Should Obsessive Compulsive Disorder be categorised as an anxiety disorder or an OC spectrum disorder?

 

            Obsessive-compulsive disorder has been classified as an anxiety disorder in the DSM-4 and is “traditionally” thought of as an anxiety disorder (APA Dictionary Of Psychology, n.d). But the truth is that “nosological status as an anxiety disorder has been debated for years” (Nutt D. & Malizia, A. (2006). But to understand why the debate exists, we must first understand what OCD is. Obsessive-compulsive disorder can be defined as “a disorder characterized by recurrent intrusive thoughts (obsessions) that prompt the performance of neutralizing rituals (compulsions)” (APA Dictionary Od Psychology, n.d). 

            Whereas anxiety can be defined as a set of disorders “that have as their central organizing theme the emotional state of fear, worry, or excessive apprehension” (Apa, 2015). The definition of these two disorders is very distinct from each other which is the first factor that makes them apart. But there are many such arguments that this blog aims to bring out. These arguments can help us understand if obsessive-compulsive disorder should or should not be considered an anxiety disorder. Also, this blog will try to include the differences and similarities between these two disorders. Change in the categorization of a disorder doesn’t affect “caseness” but it can affect improve its assessment and the treatment of a disorder (Stein et al., 2010).

            Research by (Nutt D & Mazilia A, 2006) shows the contradictory arguments for how we can distinguish between OCD and anxiety disorders by understanding that OCD was the first anxiety disorder to respond to antidepressants. This paper shows how developed an interest in people to categorise OCD as a disorder related to habits or can even be related impulse control but not being related to anxiety (Nutt D & Mazilia A, 2006). The paper makes an argument favouring why OCD should be classified as an anxiety disorder since most OCD patients have anxiety as their elementary symptom and how some people become anxious if they are denied of performing any of their compulsive behaviours (Nutt D & Mazilia A, 2006). 

            But these anxiety symptoms are not always “secondary symptoms” in OCD patients (Nutt D & Mazilia A, 2006). This paper discusses how the anxiety seen in OCD patients is similar to that in anxiety disorders but also how we should also consider the nature of OCD and how it has some specific behaviours and habits which make OCD a complex mixture of such symptoms. Additionally, the treatment used for anxiety disorder is similar to the anxiety seen in OCD patients (Nutt D & Mazilia A, 2006). These arguments support the debate of categorising OCD as an anxiety disorder. This made me wonder how anxiety seen in OCD patients is distinguished from the anxiety seen in patients suffering from an anxiety disorder. Also, how does anxiety differ among these disorders is it qualitatively or quantitatively?

            The research article by Stein et al. (2010) argues for having a different name for the category which will consist of OCD, OC spectrum disorders and anxiety disorders as there are overlaps between disorders of these categories. This review showed how there were overlaps between OCD and OC spectrum scale disorder which supports the debate of categorising OCD as an OC spectrum scale as they both have obsessive thoughts and compulsive habits\behaviours. Whereas anxiety disorders don’t have these obsessive thoughts and compulsive behaviours. But we do see overlaps in terms of the treatments that are undertaken to cure these disorders (Stein et al., 2010). This research article emphasises the categorization of OC spectrum disorders with OCD. A research paper by Bratz & Hollander (2006) emphasizes distinguishing OCD from anxiety disorders because the cases of OCD go undetected because they are often categorised as an anxiety disorder. This is not an ideal situation because they mention though these disorders might overlap in the treatments not all common anxiety treatments work for OCD patients (Bratz & Hollander, 2006).  This shows the need of distinguishing anxiety disorders from OCD to have proper and “systematic screening” of OCD from any other anxiety symptoms (Bratz & Hollander, 2006).

            In the study conducted by Bienvenu et al. (2011), the researchers show how the data found through family studies found that there was comorbidity and familial influences of OCD with anxiety disorders and other categories of disorders. Therefore, the study supports the initiative of including a category known as ‘anxiety and obsessive-compulsive disorders and not an OCD spectrum category (Bienvenu, 2011). This made me raise the question though having an OCD spectrum, in particular, would not be ideal, but don’t we consider OCD as a disorder which is based on a spectrum and not a definite order or degree?

            These studies show how the debate on this issue is unsettling and how there is no one specific answer to this debate. The implication for this debate is that now we will be more vigilant in the categorization of these disorders and also during their screening as they may overlap with other disorders in multiple aspects but need a specific and proper diagnosis in order to treat them. I believe having a category for the obsessive-compulsive spectrum may prove to be important as these as previously mentioned have obsessive thoughts and compulsive behaviour patterns very distinguished from other disorders. Lastly, I believe a future direction for research in this field is being able to study anxiety in a much more nuanced manner to be able to understand how it differs in multiple disorders. We can work more on the systematic screening of these disorders so that the inter-rater reliability that we can categorise them in a more efficient manner. 

 

                                                                       Reference 

 

Nutt, D., & Malizia, A. (2006). Anxiety and OCD – the chicken or the egg? Journal of Psychopharmacology. doi:10.1177/0269881106068424

Bartz & Hollander (2006). Is obsessive-compulsive disorder an anxiety disorder? 30(3), 338-352. doi:10.1016/j.pnpbp.2005.11.003.

Stein et al. (2010). Should OCD be classified as an anxiety disorder in DSM-V?, 27(6), 495–506. doi:10.1002/da.20699

Bienvenu et al. (2012). Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychological Medicine, 42(1), 1–13. doi:10.1017/S0033291711000742

Walitza S. (2014). DSM-5 [Obsessive-compulsive disorders in DSM-5 – what is new?]. 42(2), 121–127. https://doi.org/10.1024/1422-4917/a000279

 APA Dictionary of Psychology. (n.d). Anxiety Disorder. Retrieved October 20, 2022, from  https://dictionary.apa.org/anxiety-disorder

APA Dictionary of  Psychology. (n.d). Obsessive Compulsive Disorder. Retrieved October 20, 2022, from https://dictionary.apa.org/obsessive-compulsive-disorder