Elsevier

Journal of Psychiatric Research

Volume 93, October 2017, Pages 72-78
Journal of Psychiatric Research

Developmental and clinical predictors of comorbidity for youth with obsessive compulsive disorder

https://doi.org/10.1016/j.jpsychires.2017.05.002Get rights and content

Abstract

Objective

To date, few studies of childhood obsessive compulsive disorder (OCD) have been adequately powered to examine patterns and predictors of comorbidity, despite the frequency with which it occurs. We address this gap, drawing on a large sample of youth with OCD who were systematically assessed through research and clinical programs in a university-based specialty program for children and adolescents with OCD. We examine patterns of comorbidity across different epochs of development and predict specific classes of OCD (comorbidity internalizing/externalizing/both) from key demographic and clinical variables that may be useful in guiding individualized treatment.

Method

A total of 322 youths (mean age = 12.28, 53% male) were assessed using the Anxiety Disorders Interview Schedule (ADIS; Silverman and Albano, 1996), the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997) and other standardized measures.

Results

Consistent with prior research, 50% of youth met criteria for a co-occurring anxiety or depressive disorder. Rates of externalizing disorders were lower (16%). Developmental differences emerged such that older youth met criteria for a higher number of co-occurring disorders. As expected, adolescents in particular were more likely to have a co-occurring internalizing disorder compared to early or pre-adolescent peers. Surprisingly, they were also more likely to have a comorbid externalizing disorder. Developmental trends were particularly striking with respect to depression, with adolescents with OCD demonstrating a six-fold greater likelihood of co-occurring depressive disorder compared to younger counterparts.

Discussion

Clinical implications are discussed with eye toward tailoring interventions, particularly during the transition to adolescence when youth are at heightened risk for depression.

Section snippets

Participants

The full sample consisted of 322 youths presenting for services at a university-based program specializing in the treatment of child and adolescent OCD, anxiety, and tic disorders. The program provides both clinical and research services to youth with these conditions, and it is the primary treatment center in the region, with a catchment area of over 18 million people. Clinical services include an outpatient treatment clinic offering weekly evidence-based intervention using cognitive behavior

Results

Overall Rates of Comorbidity. The number of comorbid diagnoses in this sample ranged from zero to six (M = 1.15, SD = 1.16), with the percentage of youth meeting one (35%), two (18%), three (9%), four (3%), five (1%), and six (<1%) comorbid diagnoses decreasing as the number of comorbidities increased. As expected, the total number of comorbid diagnoses demonstrated small positive correlations with higher levels of OCD symptom severity on the CYBOCS (r = 0.14, p = 0.012) and CGI-S (r = 0.23, p

Discussion

This study examined patterns of comorbidity among a large sample of youth with primary OCD. Overall, age differences emerged such that older youth met criteria for a higher number of co-occurring disorders. As expected, adolescents in particular were more likely to have a co-occurring internalizing disorder compared to their younger counterparts. Somewhat surprisingly, adolescents were also more likely to have a comorbid externalizing disorder compared to either children or pre-adolescents.

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    This research was supported by grants from the International Obsessive Compulsive Foundation (Peris, Piacentini), NARSAD (Bergman, Peris); NIMH K23 MH085058 (Peris); R01 MH58549 (Piacentini); R01MH081864 (O'Neill, Piacentini, dual PIs); R34MH095885 (Chang) and T32 MH073517 (Piacentini). We gratefully acknowledge the contributions of the children, families, and program staff who have made this work possible.

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