Elsevier

Psychiatry Research

Volume 170, Issue 1, 30 November 2009, Pages 3-6
Psychiatry Research

Review article
Cross-cutting issues and future directions for the OCD spectrum

https://doi.org/10.1016/j.psychres.2008.07.015Get rights and content

Abstract

The research planning agenda for DSM-V examined possible similarities in phenomenology, comorbidity, familial and genetic features, brain circuitry, and treatment response between obsessive-compulsive disorder (OCD) and several related disorders that are characterized by repetitive thoughts or behaviors. Such data support a re-examination of the DSM-IV-TR classification of OCD and the anxiety disorders, with possible inclusion of a group of obsessive-compulsive spectrum disorders (OCSDs) in DSM-V. Various disorders were systematically examined for inclusion in such a grouping, and later a smaller number were determined to meet threshold criteria for inclusion in the OCSDs. The disorders that were originally examined included OCD, obsessive-compulsive personality disorder (OCPD), Tourette's syndrome (TS) and other tic disorders, Sydenham's chorea, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), trichotillomania (TTM), body dysmorphic disorder (BDD), autism, eating disorders, Huntington's and Parkinson's disease, impulse control disorders, as well as substance and behavioral addictions. Certain disorders such as BDD, OCPD, TS, and TTM share many commonalities with OCD in phenomenology, comorbidity, familial and genetic features, brain circuitry, and treatment response. Other disorders, such as the impulse control disorders (ICDs) share some common features with OCD, but also differ in many ways as well. The articles presented in this issue of Psychiatry Research are a result of this international collaboration, which examined diagnostic and classification issues of OCSDs for DSM-V in a conference titled “The Future of Psychiatric Diagnosis: Refining the Research Agenda: Obsessive-Compulsive Behavior Spectrum” held in June 2006 at the American Psychiatric Association's headquarters in Arlington, VA.

Introduction

The research planning agenda for DSM-V examined possible similarities in phenomenology, comorbidity, familial and genetic features, brain circuitry, and treatment response between obsessive-compulsive disorder (OCD) and several related disorders that are characterized by repetitive thoughts or behaviors. Such data support a re-examination of the DSM-IV-TR classification of OCD and the anxiety disorders, with possible inclusion of a group of obsessive-compulsive spectrum disorders (OCSDs) in DSM-V. Various disorders were systematically examined for inclusion in such a grouping, and later a smaller number were determined to meet threshold criteria for inclusion in the OCSDs. The disorders that were originally examined included OCD, obsessive-compulsive personality disorder (OCPD), Tourette's syndrome (TS) and other tic disorders, Sydenham's chorea, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), trichotillomania (TTM), body dysmorphic disorder (BDD), autism, eating disorders, Huntington's and Parkinson's disease, impulse control disorders, as well as substance and behavioral addictions.

Certain disorders such as BDD, OCPD, TS, and TTM share many commonalities with OCD in phenomenology, comorbidity, familial and genetic features, brain circuitry, and treatment response. Other disorders, such as the impulse control disorders (ICDs) share some common features with OCD, but also differ in many ways as well. The articles presented in this issue of Psychiatry Research are a result of this international collaboration, which examined diagnostic and classification issues of OCSDs for DSM-V in a conference titled “The Future of Psychiatric Diagnosis: Refining the Research Agenda: Obsessive-Compulsive Behavior Spectrum” held in June 2006 at the American Psychiatric Association's headquarters in Arlington, VA.

Section snippets

Genetics and OCD nosology

Nicolini et al. provide insights into the genetics and familial factors of OCD and related disorders. Family studies of OCD generally show that the prevalence of OCD is significantly higher in relatives, especially in the presence of comorbid tics and earlier age of onset, and also depends on the types of obsessions and compulsions exhibited by probands. Twin studies, although few in number, have suggested some significant genetic influence in the heritability of OC symptoms. The most studied

Cross-species models of OCD-spectrum disorders

Boulougouris, Chamberlain, and Robbins describe animal modeling of OCSDs as occurring on two levels—the etiological level and the symptomatic level. It is probable that several candidate genes contribute to OCD vulnerability so that difficulties in modeling arise. Furthermore, behavioral symptoms simulated in mice may not wholly reflect the subtleties of the disorder. Still, advances in understanding the neural substrates of OCD and efficacy of pharmacologic treatment may validate animal

OCD and impulse control disorders

Potenza, Koran, and Pallanti describe both commonalities and differences in the clinical, phenomenological, and biological features between intermittent explosive disorder (IED), pathological gambling (PG), and OCD, with the overarching similarity being an inability to resist repetitive behaviors that may be harmful to the self or others. A distinct contrast between these disorders is the ego-dystonic nature of OCD versus the ego-syntonic nature of impulse control disorders (ICDs). However, the

Tourette's disorder, trichotillomania, and OCD

Ferrao, Miguel, and Stein compare the phenomenology, psychobiology, and treatment response of OCD, Tourette's syndrome (TS), and trichotillomania (TTM) in considering their reclassification into a spectrum of related disorders. While compulsive behaviors observed in OCD without TS are responses to obsessive thoughts, the repetitive behaviors in TS and OCD with tics are usually exhibited to alleviate unpleasant sensations. Similarly, while the repetitive behavior of TTM exclusively involves

Autism and Parkinson's disease and OCD

Hollander, Wang, Braun, and Marsh discuss two neurological disorders that encompass OC features: autism and Parkinson's disease (PD). Although autism, a developmental disorder, and PD, a degenerative disorder, may at first appear dissimilar, both disorders may be characterized by repetitive behaviors and impulsive behaviors, and similar processes may occur in both a developmental and a degenerative disorder. Autism spectrum disorders and OCD are similarly characterized by rigid observance of

Schizophrenia and OCD

Schizo-OCD refers to clinical presentation of both schizophrenia and OCD symptoms in a patient. This dual diagnosis can be perplexing with regards to neurofunctional alteration, given that OCD is typically characterized by hyperfrontality whereas schizophrenia is marked by hypofrontality. Several studies have attempted to compare schizophrenia, OCD, and Schizo-OCD using various cognitive tasks, but results are inconclusive. Pallanti et al. investigated cognitive event related potentials (ERP)

Methodological issues in the obsessive-compulsive spectrum

McKay and Neziroglu discuss methodological and statistical approaches to classifying disorders in the OCSD. In their article they elucidate concerns regarding the heterogeneity of conditions in this spectrum, and particularly discuss the differences in classifying a disorder as an OCD subtype versus a distinct disorder in the OCSD. An OCD subtype must demonstrate the core symptoms and phenomenology of obsessions and compulsions, and must lack other prominent symptoms which might distinguish it

Conclusion

There is growing interest in the scientific community to explore the relationships between OCSDs and OCD based on commonalities of phenomenology, comorbidity, course of illness, brain circuitry, familial and genetic factors, and treatment response. The research planning conference on OCSDs aimed to bring an international group of scientists together to gather empirical research that may inform classification for future DSM efforts. The articles in this issue of Psychiatry Research present some

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