Incidence of Obsessive-Compulsive Disorder in a Community Sample of Young Adolescents

doi:10.1097/00004583-199607000-00015

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 35, Issue 7, July 1996, Pages 898-906

https://doi.org/10.1097/00004583-199607000-00015 Get rights and content

ABSTRACT

Objective

To investigate the incidence, transition probabilities, and risk factors for obsessive-compulsive disorder (OCD) and subclinical OCD in adolescents.

Method

A two-stage epidemiological study originally designed to investigate depression was conducted between 1987 and 1989 in the southeastern United States. For the screening, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children was administered to 488 mother–child pairs. Baseline screening and diagnostic data from the first year the subject completed an interview and follow-up diagnostic data from subsequent years were used.

Results

The 1-year incidence rates of OCD and subclinical OCD were found to be 0.7% and 8.4%, respectively. Transition probabilities demonstrated a pattern of moving from more severe to less severe categories. Of those with baseline OCD, 17% had the diagnosis of OCD at follow-up; 62% moved to the referent group. Of those with baseline subclinical OCD, 1.5% had OCD at follow-up and 75% moved to the referent group. Black race (odds ratio [OR] = 23.38), age (OR = 4.02), desirable life events (OR = 0.78), undesirable life events (OR = 1.21), and socioeconomic status (OR not estimable) were significant predictors of incident OCD. Age (OR = 2.30), desirable life events (OR = 0.92), and undesirable life events (OR = 1.13) were significantly associated with incident subclinical OCD.

Conclusion

An initial diagnosis of subclinical OCD was not significantly predictive of a diagnosis of OCD at 1-year follow-up. The overall morbidity remained higher at follow-up in the baseline OCD group than in the baseline subclinical OCD group. The baseline subclinical OCD group was more dysfunctional at follow-up than was the baseline referent group. Further research concerning differences in symptomatology and impairment between OCD and subclinical OCD is warranted.

REFERENCES (49)

A Apter et al.
Fluvoxamine open-label treatment of adolescent inpatients with obsessive-compulsive disorder or depression
J Am Acad Child Adolesc Psychiatry
(1994)
CZ Berg et al.
Childhood obsessive compulsive disorder: a two-year prospective follow-up of a community sample
J Am Acad Child Adolesc Psychiatry
(1989)
RD Coddington
The significance of life events as etiologic factors in the diseases of children
J Psychosom Res
(1972)
MF Flament et al.
Obsessive compulsive disorder in adolescence: an epidemiological study
J Am Acad Child Adolesc Psychiatry
(1988)
CZ Garrison et al.
A longitudinal study of suicidal ideation in young adolescents
J Am Acad Child Adolesc Psychiatry
(1991)
CZ Garrison et al.
The CES-D as a screen for depression and other psychiatric disorders in adolescents
J Am Acad Child Adolesc Psychiatry
(1991)
DA Geller et al.
Similarities In response to fluoxetine in the treatment of children and adolescents With obsessive-compulsive disorder
J Am Acad Child Adolesc Psychiatry
(1995)
GL Hanna
Demographic and clinical features of obsessive compulsive disorder in children and adolescents
J Am Acad Child Adolesc Psychiatry
(1995)
CE Hollingsworth et al.
Longterm outcome of obsessive-compulsive disorder in childhood
J Am Acad Child Psychiatry
(1980)
MC Lenane et al.
Psychiatric disorders in first degree relatives of children and adolescents with obsessive compulsive disorder
J Am Acad Child Adolesc Psychiatry
(1990)

JS March et al.

Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder: an open trial of a new protocol-driven treatment package

J Am Acad Child Adolesc Psychiatry

(1994)

DC Rettew et al.

Obsessions and compulsions across time in 79 children and adolescents with obsessive-compulsive disorder

J Am Acad Child Adolesc Psychiatry

(1992)

MA Riddle et al.

Obsessive compulsive disorder in children and adolescents: phenomenology and family history

J Am Acad Child Adolesc Psychiatry

(1990)

MA Riddle et al.

Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder

J Am Acad Child Adolesc Psychiatry

(1992)

LA Valleni-Basile et al.

Frequency of obsessive-compulsive disorder in a community sample of young adolescents

J Am Acad Child Adolesc Psychiatry

(1994)

AH Zohar et al.

An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents

J Am Acad Child Adolesc Psychiatry

(1992)

CL Addy et al.

Two-stage sampling designs for adolescent depression studies

American Psychiatric Association

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)

(1980)

CB Begg et al.

Calculation of polychotomous logistic regression parameters using individualized regressions

Biometrika

(1984)

L Berman

Obsessive-compulsive neurosis in children

J Nerv Ment Dis

(1942)

HR Bird et al.

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures

Arch Gen Psychiatry

(1988)

A Black

The natural history of obsessional neurosis

WJ Chambers et al.

The assessment of affective disorders in children and adolescents by semi-structured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode Version

Arch Gen Psychiatry

(1985)

DW Goodwin et al.

Follow-up studies in obsessional neurosis

Arch Gen Psychiatry

(1969)

Cited by (113)

Evoking network profiles of the dorsal anterior cingulate in youth with Obsessive-Compulsive Disorder during motor control and working memory
2021, Journal of Psychiatric Research
Interest in the pathology of Obsessive-Compulsive Disorder\has focused on brain network profiles of the dorsal Anterior Cingulate Cortex (dACC), given its role as a principal control region. Both motor control and working memory tasks induce dysfunctional dACC profiles in OCD. H H We contrasted dACC network profiles in OCD and age-comparable controls during both tasks (from data collected in the same participants). The motor task required participants to tap their right forefinger in response to a flashing white probe; the memory task was a standard n-back (2-Back) requiring participants to identify if a current stimulus was identical to the one presented two items before it in the sequence. Network interactions were modeled using Psychophysiological Interactions (PPI), a model of directional functional connectivity. Inter-group analyses indicated a) that the motor control task evoked greater dACC modulation than the working memory task, and b) that the modulatory effect was significantly greater in the OCD group. We also investigated the relationship between OCD symptom dimensions (lifetime obsession and lifetime compulsion measured using the CY-BOCS) and dACC network profiles in OCD. This analysis revealed a dichotomy between Obsessive-Compulsive symptom dimensions and the degree of dACC modulation: primarily increased obsessions predicted increased modulation during the motor control task, but primarily increased compulsions predicted increased modulation during the working memory task. These results re-emphasize the salience of the dACC in OCD, and the primacy of tasks of motor control in evoking dACC pathology in the disorder.
Clinical characteristics and comorbidity associated with female gender in obsessive-compulsive disorder
2020, Journal of Psychiatric Research
Obsessive-compulsive disorder (OCD) is a heterogeneous condition characterized by largely variable phenotypic expressions. Previous findings suggested that gender may be a relevant factor in mediating this heterogeneity. The present study aimed at exploring gender differences in a large clinical sample of Italian OCD patients.
Socio-demographic and clinical variables of a sample of 229 consecutive OCD outpatients were included in a common database. Patients were assessed through structured clinical interviews, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale.
Female OCD patients were more likely than males to have lifetime psychiatric comorbidities (72.6% vs 56.9%; p < 0.05), poly-comorbidities being twice as high compared to males. The female group also showed a significant later onset of symptoms (63.7% vs 44.8%; p < 0.005) and a higher age at first treatment (30.98 ± 13.1 years vs 27.81 ± 11.3; p < 0.005). Moreover, the female subgroup presented higher rates of cleaning and washing compulsions, compared to the male subgroup (28.7% vs 12.6% in the male group; p < 0.005).
The current study supports the notion that OCD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to male patients. These findings should be considered in epidemiologic and therapeutic perspectives.
Social losses predict a faster onset and greater severity of obsessive-compulsive disorder
2020, Journal of Psychiatric Research
While stressful life events increase the risk of developing a range of psychiatric disorders, including obsessive-compulsive disorder (OCD), their ability to precipitate specific obsessive-compulsive symptoms' dimensions is unknown. Here we aimed to evaluate the potential role of three different types of stressful life events, herein termed losses (death of a loved one, termination of a romantic relationship and severe illness) in predicting the speed of progression from subclinical to clinical OCD and the severity of specific OCD dimensions in a large multicentre OCD sample.
Nine hundred and fifty-four OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used, including the Structured Clinical Interview for DSM-IV Axis I Disorders, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Yale OCD Natural History Questionnaire. Regression models investigated the interaction between types of loss and gender to predict speed of progression from subclinical obsessive-compulsive symptoms to OCD, and the severity of five symptom dimensions.
While termination of a relationship was associated with a faster speed of progression from subthreshold to clinical OCD, the death of a loved one was associated with increased severity of hoarding symptoms. There was also an interaction between gender and experiences of death, which predicted a faster speed of progression to OCD in males.
Stressful life events have the ability to accelerate the progression from subclinical to clinical OCD, as well as impact the severity of specific OCD dimensions. Gender also plays a role in both the progression and severity of symptoms. These findings suggest that stressful life events may represent a marker to identify individuals at risk of progressing to clinical OCD.
Parental emotional warmth interacts with traumatic life events in predicting the onset of obsessive-compulsive disorder: Parental rearing, adverse life events and OCD
2020, Journal of Obsessive-Compulsive and Related Disorders
Adverse life events increase the risk of obsessive-compulsive disorder (OCD). Parental rearing may serve as a protective factor in the face of adversity. We investigated whether parental rearing moderates the association between adverse life events and the subsequent first onset of OCD. A representative sample of individuals (aged 14–24 years) was followed for over 10 years (N = 2210). OCD and any adverse life event, that is, any separation event or any traumatic life event, were assessed using the Munich-Composite International Diagnostic Interview. Parental rearing was assessed by self-report, using the Questionnaire of Recalled Parental Rearing Behavior. Both maternal (risk ratio, RR = 0.08, 95% confidence interval, CI [0.02, 0.31]) and paternal (RR = 0.16, 95% CI [0.03, 0.89]) emotional warmth moderated the association between any adverse life event and OCD. Maternal (RR = 0.16, 95% CI [0.03, 0.77]) and paternal (RR = 0.17, 95% CI [0.04, 0.78]) emotional warmth interacted specifically with any traumatic life event but not with any separation event in predicting OCD. We did not find any interactions with parental overprotection or rejection in predicting OCD. Parental emotional warmth may be a protective factor for OCD among individuals who experience traumatic life events. Future studies should evaluate whether interventions enhancing parental emotional warmth among those who experience traumatic life events can prevent OCD.
Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study
2019, European Psychiatry
Punitive parenting and stressful life events are associated with obsessive-compulsive symptoms (OCS). However, the lack of longitudinal, genetically-informative studies means it remains unclear whether these factors represent environmentally-mediated risks for the development of OCS.
Twins and siblings from the Genesis1219 study completed self-report questionnaires two years apart (Time 1: N = 2616, mean age = 15.0; Time 2: N = 1579, mean age = 17.0 years) assessing OCS, maternal and paternal punitive parenting, and dependent stressful life events. Multiple regression models tested cross-sectional and longitudinal associations between the putative environmental risk factors and obsessive-compulsive symptoms using: (a) individual scores; and (b) monozygotic twin difference scores. The aetiologies of significant phenotypic associations between putative risk factors and OCS were further examined using multivariate genetic models.
At a phenotypic level, maternal and paternal punitive parenting and stressful life events were all associated with OCS both cross-sectionally and longitudinally. However, only stressful life events predicted the subsequent development of OCS, after controlling for earlier symptoms. Genetic models indicated that the association between life events and change in OCS symptoms was due to both genetic (48%) and environmental (52%) influences. Overall, life events associated with change in OCS accounted for 1.2% of variation in OCS at Time 2.
Stressful life events, but not punitive parenting, predict OCS change during adolescence at a phenotypic level. This association exists above and beyond genetic confounding, consistent with the hypothesis that stressful life events play a causal role in the development of obsessive-compulsive symptoms.
The role of behavioral inhibition, perceived parental rearing, and adverse life events in adolescents and young adults with incident obsessive-compulsive disorder
2018, Journal of Obsessive-Compulsive and Related Disorders
The role of behavioral inhibition (BI), parental rearing, and adverse life events in the development of obsessive–compulsive disorder (OCD) is unresolved. We prospectively examined whether BI and perceived parental rearing predicted the subsequent first onset of OCD and whether BI moderated the association between perceived parental rearing/adverse life events and the first onset of OCD. Data come from a prospective-longitudinal study among community adolescents and young adults (aged 14–24) who were followed up over 10 years (N = 2210). OCD and adverse life events were assessed with the DSM-IV/M-CIDI. BI and parental rearing were assessed by self-report. In adjusted logistic regressions, BI (risk ratio, RR = 8.8,95% confidence interval, CI,[3.3,23.2]), both the social (RR = 2.6,95%CI[1.04,6.3]) and nonsocial fear (RR = 4.5,95%CI[2.3,8.6]) components, and paternal rejection (RR = 3.9,95%CI[1.6,9.7]) predicted OCD. Social BI moderated the association of adverse life event (RR = 11.98,95%CI[1.8,82.1]) and paternal overprotection (RR = 5.5,95%CI[2.1,14.8]) with OCD. Nonsocial fear BI moderated the association between paternal emotional warmth (RR = 0.37,95%CI[0.1,0.99]) and OCD. BI and paternal rejection were associated with an increased risk of first onset of OCD. Individuals with high social BI who experienced paternal overprotection or any adverse life events may profit from early targeted prevention. Emotional warmth may buffer the association between nonsocial fear BI and OCD.

View all citing articles on Scopus

: This research was supported by NIMH grant MH40363.

View full text

Special SectionIncidence of Obsessive-Compulsive Disorder in a Community Sample of Young Adolescents

ABSTRACT

Objective

Method

Results

Conclusion

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Psychosom Res

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Two-stage sampling designs for adolescent depression studies

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)

Calculation of polychotomous logistic regression parameters using individualized regressions

Biometrika

Obsessive-compulsive neurosis in children

J Nerv Ment Dis

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures

Arch Gen Psychiatry

The natural history of obsessional neurosis

The assessment of affective disorders in children and adolescents by semi-structured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode Version

Arch Gen Psychiatry

Follow-up studies in obsessional neurosis

Arch Gen Psychiatry

Special Section
Incidence of Obsessive-Compulsive Disorder in a Community Sample of Young Adolescents