title: Phenomenology of OCD: lessons from a large multicenter study and implications for ICD-11.
abstract: This study aimed to investigate the phenomenology of obsessive-compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased.
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Brazil. Electronic address: roseligshavitt@gmail.com.
authors.forename: Roseli G
authors.initials: RG
authors.lastname: Shavitt
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Brazil.
authors.forename: Maria Alice
authors.initials: MA
authors.lastname: de Mathis
authors.affiliation: Institute of Mathematics and Statistics, University of Sao Paulo, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Oki
authors.affiliation: Department of Psychiatry/Internal Medicine, Federal University of Health Sciences, Porto Alegre, Brazil.
authors.forename: Ygor A
authors.initials: YA
authors.lastname: Ferrao
authors.affiliation: Anxiety and Depression Program, Institute of Psychiatry, Federal University of Rio de Janeiro & Institute D'Or of Research and Education, Rio de Janeiro, Brazil.
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
authors.affiliation: Department of Neurology, Psychology and Psychiatry, State University of Sao Paulo, Botucatu, Brazil.
authors.forename: Albina R
authors.initials: AR
authors.lastname: Torres
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Brazil.
authors.forename: Juliana B
authors.initials: JB
authors.lastname: Diniz
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Brazil.
authors.forename: Daniel L C
authors.initials: DL
authors.lastname: Costa
authors.affiliation: Federal University of Sao Paulo, Brazil; Yale University, New Haven, USA.
authors.forename: Maria Conceição
authors.initials: MC
authors.lastname: do Rosário
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Brazil.
authors.forename: Marcelo Q
authors.initials: MQ
authors.lastname: Hoexter
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Brazil.
authors.forename: Euripedes C
authors.initials: EC
authors.lastname: Miguel
authors.affiliation: College of Physicians and Surgeons at Columbia University, USA; Anxiety Disorders Clinic and the Center for OCD and Related Disorders at the New York State Psychiatric Institute, USA.
authors.forename: H Blair
authors.initials: HB
authors.lastname: Simpson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003192:Compulsive Behavior / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009770:Obsessive Behavior / Q000175:diagnosis* / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D010552:Personality Assessment / Q000592:standards*; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D055815:Young Adult
keywords: Insight; Mental compulsions; Obsessive–compulsive disorder; Phenomenology; Sensory phenomena