Exploring new diagnostic concepts in psychopathology: a clinical and methodological critique to the obsessive-compulsive spectrum (original) (raw)
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Nuovi concetti in psicopatologia: una critica clinico-metodologica allo spettro ossessivo-compulsivo
Official Journal of the Italian Society of Psychopathology, 2006
Aims In view of the DSM-V, the limits of the DSM categorial approach to diagnosis have recently been discussed and alternative concepts like spectrum and dimensional diagnosis were proposed. In this investigation the spectrum will be studied in order to understand if it is enough coherent and consistent. Indeed, the spectrum can be accepted as a possible model for the development of an alternative diagnostic system only if it proves to be better than the current model. Methods A conceptual analysis of the characteristics of the spectrum in psychopathology was first performed. Then, a computerized PubMed search for the years 1980-2005 was made in order to select possible uses of the term spectrum in psychiatric nosology. This search was then expanded through reference lists and other available sources. In order to focalize the research as much as possible, the obsessive-compulsive spectrum was selected as a typical example of spectrum diagnosis. Therefore, this paper focuses on this specific kind of spectrum. Any of the proposed similarities shared by disorders included in the obsessive spectrum were considered in order to determine whether at least one of them was specific for the spectrum (that is, to be present in all the spectrum disorders considered and to be absent in disorders outside the spectrum boundaries). Results The conceptual analysis shows that in psychiatry the term spectrum has been transposed from research in optics to refer to a group of different syndromes the phenomenology of which is partially similar and which are linked on the basis of one common characteristic (usually the hypothesized underlying biological cause). When the obsessive-compulsive spectrum was considered, a single common characteristic, linking all the included disorders, could not be found. On the contrary, it emerged that, even if the included disorders shared some similarities, such as course, sex ratio, age at onset, comorbidity, neurobiology, aetiologic hypotheses and therapeutic response, none of these features was specific to the obsessive spectrum. As a consequence, there were no clear inclusion/exclusion rules, and the list of disorders included into the obsessive-compulsive spectrum was different in different papers, depending mainly on the point of view of the authors rather than on the diagnostic criteria of the spectrum. Conclusions The analysis shows that the obsessive spectrum is an "amorphous" concept without clear diagnostic criteria and with uncertain boundaries. The analysis of other kinds of spectra that have recently been proposed in the diagnostic debate shows that they seem to share, with the obsessive spectrum, a similar indetermination; thus, it is likely that the conclusions reported here may be generalized to other spectra. In conclusion, whether this kind of spectra may be of any help for the advancement of psychiatric nosology is questioned and the answer is skeptical. Accordingly, at present, the spectrum seems to be mainly an instrument to disorganize the current diagnostic system rather than heuristic device to improve psychiatric diagnosis.
Methodological issues in the obsessive–compulsive spectrum
Psychiatry Research, 2009
The obsessive-compulsive spectrum is a heterogeneous class of conditions. Recently, expert consensus has emerged regarding possible candidate disorders [Mataix-Cols, D., Petrusa, A., Leckman, J.F., 2007. Issues for DSM-V: How should obsessive-compulsive and related disorders should be classified. American Journal of Psychiatry, 164, 1313-1314]. Further, expert survey data suggest that obsessive-compulsive disorder is composed of overlapping subtypes. However, methodological approaches for testing whether candidate disorders properly belong in the spectrum have varied widely, and do not necessarily differentiate conditions from subtypes. We describe preliminary methodological and statistical recommendations for a systematic approach to determining what constitutes a subtype, how to determine inclusion in the spectrum, and means for ruling out candidate disorders.
Obsessive-compulsive and related disorders: a critical review of the new diagnostic class
Annual review of clinical psychology, 2015
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders 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, its empirical validity and practical utility are questionable. This article reviews the phenomenology of OCD and then presents a critical analysis of the arguments underlying the new OCRD class. This analysis leads to a rejection of the OCRD classification on both scientific and logical grounds. The article closes with a discussion of the treatment implications of the OCRDs approach.
Depression and Anxiety, 2010
Background: Since the publication of the DSM-IV in 1994, research on obsessive-compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include:
The structure of obsessive-compulsive symptoms
Behaviour Research and Therapy, 1995
In the present study, the structure of obsessive-compulsive symptoms was investigated by means of the Padua Inventory (PI). Simultaneous Components Analysis on data from obsessive-compulsives (n = 206), patients with other anxiety disorders (n = 222), and a non clinical sample (n = 430) revealed a five-factor solution. These factors are: (I) impulses; (II) washing; (III) checking; (IV) rumination; and (V) precision. Forty-one items were selected as measure of these factors. The reliability for the five subscales, assessing each of the five factors, was found to be satisfactory to excellent. Four subscales (washing, checking, rumination and precision) discriminated between panic disorder patients, social phobics and normals on the one hand and obsessive compulsives on the other. The Impulses subscale discriminated between obsessive-compulsives on the one hand and normals on the other, but not between obsessive-compulsives and social phobics or panic patients. Some evidence in support of the construct validity was found. The Padua Inventory-Revised (41-items) appears to measure the structure of obsessive compulsive symptoms: The main types of behaviours and obsessions as seen clinically are assessed by this questionnaire, apart from obsessional slowness.
Assessment of Obsessive‐Compulsive Disorder and Spectrum Disorders
Brief Treatment and Crisis Intervention, 2003
This paper summarizes a variety of assessment tools for use with obsessive-compulsive disorder (OCD) and obsessive-compulsive (OC) spectrum conditions. The description of instruments and methods of assessment is intended to help clinicians identify measures that might be especially useful in determining, first, what problems to address in treatment and, second, whether therapy is having the desired effect. Included are clinician interviews, self-report questionnaires, clinician-rated forms, and behavioral observations and self-monitoring by the patient. These cover patients' presenting symptoms, comorbid conditions, mood, ability to function, family aspects, and cognitive factors including insight, beliefs, and motivation. Clinicians are encouraged to provide immediate feedback about patients' responses to interviews, questionnaires, and behavioral measures so that they understand the purpose of the instrument and its relevance to their treatment. [Brief Treatment and Crisis Intervention 3:169-185 (2003)]
Schizophrenia-spectrum psychopathology in obsessive-compulsive disorder: an empirical study
European Archives of Psychiatry and Clinical Neuroscience, 2019
The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clini-cian. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizo-phrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.
Obsessive-compulsive spectrum disorders
Dialogues in clinical neuroscience, 2003
The obsessive-compulsive spectrum is an important concept referring to a number of disorders drawn from several diagnostic categories that share core obsessive-compulsive features. These disorders can be grouped by the focus of their symptoms: bodily preoccupation, impulse control, or neurological disorders. Although the disorders are clearly distinct from one another, they have intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics, and treatment response. In combination with the knowledge gained through many years of research on obsessive-compulsive disorder (OCD), the concept of a spectrum has generated much fruitful research on the spectrum disorders. It has become apparent that these disorders can also be viewed as being on a continuum of compulsivity to impulsivity, characterized by harm avoidance at the compulsive end and risk seeking at the impulsive end. The compulsive and impulsive disorders differ in systematic ways that are just begi...
Complexities and lesser known aspects of obsessive-compulsive and related disorders
Cognitive and Behavioral Practice, 1994
Obsessive compulsive disorder (OCD) affects 1 out of 40 Americans (Robins et al., 1984). This means that approximately 5 million individuals will develop the disorder during their lifetime. Therefore, as a clinician, the likelihood of being asked to treat this disorder is very high. In addition, when one considers obsessivecompulsive related disorders, (e.g., body dysmorphic disorder, hypochondriasis, trichotillomania, Gilles de la Tourette syndrome) and obsessive compulsive behaviors observed in various conditions, the number of individuals affected is even greater. In approximately 27 years since the development of a behavioral treatment approach for obsessive-compulsive disorder (OCD), many advances have occurred. In this paper, the assessment and behavioral treatment of obsessive compulsive and related disorders will be discussed. In addition, some conditions where obsessive compulsive behavior is common will be explored. Prognostic indicators such as the severity of the initial depression or anxiety and the strength of the belief in the obsession and its role in treatment outcome will be presented. Ways to overcome these barriers will be discussed. Differential Diagnosis and Assessment Tools To date, there is no specific instrument to diagnose OCD: The Yale-Brown Obsessive-Compulsive Scale (YBOCS) (Goodman et al., 1989) is an interview based scale that primarily measures the severity of the symptoms. It does provide a checklist of obsessions and compulsions that the clinician uses to assess