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Nifty interview on OCD treatment


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http://www.primarypsychiatry.com/aspx/arti...x?articleid=260

I particular, I thought this was really cool:

Dr. Hollander: First of all, there may be big changes coming down the road with regard to the DSM and OCD. I co-chair the American Psychiatric Association (APA)/National Institute of Mental Health Research Planning Agenda for the fifth edition of the DSM (DSM-V), along with Joseph Zohar, MD, of the Chaim Sheba Medical Center in Tel Hashomer, Israel, which is currently examining whether OCD should be taken out of the anxiety disorders and clustered with a group of related or spectrum conditions. OCD in some respects differs from the other anxiety disorders in terms of phenomenology, brain circuitry, family history, and treatment response. Instead, it shares features of basic etiology, brain circuitry, and genetics with a group of other related or OCD spectrum disorders. These may include Tourette
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Innnteresting.

Have you run into the idea of "OCD spectrum disorders" before? I've only seen the spectrum disorders concept show up with respect to bipolar and autism.

Not in so many words I don't think. I've bumped into the relationship between tourette's, ADD and OCD before. The idea of distinct OCD subtypes has been around for a while as well.

The notion of shadow syndromes more or less implies that pretty much every medical diagnosis is part of a spectrum of some kind.

As time goes by, we find that the art of diagnosis grows ever more fragmented; seemingly sound diagnostic categories keep breaking down. Emotional problems do not fit the "concrete blocks" of the DSM-I, -II, -III, or -IV; real people come into the office with bits of this and pieces of that. A patient might show signs of panic disorder, signs of major depressive disorder, and signs of a narcissistic personality disorder all in the same package. He or she may have parts of a whole array of syndromes, and yet not suffer from all of the symptoms of any one syndrome. Or he may fit every aspect of a syndrome down to the smallest detail and yet be so mildly affected compared to other people suffering from that problem that even a good therapist might miss the diagnosis. Finally, a patient may exhibit only one or two symptoms from a particular syndrome, a condition long known as a forme fruste in conventional medicine. A patient with a forme fruste of Graves disease, for instance, might have the bulging eyes without the sweaty hands, rapid heartbeat, irritability, and weight loss that accompany a full-blown case of the illness. A forme fruste is an incomplete expression of an illness, though the term is little used today. We have chosen to replace it here with the phrase shadow syndrome because the meanings of the word shadow, both literal and metaphorical, capture the nature of a mild mental disorder. In the literal sense, a shadow is an indistinct form of something all too vivid and real, just as a shadow syndrome is an indistinct and seldom obvious form of a severe disorder. And metaphorical shadows cast a pall across a day that might otherwise be sunny and clear. This is what shadow syndromes do in the realms of work and love: they cast a shadow.
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