"Pure OCD"

[Angrboda]

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) requires that a patient have either obsessions or compulsions that are a significant source of distress; are time-consuming; or interfere significantly with the person's normal routine, occupational functioning, or usual social activities or relationships. At some point during the course of the illness, the adult patient must recognize that the obsessions or compulsions are excessive or unreasonable. According to DSM-IV, obsessions are defined by the following features:

1. Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance as intrusive and inappropriate and that cause marked anxiety or distress.
   
2. Thoughts, impulses, or images that are not simply excessive worries about real-life problems.
   
3. Attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action.
   
4. Recognition that the obsessional thoughts, impulses, or images are a product of one's own mind, not imposed from without as in thought insertion.
   

Clinically, the most common obsessions are repetitive thoughts of violence (for example, killing one's child), contamination (for example, becoming infected by shaking hands), and doubt (for example, repeatedly wondering whether one has performed some act, such as having hurt someone in a traffic accident).

Compulsions are defined as follows:

1. Repetitive behaviors that the person feels driven to perform in response to an obsession or according to rules that must be rigidly applied.
   
2. Behaviors or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation. Those behaviors or mental acts are either unconnected realistically with what they are designed to neutralize or prevent, or clearly excessive.

Typical compulsions include handwashing, ordering, and checking. A significant change from DSM-III-R to DSM-IV is reflected in the addition of mental compulsions, such as praying, counting, and repeating words silently. In DSM-III-R, those were called obsessions, but because such repetitive mental actions generally serve to decrease anxiety, it was felt that they would be better characterized as mental compulsions. Obsessions are usually anxiety-provoking, whereas compulsions are usually anxiety-relieving (at least over the short term).

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I'm not trying to start an argument here, but I'm somewhat confused. From this, it would appear that OCD without compulsions is already recognized as a form of OCD. I guess my questions would be, a) is Pure OCD recognized as an independent diagnosis in either the DSM or ICD, and b) why it is being separated out. I can understand wanting to highlight it as a form of compulsive disorder which lives in the shadow of OCD with compulsions, and I don't mean to slight that, or doing so. Nor to try to sweep it back under the rug with general OCD. But two thoughts concern me. First, diagnoses are, imo, geared towards guiding treatment, because similar presentations or syndromes tend to respond similarly to similar treatment interventions; does pure OCD differ from OCD with compulsions in terms of treatment and prognosis? Second, as a person with schizo-affective disorder, I see the concept of schizotypy and schizotypal personality traits being tossed around in relation to both schizophrenia and schizo-affective disorder, including using tests for schizotypy to diagnose children who show signs typical of pre-onset schizophrenia, and then being prescribed anti-psychotics and being separated out from their peers for special treatment. Unfortunately, the concept of schizotypy is still ill-defined and conjectural, and I would hesitate to use a scientific concept which isn't clearly defined or well proven (not saying Pure OCD is like this, but treating it separately might be).

I also know that persons with borderline personality disorder are prone to thoughts about hurting others that are similarly distressing. Again, not trying to argue against Pure OCD itself, other than to note that diagnosis can be somewhat tricky, and such. In my brief googling, someone refers to themselves as being diagnosed as Pure-OCD, so some people are making the diagnosis. But is it similar to the off-label prescription of drugs?

I apologize in advance if I offend or misstate or make ignorant assumptions as a consequence of not doing more research on the matter. None is intended. I'm just trying to learn, and unfortunately I don't have the time or inclination to research it myself at present. Mea culpa.