Level: Basic Presenter: Jonathan S. Abramowitz, Ph. D., University of North Carolina–Chapel Hill Moderator

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Invited Speakers

Presidential Address
Title: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5’s New Category
Level: Basic
Presenter: Jonathan S. Abramowitz, Ph.D., University of North Carolina–Chapel Hill
Moderator: Michelle Craske, Ph.D., UCLA
The creators of DSM-5 have moved obsessive-compulsive disorder (OCD) from its previous designation as an Anxiety Disorder to a newly introduced category of “Obsessive-Compulsive and Related Disorders” (OCRDs). Along with OCD, the OCRDs include body dysmorphic disorder, hoarding disorder, hair-pulling disorder (trichotillomania), and excoriation (skin picking) disorder. The framers of DSM-5 assert that all of these conditions overlap in their symptom presentation, etiology, and treatment response. Although incorporating these problems within the same diagnostic class might raise awareness of the more underrecognized and understudied conditions, the new category’s conceptual validity, scientific basis, and practical utility are a matter of sharp disagreement among clinicians and researchers alike. In this address I will consider the nature of the putative OCRDs, examine the empirical grounds for this new diagnostic class, and discuss treatment implications. Careful inspection indicates that the DSM-5’s new OCRDs category has insufficient empirical support and might ultimately be a detriment to the clinical management of these problems. For example, apparent overlaps in “compulsive” behavior disappear at the functional level and family studies suggest OCD is more closely related to anxiety disorders than to the other OCRDs. Moreover, clinicians might incorrectly assume that comparable interventions can be applied to all conditions within the broader category. I therefore propose a more evidence-based and clinically useful nosology of obsessive-compulsive and putatively related problems.

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