Separation anxiety disorder in OCD

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1629 Thames Street, Baltimore, MD 21287, USA.
Depression and Anxiety (Impact Factor: 4.41). 03/2011; 28(3):256-62. DOI: 10.1002/da.20773
Source: PubMed


A history of separation anxiety disorder (SAD) is frequently reported by patients with obsessive-compulsive disorder (OCD). The purpose of this study was to determine if there are clinical differences between OCD-affected individuals with, versus without, a history of SAD.
Using data collected during the OCD Collaborative Genetic Study, we studied 470 adult OCD participants; 80 had a history of SAD, whereas 390 did not. These two groups were compared as to onset and severity of OCD, lifetime prevalence of Axis I disorders, and number of personality disorder traits.
OCD participants with a history of SAD were significantly younger than the non-SAD group (mean, 34.2 versus 42.2 years; P<.001). They had an earlier age of onset of OCD symptoms (mean, 8.0 versus 10.5 years; P<.003) and more severe OCD, as measured by the Yale-Brown Obsessive Compulsive Scale (mean, 27.5 versus 25.0; P<.005). In addition, those with a history of SAD had a significantly greater lifetime prevalence of agoraphobia (odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.4-4.6, P<.003), panic disorder (OR = 1.84, CI = 1.03-3.3 P<.04), social phobia (OR = 1.69, CI 1.01-2.8, P<.048), after adjusting for age at interview, age at onset of OCD, and OCD severity in logistic regression models. There was a strong relationship between the number of dependent personality disorder traits and SAD (adjusted OR = 1.42, CI = 1.2-1.6, P<.001).
A history of SAD is associated with anxiety disorders and dependent personality disorder traits in individuals with OCD.

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    • "Among OCD patients presenting SAD as the first comorbid diagnosis, the lifetime frequency of post-traumatic stress disorder (PTSD) is higher, as are scores on the sexual/ religious dimension of the Dimensional Yale-Brown Obsessive- Compulsive Scale (DY-BOCS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI), indicating that SAD is a predictor of anxiety later in life in OCD patients [10]. In the only study examining the differences between OCD patients with and without SAD, which included 470 patients, those with SAD (n = 80) were younger, had an earlier obsessive-compulsive symptom (OCS) onset, as well as greater OCS severity and higher prevalence of PD, agoraphobia and social phobia [37]. The objective of the present study was to further explore comorbidity between OCD and SAD in a large patient sample, using highly specific instruments and detailed questionnaires (to better explore OCD dimensions, sensory phenomena, suicidality, insight and psychiatric comorbidities), in order to determine whether adult OCD patients with SAD differ from those without, across a range of socio-demographic and clinical characteristics. "
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    ABSTRACT: Objective: Individuals with obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) tend to present higher morbidity than do those with OCD alone. However, the relationship between OCD and SAD has yet to be fully explored. Method: This was a cross-sectional study using multiple logistic regression to identify differences between OCD patients with SAD (OCD+SAD, n=260) and without SAD (OCD, n=695), in terms of clinical and socio-demographic variables. Data were extracted from those collected between 2005 and 2009 via the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders project. Results: SAD was currently present in only 42 (4.4%) of the patients, although 260 (27.2%) had a lifetime diagnosis of the disorder. In comparison with the OCD group patients, patients with SAD+OCD showed higher chance to present sensory phenomena, to undergo psychotherapy, and to have more psychiatric comorbidities, mainly bulimia. Conclusion: In patients with primary OCD, comorbid SAD might be related to greater personal dysfunction and a poorer response to treatment, since sensory phenomena may be a confounding aspect on diagnosis and therapeutics. Patients with OCD+SAD might be more prone to developing specific psychiatric comorbidities, especially bulimia. Our results suggest that SAD symptom assessment should be included in the management and prognostic evaluation of OCD, although the psychobiological role that such symptoms play in OCD merits further investigation.
    European Neuropsychopharmacology 06/2014; 30(1). DOI:10.1016/j.eurpsy.2014.04.007 · 4.37 Impact Factor
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    • "A comprehensive clinical evaluation was conducted and some features were investigated using innovative assessment instruments (e.g. the Dimensional Yale–Brown Obsessive–Compulsive Scale to evaluate the presence and severity of OCD symptom dimensions and the USP-Sensory Phenomena Scale to assess sensory phenomena). Given that the literature usually reports PD/AG findings together, we could only hypothesize that OCD patients with comorbid PD/AG, compared to those without PD/AG would: (1) be more frequently female [27] and more impaired, as indicated by lower educational, occupational and socioeconomic levels [1] [27] [28]; (2) present greater clinical severity, including obsessive–compulsive, anxious and depressive symptoms [1] [7] and more suicidal thoughts and attempts [29] [30] [31] [32] [33] [34] [35]; (3) present more aggressive symptoms [36] and comorbidity with depressive [37] [38] [39] and bipolar disorders [40] [41] [42] [43], other anxiety disorders [44] [45] [46], hypochondriasis [47] [48] [49], somatization disorder [47], tic disorders [44] and substance use disorders [50] "
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    ABSTRACT: Panic Disorder (PD) and agoraphobia (AG) are frequently comorbid with obsessive-compulsive disorder (OCD), but the correlates of these comorbidities in OCD are fairly unknown. The study aims were to: 1) estimate the prevalence of PD with or without AG (PD), AG without panic (AG) and PD and/or AG (PD/AG) in a large clinical sample of OCD patients and 2) compare the characteristics of individuals with and without these comorbid conditions. A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Bivariate analyses were followed by logistic regression models. The lifetime prevalence of PD was 15.3% (N=153), of AG 4.9% (N=49), and of PD/AG 20.2% (N=202). After logistic regression, hypochondriasis and specific phobia were common correlates of the three study groups. PD comorbidity was also associated with higher levels of anxiety, having children, major depression, bipolar I, generalized anxiety and posttraumatic stress disorders. Other independent correlates of AG were: dysthymia, bipolar II disorder, social phobia, impulsive-compulsive internet use, bulimia nervosa and binge eating disorder. Patients with PD/AG were also more likely to be married and to present high anxiety, separation anxiety disorder, major depression, impulsive-compulsive internet use, generalized anxiety, posttraumatic stress and binge eating disorders. Some distinct correlates were obtained for PD and AG in OCD patients, indicating the need for more specific and tailored treatment strategies for individuals with each of these clinical profiles.
    Comprehensive psychiatry 11/2013; 55(3). DOI:10.1016/j.comppsych.2013.11.017 · 2.25 Impact Factor
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    • "Furthermore, worries that children with separation anxiety have can take on obsessional qualities and it can sometimes be difficult to distinguish between SAD and OCD. Moreover Mroczkowski et al. (2011) also concluded that this kind of anxiety could be correlated with adult emotional disorders, including panic disorder and major depression. On the other hand, the relation found in our study between OCD and the most common anxiety symptoms in children corroborate the classification of OCD as an anxiety disorder. "
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    ABSTRACT: Con el objetivo de investigar la capacidad predictiva de características psicopatológicas y sociodemográficas sobre el diagnóstico del trastorno obsesivo compulsivo (TOC) clínico y subclínico, y observar las posibles asociaciones entre estas variables y los dos tipos de diagnósticos, 1.514 escolares españoles con edades comprendidas entre 8 y 12 años completaron cuestionarios de riesgo de trastornos emocionales (obsesivo-compulsivos, de ansiedad y de depresión). Al año siguiente, 562 sujetos (grupo de riesgo y grupo sin riesgo) fueron re-evaluados realizándose el diagnóstico de TOC o de TOC subclínico. De ellos, 20 sujetos presentaron TOC clínico y 46 presentaron TOC subclínico. La ansiedad de separación y los síntomas somáticos resultaron ser buenos predictores para el diagnóstico de TOC clínico, mientras que la preocupación obsesiva fue un predictor significativo para el TOC subclínico. El TOC clínico está asociado a un nivel socioeconómico bajo y a síntomas de orden/comprobación/contaminación y el TOC subclínico se relaciona significativamente con manifestaciones de hiperactividad e impulsividad, preocupaciones obsesivas, supersticiones y compulsiones mentales. La detección precoz y el seguimiento de los síntomas ansiosos y de obsesividad en los niños pueden ser muy importantes para la prevención de trastornos como el TOC.
    International Journal of Clinical and Health Psychology 05/2013; 13(2):118-126. DOI:10.1016/S1697-2600(13)70015-2 · 2.79 Impact Factor
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