The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group

Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, N.Y.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 04/1994; 55 Suppl(suppl):5-10.
Source: PubMed


Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.

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    • "The ICD-10 diagnostic guidelines for OCD also contain somewhat confusing instructions that a depressive disorder diagnosis should be given primacy over OCD; diagnostic co-occurrence of OCD and depressive disorder is permitted under the proposed ICD-11 diagnostic guidelines. This change is based on evidence that OCD often precedes depressive disorders (Ruscio et al., 2010), outlasts typical depressive episodes and is more likely to be chronic rather than episodic (Ravizza et al., 1997; Skoog and Skoog, 1999), and can be distinguished from depressive disorders in community samples (Weissman et al., 1994). Giving primacy to depressive disorders may have led to underreporting of OCD when using ICD-10. "
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    ABSTRACT: Background: To present the rationale for the new Obsessive-Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping. Methods: Review of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity. Results: The rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing. Limitations: Alternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability. Conclusion: It is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.
    Journal of Affective Disorders 11/2015; 190. DOI:10.1016/j.jad.2015.10.061 · 3.38 Impact Factor
    • "Patients with covert compulsions, variously described as ruminators , pure obsessional, primary obsessional, pure-O, were once thought to be rare. However, cross-national epidemiological studies have shown the proportion of cases of OCD in the community reporting covert compulsions may be up to 50–60% (Weissman et al., 1994). The patients with covert compulsions were considered nonresponsive to neither cognitive-behavioral treatment (Jenike, 1993) nor behavioral therapy (Rachman, 1997). "
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    ABSTRACT: Pharmacotherapy and cognitive-behavioral therapy (CBT) present limitations when they are used to treat obsessive-compulsive disorder (OCD), a severe and debilitating psychiatric disorder. To search for more efficacious treatment, we investigated the effects of pharmacotherapy plus cognitive-coping therapy (pCCT) on adult OCD patients with overt or covert compulsions. Two hundred and fifteen OCD patients were randomized into pharmacotherapy plus psychological support (PPS, n=107) and pCCT (n=108). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to measure severity of symptoms in the OCD patients. The Y-BOCS scores were significantly lower in pCCT than in PPS in both acute term (<3 months) and long-term follow-up. In pCCT, severity of symptoms was not different between those with covert compulsions and those with overt compulsions, but was significantly reduced at any post-treatment time-point. Y-BOCS scores in the two subtype compulsions were significantly lower in pCCT than in PPS at any post-treatpost-treatment time-point. Compared with PPS, effect size, response rate and remission rate were significantly higher in pCCT. Our findings corroborated with the hypothesis that pCCT could efficaciously treat OCD with overt compulsions or covert compulsion, suggesting that pCCT might be a potential option for adult OCD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    08/2015; 229(3):PSYD1500170. DOI:10.1016/j.psychres.2015.08.010
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    • "Obsessive compulsive disorder (OCD) is a chronic and disabling illness [1], typically more associated with young adult sufferers, with a mean age of onset between the 20s and early 30s [2] [3] [4]. OCD rarely emerges after the age of 30 [5]. "
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    ABSTRACT: Background: Patients suffering from obsessive compulsive disorder (OCD), despite heightened levels of functional impairment and disability, often wait several years before starting pharmacological treatment. The interval between the onset of a specific psychiatric disorder and administration of the first pharmacological treatment has been conceptualized as the duration of untreated illness (DUI). The DUI has been increasingly investigated as a predictor of long-term outcomes for OCD and other anxiety disorders. The present study investigated DUI, and demographic-clinical factors associated with DUI, among a sample of patients with OCD. The relationships between DUI, insight, and treatment outcomes were also assessed. Methods: We evaluated 96 subjects with a DSM-IV diagnosis of OCD using the Structured Clinical Interview for DSM-IV Axis I disorders, a semistructured interview for sociodemographic and clinical features, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and a questionnaire designed by our group to identify reasons for delaying psychiatric admission. Patients with OCD showed a mean DUI of 84 months. However, DUI was not predictive of remission defined by a Y-BOCS total score of 10. Using the median value, a categorical cut-off for DUI of 4 years was calculated. Results: For patients with a shorter DUI (≤4 years), the age of OCD onset was significantly older than patients with a longer DUI (>4 years) (p<.001). The following four items related to reasons for delaying treatment were significantly endorsed by patients: the fact that symptoms were spontaneously fluctuating over time (61.5%), believing that OCD symptoms were not associated with an illness (60.4%), believing that one can overcome symptoms by him/herself (55.2%), and not being significantly disturbed by OCD symptoms (33.3%). Delaying treatment because of perceived social stigma was only endorsed by 12.5% of patients. Believing that OCD symptoms were not associated with an illness was significantly associated with a longer DUI (p=.039). Conclusions: Results from the present study suggest that patients with OCD show a significant inclination toward delaying treatment admission. However, DUI was not predictive of remission in terms of symptomatology. Believing that OCD symptoms are not associated with an illness might indicate impairment in insight, a denial of the problem or could be associated with awareness of OCD as a mental illness. Factors related to the nature and course of OCD appear to be important determinants in delaying treatment among patients with OCD.
    Comprehensive Psychiatry 04/2015; 58:88-93. DOI:10.1016/j.comppsych.2014.12.019 · 2.25 Impact Factor
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