Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. jbienven@jhmi Psychological Medicine
(Impact Factor: 5.94).
05/2011; 42(1):1-13. DOI: 10.1017/S0033291711000742
Experts have proposed removing obsessive-compulsive disorder (OCD) from the anxiety disorders section and grouping it with putatively related conditions in DSM-5. The current study uses co-morbidity and familiality data to inform these issues.
Case family data from the OCD Collaborative Genetics Study (382 OCD-affected probands and 974 of their first-degree relatives) were compared with control family data from the Johns Hopkins OCD Family Study (73 non-OCD-affected probands and 233 of their first-degree relatives).
Anxiety disorders (especially agoraphobia and generalized anxiety disorder), cluster C personality disorders (especially obsessive-compulsive and avoidant), tic disorders, somatoform disorders (hypochondriasis and body dysmorphic disorder), grooming disorders (especially trichotillomania and pathological skin picking) and mood disorders (especially unipolar depressive disorders) were more common in case than control probands; however, the prevalences of eating disorders (anorexia and bulimia nervosa), other impulse-control disorders (pathological gambling, pyromania, kleptomania) and substance dependence (alcohol or drug) did not differ between the groups. The same general pattern was evident in relatives of case versus control probands. Results in relatives did not differ markedly when adjusted for demographic variables and proband diagnosis of the same disorder, though the strength of associations was lower when adjusted for OCD in relatives. Nevertheless, several anxiety, depressive and putative OCD-related conditions remained significantly more common in case than control relatives when adjusting for all of these variables simultaneously.
On the basis of co-morbidity and familiality, OCD appears related both to anxiety disorders and to some conditions currently classified in other sections of DSM-IV.
Available from: Geoffrey M. Reed
- "Hypochondriasis has been found to have high rates of co-occurrence and familiality with other OCRD (Bienvenu et al., 2012). Somatoform Disorders, notably somatization disorder, also frequently co-occurs with hypochondriasis (Barsky et al., 1992; Noyes et al., 1994; Rief et al., 1998), however, this may reflect overreliance in earlier classifications on shared rather than distinct features to define these disorders. "
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To present the rationale for the new Obsessive-Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping.
Review of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity.
The rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing.
Alternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability.
It is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.
Available from: Spiro Pantazatos
- "Cardinal features include fear of social situations, particularly those involving exposure to unfamiliar persons, which is associated with avoidance and significant functional impairment (Filho et al., 2010). SAD also shares a number of clinical features with other anxiety syndromes (Bienvenu et al., 2011; Stein et al., 2011), and one of the aims of neuroimaging studies has been to identify similarities and differences at the brain level that may guide more precise understanding of etiology, pathophysiology, and mechanisms of treatment response. Well-established treatments for SAD include cognitive-behavioral therapy and selective serotonin reuptake inhibitor (SSRI) medications; however, as many as half of patients do not respond to a course of either treatment (Stein and Stein, 2008). "
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ABSTRACT: Social anxiety disorder (SAD) has received relatively little attention in neurobiological studies. We sought to identify neuro-anatomical changes associated with successful treatment for the disorder. Fourteen patients (31 years; 57% female) with DSM-IV generalized SAD were imaged before and after 8-weeks of paroxetine treatment on a 1.5T GE Signa MRI scanner. Symptoms were assessed by a clinician using the Liebowitz Social Anxiety Scale (LSAS). Longitudinal changes in voxel based morphometry (VBM) were determined using the VBM8 Toolbox for SPM8. Symptom severity decreased by 46% following treatment (p<0.001). At week 8, significant gray matter reductions were detected in bilateral caudate and putamen, and right thalamus, and increases in the cerebellum. Gray matter decreases in left thalamus were correlated with clinical response. This is the first study to our knowledge to identify treatment related correlates of symptom improvement for SAD. Replication in larger samples with control groups is needed to confirm these findings, as well as to test their specificity and temporal stability.
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Available from: Muhammed Tayyib Kadak
- "Neuroimaging studies of pediatric OCD have led to causal role of the cortico-basal ganglia-thalamo-cortical loops that involve the orbitofrontal cortex and the anterior cingulate cortex . Although OCD is a genetical basednature , studies suggest that both shared and nonshared environmental factors have contributions  . Environmental factors such as shared personality factors, fostering and parental factors may increase the risk of OCD among first-degree relatives of OCD subjects  . "
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