Hostname: page-component-784d4fb959-mvngg Total loading time: 0 Render date: 2025-07-16T11:57:35.981Z Has data issue: false hasContentIssue false
  • English
  • Français

Obsessive-Compulsive Disorder and Obsessive-Compulsive Spectrum Disorders: Diagnostic and Dimensional Issues

Published online by Cambridge University Press:  07 November 2014

Eric Hollander ,
Suah Kim ,
Sumant Khanna  and
Stefano Pallanti
Get access Rights & Permissions [Opens in a new window]

Abstract

Although obsessive-compulsive disorder (OCD) is classified as an anxiety disorder in the DSM-IV, recent considerations for a reclassification into an obsessive-compulsive spectrum disorders (OCSDs) cluster are gaining prominence. Similarities in symptomatology, course of illness, patient population, and neurocircuitry of OCD and OCSD are supported by comorbidity, family, and neurological studies, which also offer a critical re-evaluation of the relationship between OCD and anxiety disorders. This review examines potential classifications of OCD among the wider spectrum of affective disorders and at the interface between affective disorders and addiction. In addition, it has been suggested that the categorical diagnostic approach would be enhanced by an additional dimensional approach, including parameters such as stability of mood and ability to sustain attention. With further studies, it is ultimately the goal to define OCD and related disorders based on endophenotypes.

Despite efforts in this field, there are several fundamental unresolved issues, including the question of which disorders should be grouped together in this category and which characteristics to include as their shared common features. A reclassification of OCD among the OCSDs would allow for better scrutiny of distinct obsessive-compulsive symptoms, as currently this disorder often goes undetected in patients who complain of a broad symptom of anxiety. Advantages and disadvantages of establishing OCSDs and its implications for diagnosis, treatment, and research are discussed.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1. Diagnostic and Statistical Manual of Mental Disorders. 4th ed text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
2. Tynes, LL, White, K, Steketee, GS. Toward a new nosology of obsessive compulsive disorder. Compr Psychiatry. 1990;31:465–480.CrossRefGoogle Scholar
3. Marks, IM. Fears, Phobias and Rituals: Panic, Anxiety and their Disorders. New York, NY: Oxford University Press; 1987.Google Scholar
4. Hollander, E. Obsessive-Compulsive Related Disorders. American Psychiatric Press: Washington, DC; 1993.Google Scholar
5. Hollander, E, Friedberg, JP, Wasserman, S, Yeh, CC, Iyengar, R. The case for the OCD spectrum. In: Abramowitz, JS, Houts, AC, eds. Handbook of Controversial Issues in Obsessive-Compulsive Disorder. Kluwer Academic Press; 2005.Google Scholar
6. Jenike, MA. Illnesses related to obsessive-compulsive disorder. In: Jenike, MA, Baer, LB, Minichiello, WE, eds. Obsessive Compulsive Disorders: Theory and Management. 2nd ed. Year Book Medical; 1990;39–60.Google Scholar
7. McElroy, SL, Phillips, KA, Keck, PE. Obsessive compulsive spectrum disorder. J Clin Psychiatry. 1994;55(suppl 10):33–51.Google ScholarPubMed
8. Stein, DJ. Neurobiology of the obsessive-compulsive spectrum disorders. Biol Psychiatry. 2002;47:296–304.CrossRefGoogle Scholar
9. Leckman, JF, Zhang, H, Alsobrook, JP, Pauls, DL. Symptom dimensions in obsessive-compulsive disorder Toward Quantitative phenotypes. Am J Med Gen. 2001;105:28–30.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
10. Baer, L. Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. J Clin Psychiatry. 1994;55:18–23.Google ScholarPubMed
11. Samuels, J, Bienvenu, OJ, Riddle, MA, et al. Hoarding in obsessive compulsive disorder: results from a case-control study. Behav Res Ther. 2002;40(5):517–528.CrossRefGoogle ScholarPubMed
12. Mataix-Cols, D, Conceicao do Rosario-Campos M, Leckman JF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry. 2005;162:228–238.CrossRefGoogle Scholar
13. Pauls, DL, Alsobrook, J, Goodman, W, Rasmussen, S, Leckman, JF. A family study of obsessive-compulsive disorder. Am J Psychiatry. 1995;152:76–84.Google ScholarPubMed
14. Holzer, JC, Goodman, WK, McDougle, CJ, et al. Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients. Br J Psychiatry. 1994;164:469–473.CrossRefGoogle ScholarPubMed
15. Hollander, E, Wong, CM. Obsessive-compulsive spectrum disorders. J Clin Psychiatry. 1995;56(suppl 4):3–6.Google ScholarPubMed
16. Blaszczynski, A. Pathological gambling and obsessive–compulsive spectrum disorders. Psychol Rep. 1999;84:107–113.CrossRefGoogle ScholarPubMed
17. Dale, RC. Autoimmunity and the basal ganglia: new insights into old diseases. OJM. 2003;96:183–191.Google ScholarPubMed
18. Peterson, BS, Thomas, P, Kane, MJ, Scahill, L, Zhang, H, Bronen, R. Basal Ganglia volumes in patients with Gilles de la Tourette syndrome. Arch Gen Psychiatry. 2003;60:415–424.CrossRefGoogle ScholarPubMed
19. Sears, LL, Vest, C, Mohamed, S, Bailey, J, Ranson, BJ, Piven, J. An MRI study of the basal ganglia in autism. Prog Neuropsychopharmacol Biol Psychiatry. 1999;23:673–624.CrossRefGoogle ScholarPubMed
20. Cath, DC, Spinhoven, P, Hoogduin, CA, Landman, AD, van Woerkom, TC, van de Wetering, BJ. Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences? Psychiatry Res. 2001;101:171–185.CrossRefGoogle ScholarPubMed
21. McDougle, CJ, Kresch, LE, Goodman, WK, Naylor, ST, Volkmar, FR, Cohen, DJ. A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. Am J Psychiatry. 1995;152:772–777.Google ScholarPubMed
22. World Health Organization G. The ICD-10 Classification of Mental and Behavioral Disorders—Diagnostic Criteria for Research. Geneva, Switzerland: World Health Organization; 1993.Google Scholar
23. Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS. National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–389.CrossRefGoogle ScholarPubMed
24. Robins, LN, Helzer, JE, Orvaschel, H, Anthony, JS, Blazer, DG, Burnham, A. The diagnostic interview schedule. In: Eaton, WW, Kessler, LG, eds. Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Orlando, FL: Academic Press; 1985;143–168.CrossRefGoogle Scholar
25. Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J. The composite international diagnostic interview An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988;45:1069–1077.CrossRefGoogle ScholarPubMed
26. Robins, L, Helzer, J, Cottier, L, Goldring, E. NIMH Diagnostic Interview Schedule. 3rd ed rev. St Louis, MO: Washington; 1988.Google Scholar
27. Endicott, J, Spitzer, RL. A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry. 1978;35:837–844.CrossRefGoogle ScholarPubMed
28. Lewis, G, Pelosi, AJ, Araya, R, Dunn, G. Measuring psychiatry disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med. 1992;22:465–486.CrossRefGoogle ScholarPubMed
29. Weissman, MM, Bland, RC, Camino, GJ, Greenwald, S, Hwu, HG, Lee, CK. The cross epidemiology of obsessive compulsive disorder The Cross National Collaborative Group. J Clin Psychiatry. 1994;55(suppl):5–10.Google ScholarPubMed
30. Andrade, L, Walters, EE, Gentil, V, Laurenti, R. Prevalence of ICD-10 mental disorders in a catchment area in the city of Sao Paulo, Brazil. Soc Psychiatry Epidemiol. 2002;37:316–325.CrossRefGoogle Scholar
31. Stein, MB, Forde, DR, Anderson, G, Walker, JR. Obsessive-compulsive disorder in the community: an epidemiologic survey with clinical reappraisal. Am J Psychiatry. 1997;154:1120–1126.Google ScholarPubMed
32. Fontenelle, LF, Mendlowicz, MV, Versiani, M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(1):327–337.Google Scholar
33. Mohammad, MR, Ghanizadeh, A, Rahgozar, M, Noorbala, AA, Davidian, H, Afzali, HM. Prevalence of obsessive-compulsive disorder in Iran. BMC Psychaitr. 2004;4:2.CrossRefGoogle Scholar
34. Karno, M, Golding, JM, Dorenson, SB, Burnam, MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45:1094–1099.CrossRefGoogle ScholarPubMed
35. Guerrero, AP, Hishinuma, ES, Andrade, NN, Bell, CK, Kurahara, DK, Lee, TG. Demographic and clinical characteristics of adolescents in Hawaii with obsessive-compulsive disoder. Arch Pediatr Adolesc Med. 2003;157:665–670.CrossRefGoogle Scholar
36. Nestadt, G, Samuels, JF Romanoski, AJ, Folstein, MF, McHugh, PR. Obsessions and compulsions in the community. Acta Psychiatr Scand. 1994;89:219–224.CrossRefGoogle ScholarPubMed
37. Nestadt, G, Bienvenu, OJ, Cai, G, Samuels, J, Eaton, WW. Incidence of obsessive-compulsive disorder in adults. J Nerv Ment Dis. 1998;186:401–406.CrossRefGoogle ScholarPubMed
38. Fireman, B, Koran, LM, Leventhal, JL, Jacobson, A. The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization. Am J Psychiatry. 2001;158:1904–1910.CrossRefGoogle Scholar
39. Fontenelle, LF, Mendlowicz, MV, Marques, C, Versiani, M. Trans-cultural aspects of obsessive-compulsive disorder: a description of a Brazillian sample and a systemic review of international clinical studies. J Psychiatr Res. 2004;38:403–411.CrossRefGoogle Scholar
40. LaSalle, VH, Cramer, KR, Nelson, KN, Kazuba, D, Justement, L, Murphy, DL. Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive–compulsive disorder. Depress Anxiety. 2004;19:163–173.CrossRefGoogle ScholarPubMed
41. Denys, D, Tenney, N, van Megen, HJ, de Geus, F Westenberg, HG. Axis I and II comorbidity in a large sample of patients with obsessive—compulsive disorder. J Affect Disord. 2004;80:155–162.CrossRefGoogle Scholar
42. Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110:585–599.CrossRefGoogle Scholar
43. du Toit, PL, van Kradenburg, J, Niehaus, D, Stein, DJ. Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview. Compr Psychiatry. 2001;42:291–300.CrossRefGoogle ScholarPubMed
44. Gunstad, J, Phillips, KA. Axis I comorbidity in body dysmorphic disorder. Compr Psychiatry. 2003;44:270–276.CrossRefGoogle ScholarPubMed
45. Thornton, C, Russell, J. Obsessive compulsive comorbidity in the dieting disorders. Int J Eat Disord. 1997;21:83–87.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
46. Jaisoorya, TS, Reddy, YC, Srinath, S. The relationship of obsessive-compulsive disorder to putative spectrum disorders: results from an Indian study. Compr Psychiatry. 2003;44:317–323.CrossRefGoogle ScholarPubMed
47. Park, S, Como, PG, Cui, L, Kurlan, R. The early course of the Tourette's syndrome clinical spectrum. Neurology. 1993;43:1712–1715.CrossRefGoogle ScholarPubMed
48. Grados, MA, Walkup, J, Walford, S. Genetics of obsessive-compulsive disorders: new findings and challenges. Brain Dev. 2003;25(suppl):S55–S61CrossRefGoogle Scholar
49. Richter, MA, Summerfeldt, LJ, Antony, MM, Swinson, RP. Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depress Anxiety. 2003;18:118–127.CrossRefGoogle ScholarPubMed
50. Nestadt, G, Samuels, J, Riddle, MA, Liang, KY, Bienvenu, OJ, Hoehn-Saric, R. The relationship between obsessive—compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychol Med. 2001;31:481–487.CrossRefGoogle ScholarPubMed
51. Carter, AS, Pollock, RA, Suvak, MK, Pauls, DL. Anxiety and major depression comorbidity in a family study of obsessive—compulsive disorder. Depress Anxiety. 2004;20:165–174.CrossRefGoogle Scholar
52. Bienvenu, OJ, Samuels, JF, Riddle, MA, Hoehn-Saric, R, Liang, KY, Cullen, BA. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000;48:287–293.CrossRefGoogle ScholarPubMed
53. Black, DW, Goldstein, RB, Noyes, R, Blum, N. Compulsive behaviors and obsessive—compulsive disorder (OCD): lack of a relationship between OCD, eating disorders, and gambling. Compr Psychiatry. 1994;35:145–148.CrossRefGoogle Scholar
54. Bellodi, L, Cavallini, MC, Bertelli, S, Chiapparino, D, Riboldi, C, Smeraldi, E. Morbidity risk for obsessive-compulsive spectrum disorders in first-degree relatives of patients with eating disorders. Am J Psychiatry. 2001;158:563–569.CrossRefGoogle ScholarPubMed
55. Lilenfeld, LR, Kaye, WH, Greeno, CG, Merikangas, KR, Plotnicov, K, Pollice, C. A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry. 1998;55:603–610.CrossRefGoogle ScholarPubMed
56. Grados, MA, Riddle, MA, Samuels, JF, Liang, KY, Hoehn-Saric, R, Bienvenu, OJ. The familial phenotype of obsessive-compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biol Psychiatry. 2001;50:559–565.CrossRefGoogle ScholarPubMed
57. Hollander, E, King, A, Delaney, K, Smith, CJ, Silverman, JM. Obsessive-compulsive behaviors in parents of multiplex autism families. Psychiatry Res. 2003;117:11–16.CrossRefGoogle ScholarPubMed
58. Buxbaum, JD, Silverman, J, Keddache, M, Smith, CJ, Hollander, E, Ramoz, N. Linkage analysis for autism in a subset of families with obsessive-compulsive behaviors: evidence for an autism susceptibility gene on chromosome 1 and further support for susceptibility genes on chromosome 6 and 19. Mol Psychiatry. 2004;9:144–150.CrossRefGoogle Scholar
59. Greer, JM, Capecchi, MR. Hoxb8 is required for normal grooming behavior in mice. Neuron. 2002;33:23–34.CrossRefGoogle ScholarPubMed
60. Saxena, S, Rauch, SL. Functional neuroimaging and the neuroanatomy of obsessive—compulsive disorder. Psychiatr Clin North Am. 2000;23:563–586.CrossRefGoogle ScholarPubMed
61. Whiteside, SP, Port, JD, Abramowitz, JS. A meta-analysis of functional neuroimaging in obsessive—compulsive disorder. Psychiatry Res. 2004;132:69–79.CrossRefGoogle ScholarPubMed
62. Breiter, HC, Rauch, SL, Kwong, KK, Baker, JR, Weisskoff, RM, Kennedy, DN. Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder. Arch Gen Psychiatry. 1996;53:595–606.CrossRefGoogle ScholarPubMed
63. Charney, DS. Neuroanatomical circuits modulating fear and anxiety behaviors. Acta Psychiatr Scand. 2003;417(suppl):38–50.CrossRefGoogle Scholar
64. Kent, JM, Rauch, SL. Neurocircuitry of anxiety disorders. Curr Psychiatry Rep. 2003;5:266–273.CrossRefGoogle ScholarPubMed
65. Hollander, E, Anagnoustou, E, Chaplin, W, Esposito, K, Haznedar, MM, Licalzi, E et al. Striatal volume on magnetic resonance imagine and repetitive behaviors in autism. Biol Psychiatry. 2005;58:226–232.CrossRefGoogle Scholar
66. Rauch, SL, Phillips, KA, Segal, E, Makris, N, Shin, LM, Whalen, PJ. A preliminary morphometric magnetic resonance imaging study of regional brain volumes in body dysmorphic disorder. Psychiatry Res. 2003;122:13–19.CrossRefGoogle ScholarPubMed
67. Harel, Z, Hallett, J, Riggs, S, Vaz, R, Kiessling, L. Antibodies against human putamen in adolescents with anorexia nervosa. Int J Eat Disord. 2001;29:463–469.CrossRefGoogle ScholarPubMed