Obsessive-compulsive Spectrum: What It Is And What Disorders It Groups Together
The latest edition of the DSM (Diagnostic Manual of Mental Disorders), in addition to betting on a more dimensional rather than categorical approach to mental disorders, involved 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, anxiety disorders or somatoform disorders).
In this article we will learn what disorders are included in this spectrum, the changes compared to the previous version, similarities of these disorders with OCD and their most relevant characteristics.
The obsessive-compulsive spectrum encompasses what are called “Obsessive-compulsive and related disorders”, and is made up of nine disorders (in summary): OCD, body dysmorphic disorder, hoarding disorder, picking disorder, trichotillomania, other medical illness-induced, substance-induced others specified and others not specified.
Obsessive-compulsive spectrum disorders, as we have said, share a series 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 in the DSM-5. .
Thus, the obsessive-compulsive spectrum It is actually a theoretical classification model which groups the different disorders mentioned within a spectrum of disorders related to obsessive-compulsive disorder (OCD), because they share notable characteristics of a different nature.
Why this new category?
The creation of this new category of disorders in the DSM-5 originates from the similarity of characteristics, manifestations, comorbidity, neuronal circuits involved, etc., of all these disorders. That is to say, The objective was to create a homogeneous group with unified criteria
However, there are authors who consider that the expectations of the DSM-5 have not been met in relation to the usefulness of this new chapter and the degree of phenomenological similarity of these disorders; Others, however, do see the creation of this new chapter of obsessive-compulsive spectrum disorders as a necessary, useful and correct change.
Characteristics of each disorder
Let’s see what each obsessive-compulsive spectrum disorder consists of and where it was previously located in the DSM-IV-TR classification (or also if it is a newly created disorder).
1. OCD (Obsessive-Compulsive Disorder)
OCD is the disorder par excellence within 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 (along with the other disorders of the new category) presented notable similarities, and how it could be considered a group of independent and differentiated disorders.
OCD includes two main symptoms: compulsions and obsessions In the DSM-IV-TR, both symptoms were necessary to make the diagnosis. In the DSM-5, on the other hand, it is only necessary to present one of the two (or obsessions or compulsions), although both frequently appear.
2. Body dysmorphic disorder
Body dysmorphic disorder (BDD) was previously located (in the DSM-IV-TR) within somatoform disorders However, it was seen how this disorder (along with the others in the “OCD and related” category) shared many characteristics of the obsessive-compulsive spectrum.
Thus, BDD has an important obsessive and compulsive component. In this way, people who suffer from the disorder manifest obsessive behaviors and/or thoughts in relation to a specific part of their body (for example, the nose), and they can apply a series of rituals (compulsive behaviors) to reduce the anxiety that comes with their dislike and rejection of that area of the body
Hoarding disorder is a new disorder, which did not exist as such in the DSM-IV-TR. However, a similar disorder did exist: Diogenes Syndrome. This syndrome, however, does not exist as an official diagnosis in the DSM, but rather it is a diagnosis that is made in clinical practice to name those patients who compulsively accumulate unnecessary objects. The difference with hoarding disorder is that in Diogenes Syndrome the majority of patients have some pathology that affects the frontal lobe and explains said syndrome. Furthermore, in Diogenes Syndrome the person also accumulates dirt, as well as objects, and ends up abandoning their hygiene and basic care.
In hoarding disorder, on the other hand, there is no previous disorder that can explain the symptoms. This disorder is included within the obsessive-compulsive spectrum because also presents this type of obsessive and compulsive symptoms
On the one hand, the person accumulates possessions compulsively and without control over it. On the other hand, he has an obsession with carrying out this behavior, reaching the point that the accumulation of objects prevents him from developing a normal life in his home.
4. Excoriation disorder
Excoriation disorder is new to the latest edition of the DSM-5, just like the previous one. This disorder It consists of scratching the skin (especially the face) repeatedly and without being able to stop especially in times of stress and/or anxiety.
These scratching behaviors are compulsive, that is, they are aimed at reducing anxiety, and they are irresistible for the patient (they cannot control them, or if they do, it is with significant effort). That is why it also constitutes an obsessive-compulsive spectrum disorder.
5. Trichotillomania
Trichotillomania was classified in the DSM-IV-TR as an “Impulse Control Disorder,” along with others such as Intermittent Explosive Disorder. It was relocated as an obsessive-compulsive spectrum disorder as it resembled OCD in some of its manifestations.
In trichotillomania, the person pulls out their hair compulsively (“can’t resist”); Often, after doing so, anxiety is reduced, and the person feels a relief from tension (as occurs with the compulsions typical of OCD, which the patient manifests to reduce anxiety, sometimes caused by the obsessions themselves).
On the other hand, we can think about the proximity of trichotillomania to OCD, since this disorder is more common in people with OCD and their first-degree relatives, if we compare it with the general population. For this and other reasons, it is classified as an obsessive-compulsive spectrum disorder.
6. Induced by another medical/substance illness
The so-called “Obsessive-compulsive and related disorders induced by another medical illness” correspond here; As its name indicates, They appear as a result of a previous illness or the ingestion of certain types of psychoactive substances (or because of its withdrawal syndrome).
Thus, any of the previous disorders caused by an underlying medical illness or substance use (or its withdrawal syndrome) are grouped together.
Difference between impulsion and compulsion
Finally, it is important to be clear about some specifications in order to make a good differential diagnosis. One of them is knowing the difference between an impulse and a compulsion (this being a characteristic of the obsessive-compulsive spectrum). Broadly speaking, the basic difference between an impulsive act and a compulsive act is that in the former the person feels pleasure when performing the impulsive behavior; in the compulsive act, on the other hand, More than pleasure, what the person feels is a release of tension and discomfort.
