The latest edition of the Diagnostic Manual of Mental Disorders (DSM), in addition to advocating a more dimensional than categorical approach to mental disorders, has led to many important changes. One of them is the new category of disorders, “obsessive-compulsive and related disorders”.
This new category, also called the obsessive-compulsive spectrum, is made up of 9 disorders related to OCD. Some of them were previously included in different categories (for example in anxiety disorders or somatomorphic disorders).
In this article, we will know which disorders are included in this spectrum, the changes from the previous version, the similarities of these disorders to OCD and their most relevant features.
What is the obsessive-compulsive spectrum?
Obsessive-compulsive disorder encompasses the so-called “obsessive-compulsive and related disorders”, and is made up of nine disorders (synthetically): OCD, Body Dysmorphic Disorder, Accumulation Disorder, Excoriation Disorder, Trichotillomania, Other Medical Disease Induced, Substance Induced, Others specified and others not specified.
Obsessive-Compulsive Disorder, as we have said, shares a number of characteristics, not only at the symptomatic level, but also at the etiological and phenomenological level, which constitutes them as a group of disorders independent of other groups of disorders. . 5.
Thus, the obsessive-compulsive spectrum it is in fact a theoretical model of classification, Which groups together the various disorders cited within a spectrum of disorders related to obsessive-compulsive disorder (OCD), to share notable characteristics of a different nature.
Why this new category?
The creation of this new category of disorders in DSM-5 arises from the similarity in characteristics, manifestations, comorbidity, neural circuits involved, etc., of all these disorders. In other words, that is to say the objective was to create a homogeneous group with unified criteria.
However, some authors consider that the expectations of DSM-5 have not been met with regard to the usefulness of this new chapter and the degree of phenomenological similarity of these disorders; others, on the other hand, see the creation of this new chapter in obsessive-compulsive disorder as a necessary, useful and successful change.
Characteristics of each disorder
Let’s see what each obsessive-compulsive spectrum disorder is and where it was previously in the DSM-IV-TR classification (or also if it is a newly created disorder).
1. OCD (obsessive-compulsive disorder)
OCD is the quintessential disorder in the obsessive-compulsive spectrum. In the previous edition of the DSM (DSM-IV) it was included in anxiety disorders. However, it was observed how the characteristics of OCD (as well as the other disorders in the new category) showed remarkable similarities and how a group of independent and differentiated disorders could be envisioned.
TOC it includes two main symptoms: compulsions and obsessions. In DSM-IV-TR, both symptoms were necessary to make the diagnosis. In DSM-5, on the other hand, only one of the two (or obsessions or compulsions) should be presented, although both appear frequently.
2. Body dysmorphic disorder
Body dysmorphic disorder (CHD) it was previously located (in the DSM-IV-TR) in somatomorphic disorders. However, we have seen how this disorder (along with others in the category “OCD and related”) shared many characteristics specific to the obsessive-compulsive spectrum.
Thus, TDC has an important obsessive and compulsive component. In this way, people with the disorder exhibit obsessive behaviors and / or thoughts related to a specific part of their body (e.g. the nose), and can even apply a series of rituals (compulsive behaviors) to reduce anxiety caused by their disgust and rejection of that area of the body.
3. Accumulation disorder
Accumulation disorder is a new disorder, Which did not exist as such in the DSM-IV-TR. However, a similar disorder existed: Diogenes syndrome. This syndrome, however, does not exist as an official diagnosis in DSM, but rather is a diagnosis that is made in clinical practice to name those patients who compulsively accumulate unnecessary items. The difference with accumulation disorder is that in Diogenes syndrome most patients have a pathology that affects the frontal lobe and explains this syndrome. In addition, in Diogenes syndrome, the person also accumulates dirt, in addition to objects, and eventually abandons basic hygiene and care.
In accumulation disorder, on the other hand, there is no previous disorder that can explain the symptoms. This disorder is included in the obsessive-compulsive spectrum because he also has this type of obsessive and compulsive symptoms.
On the one hand, the person accumulates goods compulsively and without control over himself. On the other hand, he has an obsession with performing this behavior, going so far as to accumulate objects that prevent him from developing a normal life at home.
4. Excoriation disorder
Excoriation disorder is new in the latest edition of DSM-5, just like the previous one. this disorder it consists of scratching the skin (especially the face) several times without being able to stop, Especially in times of stress and / or anxiety.
These scratching behaviors are compulsive, that is, they aim to reduce anxiety, and are irresistible to the patient (he cannot control them, or if he does, it is with a significant effort). This is why it is also an obsessive-compulsive spectrum disorder.
Trichotillomania has been classified in the DSM-IV-TR as an “impulse control disorder”, with others as intermittent explosive disorder. It has been moved as obsessive-compulsive spectrum disorder by resembling OCD in some of its manifestations.
With trichotillomania, the person compulsively pulls their hair (“I can not resist”); often after this the anxiety is reduced and the person experiences tension relief (as with OCD compulsions, which the patient manifests to reduce anxiety, sometimes caused by their own obsessions).
In contrast, one can think of the closeness of trichotillomania to OCD, as this disorder is more common in people with OCD and their first-degree relatives, when compared to the general population. For this reason and others, it is classified as an obsessive-compulsive spectrum disorder.
6. Induced by other medical disease / by substances
Here correspond the so-called “obsessive-compulsive and related disorders induced by another medical disease”; as indicated by his name, appear as a result of a previous illness or the ingestion of certain types of psychoactive substances (Or for his abstinence syndrome).
So any of the above disorders caused by an underlying medical condition or substance use (or its withdrawal syndrome) are grouped together.
Difference between drive and compulsion
Finally, it is important to have clear specifications in order to make a good differential diagnosis. The first is to know the difference between an impulse and a compulsion (this being a characteristic of the obsessive-compulsive spectrum). Generally speaking, the fundamental difference between an impulsive act and a compulsive act is that in the former case, the person enjoys performing the impulsive behavior; in the compulsive act, on the contrary, more than pleasure, what the person feels is a release of tension and discomfort.
- American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA. (Transl. Cast .: Barcelona: Masson, 1998).
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: APA. (Transl. Cast .: Madrid: Editorial Mèdica Panamericana, 2014).
- Castellón, T. (2014). The obsessive-compulsive spectrum in the DSM 5. Psychosomatic medicine and psychiatry notebooks. Ibero-American Journal of Psychosomatics, 112: 23 – 27.