Factor analysis of symptom profile in early onset and late onset OCD
Introduction
Obsessive compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent intrusive ideas, impulses, or urges (obsessions) along with overt or covert behaviors (compulsions) aimed at reducing the distress. The prevalence of OCD and obsessive compulsive spectrum disorder ranges from 2% to 5% in community samples (Rasmussen and Eisen, 1992, Adam et al., 2012, Fineberg et al., 2013). There have been attempts to subgroup patients with OCD to differentiate various groups of distinct symptom profile, associated neuropsychological findings and treatment response (Roth et al., 2005). It has been suggested that sub-grouping of OCD might be helpful in discerning categories with differential response to treatment (Knopp et al., 2013).
Sub-classifying OCD on the basis of age of onset of symptoms into early and late onset categories has been attempted, especially in terms of finding out the phenomenological characteristics (Hemmings et al., 2004, Butwicka and Gmitrowicz, 2010, Taylor, 2011). The early onset OCD has been associated with more frequent occurrence of Tourette's disorder and tics (Hemmings et al., 2004). One study found contamination obsessions less commonly in the early onset OCD (Butwicka and Gmitrowicz, 2010), while religious, sexual and somatic obsessions were more common for this group. Another study reported that early onset OCD was associated with male gender, greater global severity of OCD, and were likely to have comorbid tics (Taylor, 2011). Though there has been a debate about what should be the cutoff for defining early onset OCD (Taylor, 2011), a cutoff of 18 years looks promising and has been utilized in previous studies (Butwicka and Gmitrowicz, 2010, Katerberg et al., 2010, Kichuk et al., 2013).
Factor analysis of symptom profile has been attempted to discern the phenomenological subgroups of OCD (Mataix-Cols et al., 2005, Katerberg et al., 2010). Analysis of what symptoms co-occur together might help predict particular obsessions and compulsions. Also, when used in treatment studies, it can help to know which symptom subgroups are relatively difficult to treat (Ball et al., 1996, Knopp et al., 2013). Such factor analytic studies of symptoms of OCD have been conducted separately in young as well as adult patients (Ball et al., 1996, Girishchandra and Khanna, 2001; Delorme et al., 2005, McKay et al., 2006). However, none of the previous researches have attempted to find out factor structure in the early onset and late onset OCD as a part of the same study. Using the same study to find factor structures can help in getting more confirmatory answers as the recruitment and ratings would be similar for both the age categories and comparability of results would be higher. Hence, this study aimed to assess the factor structure of early and late onset OCD in a set of patients recruited from a hospital setting in North India. Additionally, cluster analysis was conducted in the same sample to assess the applicability of the factors.
Section snippets
Setting and participants
The present study was conducted at the outpatient services of a tertiary care multispecialty teaching hospital in North India. All the patients were recruited after obtaining written informed consent. The study was approved by the Institute Ethics Committee.
The study sample comprised of outpatients and inpatients diagnosed with OCD according to DSM IV TR (American Psychiatric Association, 2000). To be included in the study, the participants were required to be clinically diagnosed with OCD.
Results
A total of 345 participants were included in the analysis. The sample was divided into early onset (onset of symptoms at age ≤ 18 years) and late onset (onset at age > 18 years) OCD. The clinical and demographic details of early and late onset groups are shown in Table 1. As expected, early onset OCD group had a lower mean age of presentation. Also, males were more frequent in the early onset OCD group. The early onset group of OCD patients was less likely to be married, less likely to be
Discussion
Assessment of the differences in the phenomenology and characteristics of early and late onset OCD is important from a clinical perspective. Differentiating early and late onset OCD might help to discern further the type of symptoms experiences, the comorbidities that are expected and estimate the prognosis of the case. Further research implication of differentiating OCD into early and late subtypes lies in exploring the genetic and neurobiological determinants of OCD, and predicating the best
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