Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-17T21:31:06.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Obsessive-Compulsive Disorder Spectrum as a Scientific “Metaphor”

Published online by Cambridge University Press:  07 November 2014

Stefano Pallanti  and
Eric Hollander
Stefano Pallanti*
Affiliation:
Dr. Pallanti is visiting associate professor of psychiatry and director of the Strategic Center of Excellence of Psychiatry in the Department of Psychiatry at the, Mount Sinai School of Medicineand director of the Institute of Neuroscience in Florence, Italy
Eric Hollander
Affiliation:
Dr. Hollander is Esther and Joseph Klingenstein Professor and Chairman of Psychiatry at the, Mount Sinai School of Medicine, and director of the Seaver and New York Autism Center of Excellence in New York City
*
Istituto di Neuroscienze, Viale Ugo Bassi 1, 50137, Firenze, Italy. Tel: 39-55-587889; Fax:, 39-55-581051; E-mail:, stefano.pallanti@mssm.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

As a result of clinical, epidemiological, neuroimaging, and therapy studies that took place in the late 1980s, obsessive-compulsive disorder (OCD) has been well-characterized in the field of anxiety disorders. Other disorders attracted attention for their similarities to OCD, and were located in the orbit of the disorder. OCD has become known as the “primary domain” of a scientific “metaphor” comprising the putative cluster of OCD-related disorders (OCRDs). It is a “paradigm” with which to explore basal ganglia dysfunction. The OCRDs share common phenomenology, comorbidities, lifetime course, demographics, possible genetics, and frontostriatal dysfunction (particularly caudate hyperactivity.) The adoption of this metaphor analogy has proven useful. However, 15 years since its emergence, the spectrum of obsessive-compulsive disorders remains controversial. Questions under debate include whether OCD is a unitary or split condition, whether it is an anxiety disorder, and whether there exists only one spectrum or several possible spectrums. Further work is needed to clarify obsessive-compulsive symptoms, subtypes, and endophenotypes. There is need to integrate existing databases, better define associated symptom domains, and create a more comprehensive endophenotyping protocol for OCRDs. There is also a need to integrate biological and psychological perspectives, concepts, and data to drive this evolution. By increasing research in this field, the OCD spectrum may evolve from a fragmented level of conceptualization as a “metaphor” to one that is more comprehensive and structured.

Type
Research Article
Information
CNS Spectrums , Volume 13 , Issue S14 , 2008 , pp. 6 - 15
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Karno, M, Golding, JM, Sorenson, SB, Burnam, MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45(12):1094–1099.CrossRefGoogle ScholarPubMed
2.Rasmussen, SA, Eisen, JL. Epidemiology of obsessive compulsive disorder. J Clin Psychiatry. 1990;51(Suppl):10-3;discussion 14.Google Scholar
3.Zohar, J, Mueller, EA, Insel, TR, Zohar-Kadouch, RC, Murphy, DL. Serotonergic responsivity in obsessive-compulsive disorder. Comparison of patients and healthy controls. Arch Gen Psychiatry. 1987;44(11):946–951.Google Scholar
4.Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev. 2008;32(3):525–549.Google Scholar
5.An, SK, Mataix-Cols, D, Lawrence, NS, et al.To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder. Mol Psychiatry. 2008 [Epub ahead of print].Google Scholar
6.Pato, MT, Hill, JL, Murphy, DL. A clomipramine dosage reduction study in the course of long-term treament of obsessive-compulsive disorder patients. Psychopharmacol Bull. 1990;26(2):211–214Google Scholar
7.Baxter, LR. Brain imaging as a tool in establishing a theory of brain pathology in obsessive compulsive disorder. J Clin Psychiatry. 1990;51(suppl):22–25;discussion 26.Google ScholarPubMed
8.Hollander, E, Stein, DJ, Decaria, CM, Cohen, L, Islam, M, Frenkel, M. Disorders related to OCD--neurobiology. Clin Neuropharmacol. 1992;15(suppl 1 pt A):259A–260A.Google Scholar
9.Miguel, EC, Leckman, JF, Rauch, S, et al.Obsessive-compulsive disorder phenotypes: implications for genetic studies. Mol Psychiatry. 2005;10(3):258–275.Google Scholar
10.Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
11.Stein, DJ, Lochner, C. Obsessive-compulsive spectrum disorders: a multidimensional approach. Psychiatr Clin North Am. 2006;29(2):343–351.Google Scholar
12.Black, M. Models and Metaphors. Ithaca, NY: Cornell University Press; 1962.CrossRefGoogle Scholar
13.Asimov, I. Profession. In: The Mammoth Book of Short Science Fiction Novels. Asimov, I, Greenburg, MH, Wuagh, CG. London: Robinson Publishing; 1986:1–45.Google Scholar
14.Rosenblueth, A, Wiener, N. Purposeful and non-purposeful behavior. Philosophy of Science. 1950;17:318–326.Google Scholar
15.Janet, P. Les obsessions et la psychasthénie. 1903. Fdlix Alcan, Paris: Reprint: New York, NY: Arno Press; 1976.Google Scholar
16.Luys, M. Des Obsession pathologiques dans leur rapports avec l’activitè automatique des elements nerveux. Encephali. 1883;3:20–61.Google Scholar
17.Leckman, JF, Zhang, H. Symptom dimensions in obsessive-compulsive disorder: toward quantitative phenotypes. Am J Med Genet. 2001;105(1):28–30.Google Scholar
18.Pertusa, A, Fullana, MA, Singh, S, Alonso, P, Menchówn, JM, Mataix-Cols, D. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both?Am J Psychiatry. 2008 [Epub ahead of print].Google Scholar
19.Rauch, SL, Shin, LM, Dougherty, DD, Alpert, NM, Fischman, AJ, Jenike, MA. Predictors of fluvoxamine response in contamination-related obsessive compulsive disorder: a PET symptom provocation study. Neuropsychopharmacology. 2002;27(5):782–791.Google Scholar
20.Baer, L, Jenike, MA. Personality disorders in obsessive compulsive disorder. Psychiatr Clin North Am. 1992;15(4):803–812.Google Scholar
21.Bienvenu, OJ, Samuels, JF, Riddle, MA, et al.The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000;48(4):287–293.Google Scholar
22.Saxena, S, Brody, AL, Maidment, KM, et al.C erebral glucose metabolism in obsessive compulsive hoarding. Am J Psychiatry. 2004;161(6):1038–1048.Google Scholar
23.Mataix-Cols, D, Rosario-Campos, MC. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry. 2005;162(2):228–238.Google Scholar
24.Skoog, G, Skoog, I. A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1999;56(2):121–127.Google Scholar
25Mataix-Cols, D, Rauch, SL, Baer, L, et al.Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. Am J Psychiatry. 2002;159(2):263–268.Google Scholar
26.Rufer, M, Grothusen, A, Mass, R, Peter, H, Hand, I. Temporal stability of symptom dimensions in adult patients with obsessive-compulsive disorder. J Affect Disord. 2005;88(1):99–102.Google Scholar
27.Pauls, DL, Alsobrook, JP 2nd, Goodman, W, et al.A family study of obsessive-compulsive disorder. Am J Psychiatry. 1995;152(1):76–84.Google Scholar
28.Holzer, JC, Goodman, WK, McDougle, CJ, et al.Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients. Br J Psychiatry. 1994;164(4):469–473.Google Scholar
29.Mathew, SJ, Coplan, JD, Perko, KA, et al.Neuroendocrine predictors of response to intravenous clomipramine therapy for refractory obsessive-compulsive disorder. Depress Anxiety. 2001;14(4):199–208.Google Scholar
30.Storch, EA, Stigge-Kaufman, D, Marien, WE, et al.Obsessive-compulsive disorder in youth with and without a chronic tic disorder. Depress Anxiety. 2007 [Epub ahead of print].Google Scholar
31.Hoekstra, PJ, Minderaa, RB. Tic disorders and obsessive-compulsive disorder: is autoimmunity involved? Int Rev Psychiatry. 2005;17(6):497–502.Google Scholar
32.Grados, MA, Mathews, CA, Tourette Syndrome Association International Consortium for Genetics. Latent Class Analysis of Gilles de la Tourette Syndrome Using Comorbidities: Clinical and Genetic Implications. Biol Psychiatry. 2008;64(3):219–25.Google Scholar
33.Bloch, MH, Peterson, BS, Scahill, L, et al.Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med. 2006;160(1):65–69.CrossRefGoogle ScholarPubMed
34.Como, PG, LaMarsh, J, O’Brien, KA. Obsessive-compulsive disorder in Tourette’s syndrome. Adv Neurol. 2005;96:249–261.Google Scholar
35.Diniz, JB, Rosario-Campos, MC, Hounie, AG, et al.Chronic tics and Tourette syndrome in patients with obsessive-compulsive disorder. J Psychiatr Res. 2006;40(6):487–493.Google Scholar
36.Grados, M, Riddle, MA. Do all obsessive-compulsive disorder subtypes respond to medication? Int Rev Psychiatry. 2008;20(2):189–193.Google Scholar
37.State, MW, Greally, JM, Cuker, A, et al.Epigenetic abnormalities associated with a chromosome 18(q21-q22) inversion and a Gilles de la Tourette syndrome phenotype. Proc Natl Acad Sci U S A. 2003;100(8):4684–4689.Google Scholar
38.Walitza, S, Wewetzer, C, Gerlach, M, et al.Transmission disequilibrium studies in children and adolescents with obsessive-compulsive disorders pertaining to polymorphisms of genes of the serotonergic pathway. J Neural Transm. 2004;111(7):817–825.Google Scholar
39.Walitza, S, Renner, TJ, Wewetzer, C, Warnke, A. Genetic findings in obsessive-compulsive disorder in childhood and adolescence and in adulthood. Z Kinder Jugendpsychiatr Psychother. 2008;36(1):45–52.CrossRefGoogle ScholarPubMed
40.Dickel, DE, Veenstra-VanderWeele, J, Bivens, NC, et al.Association studies of serotonin system candidate genes in early-onset obsessive-compulsive disorder. Biol Psychiatry. 2007;61(3):322–329.Google Scholar
41.Bartz, JA, Hollander, E. Is obsessive-compulsive disorder an anxiety disorder? Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(3):338–352.CrossRefGoogle ScholarPubMed
42.Fireman, B, Koran, LM, Leventhal, JL, Jacobson, A. The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization. Am J Psychiatry. 2001;158(11):1904–1910.Google Scholar
43.Nestadt, G, Samuels, J, Riddle, MA, et al.The relationship between obsessive-compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychol Med. 2001;31(3):481–487.Google Scholar
44.LaSalle, VH, Cromer, KR, Nelson, KN, Kazuba, D, Justement, L, Murphy, DL. Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder. Depress Anxiety. 2004;19(3):163–173.Google Scholar
45.Denys, D, Van Nieuwerburgh, F, Deforce, D, Westenberg, HG. Association between serotonergic candidate genes and specific phenotypes of obsessive compulsive disorder. J Affect Disord. 2006;91(1):39–44.Google Scholar
46.Whiteside, SP, Port, JD, Abramowitz, JS. A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Res. 2004;132(1):69–79.Google Scholar
47.Fineberg, NA and Gale, TM. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Int J Neuropsychopharmacol. 2005;8(1):107–129.CrossRefGoogle ScholarPubMed
48.Goodman, WK, Lydiard, RB. Recognition and treatment of obsessive-compulsive disorder. J Clin Psychiatry. 2007;68(12):e30.Google Scholar
49.Stein, DJ, Versiani, M, Hair, T, Kumar, R. Efficacy of paroxetine for relapse prevention in social anxiety disorder: a 24-week study. Arch Gen Psychiatry. 2002;59(12):1111–1118.CrossRefGoogle ScholarPubMed
50.Szeszko, PR, MacMillan, S, McMeniman, M, et al.Brain structural abnormalities in psychotropic drug-naive pediatric patients with obsessive-compulsive disorder. Am J Psychiatry. 2004;161(6):1049–1056.Google Scholar
51.Jenike, MA, Rauch, SL. Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry. 1994;55(suppl):11–17.Google Scholar
52.Stein, DJ, Goodman, WK, Rauch, SLThe cognitive-affective neuroscience of obsessive-compulsive disorder. Curr Psychiatry Rep. 2000;2(4):341–346.Google Scholar
53.First, MB, Pincus, HA, Levine, JB, Williams, JB, Ustun, B, Peele, R. Clinical utility as a criterion for revising psychiatric diagnoses. Am J Psychiatry. 2004;161(6):946–954.Google Scholar
54.Hollander, E, Anagnostou, E, Chaplin, W, et al.Striatal volume on magnetic resonance imaging and repetitive behaviors in autism. Biol Psychiatry. 2005;58(3):226–232.Google Scholar
55.Dale, RC. Autoimmunity and the basal ganglia: new insights into old diseases. QJM. 2003; 96(3):183–191.Google Scholar
56.Rauch, SL, Phillips, KA, Segal, E, et al.A preliminary morphometric magnetic resonance imaging study of regional brain volumes in body dysmorphic disorder. Psychiatry Res. 2003;122(1):13–19.Google Scholar
57.Harel, Z, Hallett, J, Riggs, S, Vaz, R, Kiessling, L. Antibodies against human putamen in adolescents with anorexia nervosa. Int J Eat Disord. 2001;29(4):463–469.Google Scholar
58.Wang, L, Lee, DY, Bailey, E, et al.Validity of large-deformation high dimensional brain mapping of the basal ganglia in adults with Tourette syndrome. Psychiatry Res. 2007;154(2):181–190.Google Scholar
59.Saxena, S, Brody, AL, Schwartz, JM, Baxter, LR. Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry Suppl. 1998;(35):26–37.Google Scholar
60.Leckman, JF. Tourette`s syndrome. Lancet. 2002;360:1577–1586.Google Scholar
61.Peterson, BS, Skudlarski, P, Anderson, AW, et al.A functional magnetic resonance imaging study of tic suppression in Tourette syndrome. Arch Gen Psychiatry. 1998;55(4):326–333.Google Scholar
62.Peterson, BS, Staib, L, Scahill, L, Zhang, H, Anderson, C, Leckman, JF, Cohen, DJ, Gore, JC, Albert, J, Webster, R. Regional brain and ventricular volumes in Tourette syndrome. Arch Gen Psychiatry. 2001;58(5):427–440.Google Scholar
63.Peterson, BS, Thomas, P, Kane, MJ, et al.Basal Ganglia volumes in patients with Gilles de la Tourette syndrome. Arch Gen Psychiatry. 2003;60(4):415–424.Google Scholar
64.Bloch, MH, Leckman, JF, Zhu, H, Peterson, BS. Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome. Neurology. 2005;65(8):1253–1258.Google Scholar
65.Swedo, SE, Leonard, HL, Rapoport, JL, Lenane, MC, Goldberger, EL, Cheslow, DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling) N Engl J Med. 1989;321(8):497–501.Google Scholar
66.Christenson, GA, Mackenzie, TB, Mitchell, JE, Callies, AL. A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry. 1991;148(11):1566.Google Scholar
67.Ninan, PT, Rothbaum, BO, Marsteller, FA, Knight, BT, Eccard, MB. A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry. 2000;61(1):47–50.Google Scholar
68.Bloch, MR, Elliott, M, Thompson, H, Koran, LM. Fluoxetine in pathologic skin-picking: open-label and double-blind results. Psychosomatics. 2001;42(4):314–319.Google Scholar
69.Deckersbach, T, Wilhelm, S, Keuthen, NJ, Baer, L, Jenike, MA. Cognitive-behavior therapy for self-injurious skin picking. A case series. Behav Modif. 2002;26(3):361–377.Google Scholar
70.Grant, JE, Mancebo, MC, Pinto, A, Eisen, JL, Rasmussen, SA. Impulse control disorders in adults with obsessive compulsive disorder. J Psychiatr Res. 2006;40(6):494–501.Google Scholar
71.Phillips, KA. Body dysmorphic disorder: clinical aspects and treatment strategies. Bull Menninger Clin. 1998;62(4 suppl A):A33–A48.Google Scholar
72.Eisen, JL, Phillips, KA, Coles, ME, Rasmussen, SA. Insight in obsessive compulsive disorder and body dysmorphic disorder. Compr Psychiatry. 2004;45(1):10–15.Google Scholar
73.Phillips, KA, Grant, JE, Siniscalchi, JM, Stout, R, Price, LH. A retrospective follow-up study of body dysmorphic disorder. Compr Psychiatry. 2005;46(5):315–321.Google Scholar
74.Rheaume, J, Freeston, MH, Dugas, MJ, Letarte, H, Ladouceur, R. Perfectionism, responsibility and obsessive-compulsive symptoms. Behav Res Ther. 1995;33(7):785–794Google Scholar
75.Kendler, KS. Explanatory Models for Psychiatric Illness. Am J Psychiatry. 2008;165(6):695–702.Google Scholar