Talk:Obsessive–compulsive disorder

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Inaccurate history of OCD is presented[edit]

The article neglects to mention that the first clinical description of OCD was by Abu Zayd al-Balkhi in the 9th century work Sustenance of the Body and Soul.

For details, see "Obsessional Disorders in al-Balkhi′s 9th century treatise: Sustenance of the Body and Soul" published in the Journal of Affective Disorders, Volume 180, 15 July 2015, Pages 185-189.

I am including the abstract below:

Morbid fears and phobias have been mentioned in religious, philosophical and medical manuscripts since ancient times. Despite early insights by the Greeks, phobias did not appear as a separate clinical phenomenon in Western medicine until the 17th century and has evolved substantially since. However, robust investigations attempting to decipher the clinical nature of phobias emerged in pre-modern times during the oft-overlooked Islamic Golden Era (9th–12th centuries); which overlapped with Europe’s medieval period. An innovative attempt was made by the 9th century Muslim scholar, Abu Zayd al-Balkhi, in his medical manuscript “Sustenance of the Body and Soul,” to define phobias as a separate diagnostic entity. Al-Balkhi was one of the earliest to cluster psychological and physical symptoms of phobias under one category, “al-Fazaá”, and outline a specific management plan. We analyze al-Balkhi’s description of phobias, according to the modern understanding of psychiatric classifications and symptomatology as described in the DSM-5.

Semi-protected edit request on 29 September 2020[edit]

Add this to the summary

According to the DSM-5 "The obsessive-compulsive and related disorders differ from developmentally norma-tive preoccupations and rituals by being excessive or persisting beyond developmentally appropriate periods. The distinction between the presence of subclinical symptoms and aclinical disorder requires assessment of a number of factors, including the individual’s level of distress and impairment in functioning."[1] 46.159.8.205 (talk) 14:54, 29 September 2020 (UTC)

References

  1. ^ Diagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Publishing. 2013. p. 235. ISBN 978-0-89042-555-8.
Not done Such a detailed quotation is not appropriate for the WP:LEAD. Sundayclose (talk) 15:11, 29 September 2020 (UTC)
You can omit the second sentence, but you have to add an info in any way, because it gives an explanation of the term. According to DSM-5 simptoms like preoccupations can be normal and means nothing if they are adequate to the situation, that should be said.— Preceding unsigned comment added by 46.159.8.205 (talk) 2020-09-29 17:29:46 (UTC)
 Partly done: added a qualification to the first sentence which covers the issue with a citation to the DSM-5. Goldsztajn (talk) 08:35, 11 October 2020 (UTC)

Lead misleading[edit]

Hey, I'd like to start a discussion on the topic of the lead, especially the beginning of it. It is true that OCD "... is a mental disorder in which a person feels the need to perform certain routines repeatedly (called "compulsions"), or has certain thoughts repeatedly (called "obsessions"), to an extent which generates distress or impairs general functioning."

However, placing "person feels the need to perform certain routines repeatedly" as the first sentence (together with the picture of washing hands -- but that itself is not an issue), and playing the "or" word before the obsessions sentence, leads people to think of this disorder as it would be something typical that they show you in the movies (Monk), where a person just has a compulsion to do something, when in reality the nature of the disorder is obsession first->compulsion second.

Over-all, with the following sentences of the lead also playing heavily on the compulsions part, the lead is out of balance and gives the wrong idea of the disorder.

I would suggest we follow the logic of the International OCD Foundation: Obsessive compulsive disorder (OCD) is a mental health disorder (that affects people of all ages and walks of life,) and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress. - https://iocdf.org/about-ocd/#:~:text=Obsessive%20compulsive%20disorder%20(OCD)%20is,that%20trigger%20intensely%20distressing%20feelings.

BTW - I'm not even sure if OCD has a variant where a compulsion happens without an obsession?

What do you think? Wikiekke (talk) 19:40, 29 October 2020 (UTC)

I fail to see how the image is an issue. It's an infobox image that illustrations one possible aspect of OCD. The fact that the infobox is adjacent to the lead is irrelevant. Illustrating a psychiatric disorder with an image is difficult because of the complexity of a disorder, and Wikipedia is limited in the images that are available to use. If you have a better idea for an image feel free to suggest it, but read WP:NFC and WP:COPYRIGHT first. Sundayclose (talk) 00:16, 30 October 2020 (UTC)
As I said, the image itself is not an issue. Wikiekke (talk) 08:27, 30 October 2020 (UTC)
I agree! However, we should simply flip the obsession and compulsion portions of the first sentence. Furthermore, there are variants in which people have solely compulsions or obsessions. Spyder212 (talk) 02:28, 31 October 2020 (UTC)
I'd suggest to change the "or" to "and/or". Simply "or" does not define the disorder correctly.Wikiekke (talk) 13:41, 31 October 2020 (UTC)

Neurodevelopmental disorder[edit]

@Sundayclose: Personally I think WP:MEDRS – or at least the way it is enforced – is stupid. In articles on non-medical topics it is fine to say "Some researchers think X" and drop in a few cites to papers arguing that X. It isn't claiming that X is an established fact, that X is true, or even that X is the majority opinion – it is simply letting people know that some researchers believe X is true, and the readers can read the cite to find out who those researchers are and why they think this. It is exposing people to more of the research literature, which in my view is a good thing. (And I don't see why two cites is a problem for justifying "some researchers say X"–I can find more than two if you want, how many do we need?) But then suddenly on medicine, we say that we don't want to expose people to the full breadth of views in the research literature? This special rule for medicine, which applies to no other topic – it just seems silly. Anyway, the other point is what you said about being limited to children – well obviously if paediatric OCD is neurodevelopmental, some adults with OCD have had it ever since they were children, so those cases of adult OCD would be neurodevelopmental too. The question is more around adult-onset OCD. Maybe that is neurodevelopmental, maybe that isn't. Many researchers believe that adult-onset schizophrenia is neurodevelopmental, so we can't say that it can't be neurodevelopmental simply because it is adult-onset. But we don't need to resolve that question here. My point is simply, the entirely true fact, that some researchers view OCD as being (in at least some cases) a neurodevelopmental disorder – it might be one in all cases, some cases, or no cases, but whichever may be true, it remains true that some (indeed I would even say many) researchers believe it is one. Finally, you mention they aren't review articles – I'm not sure how much relevance review articles have here. If we are talking about the question of whether an intervention is effective – well, a systematic review / meta-analysis of its effectiveness across many studies is much more convincing than a single study claiming it is effective. However, you can't do a meta-analysis to determine whether something is a neurodevelopmental disorder. That is fundamentally a qualitative rather than quantitative question. Mr248 (talk) 21:10, 17 February 2021 (UTC)

"Personally I think WP:MEDRS – or at least the way it is enforced – is stupid." "This special rule for medicine, which applies to no other topic – it just seems silly": You may think it's stupid or silly, but WP:MEDRS is the standard for medical articles. Take a few minutes to read WP:Why MEDRS.
"I don't see why two cites is a problem for justifying "some researchers say X"": That's why MEDRS emphasizes review articles, so one or two studies don't get so much WP:WEIGHT which, in a medical article, can lead to erroneous conclusions. Again, read WP:Why MEDRS.
"well obviously if paediatric OCD is neurodevelopmental, some adults with OCD have had it ever since they were children": Except your edit states "Some researchers classify OCD as a neurodevelopmental disorder". If a researcher classifies it as a developmental disorder based only on pediatric patients, that is not a justification for the broad claim that OCD is a developmental disorder. That's also why your use of the phrase "some researchers" is misleading. As for your comment about adults' OCD starting out as a developmental disorder, that's a simplistic conclusion that is based on poor logic ("if the adult had OCD as a child, then that must mean that OCD is a developmental disorder") and flies in the face of the scientific method. Again, read WP:Why MEDRS.
"you can't do a meta-analysis to determine whether something is a neurodevelopmental disorder": That comment reflects a profound misunderstanding of how biological research is conducted. Metanalyses can certainly be conducted on longitudinal research that follows OCD from childhood to adulthood, or possible neurological links between OCD and developmental disorders. Meta-analyses may not provide definitive evidence for medical conclusions (which itself is rare in science), but they certainly are more persuasive than individual studies on restricted populations. Again, read WP:Why MEDRS.
I understand that you may not like having to respect WP:MEDRS in your edits to medical articles, but MEDRS has been standard procedure for editing medical articles since it was created after extensive discussion. MEDRS exists for good reasons, and has helped keep medical articles from becoming bloated with unscientific conclusions based on misunderstandings of medical research. Sundayclose (talk) 21:47, 17 February 2021 (UTC)

Semi-protected edit request on 14 April 2021[edit]

Per the International OCD foundation and the APA OCD treatment guidelines, SSRI's and CBT are both first-line treatments, and thus should be considered equal. Hence I would like to remove the word "sometimes" for antidepressants in the article. Hpbeaver6301 (talk) 02:06, 14 April 2021 (UTC)

 Done ScottishFinnishRadish (talk) 14:14, 14 April 2021 (UTC)
I disagree with this edit, at least partially. The statement in the article is not just about what is recommended. It refers to actual clinical practice. OCD sometimes is treated successfully without medication. And sometimes it is treated with only medication. The current edit says "Treatment involves", suggesting that both modalities are always used. I changed it to "Treatment may involve". The details about what is front-line treatment is discussed later in the article. Sundayclose (talk) 22:26, 14 April 2021 (UTC)