In the last decade, there has been a considerable progress in the understanding and treatment of obsessive–compulsive and related disorders (OCRDs). First, in a major paradigm shift, obsessive–compulsive disorder (OCD) has been moved from the anxiety disorder section to the newly created section on OCRDs in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The OCRD section has thus recognized “compulsivity” as the core feature of these disorders as opposed to “anxiety”. The disorders in the OCRD section include OCD, body dysmorphic disorder, trichotillomania, skin-picking disorder, and the newly created “hoarding disorder.” Similar approaches are being employed in the International Classification of Diseases, Eleventh Revision (ICD-11). Second, in the last decade, considerable progress has been made in understanding of the neuroanatomical correlates of OCD. While the role of cortico-striato-thalamo-cortical circuits in OCD is now well recognized, the role of other areas such as parietal cortex and cerebellum is being recognized. Global collaborative efforts are being made to pool the imaging and genetic data on OCD to further our understanding. The Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) OCD consortium is one such effort in which the National Institute of Mental Health and Neurosciences (NIMHANS) OCD clinic has been an active collaborating center. There has also been a significant progress in the genetic and neuropsychological research in OCD. Third, landmark studies have been published on the role of the cognitive-behavioral therapy (CBT) in treating OCD. Fourth, research on brain stimulation in OCD, in particular, role of deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct cortical stimulation (tDCS) has accumulated. The US Food and Drug Administration (FDA) has approved DBS to treat refractory OCD under humanitarian device exemption. Recently, the US FDA has also approved deep TMS for the treatment of OCD. Finally, there is a great interest in OCRDs other than OCD.
In the context of these developments in the area of OCRDs, the NIMHANS OCD clinic organized the second international symposium titled “OCRDs: An Update on Research and Treatment Practices” on October 28 and 29, 2017, at NIMHANS, Bengaluru.
The second symposium on OCRDs also marked the successful completion of two decades of the specialty OCD clinic at the institute. The clinic has a multidisciplinary team of psychiatrists, clinical psychologists, and psychiatric social workers expert in treating OCD. Over the last two decades, the clinic has been actively involved in clinical care, postgraduate training, and research on various aspects of OCD ranging from clinical aspects, treatment resistance to neuropsychology, imaging, and genetics. The faculty of the clinic has been adequately supported by various Government of India funding agencies toward research activities. Recently, the clinic has also initiated collaborative research activities with global experts in the field.
Eminent clinicians and researchers in the area of OCRD participated in the symposium and deliberated on various aspects of OCRDs. The topics ranged from nosology of OCRDs, brain basis of compulsivity, neuropsychology, and genetics to pharmacological and nonpharmacological treatment approaches. The symposium also included talks on specific OCRDs and comorbidity of OCD with personality disorders, schizophrenia, and bipolar disorders.
This special supplement on OCRDs is a collection of up-to-date reviews on various topics deliberated in the symposium. All the speakers of the symposium were kind enough to contribute a review article to the supplement. We hope this supplement of the Indian Journal of Psychiatry on OCRDs will serve as a useful resource on the topic for years to come for both postgraduate students of psychiatry and practicing psychiatrists.