CHAPTER 9 The obsessive-compulsive spectrum
Obsessive-compulsive spectrum disorders are characterised by the presence of:
obsessional thoughts, which are recognised by the individual as their own, and are intrusive, anxiety-provoking and distressing, and
Obsessive-compulsive disorder (OCD)
When obsessional thoughts become excessively intrusive, and the obsessions and compulsions become time-consuming (over an hour a day) and interfere with daily functioning, the individual can be considered to have obsessive-compulsive disorder (OCD), as long as other psychiatric and medical (organic) causes have been excluded.
OCD itself can manifest in a number of ways. The most robust subtypes of OCD are shown in Box 9.1. There is overlap between these subtypes, and some patients present with symptoms from a number of them at the same time or at different time-points on their illness trajectory.
There is less debate about gender differences, with most studies suggesting an equal lifetime risk for males and females, but with males having an overall earlier onset of illness (late teens versus early 20s for females). The longitudinal course of illness is variable, and symptoms often wax and wane, usually worsening at times of personal stress.
