Anxiety and OC spectrum disorders over life cycle

The developmental trajectory of anxiety disorders over the life span is an area of increasing interest. Obsessive-compulsive disorder (OCD), traditionally considered an anxiety disorder, is a disabling and chronic condition that is associated with considerable negative impact on numerous aspects of daily functioning. Lifetime prevalence has been estimated at 1.6%. OCD, like other anxiety disorders, is frequently associated with comorbid depression. Unlike depression, anxiety disorders begin early in life, often early in the teenage years. Thus, the total duration of symptoms may be nearly lifelong. Although a variety of pharmacological and behavioral treatments have proven effective, many patients fail to respond, and for some of those who do respond, response may be incomplete. Patients with these disorders deserve early and rigorous treatment, but the best way of achieving this goal is unclear. The Cape Town Consensus Statement reflects the opinions of an international expert working group who convened to review what is known about OCD and to suggest directions for future research. In their view, phenomenonological, clinical, and neurobiological features of OCD do not justify continued placement in the category of anxiety disorders. It has been suggested that OCD might better be placed in a separate category of obsessive-compulsive related disorders (OCRDs). Phenomenology, demographics, epidemiology, course of illness, comorbidity, endophenotyping and treatment response are factors that may influence the definition of the boundaries and relationships between these disorders. Endophenotyping characteristics include brain circuitry, neurocognitive factors, genetics, and immune function. Incorporation of a dimensional approach to the existing categorical approach to diagnosis may help to enrich the diagnostic specificity of the approach to OC behaviors.