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What came first: dimensions or categories?

Dipartimento di Psychiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, via Roma, 67, 56100 Pisa, Italy

EDITED BY MATTHEW HOTOPF

We read with much interest the paper by O'Dwyer & Marks (2000), and think that the case vignettes reported by the authors fit perfectly with Insel & Akiskal's (1986) model that considers obsessive-compulsive disorder as a disorder that can develop along a continuum of insight. Therefore, the primary problem is not the boundaries between obsessive-compulsive disorder (or anorexia, or body dysmorphic disorder) and psychosis, but rather at which point insight is lost and the disorder under consideration becomes a frankly psychotic one. If one considers insight as a dimension spanning from normality to the most severe psychiatric conditions, then it will not be difficult to posit several psychiatric disorders along it, with all possible heterogenous combinations. The model becomes even more comprehensive if we add the ‘uncertainty/certainty’ dimension, so that prevalent ideations, and thus ‘normal’ conditions, can also be accommodated (Marazziti et al, 1999). Thus, insight can be considered to be intertwined with several other dimensions, yet to be identified, and can become disturbed when these other dimensions are altered. In our opinion, therefore, insight is a phenomenon that is only apparently heterogenous, and in fact is strictly related to other variables and/or clinical core features, so that it may well respond to serotonergic drugs and behavioural therapy, as underlined by O'Dwyer & Marks. The response of insight to various drugs may depend on how close are the links with the other dimension primarily disturbed (e.g. affect; certainty/uncertainty; anxiety). Naturally, these considerations demand new operational criteria that should complete, if not replace, current diagnostic criteria.

REFERENCES

Insel, T. R. & Akiskal, H. S. (1986) Obsessive—compulsive disorder with psychotic features: a phenomenological analysis. American Journal of Psychiatry, 143, 1527-1533.[Abstract/Free Full Text]

Marazziti, D., Akiskal, H. S., Rossi, A., et al (1999) Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine, 29, 741-745.[CrossRef][Medline]

O'Dwyer, A.-M. & Marks, I. (2000) Obsessive—compulsive disorder and delusions revisited. British Journal of Psychiatry, 176, 281-284.[Abstract/Free Full Text]

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Marazziti, D. Search for Related Content PubMed PubMed Citation Articles by Marazziti, D.