In the DSM-5, obsessive-compulsive disorder (OCD) has been removed from the category of “Anxiety Disorders” and classified into a new separate diagnostic category of “Obsessive-Compulsive and Related Disorders.” According to the diagnostic criteria, anxiety, which was the central emotional component of the OCD definition in the DSM-IV and that articulated the relation between obsessions and compulsions, will no longer have to be systematically identified in OCD patients at all. The importance of this transformation is visible in the debates that took place about the possibility of introducing a new category in the DSM-5, “Obsessive-Compulsive Spectrum Disorders.” Although it was ultimately rejected, this category was supposed to include OCD as well as Tourette syndrome, stereotypic movement disorders, or impulse control disorders. The anxious component that defined OCD as an anxiety disorder in the DSM-IV would have been used only to distinguish OCD from other diseases within the spectrum.
This chapter will clarify how this transformation is characterized conceptually by the shift in the criteria of OCD from affect to behavior, and institutionally by the entrance in the DSM of a diagnostic category that originates mostly from a research, rather than a clinical, setting. My analysis will be based on an ethnographic research of a French neuroscience team that developed experimental therapeutics for OCD.
- Deep brain stimulation
- Obsessive-compulsive disorder
- Social anthropology
“How are the clinician and researcher to understand this enigmatic and often disabling condition? Is OCD a thought disorder? Is it a disturbance of repetitive behavior? Is it a problem with impulse control? Is it one of anxiety? How one answers these questions has major implications for how they conceptualize OCD, how they study the disorder, and how they evaluate and treat affected individuals.”(Abramowitz and Deacon 2005a, p. 119)
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For a detailed conceptual history of OCD, see Castel (2012).
The disorders which associate a mental state with compulsive behaviors are Body Dysmorphic Disorder, Trichotillomania (hair-pulling disorder), and two new categories: Hoarding Disorder and Excoriation (skin-picking) Disorder.
It seems that Michael Jenike was the first author to introduce the idea of a “spectrum” concerning OCD (or rather concerning OCD “related disorders”: 1989, 1990). Hollander then appropriated the concept (Hollander and Stein 1993) and produced countless publications on the topic. The journal CNS Spectrum, of which he is editor-in-chief, provided him with a particularly timely forum during the development of the DSM-5. Researchers such as R. K. Pitman or J. Leckman also worked on this approximation through their research on the links between OCD and Tourette Syndrome (Leckman et al. 1994/1995; Pitman et al. 1987) (see Moutaud 2009, p. 295).
Interestingly, the category was temporarily renamed “Obsessive-Compulsive and Movement-Related Disorders” (my emphasis) in its description on the DSM-5 Web site. The page was deleted following publication of the DSM-5.
This is what Pallanti and Hollander seem to acknowledge when they use, fairly obscurely, the term “scientific metaphor” to qualify the prospects opened up by this spectrum (and its weaknesses) (2008). In addition, one of the direct consequences of the entry of the OCRD category in the DSM was the launch in 2012 of a journal devoted to it called Journal of Obsessive-Compulsive and Related Disorders, of which Abramowitz is the founding editor-in-chief. The journal observes, in its first editorial, that the first effect of the new classification will be to “expand the scope of what is considered an ‘obsessive-compulsive disorder’ and fuel increased funding and research on OCD and these putatively related conditions” (Abramowitz 2012, p. iii).
This invasive neurosurgical technology involves the insertion of two small electrodes inside the patient’s brain linked to a pulse generator placed in the chest, allowing physicians to modulate its activity through ongoing electrical stimulation. Invented in 1986 in France for the symptomatic treatment of Parkinson’s disease and essential tremor, DBS was rapidly considered at the end of the 1990s as a potential experimental treatment for severe forms of various neurological and psychiatric conditions (such as dystonia, OCD, depression and TS). DBS quickly became the subject of major social, scientific and ethical concerns, raising hope and fears about its increasingly widespread use.
This theory had long been supported by various experimental and clinical data, particularly neuroimaging data or that indicating the high comorbidity of TS and Parkinson’s disease with OCD (Moutaud 2008).
For an overview of the scientific debate about animal models in neuroscience, see: Rose and Abi-Rached 2013, chapter 3. From an anthropological perspective, as Schlich and colleagues put it (2009, pp. 330–331), animal experiments in medicine are a “manifestation of pure form” of the naturalistic ontology described by Descola (2005): if non-human animals and humans differ in interiority, they have a shared physicality which make animals pertinent as a human body substitute in order to experimentally manipulate its biological functions (Bynum 1990; Löwy 2000). But if the denial of human-like interiority to animals would give them the lower ethical status that allows for these experiments, it also becomes the core of the epistemological controversy concerning their use as human behavioral models in psychiatry.
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Moutaud, B. (2015). DSM-5 and the Reconceptualization of Obsessive-Compulsive Disorder. In: Demazeux, S., Singy, P. (eds) The DSM-5 in Perspective. History, Philosophy and Theory of the Life Sciences, vol 10. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-9765-8_13
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