As its name implies, the main characteristics of obsessive-compulsive disorder (OCD) are obsessions and/or compulsions. Different types of obsessions and compulsions make OCD a heterogeneous condition. Also, OCD exists on a continuum from mild cases to those with extremely severe and incapacitating manifestations generally not seen in other anxiety disorders. Clinical manifestations of OCD are striking and leave few people who observe them unimpressed. This is arguably due to the seriousness with which persons with OCD take their own obsessions and compulsions along with concurrent realization that these same obsessions and compulsions are senseless and should be gotten rid of. Indeed, there are few other examples in psychopathology where insight and deficiency of insight stand together, and where espousing and fighting the absurd are so intertwined. For all these reasons, OCD is often portrayed as a puzzling or intriguing disorder; in addition, it often represents a treatment challenge. Obsessive-compulsive disorder is probably the least controversial condition within the anxiety disorders because its clinical features are well described and relatively easily recognized and because hardly anyone doubts its existence as a psychopathological entity. What is controversial about OCD, however, is where it belongs and how it should be classified. This is a consequence of a number of features of OCD that make it look different from other anxiety disorders and of the close relationship that OCD has with some conditions outside of the realm of anxiety disorders. Listed below are a number of key questions about OCD…. 1. In view of its different clinical features and the vastly different severity of these features, should OCD be considered a unitary condition or divided into subtypes? 2. If OCD is to be divided into subtypes, on the basis of what criteria should it be done? Types of obsessions and compulsions, reasons for performing compulsions, severity of illness, degree of insight, age of onset, or something else? 3. Should neutralizing responses other than compulsions be given a more prominent role in the description and conceptualization of OCD? 4. How does insight contribute to the conceptualization of OCD? 5. What are the core features of OCD? Is OCD primarily an affective disorder, is it characterized by a primary disturbance in thinking, or is it essentially a disorder of repetitive behaviors?
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