Associations between miscellaneous symptoms and symptom dimensions in adults with obsessive-compulsive disorder.
ABSTRACT Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with a heterogeneous array of obsessions and compulsions. Although factor analytic studies have identified symptom dimensions comprising the clinical presentation of OCD, many frequently reported miscellaneous symptoms are not considered in factor analytic studies because they do not fit conceptually within a particular symptom category, despite being functionally related. In the present study, we examined the associations between miscellaneous symptoms and OCD symptom dimensions in a sample of 111 adults with OCD. Overall, most miscellaneous symptoms were associated with one or more symptom dimensions in previously identified four- (14 of the 22 symptoms) and five-factor models (12 of the 22 symptoms). In both models, Contamination/Cleaning was the only dimension not related to any miscellaneous symptom. The present results provide information about which miscellaneous symptoms may be related to particular symptom dimensions, which will assist in clinical evaluations and help planning behavioral psychotherapy (e.g., hierarchy development).
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ABSTRACT: Background: Since the publication of the DSM-IV in 1994, research on obsessive–compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered “time-consuming” for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a “general medical condition”; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to “poor insight,” and adding “tic-related OCD”); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.Depression and Anxiety 06/2010; 27(6):507 - 527. DOI:10.1002/da.20669 · 4.29 Impact Factor
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ABSTRACT: Building upon work by Rasmussen and Eisen, our group has proposed a model comprising two core motivational dimensions underlying obsessive-compulsive symptoms: harm avoidance and incompleteness. The model has received increasing attention; however the structural soundness and divergence of its factors have yet to be investigated fully, either as symptom-specific motivations for clinical OCD symptoms or as stylistic traits in the nonclinical population. This paper presents four studies designed to investigate the structural validity of harm avoidance and incompleteness in clinical and nonclinical samples. Results yielded support across method of assessment (interview, questionnaire), level of generality (symptom-specific state, trait), and population (clinical, nonclinical). Evidence was also found of the model's method invariance, with both factors strongly self-associated across method forms when ascertained as symptom-specific motivations. The results provide support for key assertions of the core dimensions model and also point to the utility of the interviewer-rated and questionnaire measures developed during this work: the Obsessive-Compulsive Core Dimensions Interview (OC-CDI) and Core Dimensions Questionnaire (OC-CDQ). Clinical and theoretical implications and challenges for future research are discussed.Journal of Obsessive-Compulsive and Related Disorders 04/2014; 3(2). DOI:10.1016/j.jocrd.2014.01.003 · 0.81 Impact Factor
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ABSTRACT: In recent years, much progress has been made in pharmacotherapy for pediatric obsessive-compulsive disorder (OCD) and chronic tic disorders (CTDs). What were previously considered relatively intractable conditions now have an array of efficacious medicinal (and psychosocial) interventions available at clinicians' disposal, including selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha-2 agonists. The purpose of this review is to discuss the evidence base for pharmacotherapy with pediatric OCD and CTDs with regard to efficacy, tolerability, and safety, and to put this evidence in the context of clinical management in integrated behavioral healthcare. While there is no single panacea for these disorders, there are a variety of medications that provide considerable relief for children with these disabling conditions.01/2011; 3:125-42. DOI:10.4137/JCNSD.S6616