Association of insight, avoidance behavior, indecisiveness, and inflated responsibility with other clinical characteristics in children and adolescents with obsessive-compulsive disorder

Objectives: Although the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) includes ancillary symptom dimensions - insight, avoidance, degree of indecisiveness, inflated sense of responsibility, pervasive slowness/disturbance of inertia, and pathological doubting -, we know little about their clinical/scientific utility. We examined these ancillary dimensions in childhood obsessive-compulsive disorder (OCD), and tested their associations with clinical characteristics. Methods: Treatment-seeking children and adolescents (n=173) with a DSM-5 OCD diagnosis were recruited from six centers in India and evaluated with a semi-structured proforma for sociodemographic/clinical details, the Structured Clinical Interview for DSM-5, the CY-BOCS, the Children's Depression Rating Scale, and the Family Interview for Genetic Studies. Regression analysis was used to study the associations between ancillary dimensions (independent variables) and clinical variables (dependent variables). Results: 87.9% of the sample reported at least a mild-moderate severity of ancillary dimensions, which were highly intercorrelated. Multiple ancillary dimensions were correlated with illness severity on the CY-BOCS. On regression analysis, only insight and avoidance retained significance. There were few differential associations between OCD symptom and ancillary dimensions. Conclusion: Ancillary dimensions are more a feature of illness severity than differentially associated with individual symptom dimensions in childhood OCD. Insight and avoidance should be considered for inclusion in the assessment of illness severity in childhood OCD.

Prevalence of hoarding disorder among primary care patients

Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

Obsessive-compulsive disorder for ICD-11: proposed changes to the diagnostic guidelines and specifiers

Since the approval of the ICD-10 by the World Health Organization (WHO) in 1990, global research on obsessive-compulsive disorder (OCD) has expanded dramatically. This article evaluates what changes may be needed to enhance the scientific validity, clinical utility, and global applicability of OCD diagnostic guidelines in preparation for ICD-11. Existing diagnostic guidelines for OCD were compared. Key issues pertaining to clinical description, differential diagnosis, and specifiers were identified and critically reviewed on the basis of the current literature. Specific modifications to ICD guidelines are recommended, including: clarifying the definition of obsessions (i.e., that obsessions can be thoughts, images, or impulses/urges) and compulsions (i.e., clarifying that these can be behaviors or mental acts and not calling these “stereotyped”); stating that compulsions are often associated with obsessions; and removing the ICD-10 duration requirement of at least 2 weeks. In addition, a diagnosis of OCD should no longer be excluded if comorbid with Tourette syndrome, schizophrenia, or depressive disorders. Moreover, the ICD-10 specifiers (i.e., predominantly obsessional thoughts, compulsive acts, or mixed) should be replaced with a specifier for insight. Based on new research, modifications to the ICD-10 diagnostic guidelines for OCD are recommended for ICD-11.