Obsessive–compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity (original) (raw)
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PLOS ONE, 2019
In this study, it is aimed to determine obsessive compulsive-related disorders (OCRDs) comorbidity among the patients with obsessive compulsive disorder (OCD) and compare patients with OCD with or without comorbid OCRDs in terms of the severity of their OCD symptoms, symptom dimensions, and comorbidity with other axis I disorders. Methods The study included 90 patients diagnosed as having OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for OCRDs were used to determine the presence of OCRDs. In order to determine the symptom dimensions and severity of these individuals' OCD symptoms, we administered the Dimensional Obsessive Compulsive Scale (DOCS) and The Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results In our study, 20% of the patients with OCD simultaneously met the criteria for at least one OCRD, we also found that a significantly greater proportion of this group were men. None of the mentioned disorders was associated with any symptom dimensions we evaluated using DOCS. In addition, no differences were found in the severity of OCD symptoms and comorbid axis I disorders between the group with comorbid OCRDs and the group without comorbid OCRDs. Discussion There was no significant relationship between the symptom dimensions of OCD and OCRDs. It is found that OCRD comorbidity does not increase the severity of OCD symptoms and the prevalence of an axis I diagnosis.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2011
Introduction: Comorbid obsessive-compulsive personality disorder (OCPD) is well-described in obsessivecompulsive disorder (OCD). It remains unclear, however, whether OCPD in OCD represents a distinct subtype of OCD or whether it is simply a marker of severity in OCD. Materials and methods: The aim of this study was to compare a large sample of OCD subjects (n = 403) with and without OCPD on a range of demographic, clinical and genetic characteristics to evaluate whether comorbid OCPD in OCD represents a distinct subtype of OCD, or is a marker of severity. Results: Our findings suggest that OCD with and without OCPD are similar in terms of gender distribution and age at onset of OC symptoms. Compared to OCD − OCPD (n = 267, 66%), those with OCD + OCPD (n = 136, 34%) are more likely to present with the OC symptom dimensions which reflect the diagnostic criteria for OCPD (e.g. hoarding), and have significantly greater OCD severity, comorbidity, functional impairment, and poorer insight. Furthermore there are no differences in distribution of gene variants, or response to treatment in the two groups. Conclusion: The majority of our findings suggest that in OCD, patients with OCPD do not have a highly distinctive phenomenological or genetic profile, but rather that OCPD represents a marker of severity.
Meta-Analysis of the Symptom Structure of Obsessive-Compulsive Disorder
American Journal of Psychiatry, 2008
Objective-OCD is a clinically heterogeneous condition. This heterogeneity has the potential to reduce power in genetic, neuroimaging, and clinical trials. Despite a mounting number of studies, there remains debate regarding the exact factor structure of OCD symptoms. The authors conducted a meta-analysis to determine the factor structure of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist. Method-Studies were included if they involved subjects with OCD and included an exploratory factor analysis of the 13 Yale-Brown Obsessive Compulsive Scale Symptom Checklist categories or the items therein. A varimax-rotation was conducted in SAS 9.1 using the PROC FACTOR CORR to extract factors from sample-size weighted co-occurrence matrices. Stratified metaanalysis was conducted to determine the factor structure of OCD in studies involving children and adults separately. Results-Twenty-one studies involving 5,124 participants were included. The four factors generated were 1) symmetry: symmetry obsessions and repeating, ordering, and counting compulsions; 2) forbidden thoughts: aggression, sexual, religious, and somatic obsessions and checking compulsions, 3) cleaning: cleaning and contamination, and 4) hoarding: hoarding obsessions and compulsions. Factor analysis of studies including adults yielded an identical factor structure compared to the overall meta-analysis. Factor analysis of child-only studies differed in that checking loaded highest on the symmetry factor and somatic obsessions, on the cleaning factor. Conclusions-A four-factor structure explained a large proportion of the heterogeneity in the clinical symptoms of OCD. Further item-level factor analyses are needed to determine the appropriate placement of miscellaneous somatic and checking OCD symptoms. Obsessive-compulsive disorder (OCD) is characterized by repetitive, intrusive thoughts and images and/or by repetitive, ritualistic physical or mental acts performed to reduce the attendant anxiety. OCD is common, affecting 1%-3% of people in both adult and pediatric samples (1-3). OCD is a clinically heterogeneous condition such that two patients with clear OCD can display completely distinct symptom patterns. Despite this obvious phenotypic heterogeneity, DSM-IV and ICD-10 have regarded OCD as a unitary nosological entity.
Comprehensive …, 2001
Increasing attention has been paid to the possibility that a range of disorders, the putative obsessive-compulsive spectrum disorders (OCSDs), may share overlapping phenomenological and neurobiological features with obsessive-compulsive disorder (OCD). The development of a structured clinician-administered interview for the putative OCSDs (SCID-OCSD) is described. This instrument was used to investigate differences between OCD patients with a comorbid putative OCSD and OCD patients without a comorbid putative OCSD. A sample of 85 adult patients (38 men and 47 women) presenting for treatment of OCD was interviewed with the SCID-OCSD. OCD patients without comorbid putative OCSDs (n ؍ 36) were compared to patients with comorbid OCSDs (n ؍ 49) in terms of demographic features, clinical characteristics, and associated comorbidity with other non-OCSD DSM-IV axis I disorders. Of the OCD patients, 57.6% currently met criteria for at least one putative OCSD and 67.1% had a lifetime history of at least one comorbid OCSD. The OCSDs with the highest preva-lence rates were compulsive self-injury (22.4%), compulsive buying (10.6%), and intermittent explosive disorder (10.6%). There was a significantly larger proportion of women in the group with comorbid OCSDs. Although the two groups did not differ in terms of severity of OCD symptoms, the group with comorbid OCSDs had significantly more obsessions and compulsions. The two groups did not differ significantly in terms of associated psychopathology other than OCSDs. We conclude that the SCID-OCSD provides clinicians and researchers with an instrument for the diagnosis of putative OCSDs. Our findings suggest that putative OCSDs have a relatively high prevalence rate in OCD patients. In addition, OCD patients with comorbid OCSDs differ with regard to certain demographic and clinical features. Further research, particularly genetic and neuroimmunological work, may ultimately be useful in validating the obsessive-compulsive spectrum.
Since the decade of the seventies, several neuropsychological abnormalities in very different cognitive domains have been described among patients with Obsessive-compulsive disorder (OCD). Due to the nature of these abnormalities, it was concluded that possibly the main dysfunction for this disorder was located in the right hemisphere, especially in the frontal cortex; nevertheless this particular brain region was found to be involved in other psychiatric disorders, so neuropsychological results were considered to be of limited precision and it was thought that the diversity in results was not due to the malfunction of one particular brain region. So it became evident that a new research methodology based in the information processing model with highly specific neuropsy-chological paradigms of frontal functioning was needed; as well as considering a subtypology based in the cognitive characteristics in patients with the same disorder and similar phenomenol-ogy. Regarding OCD it is well known that the dorsolateral prefron-tal cortex is in charge of the regulation of complex actions, executive functions and the elaboration of logical strategies in a problem solving task; so its dysfunction causes a failure in the creation of response patterns and perseverations due to the inability to change a pattern when an alternative response is needed. On the other hand, obsessions are associated mainly with the anterior cingulated cortex and the basal region of the corpus stria-tum and its connections with the limbic system, giving place to incapacity to select the relevant information from the environment , which makes the individual perceive irrelevant stimuli as threatening for physical integrity. By the way, some clinical subtypes have also been identified: contamination/washing, aggressiveness/checking, hoarding, sym-metry/order. There is also some evidence of different patterns of brain activation to several visual stimuli related to the obsessive or compulsive object in the clinical subtypes, as shown by functional magnetic resonance image in some regions of the frontal lobe, either dorsolateral, medial or basal and its connections with the basal ganglia, and in some cases thalamus or limbic system. In the face of all this evidence, the goal of the present study was to find if within this disorder it was possible, through several neuropsychological paradigms of frontal functioning, to find different patterns of execution, considering the clinical subtype and the severity of obsessions and compulsions. Fifty-eight patients with a diagnosis of OCD were studied; all patients were under treatment at the OCD clinic of the National Institute of Psychiatry Ramón de la Fuente in Mexico City. Two neuropsychological tests were administered: 1) Trail Making Test (TMT) and 2) Wisconsin Card Sorting Test (WCST). From the Target Symptom List, the clinical subtype was obtained. After the statistical analysis, we found no differences between the severity of obsessions and the severity of compulsions as measured by the Yale-Brown Scale. Also, we observed three factors concerning the neuropsychological tests, and patients were grouped in four different groups, each one with a distinct cogni-tive performance. Through the interpretation of results it was concluded that in a sample of 58 patients with OCD, different groups of neuropsy-chological functioning where distinguished. In their own, these groups where associated with different clinical subtypes. These results are in accordance with the neurobiological modular organization model of OCD, which sustains the existence of independent systems of cognitive dysfunction that regulate different symptomatic expressions. RESUMEN La metodología de investigación, a partir del modelo del procesamiento de información con paradigmas neuropsicológicos de funcionamiento del lóbulo frontal, permite un estudio más específico de los trastornos psiquiátricos con fenomenología parecida, lo que a su vez permite crear modelos basados en una subtipología de índole cognoscitiva y, por ende, lleva al
European archives of psychiatry and clinical neuroscience, 2015
Due to its heterogeneous phenomenology, obsessive-compulsive disorder (OCD) has been subtyped. However, these subtypes are not mutually exclusive. This study presents an alternative subtyping approach by deriving non-overlapping OCD subtypes. A pure compulsive and a mixed obsessive-compulsive subtype (including subjects manifesting obsessions with/without compulsions) were analyzed with respect to a broad pattern of psychosocial risk factors and comorbid syndromes/diagnoses in three representative Swiss community samples: the Zurich Study (n = 591), the ZInEP sample (n = 1500), and the PsyCoLaus sample (n = 3720). A selection of comorbidities was examined in a pooled database. Odds ratios were derived from logistic regressions and, in the analysis of pooled data, multilevel models. The pure compulsive subtype showed a lower age of onset and was characterized by few associations with psychosocial risk factors. The higher social popularity of the pure compulsive subjects and their fam...
Molecular Psychiatry, 2006
Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms representing multiple domains. This complex phenotype can be summarized using a few consistent and temporally stable symptom dimensions. The objective of this study was to assess the psychometric properties of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS). This scale measures the presence and severity of obsessive-compulsive (OC) symptoms within six distinct dimensions that combine thematically related obsessions and compulsions. The DY-BOCS includes portions to be used as a self-report instrument and portions to be used by expert raters, including global ratings of OC symptom severity and overall impairment. We assessed 137 patients with a DSM-IV diagnosis of OCD, aged 6-69 years, from sites in the USA, Canada and Brazil. Estimates of the reliability and validity of both the expert and self-report versions of the DY-BOCS were calculated. The internal consistency of each of the six symptom dimensions and the global severity score were excellent. The interrater agreement was also excellent for all component scores. Self-report and expert ratings were highly intercorrelated. The global DY-BOCS score was highly correlated with the total Yale-Brown Obsessive-Compulsive Scale score (Pearson r = 0.82, P < 0.0001). Severity scores for individual symptom dimensions were largely independent of one another, only modestly correlated with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. These results indicate that the DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in natural history, neuroimaging, treatment response and genetic studies when administered by expert clinicians or their highly trained staff.
Obsessive-compulsive disorder: subclassification based on co-morbidity
Psychological medicine, 2009
Obsessive-compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes. Seven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated. Two and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive di...