Obsessive compulsive dsm 5
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Obsessive-Compulsive Disorder in DSM-5: Key Changes and Clinical Implications
Introduction to DSM-5 Obsessive-Compulsive and Related Disorders (OCRDs)
The publication of the DSM-5 brought significant revisions to the classification and diagnostic criteria for Obsessive-Compulsive Disorder (OCD). One of the most notable changes was the creation of a new category called "Obsessive-Compulsive and Related Disorders" (OCRDs). This category now includes not only OCD but also Body Dysmorphic Disorder (BDD), Trichotillomania (Hair-Pulling Disorder), Excoriation (Skin-Picking) Disorder, Hoarding Disorder, Substance/Medication-Induced OCRD, OCRD due to another medical condition, and other specified OCRDs 19.
Changes in Diagnostic Criteria for OCD
Broadened Definition of Obsessions
In DSM-5, the definition of obsessions was broadened. Previously, obsessions had to cause marked anxiety or distress, but this requirement was removed in the new edition. This change aims to capture a wider range of symptoms and potentially increase the reported prevalence rates of OCD, which had previously been lower under DSM-IV criteria 2.
Insight and Tic-Related Subtypes
Another significant change is the consideration of the degree of insight into symptomatology, ranging from good to poor insight. Additionally, a subtype of tic-related OCD was introduced, recognizing the overlap between OCD and tic disorders 6.
Genetic and Environmental Risk Factors
Shared and Unique Risk Factors
Research has shown that genetic and environmental risk factors for OCD and related disorders can be both shared and unique. A study involving multivariate twin modeling found that a two-latent factor model best explained the data. One factor was common to all disorders, particularly OCD, BDD, and Hoarding Disorder (HD), while another was exclusive to Trichotillomania (TTM) and Skin-Picking Disorder (SPD). This suggests that while there are common genetic factors, there are also disorder-specific genetic and environmental influences 3.
Personality Traits and OCD
Overlap with Obsessive-Compulsive Personality Disorder (OCPD)
There is ongoing debate about the inclusion of Obsessive-Compulsive Personality Disorder (OCPD) in the OCRDs category. Studies have shown substantial overlap between the traits of OCPD and OCD, suggesting that they may exist along a single underlying spectrum. This integrative perspective could improve the transparency and validity of assessment procedures 7.
Dysfunctional Personality Domains
Further research has indicated that specific dysfunctional personality domains are differentially associated with various OCRDs. For example, BDD is associated with Negative Affectivity, Detachment, and Psychoticism, while HD is linked to high Negative Affectivity and Psychoticism, and SPD is associated with Detachment 5.
Clinical Implications
Treatment Approaches
The changes in DSM-5 have significant clinical implications. Cognitive Behavioral Therapy (CBT) remains the recommended treatment for OCD, often supplemented with Selective Serotonin Reuptake Inhibitors (SSRIs) in severe cases. The broadened criteria and new subtypes may also influence treatment plans and therapeutic approaches 68.
Dimensional Assessments
The DSM-5 also introduced dimensional assessments to supplement traditional categorical diagnoses. These assessments aim to provide a more nuanced understanding of the severity and range of symptoms, which can be crucial for tailoring individualized treatment plans 10.
Conclusion
The revisions in DSM-5 for OCD and related disorders reflect a more nuanced understanding of these conditions, incorporating broader definitions, new subtypes, and dimensional assessments. These changes are expected to improve diagnostic accuracy and treatment outcomes, although ongoing research is essential to fully understand their impact. The integration of genetic, environmental, and personality factors into the diagnostic framework offers a comprehensive approach to understanding and managing OCD and related disorders.
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Most relevant research papers on this topic
DSM‐5 OBSESSIVE‐COMPULSIVE AND RELATED DISORDERS: CLINICAL IMPLICATIONS OF NEW CRITERIA
The DSM-5 revisions significantly revised obsessive-compulsive disorder (OCD) and related disorders, placing them in a new category called "Obsessive-Compulsive and Related Disorders (OCRDs)."
Highly CitedObsessive-Compulsive Disorder in the Adolescent Brain Cognitive DevelopmentSM Study: Impact of Changes From DSM-IV to DSM-5.
The DSM-5 revisions may result in higher prevalence rates of obsessive-compulsive disorder in adolescents, as the definition of obsessions has been broadened and the requirement for marked anxiety or distress has been removed.
Observational StudyThe structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive-compulsive spectrum disorders.
Obsessive-compulsive and related disorders are influenced by 2 distinct liability factors, with shared genetic factors for OCD, BDD, and HD and unique genetic factors for TTM and SPD.
Observational Study
Rigorous JournalHighly CitedExamining the DSM-5 Section III Criteria for Obsessive-Compulsive Personality Disorder in a Community Sample.
The DSM-5 Section III criteria for obsessive-compulsive personality disorder (OCPD) significantly overlap with the DSM-5 Section II criteria, with rigid perfectionism, perseveration, and intimacy avoidance accounting for 53% of the variance in the latter.
Observational StudyThe relationship between obsessive-compulsive spectrum disorders and DSM-5 dysfunctional personality domains in a nonclinical sample of Italian women.
Obsessive-compulsive spectrum disorders (OCSD) are associated with dysfunctional personality domains, with Body Dysmorphic Disorder (BDD) showing the most significant relationship with these domains.
Observational StudyObsessive–compulsive disorders
The DSM-5 will likely introduce changes to obsessive-compulsive disorder, including a subtype of tic-related OCD, and emphasize the importance of insight and CBT treatment.
Rigorous JournalThe continuity between DSM-5 obsessive-compulsive personality disorder traits and obsessive-compulsive symptoms in adolescence: an item response theory study.
OCD and OCPD can be classified along a single dimension, with OCD being the extreme end of OCPD traits in adolescents.
Observational StudyUnderstanding obsessive-compulsive disorder - literature review
OCD's exact cause remains unknown, but genetic and environmental factors play a role, and art can positively impact awareness and social acceptance.
Systematic ReviewPreliminary assessment of obsessive-compulsive spectrum disorder scales for DSM-5 $
The DSM-5 scales for obsessive-compulsive spectrum disorders show strong internal consistency, convergent validity, and higher total scores in individuals with core symptoms, supporting their integration into the new diagnostic system.
Observational Study