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Letter to the Editor   |    
Dr. Mataix-Cols and Colleagues Reply
DAVID MATAIX-COLS, Ph.D.; MARIA CONCEIÇÃO do ROSARIO-CAMPOS, M.D.; JAMES F. LECKMAN, M.D.
Am J Psychiatry 2005;162:2194-2194. doi:10.1176/appi.ajp.162.11.2194

To the Editor: We were pleased to read Dr. Calamari’s letter in relation to our recently published review. It highlights methodological and conceptual issues that are unlikely to be easily resolved. Rather than diametrically opposite techniques, factor analysis and categorical approaches, such as cluster analysis, are likely to be complementary because they constitute different ways of looking at the same phenomenon—the heterogeneity of OCD (1). Both have demonstrated their usefulness. For example, tic-related OCD and early-onset OCD both appear to be overlapping and valid subtypes (2). Our preference for factor analytical techniques to address the classic symptoms of OCD is twofold.

First, our model hypothesizes that obsessive-compulsive phenomena are normally distributed in the general population (3, 4) and are not limited to the traditional diagnostic boundaries of OCD, i.e., they may be present in many other neurological and psychiatric conditions. Conceptually, a dimensional approach seems to reflect this more accurately. Second, if one adopts a strictly categorical approach, patients need to be unequivocally allocated to only one subtype: a patient is either in cluster X or in cluster Y but not both. We doubt that nature is so exact regarding these symptoms. This is one of the main limitations of the DSM-IV multiaxial system and has been heavily criticized. Along with other theoreticians (5, 6), we propose that a dimensional approach can better deal with the problem of comorbidity or the coexistence of various symptom types in OCD. In short, we reiterate the idea that different methods of analysis are probably likely to yield complementary results. We are glad that Dr. Calamari concurs that considering the heterogeneity of OCD is the direction to take in this important area of research.

McKay D, Abramowitz JS, Calamari JE, Kyrios M, Radomsky A, Sookman D, Taylor S, Wilhelm S: A critical evaluation of obsessive-compulsive disorder subtypes: symptoms versus mechanisms. Clin Psychol Rev  2004; 24:283–313
[PubMed]
[CrossRef]
 
do Rosario-Campos MC, Leckman JF, Curi M, Quantrano S, Katsovich L, Miguel EC, Pauls DL: A family study of early-onset obsessive-compulsive disorder. Am J Med Genet B Neuropsychiatr Genet 2005; May 12.
 
Rachman S, de Silva P: Abnormal and normal obsessions. Behav Res Ther  1978; 16:233–248
[PubMed]
[CrossRef]
 
Mataix-Cols D, Cullen S, Lange K, Zelaya F, Andrew C, Amaro E, Brammer MJ, Williams SCR, Speckens A, Phillips ML: Neural correlates of anxiety associated with obsessive-compulsive symptom dimensions in normal volunteers. Biol Psychiatry  2003; 53:482–493
[PubMed]
[CrossRef]
 
Krueger RF, Piasecki TM: Toward a dimensional and psychometrically informed approach to conceptualizing psychopathology. Behav Res Ther  2002; 40:485–499
[PubMed]
[CrossRef]
 
Maser JD, Patterson T: Spectrum and nosology: implications for DSM-V. Psychiatr Clin North Am  2002; 25:855–885
[PubMed]
[CrossRef]
 
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References

McKay D, Abramowitz JS, Calamari JE, Kyrios M, Radomsky A, Sookman D, Taylor S, Wilhelm S: A critical evaluation of obsessive-compulsive disorder subtypes: symptoms versus mechanisms. Clin Psychol Rev  2004; 24:283–313
[PubMed]
[CrossRef]
 
do Rosario-Campos MC, Leckman JF, Curi M, Quantrano S, Katsovich L, Miguel EC, Pauls DL: A family study of early-onset obsessive-compulsive disorder. Am J Med Genet B Neuropsychiatr Genet 2005; May 12.
 
Rachman S, de Silva P: Abnormal and normal obsessions. Behav Res Ther  1978; 16:233–248
[PubMed]
[CrossRef]
 
Mataix-Cols D, Cullen S, Lange K, Zelaya F, Andrew C, Amaro E, Brammer MJ, Williams SCR, Speckens A, Phillips ML: Neural correlates of anxiety associated with obsessive-compulsive symptom dimensions in normal volunteers. Biol Psychiatry  2003; 53:482–493
[PubMed]
[CrossRef]
 
Krueger RF, Piasecki TM: Toward a dimensional and psychometrically informed approach to conceptualizing psychopathology. Behav Res Ther  2002; 40:485–499
[PubMed]
[CrossRef]
 
Maser JD, Patterson T: Spectrum and nosology: implications for DSM-V. Psychiatr Clin North Am  2002; 25:855–885
[PubMed]
[CrossRef]
 
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