- Email: [email protected]
Obsessive Compulsive and Related Disorders
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Preface Obsessive Compulsive Disorders
Wayne K. Goodman, MD Editor
One of the most striking changes in DSM-51 is the introduction of a new section called Obsessive-Compulsive and Related Disorders.2 It contains obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder), hoarding disorder, and excoriation (skin-picking) disorder. OCD was previously classified among the anxiety disorders; BDD was a somatoform disorder, and trichotillomania was an impulse control disorder. Both hoarding disorder3 and excoriation disorder are new diagnostic entities. The common feature of these disorders is the presence of persistent interfering obsessions, preoccupations, or repetitive behaviors. Although tic and Tourette disorders are listed elsewhere in DSM-5, these neurodevelopmental disorders are also characterized by repetitive motor or vocal behaviors and share considerable comorbidity with OCD. The well-established relationship between tics and some forms of OCD4 has been codified in the DSM-5 criteria for OCD by asking the clinician to specify if the case is “tic-related” (current or past history of a tic disorder). The purpose of this volume is to provide concise expert reviews on current understanding of the clinical features, etiology, and treatment of OCD, BDD, trichotillomania, and tic disorders. Several articles are devoted to OCD, so that topics related to pathophysiology (cognitive neuroscience theories and immune-mediated etiologies) and different treatment modalities (behavioral, pharmacologic, and device-based) could be covered in greater depth. Although the impetus for this issue was the aforementioned changes in DSM-5, a radical change in the way we approach psychiatric diagnoses is also underway. The National Institute of Mental Health has launched the Research Domain Criteria initiative that takes a dimensional rather than a categorical approach to mental disorders.5 Instead of a focus on clusters of symptoms that form the clinical syndromes delineated in DSM, domains of behavior are identified that cut across conventional diagnoses and can be characterized at different levels of analysis: from genes to molecules to cells to circuits to neurophysiology to behaviors. As further research is conducted using this framework and reliable biomarkers are developed, it is conceivable that the disorders
Psychiatr Clin N Am - (2014) -–http://dx.doi.org/10.1016/j.psc.2014.06.005 0193-953X/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
psych.theclinics.com
ii
Preface
listed in the Obsessive-Compulsive and Related Disorders section of DSM will prove less related than they appear currently at the clinical surface.6 In the meantime, clinicians in the field need to grapple with our revamped DSM. Some of the changes embodied in DSM-5,7 including the move of OCD out of the anxiety disorders,8,9 have met with controversy. Because these nosologic issues are abundantly covered elsewhere in the literature,8,9 this volume does not concern itself with that debate. Thankfully, many of the world’s leading authorities on these disorders agreed to contribute to this review of obsessive-compulsive and related disorders and share their clinical and scientific expertise with the reader. Wayne K. Goodman, MD Department of Psychiatry Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1230 New York, NY 10029, USA E-mail address: [email protected] REFERENCES
1. American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. 5th edition. Washington, DC: American Psychiatric Association; 2013. 2. Stein DJ, Craske MA, Friedman MJ, et al. Anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, and dissociative disorders in DSM-5. Am J Psychiatry 2014;171:611–3. 3. Frost RO, Steketee G, Tolin OF. Diagnosis and assessment of hoarding disorder. Annu Rev Clin Psychol 2012;8:219–42. 4. Cohen SC, Leckman JF, Bloch MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev 2013;37:997–1007. 5. Cuthbert BN, Insel TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med 2013;11:126. 6. Monzani B, Rijsdijk F, Harris J, et al. The structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive-compulsive spectrum disorders. JAMA Psychiatry 2014;71:182–9. 7. First MB. Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis 2013;201:727–9. 8. Storch EA, Abramowitz J, Goodman WK. Where does obsessive-compulsive disorder belong in DSM-V? Depress Anxiety 2008;25:336–47. 9. Phillips KA, Stein DJ, Rauch SL, et al. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010;27:528–55.
Preface Obsessive Compulsive Disorders
Wayne K. Goodman, MD Editor
One of the most striking changes in DSM-51 is the introduction of a new section called Obsessive-Compulsive and Related Disorders.2 It contains obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder), hoarding disorder, and excoriation (skin-picking) disorder. OCD was previously classified among the anxiety disorders; BDD was a somatoform disorder, and trichotillomania was an impulse control disorder. Both hoarding disorder3 and excoriation disorder are new diagnostic entities. The common feature of these disorders is the presence of persistent interfering obsessions, preoccupations, or repetitive behaviors. Although tic and Tourette disorders are listed elsewhere in DSM-5, these neurodevelopmental disorders are also characterized by repetitive motor or vocal behaviors and share considerable comorbidity with OCD. The well-established relationship between tics and some forms of OCD4 has been codified in the DSM-5 criteria for OCD by asking the clinician to specify if the case is “tic-related” (current or past history of a tic disorder). The purpose of this volume is to provide concise expert reviews on current understanding of the clinical features, etiology, and treatment of OCD, BDD, trichotillomania, and tic disorders. Several articles are devoted to OCD, so that topics related to pathophysiology (cognitive neuroscience theories and immune-mediated etiologies) and different treatment modalities (behavioral, pharmacologic, and device-based) could be covered in greater depth. Although the impetus for this issue was the aforementioned changes in DSM-5, a radical change in the way we approach psychiatric diagnoses is also underway. The National Institute of Mental Health has launched the Research Domain Criteria initiative that takes a dimensional rather than a categorical approach to mental disorders.5 Instead of a focus on clusters of symptoms that form the clinical syndromes delineated in DSM, domains of behavior are identified that cut across conventional diagnoses and can be characterized at different levels of analysis: from genes to molecules to cells to circuits to neurophysiology to behaviors. As further research is conducted using this framework and reliable biomarkers are developed, it is conceivable that the disorders
Psychiatr Clin N Am - (2014) -–http://dx.doi.org/10.1016/j.psc.2014.06.005 0193-953X/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
psych.theclinics.com
ii
Preface
listed in the Obsessive-Compulsive and Related Disorders section of DSM will prove less related than they appear currently at the clinical surface.6 In the meantime, clinicians in the field need to grapple with our revamped DSM. Some of the changes embodied in DSM-5,7 including the move of OCD out of the anxiety disorders,8,9 have met with controversy. Because these nosologic issues are abundantly covered elsewhere in the literature,8,9 this volume does not concern itself with that debate. Thankfully, many of the world’s leading authorities on these disorders agreed to contribute to this review of obsessive-compulsive and related disorders and share their clinical and scientific expertise with the reader. Wayne K. Goodman, MD Department of Psychiatry Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1230 New York, NY 10029, USA E-mail address: [email protected] REFERENCES
1. American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. 5th edition. Washington, DC: American Psychiatric Association; 2013. 2. Stein DJ, Craske MA, Friedman MJ, et al. Anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, and dissociative disorders in DSM-5. Am J Psychiatry 2014;171:611–3. 3. Frost RO, Steketee G, Tolin OF. Diagnosis and assessment of hoarding disorder. Annu Rev Clin Psychol 2012;8:219–42. 4. Cohen SC, Leckman JF, Bloch MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev 2013;37:997–1007. 5. Cuthbert BN, Insel TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med 2013;11:126. 6. Monzani B, Rijsdijk F, Harris J, et al. The structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive-compulsive spectrum disorders. JAMA Psychiatry 2014;71:182–9. 7. First MB. Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis 2013;201:727–9. 8. Storch EA, Abramowitz J, Goodman WK. Where does obsessive-compulsive disorder belong in DSM-V? Depress Anxiety 2008;25:336–47. 9. Phillips KA, Stein DJ, Rauch SL, et al. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010;27:528–55.