OCD has both a compulsive behaviors component, and an “internal” component that has to do with compulsion and obsession. Plenty of people diagnosed with OCD do not have a huge component of compensatory or compulsive behaviors, but have their lives impaired by the thought patterns and obsessions themselves.Malcolm wrote: ↑Mon Jan 10, 2022 5:02 pmCorrect. And as such, it's diagnostic criteria are pretty subjective, not really evidence-based.Johnny Dangerous wrote: ↑Mon Jan 10, 2022 4:42 pm The DSM doesn’t use brain science as diagnostic criteria
https://pubmed.ncbi.nlm.nih.gov/19181456/
https://pubmed.ncbi.nlm.nih.gov/27071528/Evidence based medicine claims to be the paradigm for modern psychiatry. It represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence based treatments too often are ineffective. It cannot be assumed that classifying psychopathology diagnostically is the best way to move forward. Established diagnostic entities, are as much wish as reality. They are the result of committee decisions so tentative that DSM III and IV refuse to use the term "diagnoses" in the diagnostic manual.
In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field.Indeed, if your OCD is limited to not being able to carry magazines out of the bathroom once you have brought them in, or get in a new car with dirty underwear (true story), well, probably Depakote is probably overkill.Depakote is also a pretty serious drug with considerable side effects. Not to say it isn’t important in some circumstances, but plenty of people have successfully controlled their OCD without it.
As to evidence base, I am fairly sure there is probably a larger evidence base for CBT - based interventions or more ‘standard’ OCD treatment, if only due to how often these interventions are used.
Looks like yes, exposure therapy and SSRIs are the treatment with the most evidence behind them at the moment:
https://iocdf.org/about-ocd/ocd-treatment/
There are certainly issues with the subjectivity of assessment and diagnosis for psychiatric conditions, but there are also a lot of issues with taking imaging or presumed balance of neurotransmitters or whatever and saying “this physiological sign is x disorder”.