1,2 In fact, the World Health Organization identified OCD among the top 20 causes of years of life lived with disability for 15- to 44-year-olds.3 Although generally longitudinally stable, OCD is known for its substantial heterogeneity, as symptom presentations and comorbidity patterns can vary markedly in different individuals. Moreover, a number of other psychiatric and neurologic disorders have similar phenomenological features, can Inhibitors,research,lifescience,medical be comorbid with OCD, or are sometimes even conceptualized as uncommon presentations of OCD. These include the obsessive preoccupations and repetitive behaviors found in body dysmorphic disorder, hypochondriasis, Tourette
syndrome, Parkinson’s disease, Inhibitors,research,lifescience,medical catatonia, autism, and in some individuals with eating disorders (eg, anorexia nervosa).4-10 These heterogeneous facets of the disorder have led to a search for OCD subtypes that might be associated with different etiologies or treatment responses. Ruminative, obsessional, preoccupying mental agonies coupled with selleck kinase inhibitor perseverative, ritualized compulsionresembling behaviors have been depicted in biblical
documents as well Inhibitors,research,lifescience,medical as Greek and Shakespearian tragedies. In modern nosology, a number of different approaches have been suggested to characterize this syndrome, yet the question of how best to categorize OCD subgroups remains under debate in 2010. Currently, the Diagnostic and Statistical Inhibitors,research,lifescience,medical Manual of Mental Disorders (DSM-IV-TR) of the American Psychiatric Association, classifies OCD as an anxiety disorder. There have, however, been questions raised about this categorization
on the basis of some phenomenological differences between OCD and the other anxiety disorders. As such, suggestions have been made that, in the forthcoming 2012 DSM-5, OCD should be removed from its position as one of the six anxiety disorders – a reformulation Inhibitors,research,lifescience,medical still under debate. One solution under discussion is that OCD should constitute an independent entity in DSM-5 (ie, remain outside of any larger grouping), congruent with its designation as such in the current international diagnostic manual, ICD-10 (International Statistical Classification of Diseases and Related Health Problems).11-14 An alternative suggestion would group OCD and related disorders into a new Obsessive-Compulsive second Spectrum Disorders (OCSD) category. The concept of an OCSD classification was first postulated over a decade ago.15,16 Later, the original OCSD concept was extended with the proposal that OCD and other compulsive disorders may lie along a larger continuum of corelated compulsive-impulsive disorders.15 Disorders hypothesized at the impulsive end of this spectrum continuum include pathologic gambling, nonparaphilic compulsive sexual activity, and others.