Jonathan S. Abramowitz and Ryan J. Jacoby
University of North Carolina at Chapel Hill, Department of Psychology, Campus Box 3270, Chapel Hill, NC 27599, USA.
A reclassification of obsessive-compulsive disorder (OCD) out of the Anxiety Disorders category and into a new diagnostic category of Obsessive-Compulsive and Related Disorders (OCRDs) has been proposedfor the forthcoming Diagnostic and Statistical Manual – Fifth Edition (DSM-5). At the time of this writing, the proposed OCRDs include body dysmorphic disorder (BDD), hoarding disorder, hair-pulling disorder (currently known as trichotillomania [TTM]), and skin picking disorder (yet this is subject to change; see www.dsm5.org). Although the empirical and intuitive bases for this re-alignment have received considerable criticism [1,2], proponents argue that the new model is essentially etiological in that it defines OCD and putatively similar disorders based on endophenotypes and apparent overlaps in etiologically relevant factors such as heritability, brain circuitry, neurotransmitter abnormalities, and phenotypic similarities with other disorders .
Proponents of the OCRD category also suggest that removing OCD from the anxiety disorders and into the new diagnostic OCRD category is justified given that the putative OCRDs share similar response profiles to so-called “anti-obsessional behavioral therapies” [3-6].The present article focuses on this claim, which as we will show, reveals a fundamental misunderstanding of the behavior therapy techniques used in the treatment of OCD; i.e., exposure and response prevention. In this essay we argue that exposure-based therapy is inappropriate for the treatment of several proposed OCRDs.