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Is There a Distinct OCD Spectrum?

Published online by Cambridge University Press:  07 November 2014

Eric Hollander  and
Stephanie D. Benzaquen
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Abstract

The obsessive-compulsive disorders spectrum concept has grown in recent years because of the common clinical features, such as obsessive thinking and compulsive rituals, biological markers, presumed etiology, and treatment response, that these disorders may share with obsessive-compulsive disorder (OCD). This concept has important implications in regard to diagnosis, nosology, neurobiology, and treatment of a wide group of diverse disorders affecting up to 10% of the population. New insights in central nervous system (CNS) mechanisms that drive the repetitive behaviors of the obsessive-compulsive spectrum disorders have heightened interest in the spectrum in researchers, clinicians, and those involved in drug development.

An important approach in neuropsychiatry centers on employing a dimensional classification of psychopathology. Psychiatric phenomena often fall on a continuum. A dimensional approach allows for the classification of patients who fall at the border of classical entities or who are otherwise atypical. Diagnostic categories are considered along a spectrum if there is considerable overlap in symptoms and in etiology, as demonstrated by familial linkage biological markers, and pharmacological dissection. Categorical and dimensional approaches to the OCD spectrum could have significant implications for diagnosis, nosology, neurobiology, and treatment of a wide group of disorders affecting a sizable percentage of the population.

Recent interest has focused on spectrums in movement disorders, affective disorders, schizophrenia, epileptic and impulsive disorders, and obsessive-compulsive disorders (which we will examine here); in addition, there has been interest in the overlap between these spectrums. Viewing disorders in terms of overlapping spectrums provides researchers and clinicians a framework with which to better understand and treat these disorders.

Type
Feature Articles
Information
CNS Spectrums , Volume 1 , Issue 1: Special Academic Supplement: 2nd International OCD Conference , September 1996 , pp. 17 - 26
Copyright
Copyright © Cambridge University Press 1996

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References

1.Kendell, RE. The Role of Diagnosis in Psychiatry. Oxford, UK: Blackwell; 1975.Google Scholar
2.Hollander, E, Wong, CM. Body dysmorphic disorder, pathological gambling and sexual compulsions. J Ciin Psychiatry. 1995;56(suppl 4):7–12.Google ScholarPubMed
3.Hollander, E. Obsessive-Compulsive Related Disorders. Washington, DC: American Psychiatric Press; 1993.Google Scholar
4.Hollander, E. Obsessive-compulsive spectrum disorders: an overview. Psychiatr Ann. 1993:23:355–358.CrossRefGoogle Scholar
5.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press; 1994.Google Scholar
6.Thiel, A, Broocks, A, Ohlmeier, M. Obsessive-compulsive disorder among patients with anorexia nervosa and bulimia nervosa. Am J Psychiatry. 1995:152:72–75.Google ScholarPubMed
7.Hollander, E, Wong, CM. Introduction: obsessive-compulsive spectrum disorder. J Glin Psychiatry. 1995;56(suppl 4):3–6.Google Scholar
8.DeCaria, CM, Hollander, E. Pathological gambling. In: Hollander, E, ed. Obsessive-Compulsive Related Disorders. Washington, DC: American Psychiatric Press; 1993.Google Scholar
9.McElroy, SL, Keck, PE, Phillips, KA. Kleptomania, compulsive buying and binge eating disorder. J Clin Psychiatry. 1995;56(suppl 4):14–26.Google ScholarPubMed
10.McElroy, SL, Keck, PE, Pope, HG, et al. Compulsive buying: a report of 20 cases. J Clinical Psychiatry. 1994:55:242–248.Google Scholar
11.Wong, CM, Hollander, E. New dimensions in the OCD spectrum: autism, pathological gambling, and compulsive buying. Primary Psychiatry. 1996:3:20–38.Google Scholar
12.Coleman, E. Sexual compulsivity: definition, etiology, and treatment considerations. In: Coleman, E, ed. Chemical Dependency and Intimacy Dysfunction. New York: Hawarth Press; 1987.Google Scholar
13.Anthony, DT, Hollander, E. Sexual compulsions. In: Hollander, E, ed. Obsessive-Compulsive Related D/sorcfers. Washington, DC: American Psychiatric Press; 1993.Google Scholar
14.McElroy, SL, Hudson, JI, Opoe, HG, et al. Kleptomania: a report of 20 cases. Am J Psychiatry. 1991;148:652–657.Google ScholarPubMed
15.Goldman, MJ. (1992). Kleptomania: an overview. Psychiatr Ann. 1992:22:68–71.CrossRefGoogle Scholar
16.Soltys, SM. Pyromania and firesetting behaviors. Psychiatr Ann. 1992:22:79–83.CrossRefGoogle Scholar
17.Winchel, RM. Trichotillomania: presentation and treatment. Psychiatr Ann. 1994:22:84–89.CrossRefGoogle Scholar
18.Stein, DJ, Simeon, D, Cohen, LJ, Hollander, E. Trichotillomania and obsessive-compulsive disorder. J Clin Psychiatry. 1995;56(Suppl 4):28–34.Google ScholarPubMed
19.Favazza, AR. (1992). Repetitive self-mutilation. Psychiatr Ann. 1992:22:60–63.CrossRefGoogle Scholar
20.McDougle, CJ, Kresch, LE, Goodman, WK, et al. A case-controlled study of repetitive thoughts and behaviors in adults with autistic disorder and obsessive-compulsive disorder. Am J Psychiatry. 1995:152:772–777.Google ScholarPubMed
21.Hjort, C. Asperger's syndrome: a new diagnosis in the international classification of diseases. Ugeskr Laeger. 1994;156:2729–2734.Google ScholarPubMed
22.Swedo, SE, Leonard, HL. Childhood movement disorder and obsessive-compulsive disorder. J Clin Psychiatry. 1994;55(suppl):32–37.Google ScholarPubMed
23.Swedo, SE, Leonard, HL, Rapoport, JL, et al. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania. N Engl J Med. 1989:321:491–501.CrossRefGoogle ScholarPubMed
24.Wickens, JK, Kotter, R, Alexander, ME. Effects of local connectivity on striatal function: stimulation and analysis of a model. Synapse. 1995:20:281–298.CrossRefGoogle ScholarPubMed
25.Huber, M. Clinical aspects and- therapies of dystonias. Fortschr Neurol Psychiatr 1995:63:99–105.CrossRefGoogle ScholarPubMed
26.Black, A. The natural history of obsessional neurosis. In: Beech, HK, ed. Obsessional States. London: Metheun Press; 1974.Google Scholar
27.Degonda, M, Wyss, M, Angst, J. The Zurich Study: XVIII. obsessive-compulsive disorder and syndromes in the general population. European Arch Psychiatry Clin Neurosci. 1993:243:16–22.CrossRefGoogle ScholarPubMed
28.Okasha, A, Saad, A, Khalil, AH, et al. Phenomenology of obsessive-compulsive disorder: a transcultural study. Comprehensive Psychology. 1994;35:191–197.CrossRefGoogle ScholarPubMed
29.Pauls, DL, Alsobrook, JP, Goodman, WK, et al. A family study of obsessive-compulsive disorder. Am J Psychiatry. 1995;152:76–84.Google ScholarPubMed
30.Rosenthal, RJ. (1992). Pathological gambling. Psychiatr Ann. 1992:22:72–78.CrossRefGoogle Scholar
31.Warwick, HM. Assessment of hypochondriasis. Behav Res Ther. 1995:33:845–853.CrossRefGoogle ScholarPubMed
32.Hollingsworth, C, Tanguay, P, Grossman, L, et al. Longterm outcome of obsessive-compulsive disorder in childhood. J Am Acad Child Adolescent Psychiatry. 1980:19:134–144.CrossRefGoogle ScholarPubMed
33.Hollander, E, DeCaria, CM, Nitescu, A, et al. Serotonergic function in obsessive-compulsive disorder: behavioral and neuroendocrine response to m-CPP and fenfluramine in patients and healthy volunteers. Arch Gen Psychiatry. 1992;49:21–28.CrossRefGoogle ScholarPubMed
34.Hollander, E, Cohen, L, Simeon, D. Fluvoxamine treatment of body dysmorphic disorder. J Clin Psychopharmacol. 1994:14:75–77.Google ScholarPubMed
35.Baxter, LR, Phelps, ME, Mazziotta, JC, et al. Local cerebral glucose metabolic rates in obsessive-compulsive disorder: a comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry. 1987:44:211–218.CrossRefGoogle ScholarPubMed
36.Baxter, LR, Schwartz, JM, Bergman, KS. Caudate glucose metabolic rate changes with both drug and behavioral therapies for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992:49:681–689.CrossRefGoogle ScholarPubMed
37.Schwartz, JM, Stoessel, PW, Baxter, LR, Martin, KM, Phelps, ME. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996:53:109–113.CrossRefGoogle ScholarPubMed
38.Hollander, E, Prohovnick, H, Stein, D. Increased cerebral blood flow during m-CPP exacerbation of obsessive-compulsive disorder. J Neuropsychiatry and Clin Neuroscience. 1995:7:485–490.Google ScholarPubMed
39.Goodman, WK, Price, LH, Delgado, PL, et al. Specificity of serotonergic reuptake inhibitors in the treatment of obsessive-compulsive disorder: comparison of fluvoxamine and desipramine. Arch Gen Psychiatry. 1990:47:577–585.CrossRefGoogle Scholar
40.Flament, MF, Rapoport, JL, Berg, CL, et al. Clomipramine treatment of obsessive-compulsive disorder: a double-blind controlled study. Arch Gen Psychiatry. 1985:42:977–986.CrossRefGoogle ScholarPubMed
41.Hollander, E, Liebowitz, MR, Winchel, RW, Klumker, A, Klein, DF. Treatment of body dysmorphic disorder with serotonin-reuptake blockers. Am J Psychiatry. 1989;146:768–770.Google ScholarPubMed
42.Fallon, BA, Rasmussen, SA, Liebowitz, MR. Hypochondriasis. In: Hollander, E, ed. Obsessive-Compulsive Related Disorders. Washington, DC: American Psychiatric Press; 1993.Google Scholar
43.Hollander, E, Liebowitz, MR, Fallon, B, et al. Treatment of depersonalization with serotonin-reuptake blockers. J Clin Psychopharmacol. 1990:10:200–203.CrossRefGoogle ScholarPubMed
44.Gwirtsman, HE, Guze, BH, Yager, J, Gainsley, B. Fluoxetine treatment of anorexia nervosa: an open clinical trial. J Clin Psychiatry. 1990:51:378–382.Google ScholarPubMed
45.Hollander, E, Frenkel, M, DeCaria, CM, et al. Treatment of pathological gambling with clomipramine. (letter) Am J Psychiatry. 1992:149:710–711.Google ScholarPubMed
46.Stein, DJ, Hollander, E, Anthony, DT, et al. Serotonergic medications for sexual obsessions, sexual addictions and paraphilias. J Clin Psychiatry. 1992:53:267–271.Google ScholarPubMed
47.Hollander, E, Liebowitz, MR, DeCaria, CM. Conceptual and methodological issues in the study of obsessive-compulsive and Tourette's disorders. Psychiatr Dev. 1993:4:267–296.Google Scholar
48.Allen, AJ, Leonard, HL, Swedo, SE. Case study: a new infection-triggered, autoimmune subtype of pediatric obsessive-compulsive disorder and Tourette's syndrome. J Am Acad Child Adolesc Psychiatry. 1995:34:307–311.Google ScholarPubMed
49.Murphy, T, Fudge, M, Dalai, M, et al. D8/17 positivity in childhood-onset OCD and or TS. Poster presented at the ACNP Meeting; Puerto Rico; 1995.Google Scholar
50.Andreasen, NC, Bardach, J. Dysmorphophobia: symptom or disease. Am J Psychiatry. 1977:134:673–676.Google ScholarPubMed
51.Simeon, D, Hollaner, E, Stein, DJ, Cohen, L, et al. Body dysmorphic disorder in the DSM-IV trial for obsessive-compulsive disorder. Am J Psychiatry. 1995:152:1207–1209.Google ScholarPubMed
52.Karno, M, Golding, JM, Sorenson, SB. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988:45:1094–1099.CrossRefGoogle ScholarPubMed
53.Phillips, KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry, 1991;148:1138–1149.Google ScholarPubMed
54.Hollander, E, Phillips, KA. Body image and experience disorders. In: Hollander, E, ed. Obsessive-Compulsive Related Disorders. Washington, DC: American Psychiatric Press;1993.Google Scholar
55.Vitiello, B, DeLeon, J. Dysmorphophobia misdiagnosed as obsessive-compulsive disorder. Psychosomatics. 1990:31:220–222.CrossRefGoogle ScholarPubMed
56.Munjack, DJ. The behavioral treatment of dysmorphophobia. J Behavioral Experimental Psychiatry. 1977:9:53–56.CrossRefGoogle Scholar
57.Rosen, JC, Reiter, J, Orosan, P. Cognitive-behavioral body image therapy tor body dysmorphic disorder. J Consul Clin Psychol 1995:63:263–269.CrossRefGoogle Scholar
58.Foa, EB, Steketee, G. Obsessive-compulsive disorder. In: Lindenmann, C, ed. Handbook of Phobia Therapy: Rapid Symptom Relief in Anxiety Disorders. Northvale, NJ: Jason Aronson; 1989.Google Scholar
59.Hollander, E., Liebowitz, MR, Winchel, R, Klumker, A, Klein, DF. Treatment of body dysmorphic disorder with serotonin reuptake blockers. Am JPsychiatr. 1989:146:768–770.Google ScholarPubMed
60.Sondheimer, A. Clomipramine treatment of delusional disorder-somatic type. J Am Acade Child Adolesc Psychiatry. 1988:27:188–192.Google ScholarPubMed
61.Braddock, ZE. Dysmorphophobia in adolescence: a case report. Br J Psychiatry. 1982:140:199–201.CrossRefGoogle ScholarPubMed
62.Jenike, MA. A case report of successful treatment of dysmorphophobia with tranylcypromine. Am J Psychiatry. 1984:141:1463–1464.Google ScholarPubMed
63.Cook, EH, Leventhal, B. Neuropsychiatric disorders of childhood and adolescence. In: Yudofsky, SC, Hales, E, eds. The American Psychiatric Press Textbook of Neuropsychiatry. 2nd ed., Washington, DC: American Psychiatric Press: 1992.Google Scholar
64.Volkmar, FR, Nelson, DS. Seizure disorders in autism. J Am Acad Child Adolesc Psychiatry. 1990:29:127–129.CrossRefGoogle ScholarPubMed
65.Smalley, SL, McCraken, J, Tanguay, P. Autism, affective disorders, and social phobia. Am J Med Genet. 1995:60:19–26.Google ScholarPubMed
66.Rumsey, JM, Rapoport, JL, Sceery, WR. Autistic children as adults: psychiatric, social and behavioral outcomes. J Am Acad Child Adolesc Psychiatry. 1985:24:465–473.CrossRefGoogle ScholarPubMed
67.Gillberg, C, Coleman, M. The Biology of the Autistic Syndrome, 2nd ed. New York: Cambridge University Press;1992.Google Scholar
68.Piven, J, Tsai, G, Nehme, E, et al. Platelet serotonin: a possible marker for familial autism. J Autism Dev Disord. 1992:21:51–59.Google Scholar
69.Gordon, C, Rappaport, J, Hamburger, S, et al. Differential response of autistic disorder to clomipramine. J Am Aca Child Adolesc Psychiatr. 1991;30:164.CrossRefGoogle Scholar
70.Popper, CW. Disorders usually first evident in infancy, childhood, or adolescence. In: Talbot, JA.Hales, RE and Yudofsky, SC eds. Am Psychialr Testb Psychiatr. Washington DC, American Psychiatric Press, 1988.Google Scholar
71.Greenberg, R, Sarner, CA. Trichotillomania: symptom and syndrome. Arch Gen Psychiatry. 1965:21:482–489.Google Scholar
72.Christenson, GA, Pyle, RL, Mitchell, JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry. 1991:52:415–417.Google ScholarPubMed
73.Cohen, LJ, Stein, DJ, Simeon, D, et al. Clinical profile, comorbidity and treatment history in 123 hair pullers: a survey study. J Clin Psychiatry. 1995:56:319–326.Google ScholarPubMed
4.Winchel, RM, Jones, JS, Stanley, B, et al. Clinical characteristics of trichotillomania and its response to fluoxetine. J Clin Psychiatry. 1992:53:304–308.Google ScholarPubMed
75.Koran, LM, Ringold, A, Hewlett, W. Fluoxetine for trichotillomania: an open clinical trial. Psychopharmacol Bui. 1992:28:145–149.Google ScholarPubMed
76.Brumberg, J. Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. Cambridge, Mass: Harvard University Press; 1988.Google Scholar
77.Hsu, LK, Kaye, W, Weltzin, T. Are the eating disorders related to obsessive-compulsive disorder? Int J Eating Dis. 1993:14:305–318.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
78.Kaye, W, Weltzin, T, Hsu, LK, et al. Patients with anorexia nervosa have elevated scores on the Yale-Brown Obsessive-Compulsive Scale. Int J Eating Dis. 1992:21:57–62.3.0.CO;2-7>CrossRefGoogle Scholar
79.Crisp, AH, Lacey, JH, Crutchfield, M. Clomipramine and ‘drive’ in people with anorexia nervosa: an inpatient study. Br J Psychiatry. 1987;150:355–358.CrossRefGoogle Scholar
80.Halmi, KA, Eckert, DA, Lariu, TJ, et al. Anorexia nervosa: treatment efficacy of cyproheptadine and amitriptyline. Arch Gen Psychiatry. 1986:43:177–181.CrossRefGoogle ScholarPubMed
81.Kaye, W, Gwirtsman, H, George, D, Ebert, M. Altered serotonin activity in anorexia nervosa after long-term weight restoration. Arch Gen Psychiatry. 1991:58:556–562.CrossRefGoogle Scholar
82.Fenton, WS, McGlashan, TH. The prognostic significance of obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry. 1986:143:437–441.Google ScholarPubMed
83.Foa, EB. Failure in treating obsessive-compulsives. Behav Res Ther. 1979:17:169–176.CrossRefGoogle ScholarPubMed
84.Baer, L, Jenike, MA. Personality disorders in obsessive-compulsive disorder. Psychiatr Clin North Am. 1992:15:803–812.CrossRefGoogle ScholarPubMed
85.Stroebel, CF, Szarek, BL. Use of clomipramine in the treatment of obsessive-compulsive symptomatology. J Clin Psychopharmacol. 1984:4:98–100CrossRefGoogle ScholarPubMed
86.McDougle, CJ, Goodman, WK, Price, LH, et al. Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. Am J Psychiatry. 1990:147:652–654.Google ScholarPubMed
87.Hwang, MY, Martin, AM, Lindenmayer, JP, Stein, D, Hollander, E. Treatment of schizophrenia with obsessive-compulsive features with serotonin-reuptake inhibitors. Am J Psychiatry. 1993:150:1127Google ScholarPubMed