OCD in Egyptian Adolescents: The Effect of Culture and Religion
By Ahmed Okasha, M.D., Ph.D.
April 15, 2004
Dr. Okasha is chairperson of the department of neuropsychiatry at Ain Shams University in Cairo, Egypt. He is also director of a World Health Organization collaborating center.
There is still controversy about whether lack of insight should be regarded as the hallmark of a delusional or psychotic subtype of OCD or as a dimension that is present with different degrees of severity. It seems that the categorical diagnosis of OCD is not very satisfactory. The dimensional approach may better account for the variability in degree of insight and resistance and for the relationship between OCD and OCD spectrum disorders.
There is still incomplete evidence that OCD spectrum disorders are a separate cluster, as the similarity between them is greater than their similarity with OCD if we use proper diagnostic criteria. The fact that these patients may respond to selective serotonin reuptake inhibitors is not a valid criterion for similarity (Okasha, 2000).
Further research is also required to explore the biological and psychosocial correlates of OCD associated with depression, anxiety, psychosis, basal ganglia disorders and streptococcal infection. Should they be considered as different diagnostic subtypes?
Finally, we should have reliable tools to differentiate between OCS, traits that are prevalent in many traditional societies where religious rituals play a major role in people's lives, obsessive-compulsive personality disorder and OCD. The Y-BOCS scale has a cutoff point to differentiate between obsessive-compulsive personality disorder and OCD, but none for obsessive symptoms or traits (Okasha, 2000).
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