DSM-IV field trial: obsessive-compulsive disorder [published erratum appears in Am J Psychiatry 1995 Apr;152(4):654]

TLDR

The study examined three key issues for revising DSM‑III‑R OCD criteria—insight assessment, inclusion of mental compulsions, and ICD‑10 subcategories—by evaluating symptom patterns and obsessive belief strength in 431 patients across seven outpatient clinics. Participants were selected via consecutive clinic referrals and long‑term contacts, and assessed with the Yale‑Brown Obsessive‑Compulsive Scale and face‑valid belief‑fixity questions, revealing that most patients doubted the excessiveness of their symptoms and displayed both mental and behavioral compulsions. Findings showed equivocal ICD‑10 subcategory results, a broad spectrum of patient insight, and support for de‑emphasizing insight in DSM‑IV while adding mental rituals to the compulsion definition.

Abstract

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.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.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.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.