Observations of the past decade on one of the anxiety disorders, obsessive compulsive disorder (OCD), are instructive in terms of the unanticipated findings. These findings demonstrate how discoveries like those in the area of 5-hydroxytryptamine (5-HT) pharmacology modify concepts of both drugs and illness. As a plethora of new therapeutic agents arrive, this experience may help to prepare the clinician for future conceptual and pragmatic shifts.
New findings in OCD include how unexpectedly common this disorder is, its presentation to medical practitioners, its biologic characteristics, and its "tilt" to requiring 5-HT specificity for treatment. Modern epidemiology1 suggests that this psychiatric disorder, which once was considered rare (one in 10000 persons), is actually common (approximately one in 40 persons-more common than asthma or diabetes). The previous underestimates are related to an older diagnostically nonspecific epidemiology, often inefficient therapy, and reluctance of patients to make themselves evident because of stigma. Patients
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