An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: A multicentre study

Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Journal of psychosomatic research (Impact Factor: 2.74). 04/2013; 74(4):313-9. DOI: 10.1016/j.jpsychores.2012.12.004
Source: PubMed


In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD.
This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown Obsessive-Compulsive Scale, as well as with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).
We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR=1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001).
Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels.

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    ABSTRACT: Although a growing number of studies have examined the frequency of suicidal thoughts and behaviors in individuals with obsessive compulsive disorder (OCD), there is controversy about the frequency and burden of suicidality in OCD. This is the first systematic review aimed at examining the association between suicidality and OCD and at providing evidence about psychological mechanisms that may underlie suicidality in those with OCD. Five electronic bibliographic databases were searched up to April 2014: Medline, PsycINFO, Embase, Web of Science and CINAHL. Meta-analysis using random effects models was conducted. Forty-eight studies were included in the systematic review. The pooled effect size across 30 independent comparisons revealed a moderate to high, significant association between suicidality and OCD (Hedges' g=0.66, 95% confidence interval 0.49-0.82) which persisted across different types of suicidality including suicidal ideation and suicide attempts. Comorbid Axis I disorders, increased severity of comorbid depressive and anxiety symptoms, increased severity of obsessions, feelings of hopelessness and past history of suicide attempts were associated with worsening levels of suicidality in OCD. There was no indication for publication bias but the methodological quality of the studies was low. The theoretical, research and clinical implications of these findings are emphasized. Copyright © 2015 Elsevier Ltd. All rights reserved.
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