Should OCD be classified as an anxiety disorder in DSM-V?

Abstract

In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform disorders"). Ongoing advances in our understanding of OCD and other anxiety disorders have raised the question of whether OCD should continue to be classified with the anxiety disorders in DSM-V. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Evidence is reviewed for retaining OCD in the category of anxiety disorders, and for moving OCD to a separate category of obsessive-compulsive (OC)-spectrum disorders, if such a category is included in DSM-V. Our preliminary recommendation is that OCD be retained in the category of anxiety disorders but that this category also includes OC-spectrum disorders along with OCD. If this change is made, the name of this category should be changed to reflect this proposed change.

Structural covariance of neostriatal and limbic regions in patients with obsessive–compulsive disorder

“…51 Altogether, such results have been interpreted as indicative of impaired cortical regulation of limbic activity in individuals with high levels of anxiety. The in creased structural covariance between the vmPFC and CMS amygdala reported here suggests that patients with OCD may differ from those with other anxiety disorders, which is consis tent with a range of other data 54 and points to the need for fur ther studies of functional connectivity between the vmPFC and the amygdala in OCD samples. Importantly, in our study pa tients with a lifetime history of anxious disorders did not differ from controls in the correlation between these structures, which suggests that anxiety may partially compensate for the in creased structural covariance between the vmPFC and the amygdala observed in patients with OCD.…”

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

“…CBT was more effective than medication for panic disorder (with OCD showing a similar, though nonsignificant effect size in this direction), whereas medication was more effective than CBT for social anxiety disorder. Of these three disorders, OCD is distinct from the other two in terms of epidemiology, diagnostic comorbidity, neurobiology, [68] whereas panic and social anxiety disorders have a number of important similarities, These differential treatment response findings are difficult to interpret, and because they focus only on short-term outcome studies, must be taken with caution.…”

From anxiety to compulsivity – a review of changes to OCD classification in DSM-5 and ICD-11

“…Reducing the heterogeneity of OCD by clustering the disorder into smaller categories has had an important influence on the development of the current compulsivity-based classification of OCD, because it showed that despite all their apparent differences, all these clusters share a common core symptom repetitive behavior. On the other hand, anxiety symptoms were less consistently associated with various symptom manifestations of OCD [9].…”