin Reuptake Inhibitors

    Biological Psychiatry

    (2008)
  • J.S. Abramowitz et al.

    Exposure Therapy for Anxiety: Principles and Practice

    (2011)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • G.E. Anholt et al.

    Age of onset in obsessive–compulsive disorder: Admixture analysis with a large sample

    Psychological Medicine

    (2014)
  • M.M. Antony et al.

    Diagnostic issues and epidemiology in obsessive–compulsive disorder

  • M. Arbabi et al.

    Efficacy of citalopram in treatment of pathological skin picking, a randomized double blind placebo controlled trial

    Acta Medica Iranica

    (2008)
  • L.M. Arnold et al.

    Psychogenic excoriation: Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment

    CNS Drugs

    (2001)
  • B. Bandelow et al.

    Biological markers for anxiety disorders, OCD and PTSD – a consensus statement. Part I: Neuroimaging and genetics

    The World Journal of Biological Psychiatry

    (2016)
  • B. Bandelow et al.

    Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition

    The World Journal of Biological Psychiatry

    (2017)
  • D.H. Barlow

    Anxiety and its disorders: The nature and treatment of anxiety and panic

    (2004)
  • L.C. Barr et al.

    The serotonin hypothesis of obsessive compulsive disorder

    International Clinical Psychopharmacology

    (1993)
  • M.H. Bloch et al.

    Meta-analysis: Hoarding symptoms associated with poor treatment outcome in obsessive–compulsive disorder

    Molecular Psychiatry

    (2014)
  • 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.

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