October 2016.

What has determined the apparent rise in OCD-type behaviours?

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As far as we can tell, Obsessive Compulsive Disorder is not actually on the rise. But a very important thing you need to understand with a psychiatric label like OCD is that there’s enormous variations in how it’s diagnosed, and they are entirely to do with how the diagnostic criteria work.

If the definition of a diagnosis changes, then the diagnosis rates change, often dramatically. To give an example, Asperger’s is no longer a diagnostic criterion in the DSM [the Diagnostic and Statistical Manual of Mental Disorders] which is essentially the bible of psychiatric diagnosis. Therefore you’re now going to see a catastrophic fall-off of the number of people diagnosed with Asperger’s because theoretically – according to the DSM – that specific condition doesn’t exist any more as something in its own right, outside the wider category of autistic spectrum disorder. 

These criteria really aren’t neutral. It’s not a simple source of psychiatric fact. There are arguments and cultural shifts behind each update: after all, homosexuality was listed in the DSM as a disorder until frighteningly recently!

But there are other things happening too. Look at a disorder like ADHD [Attention Deficit Hyperactivity Disorder] for example. This has really soared in terms of numbers of diagnoses, and that seems to be driven by what American healthcare insurers will pay out for in terms of treatment. But the levels of diagnosis are way lower in this country, because it’s not standard practice to take your child off to a psychiatrist and get them on drugs, it just doesn’t work like that here.

With OCD, though, I suspect that what we’re seeing now is not more people exhibiting these behaviours, but instead a better understanding of how this is recognised. We are a more informed population about mental health problems. When I was an undergraduate student studying psychology in the 80s, I was learning about these disorders for the first time. I didn’t know about OCD or whatever before it came up in the syllabus. But now I suspect people in school are more likely to know about them or have heard “OCD” as a term to describe someone who’s just fussy about how things are laid out on their desk or whatever.

This in turn leads more people to say, “oh that sounds a bit like me, maybe I’m like that”, and if people feel that, they’re more likely to perceive that there is more OCD because it’s personal to them. They then go on to read about it or spot it in others. As with so many psychiatric diagnoses, what you’re dealing with is just one end of a spectrum but in fact that spectrum covers most people in the population. In short, we’re more likely to talk about OCD and perceive it in people now than in the past. But that doesn’t mean more people are tipping over into an actual medial diagnosis.

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