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DSM-IV field trial: obsessive-compulsive disorder

E B Foa1, M J Kozak, W K Goodman

  • 1Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129.

The American Journal of Psychiatry
|January 1, 1995
PubMed
Summary

Most patients with obsessive-compulsive disorder (OCD) are uncertain if symptoms are excessive, and many experience mental compulsions. These findings suggest revising OCD diagnostic criteria in the DSM-IV to de-emphasize insight and include mental rituals.

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Validation of the Chinese Version of Obsessive-Compulsive Inventory-Revised.

East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan·2019

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Mental Health Research

Background:

  • The Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised (DSM-III-R) criteria for obsessive-compulsive disorder (OCD) include specific requirements for symptom insight.
  • Revisions for the upcoming DSM-IV necessitate field trials to evaluate existing criteria and explore potential modifications.
  • Understanding the spectrum of OCD symptom presentation is crucial for accurate diagnosis and treatment.

Purpose of the Study:

  • To examine the validity of the DSM-III-R insight criterion for obsessive-compulsive disorder (OCD).
  • To investigate the prevalence of mental compulsions in patients diagnosed with OCD.
  • To assess the utility of proposed ICD-10 subcategories for OCD.

Main Methods:

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  • A field trial involving 431 patients with OCD across seven hospital outpatient clinics.
  • Symptom patterns and the strength of obsessive beliefs were assessed using the Yale-Brown Obsessive Compulsive Scale and specific questionnaires.
  • Patients were selected through consecutive entry and ongoing clinic contact.

    • Main Results:

    • A significant majority of patients reported uncertainty regarding whether their OCD symptoms were excessive or unreasonable.
    • Most participants exhibited both mental and behavioral compulsions.
    • Findings related to ICD-10 subcategories were inconclusive.

    Conclusions:

    • The insight criterion in the DSM-III-R for OCD should be less emphasized in the DSM-IV due to broad variability in patient insight.
    • Mental rituals should be incorporated into the definition of compulsions for OCD in future diagnostic manuals.
    • The study highlights the need for refined diagnostic criteria that better capture the heterogeneity of obsessive-compulsive disorder presentations.