Obsessive-Compulsive Disorder: Towards Better Understanding and Outcomes

Kenneth C. Kirkby


Curr Opin Psychiatry. 2003;16(1) 

In This Article

The Characterization and Aetiology of OCD

A number of publications relate to surveys and case series of OCD in specific countries, each adding to knowledge regarding the epidemiology, presentations and context of OCD around the world. The past year has seen contributions from countries including Turkey,[1*] Iran,[2*] Taiwan[3*] and Uganda.[4] A study from the USA based on a Health Maintenance Organization database of 1.7 million patients indicates that under 1 in 1000 have a registered clinical diagnosis of OCD suggesting substantial underrecognition and untreated morbidity.[5**]

Insight is a critical issue in the understanding of OCD. A large sample of 395 individuals presenting for treatment of OCD examines questionnaire responses regarding fixity of belief, perceptual distortions, magical ideation and psychotic symptoms. Individuals who reported fear of harming self or others via overwhelming impulse or by mistake, and those with religious obsessions, had poorer insight and more perceptual distortions and magical ideation than did individuals with other types of obsessions.[6*] The relevance of insight to outcome requires better definition;[7] a study of outcome with sertraline treatment did not show a correlation between insight and treatment response.[8*]

The stability of OCD symptom dimensions across time is another area of uncertainty addressed in a 2-year study with four assessment phases, showing dimensions of obsessive-compulsive phenomena tend to be persistent, whilst varying in severity, particularly following treatment.[9**] The finer definition of cognition in OCD has received limited attention, an example being work on thought-action fusion as a cognitive marker.[10*]

A wide range of environmental aetiological factors are of interest in OCD research, in part reflecting its heterogeneity, in part our imperfect understanding of core mechanisms. Varied examples in the recent literature include: parent-child relationships;[11*] childhood trauma;[12*] tic disorders;[13*] childbirth as a stressor in male partners.[14*] There is considerable interest in 'paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections' or PANDAS.[15*,16,17*,18*] One study in adults with OCD did not replicate a finding in childhood onset cases of a higher percentage of B cells that react with the monoclonal antibody D8/17, a marker for rheumatic fever;[19*] technical refinements in the B cell assay have also been reported.[20*] This area is an interesting fusion of laboratory and clinical sciences that will be clarified by further exacting research.


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