Phenomenology of OCD: Lessons from a large multicenter study and implications for ICD-11 |
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| Institution: | 1. Department of Psychiatry, University of Sao Paulo Medical School, Brazil;2. Institute of Mathematics and Statistics, University of Sao Paulo, Brazil;3. Department of Psychiatry/Internal Medicine, Federal University of Health Sciences, Porto Alegre, Brazil;4. Anxiety and Depression Program, Institute of Psychiatry, Federal University of Rio de Janeiro & Institute D''Or of Research and Education, Rio de Janeiro, Brazil;5. Department of Neurology, Psychology and Psychiatry, State University of Sao Paulo, Botucatu, Brazil;6. Federal University of Sao Paulo, Brazil;7. Yale University, New Haven, USA;8. College of Physicians and Surgeons at Columbia University, USA;9. Anxiety Disorders Clinic and the Center for OCD and Related Disorders at the New York State Psychiatric Institute, USA;1. Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 35 Gengo, Morioka-machi, Obu, Aichi 474-8511, Japan;2. Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan;1. Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA;2. Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil;3. Highly Specialized Obsessive Compulsive Disorder and Body Dysmorphic Disorder Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire AL8 6HG, UK;4. University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, UK;5. Pediatric OCD Consultation Team, Anxiety Treatment and Research Centre, St. Joseph’s Healthcare, McMaster University, 100 West 5th Street, Hamilton, ON, Canada L8N 3K7;6. VU University Amsterdam Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands;7. University of Cambridge School of Clinical Medicine, Department of Psychiatry and MRC / Welcome Trust Behavioral and Clinical Neuroscience Institute Addenbrooke׳s Hospital, Cambridge CB2 2QQ, UK;1. Department of Health Psychology, Miguel Hernandez University, Elche, Spain;2. Catholic University of Murcia (UCAM), Murcia, Spain;3. Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden;1. Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;2. Harvard University, Cambridge, MA, USA;3. University of Miami, Coral Gables, FL, USA;4. Nova Southeastern University, Fort-Lauderdale-Davie, FL, USA;5. Emory University, Atlanta, GA, USA;6. UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA;7. Texas A&M University, College Station, TX, USA;8. Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA;9. University of Texas Health Science Center at San Antonio, San Antonio, TX, USA |
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| Abstract: | This study aimed to investigate the phenomenology of obsessive–compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale–Brown Obsessive–Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased. |
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| Keywords: | Obsessive–compulsive disorder Phenomenology Sensory phenomena Mental compulsions Insight |
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