Handbook on Obsessive-Compulsive and Related Disorders
Handbook on Obsessive-Compulsive and Related Disorders examines obsessive-compulsive and related disorders (OCRDs) as a new chapter in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association 2013). This book is quite timely, because for the first time in our field, obsessive-compulsive disorder (OCD) is no longer in the chapter on anxiety disorders and is instead grouped with other related conditions, which are now known as obsessive-compulsive and related disorders. I am quite pleased to see this development and believe that this will have a profound impact not only on clinical utility—how clinicians conceptualize, diagnose, and treat patients with these conditions—but also on how researchers conduct relevant research. The DSM-5 approach to OCRDs perhaps also resonates, at least to some extent, with constructs that have been proposed by the National Institute of Mental Health in its Research Domain Criteria framework.
The book provides a “behind the scenes” examination of the concept of OCRDs; all of the chapters but one are authored or coauthored by individuals who were involved in the development of DSM-5 as Obsessive-Compulsive Spectrum Sub-Work Group members, advisors, or authors of published reviews that examined possible changes for DSM-5. This book covers disorders in the new DSM-5 OCRD chapter: OCD, body dysmorphic disorder (previously a somatoform disorder), hoarding disorder (a new disorder), trichotillomania (hair-pulling disorder) (previously an impulse-control disorder not elsewhere classified), and excoriation (skin-picking) disorder (a new disorder). It also includes discussions of other conditions, such as tic disorders, illness anxiety disorder, and obsessive-compulsive personality disorder; these disorders are not included in the DSM-5 OCRD chapter, but they were considered for inclusion in that chapter during the DSM-5 development process.
The concept of OCRDs is certainly not new. My first book on this topic, Obsessive-Compulsive Related Disorders (Hollander 1993), was published more than 20 years ago and drew attention to many of these conditions and to this spectrum concept. More recent work has highlighted a broader impulsivity-compulsivity concept (see, e.g., Fineberg et al. 2010). The OCRDs have both similarities with and important differences from OCD in terms of their phenomenology, comorbidity, family history, brain circuitry, and treatment response. This category was seen as evolving from our understanding of compulsivity as a symptom dimension arising from tightly regulated brain circuits (cortical-striatal-thalamic-cortical circuits) that give rise to a spectrum of partially overlapping diagnostic entities.
The Research Planning Agenda for DSM-5, which preceded the formal development of DSM-5, systematically examined the relationship between various putative OCRDs and OCD in terms of a number of cross-cutting issues. The proceedings of that process were published as Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V (Hollander et al. 2011). This research planning agenda laid very useful groundwork for the formal development of DSM-5. This development included a comprehensive process of literature reviews; weighing of available evidence by the Obsessive-Compulsive Spectrum Sub-Work Group members and advisors as well as the larger DSM-5 work group of which it was a component; field trials; and input and review by many other individuals, groups, and organizations. Evidence that was culled from this extensive process ultimately resulted in the inclusion of the new chapter on OCRDs in DSM-5.
The DSM-5 OCRD chapter is a great step forward, and this book’s editors (who were chair and sub-work group chair of the DSM-5 work group that was responsible for the OCRDs) are to be congratulated for their able stewardship of the DSM-5 process, which generated diagnostic criteria and text for these disorders that are clearer, more internally consistent, more precise, and better supported by the existing data than were the DSM-IV (American Psychiatric Association 1994) categories and chapter structure. Future DSM efforts might reconsider whether a broader conceptualization of compulsivity is possible that could include impulsive-compulsive disorders, obsessive-compulsive personality disorder, tic disorders, and autism spectrum disorder. Nevertheless, this book presents a unique collection of chapters and key literature reviews from DSM-5 OCRD sub-work group members and advisors that support decisions regarding boundary issues for OCRDs.
The Research Domain Criteria process has highlighted the need to understand how fundamental brain circuits drive psychopathological symptom domains, and I can think of no area where emerging basic science and animal models can better be directly translated into novel experimental therapeutics than the OCRDs, as suggested by exciting findings in optogenetics, deep brain stimulation, transcranial magnetic stimulation, and immune-inflammatory mechanisms. Nevertheless, when we consider the broadest conceptualization of “compulsivity,” there remains a very large unmet need for both services and research investment. The OCRDs contribute enormous financial costs to our society, and research networks are needed that can begin to examine real-world questions such as predicting who is at risk for negative outcomes and high costs for care. I hope you enjoy reading these chapters and that you find the book useful for your clinical practice and research endeavors.
Eric Hollander, M.D.
|March 18, 2018
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