Diagnostic Criteria for Obsessive-Compulsive Disorder

Abstract The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession (‘with resistance’) and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive–compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.

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Obsessive-Compulsive Symptoms in Schizophrenia: Are They Manifestations of a Distinct Subclass of Schizophrenia?

CNS Spectrums ◽

10.1017/s1092852900004600 ◽

1997 ◽

Vol 2 (3) ◽

pp. 45-48 ◽

Cited By ~ 9

Author(s):

Ileana Berman ◽

Demetra Pappas ◽

Stuart M. Berman

Keyword(s):

Diagnostic Criteria ◽

Obsessive Compulsive Disorder ◽

Poor Prognosis ◽

Obsessive Compulsive ◽

Schizophrenic Psychosis ◽

Obsessive Compulsive Symptoms ◽

Compulsive Disorder ◽

Number Of Patients ◽

Distinct Subtype

AbstractThe association between obsessive-compulsive (OC) symptoms and schizophrenia has been discussed in the literature for many decades. Recent studies, which have been more systematic than earlier reports and benefited from more rigorous diagnostic criteria, have generated results that contradict earlier findings. The current consensus is that OC symptoms are seen in a significant number of patients with schizophrenia, and indicate a poor prognosis. These recent studies also suggest that OC symptoms are more than just expressions of persistent schizophrenic psychosis, and that they share characteristics with obsessive-compulsive disorder (OCD). This article discusses the arguments supporting the possibility that OC symptoms are either manifestations of comorbid OCD, or are characteristics of a distinct subtype of schizophrenia.

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Diagnostic validity of early-onset obsessive-compulsive disorder in the Danish Psychiatric Central Register: findings from a cohort sample

BMJ Open ◽

10.1136/bmjopen-2017-017172 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017172 ◽

Cited By ~ 8

Author(s):

Judith Nissen ◽

Shelagh Powell ◽

Susanne V Koch ◽

James J Crowley ◽

Manuel Matthiesen ◽

...

Keyword(s):

Diagnostic Criteria ◽

Obsessive Compulsive Disorder ◽

Early Onset ◽

Primary Outcome ◽

Child And Adolescent ◽

Main Diagnosis ◽

Diagnostic Validity ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Central Register

ObjectivesEmploying national registers for research purposes depends on a high diagnostic validity. The aim of the present study was to examine the diagnostic validity of recorded diagnoses of early-onset obsessive-compulsive disorder (OCD) in the Danish Psychiatric Central Register (DPCR).DesignReview of patient journals selected randomly through the DPCR.MethodOne hundred cases of OCD were randomly selected from DPCR. Using a predefined coding scheme based on the Children’s Yale Brown Obsessive Compulsive Scale (CYBOCS), experienced research nurse or child and adolescent psychiatrists assessed each journal to determine the presence/absence of OCD diagnostic criteria. The detailed assessments were reviewed by two senior child and adolescent psychiatrists to determine if diagnostic criteria were met.Primary outcome measurementsPositive predictive value (PPV) was used as the primary outcome measurement.ResultsA total of 3462 children/adolescents received an OCD diagnosis as the main diagnosis between 1 January 1995 and 31 December 2015. The average age at diagnosis was 13.21±2.89 years. The most frequent registered OCD subcode was the combined diagnosis DF42.2. Of the 100 cases we examined, 35 had at least one registered comorbidity. For OCD, the PPV was good (PPV 0.85). Excluding journals with insufficient information, the PPV was 0.96. For the subcode F42.2 the PPV was 0.77. The inter-rater reliability was 0.94. The presence of the CYBOCS in the journal significantly increased the PPV for the OCD diagnosis altogether and for the subcode DF42.2.ConclusionThe validity and reliability of International Classification of Disease 10th revision codes for OCD in the DPCR is generally high. The subcodes for predominant obsessions/predominant compulsions are less certain and should be used with caution. The results apply for both children and adolescents and for both older and more recent cases. Altogether, the study suggests that there is a high validity of the OCD diagnosis in the Danish National Registers.

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Commentary: Meta-analysis of trials comparing antidepressants with active placebos

The British Journal of Psychiatry ◽

10.1192/s0007125000260352 ◽

1998 ◽

Vol 172 (3) ◽

pp. 232-234 ◽

Cited By ~ 4

Author(s):

David Healy

Keyword(s):

Diagnostic Criteria ◽

Obsessive Compulsive Disorder ◽

Treatment Effect ◽

Antidepressant Treatment ◽

Meta Analysis ◽

Effect Sizes ◽

Obsessive Compulsive ◽

Compulsive Disorder

This attempt to establish treatment effect sizes follows a tradition, which dates back over 20 years, of assessing the effects of antidepressant treatment under ‘blinder conditions'. The method adopted by Moncrieff et al has some merit but involves a recourse to studies, many of which are over 30 years old. While the studies may not be seriously flawed, it is difficult to have much confidence in them. None appears to have included what the authors describe as an ‘inert’ placebo, which strictly speaking would be a non-drug arm to the study. The number of studies is small. The dose of drugs used, which might be expected to have some influence on outcomes, is not mentioned. Finally, as experience with studies in obsessive-compulsive disorder indicates, treatment effect sizes can vary substantially from one decade to another –most probably because different individuals are recruited although all may apparently meet the same diagnostic criteria.

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Faculty Opinions recommendation of Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2973959.2647058 ◽

2010 ◽

Author(s):

Evelyn Stewart ◽

Yu-Pei Hu

Keyword(s):

Diagnostic Criteria ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Dsm V

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Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V

Depression and Anxiety ◽

10.1002/da.20669 ◽

2010 ◽

Vol 27 (6) ◽

pp. 507-527 ◽

Cited By ~ 171

Author(s):

James F. Leckman ◽

Damiaan Denys ◽

H. Blair Simpson ◽

David Mataix-Cols ◽

Eric Hollander ◽

...

Keyword(s):

Diagnostic Criteria ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Dsm V

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The Internal and External Boundaries of Obsessive–Compulsive Disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2000.00727.x ◽

2000 ◽

Vol 34 (2) ◽

pp. 249-255

Author(s):

David J. Castle ◽

Aaron Groves

Keyword(s):

Psychiatric Disorders ◽

Diagnostic Criteria ◽

Obsessive Compulsive Disorder ◽

Neurological Disorders ◽

Large Degree ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Degree Of Overlap

Objective: This study aims to explore the internal and external boundaries of obsessive–compulsive disorder (OCD). Method: Selected literature is reviewed. Results: Prevalence and incidence estimates for OCD vary markedly according to diagnostic criteria applied. External boundaries of the disorder are permeable, with a large degree of overlap with other psychiatric disorders, and an association with certain neurological disorders. Some cases of OCD appear to have a neurodevelopmental origin. Conclusions: Further delineation of disorders characterised by obsessional and compulsive symptoms can inform models of aetiology, pathophysiology and treatment.

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