DSM-IV field trial: obsessive-compulsive disorder.
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.


METHODS
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.
Foa
E B
EB
Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129.
Kozak
M J
MJ
Goodman
W K
WK
Hollander
E
E
Jenike
M A
MA
Rasmussen
S A
SA
D000328:Adult; D001294:Attitude to Health; D001364:Awareness; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013637:Tape Recording; D009626:Terminology as Topic