What to make of misidentification rates in obsessive-compulsive disorder.

G lazier and colleagues1 describe the considerable difficulty exhibited by nonpsychiatrist physicians in correctly identifying obsessive-compulsive disorder (OCD) caseness and show that misidentification was associated with treatment recommendations that were not evidence based. While disconcerting, the findings are not particularly surprising and are suggestive of significant gaps in mental health training and care that, while specific to OCD in this report, most likely transcend to other psychiatric disorders. Rates of OCD misdiagnosis by nonpsychiatrist physicians, especially for less well-advertised symptoms (eg, sexual or aggressive obsessions), were startling and may reflect limited breadth of medical school/residency training curricula and continuing education in psychiatry. Mental health problems are a leading cause of disability among youth and adults.2,3 Yet, nonpsychiatrist physicians have very limited training in and exposure to psychopathology and mental health treatment during medical school and residency despite the common incidence. Medical school students complete extremely brief clerkships in psychiatry, while residents often receive even less formal training/exposure while pursuing specialty training in their respective discipline. What exposure is provided has considerable heterogeneity across training programs and most likely depends on interdisciplinary relationships with teaching psychiatry/psychology departments and the resources within these departments (eg, presence of an on-site OCD clinic). To improve on OCD recognition, training during medical school, residency, and beyond must be more comprehensive and diverse than what current curricula entail, especially for certain disciplines that may commonly interface with OCD and related disorders (eg, body dysmorphic disorder) such as obstetricians, pediatricians, dermatologists, and general practitioners, among others. For example, there has been recent recognition of postpartum OCD4; yet obstetricians frequently misdiagnose or fail to diagnose OCD, and as a result, they administer the wrong treatment or no treatment and often stigmatize the patient (eg, considering a mother with harm obsessions as a threat to her child). Diversifying continuing education efforts such that nonpsychiatrist providers are required to take coursework in mental health would be a well-advised way to disseminate information