SPECTRUM AND BODY
Are you a ‘splitter’ or are you a ‘lumper’? Do you like to conceptualise psychiatric problems into yet smaller distinct categories or do you like to lump them together into a broad spectrum? Whichever conceptualisation is chosen, does it advance our understanding and treatment of a given mental disorder? In this chapter, I shall give an overview of the concept of obsessive-compulsive spectrum disorders (OCSDs). I shall then discuss some of the concerns about the concept and then highlight one disorder on the spectrum, namely body dysmorphic disorder.
One type of ‘lumping’ is the OCSDs, introduced by Hollander (1993). One immediate concern is that about a third of DSM-IV is part of the OCS! The spectrum is divided into three broad clusters. The first of these clusters is a preoccupation with bodily appearance or sensations and includes body dysmorphic disorder (BDD), hypochondriasis, depersonalisation and anorexia nervosa. These disorders are mainly characterised by beliefs, which are held extremely strongly (usually ‘overvalued ideas’; Veale, 2002), and difficulties in engaging patients in treatment. There is a high degree of comorbidity with OCD for most of these disorders. This cluster contains some evidence for a specific treatment response to serotonin reuptake inhibitors (SRIs) for body dysmorphic disorder. Some of the disorders may also respond to cognitive-behavioural therapy (CBT) but there is no evidence that this is a treatment specific response.
The second cluster is impulse control disorders, and includes pathological gambling, kleptomania, sexual compulsions, pyromania, trichotillomania and self-injurious behaviour. Compulsive and impulsive behaviours have a common characteristic of an inability to inhibit repetitive behaviour.
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.