Phenomenology of OCD: Lessons from a large multicenter study and implications for ICD-11 (original) (raw)
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Molecular Psychiatry, 2006
Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms representing multiple domains. This complex phenotype can be summarized using a few consistent and temporally stable symptom dimensions. The objective of this study was to assess the psychometric properties of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS). This scale measures the presence and severity of obsessive-compulsive (OC) symptoms within six distinct dimensions that combine thematically related obsessions and compulsions. The DY-BOCS includes portions to be used as a self-report instrument and portions to be used by expert raters, including global ratings of OC symptom severity and overall impairment. We assessed 137 patients with a DSM-IV diagnosis of OCD, aged 6-69 years, from sites in the USA, Canada and Brazil. Estimates of the reliability and validity of both the expert and self-report versions of the DY-BOCS were calculated. The internal consistency of each of the six symptom dimensions and the global severity score were excellent. The interrater agreement was also excellent for all component scores. Self-report and expert ratings were highly intercorrelated. The global DY-BOCS score was highly correlated with the total Yale-Brown Obsessive-Compulsive Scale score (Pearson r = 0.82, P < 0.0001). Severity scores for individual symptom dimensions were largely independent of one another, only modestly correlated with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. These results indicate that the DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in natural history, neuroimaging, treatment response and genetic studies when administered by expert clinicians or their highly trained staff.
2020
Background: We report results of an internet-based field study evaluating the diagnostic guidelines for the newly introduced ICD-11 grouping of obsessive-compulsive and related disorders (OCRD). We examined accuracy of clinicians’ diagnostic judgments applying draft ICD-11 as compared to the ICD-10 diagnostic guidelines to standardized case vignettes. Methods: 1,717 mental health professionals who were members of the World Health Organization’s Global Clinical Practice Network completed the study in Chinese, English, French, Japanese, Russian or Spanish. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of nine pairs of case vignettes. Results: Participants using ICD-11 outperformed those using ICD-10 in correctly identifying newly introduced OCRD, although results were mixed for differentiating OCRD from disorders in other groupings largely due to clinicians having difficulty differentiating challenging presentations of OCD. Clinicians had difficulty a...
Psychiatry Research, 2011
The Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC) was designed as a novel instrument for clinicians to assess the main cognitive and executive impairments that are hypothesized to underpin the impact of obsessive-compulsive symptoms on functioning in patients with obsessivecompulsive disorder (OCD). Initially, 18 items were selected based upon observation in the laboratory and clinical research setting, then refined to a definitive 13-item scale after excluding items due to statistical criteria. In a study involving two raters, 50 patients diagnosed with OCD were assessed using the self-rated and clinician-rated versions of the new scale. OCD patients' scores fell in the region of moderate severity on both clinician and self-rated versions of the CAIOC-13. Inter-rater reliability and Cronbach's alpha scores were satisfactory. Factor analysis indicated a one factor solution confirming its unidimensionality. Significantly higher scores in the OCD group compared to a depression group (n = 31) and a healthy control group (n = 55) were revealed. Scores on the clinician and self-rated versions of the 13-item CAIOC appear valid and reliable measures of the severity of functional impairment associated with OCD. Further validation, including research into the relationship of the CAIOC-13 with laboratory measures of cognitive impairment and evaluation of its sensitivity is indicated.
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
PLOS ONE, 2019
In this study, it is aimed to determine obsessive compulsive-related disorders (OCRDs) comorbidity among the patients with obsessive compulsive disorder (OCD) and compare patients with OCD with or without comorbid OCRDs in terms of the severity of their OCD symptoms, symptom dimensions, and comorbidity with other axis I disorders. Methods The study included 90 patients diagnosed as having OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for OCRDs were used to determine the presence of OCRDs. In order to determine the symptom dimensions and severity of these individuals' OCD symptoms, we administered the Dimensional Obsessive Compulsive Scale (DOCS) and The Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results In our study, 20% of the patients with OCD simultaneously met the criteria for at least one OCRD, we also found that a significantly greater proportion of this group were men. None of the mentioned disorders was associated with any symptom dimensions we evaluated using DOCS. In addition, no differences were found in the severity of OCD symptoms and comorbid axis I disorders between the group with comorbid OCRDs and the group without comorbid OCRDs. Discussion There was no significant relationship between the symptom dimensions of OCD and OCRDs. It is found that OCRD comorbidity does not increase the severity of OCD symptoms and the prevalence of an axis I diagnosis.
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: (1) clarifying and simplifying the definition of obsessions and compulsions(criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions-A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses.
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.
Obsessive–Compulsive Disorder with and without a Chronic Tic Disorder
British Journal of Psychiatry, 1994
The phenomenological features of 35 obsessive–compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale–Brown Obsessive–Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.