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Personality traits as predictors of OCD remission: A longitudinal study
Abstract
Background
Personality traits may confer vulnerability to psychopathology. However, few studies have examined the association between personality traits and obsessive-compulsive disorder (OCD) course. The present study investigates personality traits, OCD symptom severity, and illness duration as a predictor of OCD remission.
Methods
166 treatment-seeking adults with OCD, recruited as part of the Brown Longitudinal Obsessive-Compulsive Study, completed the NEO Five-Factor Inventory 3 (NEO-FFI) and were in episode for OCD at time of NEO-FFI completion. Participants were followed for up to 3 years.
Results
Results suggest individuals with OCD had a 21 % likelihood of reaching remission over the course of 3 years. Greater OCD symptom severity and longer illness duration were associated with a decreased likelihood of remission. Among the five factors of personality, only low extraversion was associated with a decreased rate of remission. Neuroticism, openness, agreeableness, and conscientiousness were not associated with remission.
Limitations
As this was an observational study, treatment was not controlled precluding examination of treatment on course. Further, data collected on age of onset and symptom severity during follow up were retrospective and therefore are also subject to recall bias.
Conclusions
Our findings provide preliminary support that personality traits are potential factors impacting course and symptom presentation. Future research is necessary to determine the mechanisms in which personality traits may influence the presentation and course of OCD.
... For instance, empirical evidence has demonstrated that compared to non-affected individuals, higher levels of neuroticism are observed in those with a current or lifetime diagnosis of OCD (Kotov et al., 2010;Rector et al., 2002;Samuels et al., 2000Samuels et al., , 2020Watson et al., 2018), as well as lower levels of OE and higher levels of agreeableness noted in those with either a current (Bienvenu et al., 2004) or lifetime (Samuels et al., 2000) diagnosis. Dimensional ratings also demonstrate that more severe OCD symptoms are associated with higher levels of neuroticism (Cullen et al., 2007;Law et al., 2023;Samuels et al., 2020;Watson & Naragon-Gainey, 2014) and lower levels of both extraversion (Cullen et al., 2007;Kotov et al., 2010;Law et al., 2023;Rector et al., 2002;Samuels et al., 2000Samuels et al., , 2020 and conscientiousness (Kotov et al., 2010;Law et al., 2023;Rector et al., 2002;Watson & Naragon-Gainey, 2014). Lower levels of extraversion have also been associated with lower remission rates of OCD symptoms (Law et al., 2023). ...
... For instance, empirical evidence has demonstrated that compared to non-affected individuals, higher levels of neuroticism are observed in those with a current or lifetime diagnosis of OCD (Kotov et al., 2010;Rector et al., 2002;Samuels et al., 2000Samuels et al., , 2020Watson et al., 2018), as well as lower levels of OE and higher levels of agreeableness noted in those with either a current (Bienvenu et al., 2004) or lifetime (Samuels et al., 2000) diagnosis. Dimensional ratings also demonstrate that more severe OCD symptoms are associated with higher levels of neuroticism (Cullen et al., 2007;Law et al., 2023;Samuels et al., 2020;Watson & Naragon-Gainey, 2014) and lower levels of both extraversion (Cullen et al., 2007;Kotov et al., 2010;Law et al., 2023;Rector et al., 2002;Samuels et al., 2000Samuels et al., , 2020 and conscientiousness (Kotov et al., 2010;Law et al., 2023;Rector et al., 2002;Watson & Naragon-Gainey, 2014). Lower levels of extraversion have also been associated with lower remission rates of OCD symptoms (Law et al., 2023). ...
... For instance, empirical evidence has demonstrated that compared to non-affected individuals, higher levels of neuroticism are observed in those with a current or lifetime diagnosis of OCD (Kotov et al., 2010;Rector et al., 2002;Samuels et al., 2000Samuels et al., , 2020Watson et al., 2018), as well as lower levels of OE and higher levels of agreeableness noted in those with either a current (Bienvenu et al., 2004) or lifetime (Samuels et al., 2000) diagnosis. Dimensional ratings also demonstrate that more severe OCD symptoms are associated with higher levels of neuroticism (Cullen et al., 2007;Law et al., 2023;Samuels et al., 2020;Watson & Naragon-Gainey, 2014) and lower levels of both extraversion (Cullen et al., 2007;Kotov et al., 2010;Law et al., 2023;Rector et al., 2002;Samuels et al., 2000Samuels et al., , 2020 and conscientiousness (Kotov et al., 2010;Law et al., 2023;Rector et al., 2002;Watson & Naragon-Gainey, 2014). Lower levels of extraversion have also been associated with lower remission rates of OCD symptoms (Law et al., 2023). ...
This study aimed to determine the extent to which personality and
cognitive factors contribute to the identification of shared associations between the DSM-5’s OCD and Related Disorders (OCRDs). Participants (n = 239) were treatment-seeking outpatients with a principal diagnosis of obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (TTM), or excoriation disorder (EXC), as compared to healthy community controls (n = 100). Analyses examined the relationships between diagnostic group, personality dimensions, and obsessive beliefs. Results demonstrated that compared to non-clinical controls, all diagnostic groups scored significantly higher on neuroticism and lower on extraversion and conscientiousness. Few significant differences were found across diagnostic groups: extraversion was higher in the TTM group (vs. all OCRDs), conscientiousness was lower in the HD group (vs. OCD, TTM, EXC), and openness to experience was higher in the TTM and EXC groups (vs. OCD, HD). Obsessional beliefs were significantly elevated in all clinical conditions (vs. controls) except for beliefs surrounding responsibility and threat estimation, which were only significantly higher in OCD and BDD groups. These results highlight shared personality and cognitive vulnerability in the OCRDs as well as unique disorder-specific vulnerabilities related to OCD.
... In another study, the inclination towards hoarding within the framework of OCD demonstrated a notable correlation with reduced levels of both extraversion and conscientiousness [9]. Moreover, empirical research has indicated that personality traits possess the potential to significantly impact the progression and manifestation of symptoms within OCD [10]. In the context of ROCD, a recent study found that different presentations of ROCD have different personality predictors [11]. ...
Introduction
The current study aimed to utilize a network perspective to identify the core symptoms of Relationship Obsessive–Compulsive Disorder (ROCD), encompassing both partner-focused and relationship-centered presentations. Additionally, we examined the interaction between ROCD symptoms and personality traits.
Method
493 participants were included in the current study. The Personality Inventory for DSM-5 – short form (PID-5-SF), NEO Five-Factor Inventory, Partner-Related Obsessive–Compulsive Symptoms Inventory (PROCSI), and Relationship Obsessive–Compulsive Inventory (ROCI) were used to estimate the network structure. Specifically, we computed network structure, bridge expected influence (BEI), and Exploratory Graph Analysis (EGA) for ROCD scales.
Results
In the ROCI network, items 1 and 11 (ROCI.1: "The idea that my affection for my partner is not genuine troubles me," ROCI.7: Thoughts that something is "off" in my relationship significantly disturb me.) emerged as the most important nodes (ROCI.1: Betweenness:1.777, Closeness:1.025, Strength: .872; ROCI.11" Betweenness: 1.097, Closeness:0.457, strength:.699). Additionally, ROCI.7 stands out with significant Betweenness and Expected Influence, emphasizing its importance in facilitating communication and influencing information flow. Conversely, in the PROCI network, item 2 (PROCI.2: "I am constantly questioning whether my partner is deep and intelligent enough") was identified as the most crucial node (Betweenness: 2.568, Closeness: 2.528, Strength: 1.905). Neuroticism is highly influential in the interaction of personality traits with the ROCI scale (BEI: .3781), connecting non-maladaptive traits, while Negative affect, a maladaptive trait, has a significant impact (Bridge Value: .283).
Conclusion
The present study provided a detailed examination of the psychological dynamics within romantic relationships, highlighting key cognitive processes and personality trait.
Objective:
Little is known about the role of childhood experiences in the development of obsessive-compulsive disorder (OCD). However, the influence of childhood experiences on personality, behavior, and perceived stress may vary between OCD patients and healthy individuals. The objective of this study was to use network analysis to explore the relationship between childhood trauma, personality, perceived stress, and symptom dimensions, thus finding the difference between patients' and healthy people's network.
Methods:
488 patients with OCD and 210 healthy volunteers were recruited. All of them were assessed with the Obsessive-Compulsive Inventory - Revised (OCI-R), the Perceived Stress Scale-10, the NEO Five-Factor Inventory and the Early Trauma Inventory Self-Report Short Form. Network analysis was conducted and the centrality indices were calculated. Network comparison test was performed.
Results:
In patients' network, the Obsession and the Ordering behavior were the most important nodes among the OCI-R. The perceived stress showed the strongest strength centrality of all nodes and positive correlation with the Obsession and Neuroticism. Network comparison test results indicated a statistically significant difference between network structure, and post-hoc analysis found five edges significantly differed between patients and healthy controls, mainly on Obsession and Washing behaviors.
Conclusions:
Emotional abuse was considered significant in both networks due to its higher strength centrality. Meanwhile, perceived stress was found to be more significant in the patient network and exhibited stronger associations with obsession. The obsessive thoughts and washing behavior were different among patients and healthy controls, which brought new understanding to the pathopsychological mechanisms of OCD.
Objective:
Little is known about the course of anxiety disorders in the general population. This study provides insights into the course of anxiety disorders in the general population taking into account transition to residual symptoms and to other diagnostic categories.
Methods:
Using data from three waves of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; n = 6646), subjects with anxiety disorders (T0;n = 243) were divided into three mutually exclusive course trajectories according to their diagnostic status at 3-year (T1) and 6-year (T2) follow-up: remission group (no disorder at T2), intermittent course group (no disorder at T1 and disorder at T2) and chronic course group (disorder at all measurements). Transition to residual symptoms or other psychopathology were studied. In addition, predictors of course trajectories were assessed.
Results:
During 6-year follow-up, 77.8% of subjects achieved remission, 14.0% followed an intermittent course and 8.2% a chronic course. Of those in remission, residual anxiety symptoms remained in 46.6%, while 7.9% developed another disorder between T0 and T2. Compared with the remitting group, a chronic course was predicted by not living with a partner, multiple negative life events, neuroticism, lower mental functioning, severity of anxiety symptoms, use of mental health care and medication use.
Limitations:
The intermittent and chronic course groups were small, limiting statistical power. As a result, certain predictors may not have reached significance.
Conclusions:
In the general population at 6-year follow-up, 77.8% of subjects with anxiety disorders achieved remission. Because of transition to residual symptoms or another diagnostic category, only 52.4% of those subjects had a true favourable outcome.
Adolescence is a developmental period characterized by remarkable volatility and comorbidity in internalizing disorders. Delineating internalizing symptom change in a manner that accounts for symptoms' shared versus distinctive features is imperative to an understanding of their development. An additional question concerns how vulnerabilities for internalizing disorders relate to development of internalizing symptoms. Cross-sectional and prospective associations between neuroticism and internalizing psychopathology are well-established, yet conclusive evidence on neuroticism's relation to the progression of symptom dimensions relevant to internalizing disorders remains absent. In this investigation, we used latent growth curve modeling to characterize the trajectories of tri-level model internalizing dimensions (General Distress, Anhedonia-Apprehension, Fears, Anxious Arousal, Fears of Specific Stimuli, Social Fears, Narrow Depression, Interoceptive/Agoraphobic Fears) and examined whether a general neuroticism factor predicted their growth. We used anxiety and depressive symptom data spanning 6 years, collected from 606 high school juniors mostly vulnerable for internalizing disorders. We observed a pattern of results that varied by symptom dimension. Only Anhedonia-Apprehension showed a distinct increasing trend, on average. Neuroticism predicted an adverse symptom course for the dimension of General Distress. Our results reinforce the notion that neuroticism confers substantial risk for internalizing symptom maintenance and extend past findings by demonstrating that neuroticism forecasts a poor symptom course for General Distress but not narrower dimensions of internalizing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Despite the substantial disease burden of anxiety disorders, physicians have a poor understanding of factors that predict their typical persistent course. This systematic review of predictors of persistent anxiety disorders covered 48 studies with 29 690 patients diagnosed with an anxiety disorder that were published in PubMed, PsycINFO, and Web of Science between Jan 1, 1980 (introduction of DSM-III), and Dec 1, 2019. We also compared predictors between children, adolescents, adults, and older adults (ie, ≥55 years). A persistent course was primarily predicted by clinical and psychological characteristics, including having panic attacks, co-occurring personality disorders, treatment seeking, poor clinical status after treatment, higher severity and longer duration of avoidance behaviour, low extraversion, higher anxiety sensitivity, and higher behavioural inhibition. Unlike disorder onset, sociodemographic characteristics did not predict persistence. Our results outline a profile of patients with specific clinical and psychological characteristics who are particularly vulnerable to anxiety disorder persistence. Clinically, these patients probably deserve additional or more intensive treatment to prevent development of chronicity.
General personality dimensions are associated with clinical severity and treatment response in individuals with depression and many anxiety disorders, but little is known about these relationships in individuals with obsessive–compulsive disorder (OCD). Individuals in the current study included 705 adults with OCD who had participated in family and genetic studies of the disorder. Participants self‐completed the Neuroticism, Extraversion, Openness Personality Inventory or Neuroticism, Extraversion, Openness Five‐Factor Inventory‐3. Relationships between personality scores, and subjective impairment and OCD treatment response, were evaluated. The odds of subjective impairment increased with (unit increase in) the neuroticism score (odds ratio, OR = 1.03; 95% CI = 1.01–1.04; p < 0.01) and decreased with extraversion scores (OR = 0.98; 95% CI = 0.96–0.99; p < 0.01). The odds of reporting a good response to serotonin/selective serotonin reuptake inhibitors (OR = 1.02; 95% CI = 1.01–1.04; p < 0.01) or cognitive behavioural therapy (OR = 1.03; 95% CI = 1.01–1.05; p < 0.01) increased with the extraversion score. The magnitude of these relationships did not change appreciably after adjusting for other clinical features related to one or more of the personality dimensions. The findings suggest that neuroticism and extraversion are associated with subjective impairment, and that extraversion is associated with self‐reported treatment response, in individuals with OCD. © 2019 John Wiley & Sons, Ltd.
Objective:
This study assesses the long-term course of treatment-seeking youth with a primary diagnosis of DSM-IV OCD.
Method:
Sixty youth and their parents completed intake interviews and annual follow-up interviews for 3 years using the youth version of the Longitudinal Interval Follow-up Evaluation (Y-LIFE) and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Remission was defined as no longer meeting DSM-IV criteria for OCD for 8 weeks or more, and recurrence was defined as meeting full criteria for OCD for 4 consecutive weeks after having achieved symptom remission. Remission rates for youth were compared to rates of adults participating in the same study.
Results:
The probability of achieving partial remission of OCD was 0.53 and the probability of achieving full remission was 0.27. Among the 24 youth participants who achieved remission, 79% stayed in remission throughout the study (mean of 88 weeks of follow-up) and 21% experienced a recurrence of symptoms. Better functioning at intake and a shorter latency to initial OCD treatment were associated with faster onset of remission (P<.001).
Conclusions:
Remission is more likely among youth versus adults with OCD. Treatment early in the course of illness and before substantial impact on functioning predicted a better course.
The five-factor model is a dimensional representation of personality structure that has recently gained widespread acceptance among personality psychologists. This article describes the five factors (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness); summarizes evidence on their consensual validity, comprehensiveness, universality, heritability, and longitudinal stability; and reviews several approaches to the assessment of the factors and their defining traits. In research, measures of the five factors can be used to analyze personality disorder scales and to profile the traits of personality-disordered patient groups; findings may be useful in diagnosing individuals. As an alternative to the current categorical system for diagnosing personality disorders, it is proposed that Axis II be used for the description of personality in terms of the five factors and for the diagnosis of personality-related problems in affective, interpersonal, experiential, attitudinal, and motivational areas.
This study examined the influence of personality on stressor appraisals and emotional, physiological, and behavioral responses to psychosocial stress. Appraisals were used to classify participants as threatened (they believed their coping resources were inadequate relative to stressor demands) or challenged (they believed their coping resources were commensurate with stressor demands). Neuroticism predicted threat appraisals, and both were related to negative emotional experience and poor task performance. The influence of neuroticism on negative emotions and poor performance was mediated by threat appraisals. High neuroticism confers stress vulnerability, but only when conditions are construed as threatening.
This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.
Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.
Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.
Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.
We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66 meta-analyses. The review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1,076 to 75,229). All diagnostic groups were high on neuroticism (mean Cohen's d = 1.65) and low on conscientiousness (mean d = -1.01). Many disorders also showed low extraversion, with the largest effect sizes for dysthymic disorder (d = -1.47) and social phobia (d = -1.31). Disinhibition was linked to only a few conditions, including SUD (d = 0.72). Finally, agreeableness and openness were largely unrelated to the analyzed diagnoses. Two conditions showed particularly distinct profiles: SUD, which was less related to neuroticism but more elevated on disinhibition and disagreeableness, and specific phobia, which displayed weaker links to all traits. Moderator analyses indicated that epidemiologic samples produced smaller effects than patient samples and that Eysenck's inventories showed weaker associations than NEO scales. In sum, we found that common mental disorders are strongly linked to personality and have similar trait profiles. Neuroticism was the strongest correlate across the board, but several other traits showed substantial effects independent of neuroticism. Greater attention to these constructs can significantly benefit psychopathology research and clinical practice.
Surprisingly little is known about the long-term course of obsessive-compulsive disorder (OCD). This prospective study presents 2-year course findings, as well as predictors of course, from the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the observational course of OCD in a large clinical sample.
The sample included 214 treatment-seeking adults with DSM-IV OCD at intake who identified OCD as the most problematic disorder over their lifetime. Subjects were enrolled from 2001-2004. At annual interviews, data on weekly OCD symptom status were obtained using the Longitudinal Interval Follow-Up Evaluation. Probabilities of full remission and partial remission over the first 2 years of collected data and potential predictors of remission were examined.
The probability of full remission from OCD was 0.06, and the probability of partial remission was 0.24. Of the 48 subjects whose OCD symptoms partially or fully remitted, only 1 relapsed within the first 2 years. Earlier age at onset of OCD, greater severity of symptoms at intake, older age at intake, and being male were associated with a decreased likelihood of remission. Insight, diagnostic comorbidity, and treatment were not found to be associated with the likelihood of achieving full or partial remission.
Though one-quarter of the sample had periods of subclinical OCD symptoms during the prospective period, full remission was rare, consistent with the view of OCD as a chronic and persistent illness. Age at onset, OCD symptom severity, current age, and sex emerged as potent predictors of course.
Recent progress toward the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders includes a proposed quantitative hierarchical structure of internalizing pathology with substantial, supportive evidence (D. Watson, 2005). Questions about such a taxonomic shift remain, however, particularly regarding how best to account for and use existing diagnostic categories and models of personality structure. In this study, the authors use a large sample of psychiatric patients with internalizing diagnoses (N = 1,319) as well as a community sample (N = 856) to answer some of these questions. Specifically, the authors investigate how the diagnoses of obsessive-compulsive disorder (OCD) and bipolar disorder compare with the other internalizing categories at successive levels of the personality hierarchy. Results suggest unique profiles for bipolar disorder and OCD and highlight the important contribution of a 5-factor model of personality in conceptualizing internalizing pathology. Implications for personality-psychopathology models and research on personality structure are discussed.
Regression models and life tables were used to describe the phenomenon of recovery from major depressive disorder for 101 patients in a naturalistic study in which treatment was not controlled by the investigators. Time to recovery from the onset of the episode was protracted, as only about 50% of patients recovered by one year. Annual rates of recovery then declined steadily to 28% in the second year, 22% in the third year, and 18% in the fourth year. In contrast, speed of recovery from entry into the study was more rapid, and 63% of patients recovered by four months. The recovery rates were about 20% each month for the first four months and then declined sharply for the remaining months of the one-year follow-up. Several clinical variables were statistically significant predictors of recovery when measured from entry into the study: superimposition of the acute episode on a chronic underlying depression, acuteness of onset of he depression, and severity of depression for the subgroup of patients without superimposed illness.
Data from a 4-year longitudinal study of young adults were used to examine the causal pathways between personality and life events. To reduce measurement artifacts, analyses were conducted using reports of more objective life events. It was found that extraversion predisposed participants to experience more positive objective life events, whereas neuroticism predisposed people to experience more negative objective events. In contrast, personality was somewhat stable, and life events were found not to have a prospective influence on it. Objective positive and negative life events covaried, suggesting that people who experience more of 1 type of event are also likely to experience more events of the opposite valence as well. The findings indicate that life events cannot be viewed as a source of influence independent of personality. Although factors that are independent of the person undoubtedly influence life events to some degree, the personality of the individual also appears to do so.
The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.
Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.
Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.
These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.
Personality may directly facilitate or constrain coping, but relations of personality to coping have been inconsistent across studies, suggesting a need for greater attention to methods and samples. This meta-analysis tested moderators of relations between Big Five personality traits and coping using 2,653 effect sizes drawn from 165 samples and 33,094 participants. Personality was weakly related to broad coping (e.g., Engagement or Disengagement), but all 5 traits predicted specific strategies. Extraversion and Conscientiousness predicted more problem-solving and cognitive restructuring, Neuroticism less. Neuroticism predicted problematic strategies like wishful thinking, withdrawal, and emotion-focused coping but, like Extraversion, also predicted support seeking. Personality more strongly predicted coping in young samples, stressed samples, and samples reporting dispositional rather than situation-specific coping. Daily versus retrospective coping reports and self-selected versus researcher-selected stressors also moderated relations between personality and coping. Cross-cultural differences were present, and ethnically diverse samples showed more protective effects of personality. Richer understanding of the role of personality in the coping process requires assessment of personality facets and specific coping strategies, use of laboratory and daily report studies, and multivariate analyses.
High scores on markers of psychological vulnerability have been associated with a worse course of affective disorders. However, little is known about the specificity of those associations in predicting the course of different depressive and anxiety disorders. We examined the impact of psychological vulnerability on the short- and long-term course of depressive and anxiety disorders. Participants from the Netherlands Study of Depression and Anxiety with a current diagnosis of depression or anxiety (n = 1256) were reassessed after 2 and 6 years. Diagnostic status and chronic duration (>85% of the time) of symptoms were the outcomes. Predictors were neuroticism, extraversion, locus of control, cognitive reactivity (rumination and hopelessness reactivity), worry and anxiety sensitivity. High neuroticism, low extraversion and external locus of control predicted chronicity of various affective disorders. Rumination, however, predicted chronicity of depressive but not anxiety disorders. Worry specifically predicted chronicity of GAD and anxiety sensitivity predicted chronicity of panic disorder and social anxiety disorder. These patterns were present both at short-term and at long-term, without losing predictive accuracy. Psychological vulnerabilities that are theoretically specific to certain disorders indeed selectively predict the course of these disorders. General markers of vulnerability predicted the course of multiple affective disorders. This pattern of results supports the notion of specific as well as transdiagnostic predictors of the course of affective disorders and is consistent with hierarchical models of psychopathology.
This is a book for statistical practitioners, particularly those who design and analyze studies for survival and event history data. Its goal is to extend the toolkit beyond the basic triad provided by most statistical packages: the Kaplan-Meier estimator, log-rank test, and Cox regression model. Building on recent developments motivated by counting process and martingale theory, it shows the reader how to extend the Cox model to analyse multiple/correlated event data using marginal and random effects (frailty) models. It covers the use of residuals and diagnostic plots to identify influential or outlying observations, assess proportional hazards and examine other aspects of goodness of fit. Other topics include time-dependent covariates and strata, discontinuous intervals of risk, multiple time scales, smoothing and regression splines, and the computation of expected survival curves. A knowledge of counting processes and martingales is not assumed as the early chapters provide an introduction to this area. The focus of the book is on actual data examples, the analysis and interpretation of the results, and computation. The methods are now readily available in SAS and S-Plus and this book gives a hands-on introduction, showing how to implement them in both packages, with worked examples for many data sets. The authors call on their extensive experience and give practical advice, including pitfalls to be avoided. Terry Therneau is Head of the Section of Biostatistics, Mayo Clinic, Rochester, Minnesota. He is actively involved in medical consulting, with emphasis in the areas of chronic liver disease, physical medicine, hematology, and laboratory medicine, and is an author on numerous papers in medical and statistical journals. He wrote two of the original SAS procedures for survival analysis (coxregr and survtest), as well as the majority of the S-Plus survival functions. Patricia Grambsch is Associate Professor in the Division of Biostatistics, School of Public Health, University of Minnesota. She has collaborated extensively with physicians and public health researchers in chronic liver disease, cancer prevention, hypertension clinical trials and psychiatric research. She is a fellow the American Statistical Association and the author of many papers in medical and statistical journals.
Objective:
Although conscientiousness/disinhibition plays a substantial role in internalizing and externalizing psychopathology, the underlying mechanisms are not well-understood. We aim to clarify facet-level associations, and to examine whether (a) impairment mediates the link of conscientiousness with internalizing and externalizing symptoms, and (b) demoralization (assessed via neuroticism) accounts for their associations.
Method:
450 participants (Mage =42; primarily female and Caucasian) who reported current/recent psychiatric treatment completed two measures of domain and facet-level traits (i.e., NEO PI-3, PID-5), as well as interview measures of impairment and disorders. Correlation, regression, and mediation analyses were conducted.
Results:
Internalizing disorders (and particularly, the distress disorders) were uniquely associated with facets related to low self-efficacy, whereas externalizing disorders were uniquely associated with risk-taking and disregarding rules. For the internalizing disorders only, these associations were reduced after accounting for neuroticism, though associations with distress disorders remained significant. Impairment mediated the link between conscientiousness and symptoms for internalizing disorders, but not consistently for externalizing disorders.
Conclusions:
The internalizing and externalizing disorders are associated with conscientiousness due to different facet-level content. Demoralization and impairment both contribute to the link between internalizing disorders and conscientiousness, whereas neither process accounts substantially for the relation of externalizing disorders with conscientiousness. This article is protected by copyright. All rights reserved.
Background Little is known about personality disorders and normal personality dimensions in relatives of patients with obsessive—compulsive disorder (OCD).
Aims To determine whether specific personality characteristics are part of a familial spectrum of OCD.
Method Clinicians evaluated personality disorders in 72 OCD case and 72 control probands and 198 case and 207 control first-degree relatives. The selfcompleted Revised NEO Personality Inventory was used for assessment of normal personality dimensions. The prevalence of personality disorders and scores on normal personality dimensions were compared between case and control probands and between case and control relatives.
Results Case probands and case relatives had a high prevalence of obsessive—compulsive personality disorder (OCPD) and high neuroticism scores. Neuroticism was associated with OCPD in case but not control relatives.
Conclusions Neuroticism and OCPD may share a common familial aetiology with OCD.
The study objective was to apply machine learning methodologies to identify predictors of remission in a longitudinal sample of 296 adults with a primary diagnosis of obsessive compulsive disorder (OCD). Random Forests is an ensemble machine learning algorithm that has been successfully applied to large-scale data analysis across vast biomedical disciplines, though rarely in psychiatric research or for application to longitudinal data. When provided with 795 raw and composite scores primarily from baseline measures, Random Forest regression prediction explained 50.8% (5000-run average, 95% bootstrap confidence interval [CI]: 50.3-51.3%) of the variance in proportion of time spent remitted. Machine performance improved when only the most predictive 24 items were used in a reduced analysis. Consistently high-ranked predictors of longitudinal remission included Yale-Brown Obsessive Compulsive Scale (Y-BOCS) items, NEO items and subscale scores, Y-BOCS symptom checklist cleaning/washing compulsion score, and several self-report items from social adjustment scales. Random Forest classification was able to distinguish participants according to binary remission outcomes with an error rate of 24.6% (95% bootstrap CI: 22.9-26.2%). Our results suggest that clinically-useful prediction of remission may not require an extensive battery of measures. Rather, a small set of assessment items may efficiently distinguish high- and lower-risk patients and inform clinical decision-making. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
• The Longitudinal Interval Follow-up Evaluation (LIFE) is an integrated system for assessing the longitudinal course of psychiatric disorders. It consists of a semistructured interview, an instruction booklet, a coding sheet, and a set of training materials. An interviewer uses the LIFE to collect detailed psychosocial, psychopathologic, and treatment information for a six-month follow-up interval. The weekly psychopathology measures ("psychiatric status ratings") are ordinal symptom-based scales with categories defined to match the levels of symptoms used in the Research Diagnostic Criteria. The ratings provide a separate, concurrent record of the course of each disorder initially diagnosed in patients or developing during the follow-up. Any DSM-III or Research Diagnostic Criteria disorder can be rated with the LIFE, and any length or number of follow-up intervals can be accommodated. The psychosocial and treatment information is recorded so that these data can be linked temporally to the psychiatric status ratings.
• The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.
• The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessivecompulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's α coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
Elevated levels of Neuroticism and lower levels of Extraversion have been reliably shown in patients with anxiety and depressive disorders and some studies have demonstrated these patterns amongst patients diagnosed with Obsessive–Compulsive Disorder (OCD). However, because comorbid anxiety and depression is common in OCD, it is unclear whether the previously observed relationships are due to comorbid anxiety and depression or are more specifically related to the presence of OCD. This study sought to disentangle the relationship between personality and OCD by investigating the relationship between Extraversion, Neuroticism and OCD symptom severity and illness duration. Additionally, we explored the relationship between these variables and the additional variable of depression. Specifically, we tested whether depression mediated these relationships amongst a sample of 322 outpatients diagnosed with OCD. We found that depression fully mediated the relationship between personality and OCD symptom severity but not duration. Indeed, neither personality nor depression could explain illness duration. The results suggest that depression is an important variable to consider when understanding OCD symptom severity and trumps personality variables in terms of its explanatory power. The results also suggest that further work is needed to identify the variables that best explain illness duration in OCD.
Neuroticism is a robust personality trait that constitutes a risk factor for mood disorders. Neuroimaging findings related to neuroticism have been inconsistent across studies and hardly integrated in order to construct a model of the underlying neural correlates of neuroticism. The aim of the current meta-analysis was to provide a quantitative summary of the literature, using a parametric coordinate-based meta-analysis (PCM) approach. Data were pooled for emotion processing tasks investigating the contrasts (negative>neutral) and (positive>neutral) to identify brain regions that are consistently associated with neuroticism across studies. Significant negative and positive correlations with neuroticism were found only for the contrast (negative>neutral) after multiple comparisons correction. Differences in brain activation were found to be associated with neuroticism during fear learning, anticipation of aversive stimuli and the processing and regulation of emotion. The relationship between neuroticism and these three psychological processes and their corresponding neural correlates is discussed. Furthermore, the meta-analytic findings are incorporated into a general model of emotion processing in neuroticism.
Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD.
A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as part of the Brown Longitudinal Obsessive Compulsive Study, a prospective, naturalistic study of treatment-seeking adults with primary OCD. OCD symptoms were assessed annually over the 5-year follow-up period using the Longitudinal Interval Follow-Up Evaluation.
Thirty-nine percent of participants experienced either a partial (22.1%) or a full (16.9%) remission. Two OCD symptom dimensions impacted remission. Participants with primary obsessions regarding overresponsibility for harm were nearly twice as likely to experience a remission (P < .05), whereas only 2 of 21 participants (9.5%) with primary hoarding achieved remission. Other predictors of increased remission were lower OCD severity (P < .0001) and shorter duration of illness (P < .0001). Fifty-nine percent of participants who remitted subsequently relapsed. Participants with obsessive-compulsive personality disorder were more than twice as likely to relapse (P < .005). Participants were also particularly vulnerable to relapse if they experienced partial remission versus full remission (70% vs 45%; P < .05).
The contributions of OCD symptom categories and comorbid obsessive-compulsive personality disorder are critically important to advancing our understanding of the prognosis and ultimately the successful treatment of OCD. Longer duration of illness was also found to be a significant predictor of course, highlighting the critical importance of early detection and treatment of OCD. Furthermore, having full remission as a treatment target is an important consideration for the prevention of relapse in this disorder.
To examine the prognostic value of personality dimensions and negative and positive life events for diagnostic and symptom course trajectories in depressive and anxiety disorder.
A total of 1209 subjects (18-65 years) with depressive and/or anxiety disorder were recruited in primary and specialized mental health care. Personality dimensions at baseline were assessed with the NEO-FFI and incidence and date of life events retrospectively with a structured interview at 2-year follow-up. DSM-IV-based diagnostic interviews as well as life chart assessments allowed course assessment at both the diagnostic and symptom trajectory level over 2 years.
Life events were significantly related to diagnostic and symptom course trajectories of depression and anxiety also after correcting for sociodemographic and clinical characteristics. Only negative life events prospectively predicted longer time to remission of depressive disorder. Prospective associations of neuroticism and extraversion with prognosis of anxiety and depression were greatly reduced after correcting for baseline severity and duration of index disorder. Personality traits did not moderate the effect of life events on 2-year course indicators.
Negative life events have an independent effect on diagnostic and symptom course trajectories of depression and to a lesser extent anxiety unconfounded by sociodemographic, clinical, and personality characteristics.
The current study examined how specific coping strategies mediate the relationship between Conscientiousness (C) and positive affect (PA) in a large, multiethnic sample. Using an internet-based daily diary approach, 366 participants (37.6% Caucasian, 30.6% Asian American, 20.7% Hispanic, 9.1% African American) completed measures that assessed daily stressors, coping strategies used to deal with those stressors, and PA over the course of five days. In addition, participants completed a measure of the Five-Factor Model of Personality. Problem-Focused coping partially mediated the relationship between C and PA. Individuals higher in C used more problem-focused coping, which, in turn, was associated with higher PA. The findings of the current study suggest C serves as a protective factor from stress through its influence on coping strategy selection. Other possible mediators in the C-PA relationship are discussed.
The Duration of Untreated Illness (DUI), defined as the time elapsing between the onset of a disorder and the beginning of the first pharmacological treatment, has been increasingly investigated as a predictor of outcome and course across different psychiatric disorders. Purpose of this naturalistic study was to evaluate the influence of DUI on treatment response and remission in a sample of patients with obsessive-compulsive disorder (OCD).
Sixty-six outpatients with a DSM-IV diagnosis of OCD were included in the study. Patients received, according to their clinical conditions, an open pharmacological treatment of 12 weeks and were evaluated by the administration of the Yale Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and endpoint. Treatment response was defined as a decrease .25% on Y-BOCS score compared to baseline, while remission was defined as an endpoint Y-BOCS total score #10. A logistic regression was performed considering DUI as the independent continuous variable and treatment response and remission as the dependent variables. Moreover, the sample was divided into two groups according to a categorical cut-off for the DUI of 24 months and odds ratios (OR) were calculated on the basis of the same variables.
DUI, considered as a continuous variable, was not predictive of treatment response (OR51.00, P50.15) nor remission (OR51.00, P50.59). When considered as a categorical variable, however, a DUI # 24 months was predictive of treatment response (OR50.27, P50.03).
Results from the present naturalistic study suggest a complicated relationship between DUI and treatment outcome in OCD encouraging further investigation with larger samples in order to better define long versus short DUI in this condition.
The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
The Longitudinal Interval Follow-up Evaluation (LIFE) is an integrated system for assessing the longitudinal course of psychiatric disorders. It consists of a semistructured interview, an Instruction booklet, a coding sheet, and a set of training materials. An interviewer uses the LIFE to collect detailed psychosocial, psychopathologic, and treatment information for a six-month follow-up interval. The weekly psychopathology measures ("psychiatric status ratings") are ordinal symptom-based scales with categories defined to match the levels of symptoms used in the Research Diagnostic Criteria. The ratings provide a separate, concurrent record of the course of each disorder initially diagnosed in patients or developing during the follow-up. Any DSM-III or Research Diagnostic Criteria disorder can be rated with the LIFE, and any length or number of follow-up intervals can be accommodated. The psychosocial and treatment information is recorded so that these data can be linked temporally to the psychiatric status ratings.
The LIFE-UP, an instrument for prospectively following course for psychiatric disorders, has been extended to include Psychiatric Status Ratings (PSRs) for the DSM-III-R anxiety disorders panic (with and without agoraphobia), agoraphobia without panic, generalized anxiety disorder, social phobia, and simple phobia. This paper reports data on the reliability and validity of the LIFE-UP as used in the Harvard/Brown Anxiety Disorders Research Program. We found generally good reliability for the PSRs, both inter-rater and long-term test-retest. The reliability coefficients for the rater-administered instruments were very similar to those for the self-reports, suggesting that a large proportion of the variance was due to subject variability rather than rater variability. Reliability for the beginning of the year of follow-up was very similar to that for the time just before the interview. In addition, correlations with other measures of psychosocial function or anxiety symptomatology provided evidence for the external validity of the PSRs as measures of psychiatric morbidity.
Systematic studies of course of illness in obsessive-compulsive disorder (OCD) using standardized diagnostic criteria are relatively rare. In the present study, 100 patients diagnosed with OCD were prospectively followed for up to 5 years. Other comorbid conditions included anxiety disorders (76%), major depressive disorder (33%), and at least one personality disorder (33%), mainly in the anxious cluster. Approximately 20% of patients had full remission and 50% had partial remission during follow-up. Significant predictors of partial remission included being married and having lower global severity scores at intake; the presence of major depression was marginally predictive of poorer course. Adequate serotonergic medication was associated with worse course, but findings are likely spurious. Only marital status and global severity were retained as predictors in a final regression model. Findings are discussed with regard to sample characteristics and similarity to other reports on predictors of course and of treatment outcome.
The ascendance of emotion theory, recent advances in cognitive science and neuroscience, and increasingly important findings from developmental psychology and learning make possible an integrative account of the nature and etiology of anxiety and its disorders. This model specifies an integrated set of triple vulnerabilities: a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences in developing a sense of control over salient events, and a more specific psychological vulnerability in which one learns to focus anxiety on specific objects or situations. The author recounts the development of anxiety and related disorders based on these triple vulnerabilities and discusses implications for the classification of emotional disorders.
Previous research conducted on the five-factor model of personality (FFM) in obsessive-compulsive disorder (OCD) has demonstrated that community and clinical participants score significantly higher than controls on the domains and facets of neuroticism and extraversion and selective facets of agreeableness and conscientiousness. However, studies have yet to examine the extent to which personality traits, as assessed by the FFM, are associated with the specific symptoms of OCD. The purpose of this study was to examine further the personality predictors of obsessive-compulsive symptoms in clinical participants using the facets of the FFM. Patients with a DSM-IV diagnosis of OCD (N = 56) completed the Revised NEO Personality Inventory, the Yale Brown Obsession Compulsion Scale, and the Beck Depression Inventory. Lower scores on openness to ideas were uniquely associated with greater obsession severity, whereas lower openness to actions was uniquely associated with greater compulsive severity. In contrast with past research that has emphasized the association between neuroticism and extraversion and dimensionally rated obsessive-compulsive symptoms, this study demonstrates the specific associations between selective facet traits of openness and clinical obsessions and compulsions. Whereas tendencies toward negative affectivity may confer a nonspecific vulnerability to the development of OCD, facets of openness may impact on the particular expression and severity of obsessive-compulsive symptoms.
Developing a comprehensive understanding of resilience across the lifespan is potentially important for mental health promotion, yet resilience has been vastly understudied compared to disease and vulnerability. The present study investigated the relationship of resilience to personality traits, coping styles, and psychiatric symptoms in a sample of college students. Measures included the Connor-Davidson Resilience Scale, NEO Five Factor Inventory, Coping Inventory for Stressful Situations, and Brief Symptom Inventory. Results supported hypotheses regarding the relationship of resilience to personality dimensions and coping styles. Resilience was negatively associated with neuroticism, and positively related to extraversion and conscientiousness. Coping styles also predicted variance in resilience above and beyond the contributions of these personality traits. Task-oriented coping was positively related to resilience, and mediated the relationship between conscientiousness and resilience. Emotion-oriented coping was associated with low resilience. Finally, resilience was shown to moderate the relationship between a form of childhood maltreatment (emotional neglect) and current psychiatric symptoms. These results augment the literature that seeks to better define resilience and provide evidence for the construct validity of the Connor-Davidson Resilience Scale.
Most research on relations between Obsessive-Compulsive Disorder (OCD) and personality addresses only comorbidity rates between OCD and Obsessive-Compulsive Personality Disorder (OCPD). We first investigated empirical OCD-OCPD relations, but then also examined patterns of dimensional traits in OCD patients versus students and general outpatients. Results did not support a specific OCD-OCPD relation and the implications of this conclusion are discussed. Regarding traits, OCD patients shared with other patients elevated negative affectivity and lower positive affectivity. Differences on several lower order dimensions, including lower scores on manipulativeness, mistrust, and disinhibition distinguished the personality profile of OCD patients from others. Also noteworthy was a pattern of very low self-image for OCD patients, as suggested by the combination of low self-esteem and low entitlement scores. Overall, OCD patients showed a more specific pattern of personality pathology than did general outpatients, who were elevated more generally across personality disorders and negative affectivity scales.
This article describes the method and intake findings of the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the naturalistic course of obsessive-compulsive disorder (OCD) in a large clinical sample using longitudinal research methodology.
Intake data, collected between June 2001 and October 2004, are presented for 293 adult participants in a prospective, naturalistic study of OCD. Participants had a primary diagnosis of DSM-IV OCD and had sought treatment for the disorder.
Our findings indicate that OCD typically has a gradual onset and a continuous course regardless of age at onset. There is a substantial lag between the onset of the disorder and initiation of treatment. OCD, which almost always coexists with other psychiatric symptoms, leads to serious social and occupational impairment. Compared with participants with late-onset OCD, early-onset participants had higher rates of lifetime panic disorder, eating disorders, and obsessive-compulsive personality disorder. The groups also differed on the types of obsessive-compulsive symptoms that were first noticed, as well as on rates of current obsessions and compulsions.
The demographics, clinical characteristics, comorbidity rates, and symptom presentation of the sample are consistent with those reported for cross-sectional studies of OCD, including the DSM-IV Field Trial. The current sample has a number of advantages over previously collected prospective samples of OCD in that it is large, diagnostically well characterized, recruited from multiple settings, and treatment seeking. This unique data set will contribute to the identification of meaningful phenotypes in OCD based on stability of symptom dimensions, prospective course patterns, and treatment response.
This study aimed to evaluate the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and to identify predictors of clinical outcome. Seventy-nine patients fulfilling DSM-IV criteria for OCD were followed prospectively for 3 years. Baseline information was collected on demographic and clinical characteristics, using standardized instruments. During the follow-up period, the clinical status of each patient was evaluated monthly in the first year and bimonthly thereafter by means of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Rating Scale for Depression (HDRS). The cumulative probability of achieving at least partial remission from obsessive-compulsive (OC) symptoms during the 3-year period was 65%. The probability of full remission was 38%. For subjects who achieved at least partial remission, the probability of subsequent relapse was 60%. Significant predictors of poor outcome included a longer duration of illness, a greater severity of OC symptoms at intake, and the presence of comorbid schizotypal personality disorder. The findings confirm that the course of illness in OCD is usually continuous with fluctuations in the intensity of OC symptoms. Despite adequate SRI therapy, relatively few patients achieve a completely asymptomatic state, and of those who achieve at least a partial remission, a substantial proportion subsequently relapse. One third of OCD patients is treatment-resistant. Further studies with large samples are required to adequately identify predictors of long-term outcome of OCD in order to optimize the choice among the existing treatment modalities. The development of alternative strategies is needed to improve the treatment approaches for treatment-resistant OCD patients.
Two methods for predicting remissions in obsessive-compulsive disorder (OCD) treatment are evaluated. Y-BOCS measurements of 88 patients with a primary OCD (DSM-III-R) diagnosis were performed over a 16-week treatment period, and during three follow-ups.
Remission at any measurement was defined as a Y-BOCS score lower than thirteen combined with a reduction of seven points when compared with baseline. Logistic regression models were compared with a Cox regression for recurrent events model.
Logistic regression yielded different models at different evaluation times. The recurrent events model remained stable when fewer measurements were used. Higher baseline levels of neuroticism and more severe OCD symptoms were associated with a lower chance of remission, early age of onset and more depressive symptoms with a higher chance.
Choice of outcome time affects logistic regression prediction models. Recurrent events analysis uses all information on remissions and relapses. Short- and long-term predictors for OCD remission show overlap.
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