Am J Psychiatry 1995; 152:90-96
Copyright © 1995 by American Psychiatric Association
DSM-IV field trial: obsessive-compulsive disorder [published erratum appears in Am J Psychiatry 1995 Apr;152(4):654]
EB Foa, MJ Kozak, WK Goodman, E Hollander, MA Jenike and SA Rasmussen
Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129.
OBJECTIVE: Three issues relevant to revising the DSM-III-R criteria for
obsessive-compulsive disorder were examined in a field trial: 1) the
requirement that symptoms of obsessive-compulsive disorder be viewed by the
patient as excessive or unreasonable, 2) the presence of mental compulsions
in addition to behavioral compulsions, and 3) ICD-10 subcategories. METHOD:
The authors studied symptom patterns of obsessive-compulsive disorder as
well as strength of obsessive belief among 431 patients with
obsessive-compulsive disorder at seven hospital outpatient clinics. Two
methods of subject selection were used: consecutive entry of everyone who
contacted the clinics for evaluation of obsessive-compulsive disorder and
entry of patients with obsessive- compulsive disorder who had continuing
contact with the clinics since before the field trial and who were still
symptomatic. Primary measures were the Yale-Brown Obsessive Compulsive
Scale and face-valid questions about fixity of obsessive-compulsive
beliefs. RESULTS: The large majority of patients were uncertain about
whether their obsessive- compulsive symptoms were unreasonable or
excessive, and most had both mental and behavioral compulsions. Results on
the ICD-10 subcategories were equivocal. CONCLUSIONS: The present results
converge with previous findings to indicate a broad range of insight among
patients with obsessive-compulsive disorder. The DSM-III-R requirement for
insight should be de-emphasized in DSM-IV, and mental rituals should be
included in the definition of compulsions.
