Obsessive Compulsive Disorder (OCD) is an
anxiety disorder, characterized by repetitive unwanted obsessions and
compulsions, with a prevalence of 0.5-1% to 4% in childhood and adolescence.
Recent appraisals of OCD using the Composite International Diagnostic Interview
(CIDI) and The Diagnostic and Statistical Manual (DSM)-IV criteria show more
cross national variability than formerly reported. No cases have been reported
in metropolitan China and rates of 12-month OCD among adults are 0.1% in
Nigeria, 0.5% in The Netherlands, 0.6% in Germany, 0.6% in South Korea, 0.7% in
Australia, 1% in the United States (US), and 3% in Turkey. Median prevalence in
16 European countries is 0.7%. Further, in general US and European rates for
OCD lie within the international range. With some exceptions, the lowest rates
of anxiety disorders (including OCD) are consistently found in Asia and Africa,
and are frequently replicated by lower rates of disorder among US populations of
Asian and African descent.
The 2 primary classifications used for
mental health diagnoses are the DSM and the International Classification of
Diseases (ICD). The essential differences between these 2 systems are that ICD
is the official world classification of mental disorders endorsed by the World
Health Organization, while the DSM is a United States (US) based system, but followed
in many other countries too. The major focus of the ICD is on clinical utility,
with reduction of number of diagnoses. The ICD provides diagnostic
descriptions, and guidance, but does not employ operational criteria and gives
special attention to primary care and lowand middle- income countries. The DSM,
on the contrary, is focused mainly on secondary psychiatric care in high income
countries, tends to increase the number of diagnoses with each succeeding
revision and is a diagnostic system that depends on operational criteria using
a polythetic system for most conditions (i.e. combination of criteria that need
not all be the same. The DSM IV TR defines obsessions and compulsions as:
Obsessions: persistent ideas, thoughts, impulses, or images that are
experienced as inappropriate or intrusive and that cause anxiety and distress.
The content of the obsession is often perceived as alien and not under the
person’s control.
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