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Suicidality in Obsessive-Compulsive Disorder: Prevalence and Relation to Symptom Dimensions and Comorbid Conditions
Abstract
Suicidal thoughts and behaviors, also known as suicidality, are a fairly neglected area of study in patients with obsessive-compulsive disorder (OCD).
To evaluate several aspects of suicidality in a large multicenter sample of OCD patients and to compare those with and without suicidal ideation, plans, and attempts according to demographic and clinical variables, including symptom dimensions and comorbid disorders.
This cross-sectional study included 582 outpatients with primary OCD (DSM-IV) recruited between August 2003 and March 2008 from 7 centers of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. The following assessment instruments were used: the Yale-Brown Obsessive Compulsive Scale, the Dimensional Yale-Brown Obsessive Compulsive Scale, the Beck Depression and Anxiety Inventories, the Structured Clinical Interview for DSM-IV Axis I Disorders, and 6 specific questions to investigate suicidality. After univariate analyses, logistic regression analyses were performed to adjust the associations between the dependent and explanatory variables for possible confounders.
Thirty-six percent of the patients reported lifetime suicidal thoughts, 20% had made suicidal plans, 11% had already attempted suicide, and 10% presented current suicidal thoughts. In the logistic regression, only lifetime major depressive disorder and posttraumatic stress disorder (PTSD) remained independently associated with all aspects of suicidal behaviors. The sexual/religious dimension and comorbid substance use disorders remained associated with suicidal thoughts and plans, while impulse-control disorders were associated with current suicidal thoughts and with suicide plans and attempts.
The risk of suicidal behaviors must be carefully investigated in OCD patients, particularly those with symptoms of the sexual/religious dimension and comorbid major depressive disorder, PTSD, substance use disorders, and impulse-control disorders.
... 14 According to another similar study, 36 % of the OCD patients reported that they had suicidal thoughts during their life time at some point, 20% patients actually thought of suicidal plans, 11% had history of attempted suicide, and 10% had currently expressed their suicidal thoughts. 15 According to another prospective study conducted in Barcelona, Spain on two hundred and eighteen outpatients from a specialized OCD Unit 8.2% patients reported persistence of suicidal ideation, 0.91% patients actually committed suicide and 5.0% patients had attempted suicide. 16 Suicide is not uncommon in psychiatric patients rather it is thought that suicide is one of the major cause of deaths among patients with mental illnesses. ...
... 19 Similarly, in another study 36% of OCD subjects reported that they had suicidal thoughts during their life time; 20% mentioned that they made suicide plans; 11% were among those who attempted suicide; and 10% patients expressed suicidal thoughts on current examination. 15 The reported frequency regarding suicidal ideation among OCD patients in the current study falls to a lower side. i.e. 25.2% of the range mentioned in literature. ...
... An early age of onset and poorer disease control are also associated factors. 8,14,15,22 Some other studies have also searched the factors which can contribute towards the increased risk of suicidal behavior in patients of OCD. It was found that concomitant presence of depressive disorder 19,23 and severity of its symptoms 13,22 ; higher severity of OCD symptoms; 13,22 higher rate of aggressive behaviour, 13 severity of sexual and religious thoughts 24 and/or symptoms of symmetry/ordering increase the suicidal behavior in patients of OCD. ...
ORIGINAL ARTICLE PREVALENCE OF SUICIDAL IDEATION AMONG THE PATIENTS SUFFERING FROM OBSESSIVE COMPULSIVE DISORDER ATTENDING PSYCHIATRY DEPARTMENTS OF A TERTIARY CARE HOSPITALS OF LAHORE, PAKISTAN Ahmed Waheed, M. Ismail Tariq, Sumira Qambar Bokhari, Shahid Hameed Warris, Aysha Rashid, Surya Fazal Hashmi. ABSTRACT Background: Obsessive compulsive disorder (OCD) is a debilitating disease which runs a chronic course and affects patient’s functioning badly. Frequency of Suicidal thoughts and attempts is much more common in OCD patients than it was thought previously. Objective: To determine the frequency of suicidal ideation among patients with obsessive compulsive disorder presenting in a tertiary care hospital. Material & Methods This Cross-sectional study was done in a tertiary care hospital on 159 patients of OCD. Demographic data was taken. All patients were assessed for history of suicidal attempt. History of suicidal ideation was obtained from patients on a Performa comprising of BECK suicidal intent scale. Data was analyzed on SPSS version 20. Results: Suicidal ideation was found in 40(25.2%) patients. Frequency of suicidal ideation was higher among female (57.5%) patients as compared to male (42.5%) patients. Socio-demographic factors like age, gender, duration of OCD, marital status, educational status and financial condition did not show any statistically significant association with suicidal ideation. Conclusion: Current study showed that suicidal ideation was present in 25% of the patients of OCD which signifies the importance of assessment of suicidal ideation in all OCD patients routinely. Key words: Suicidal ideation, Obsessive compulsive disorder, Psychiatry department.
... Historically, clinicians did not consider OCD patients to be at elevated risk of suicide, based on small clinical case series with short-term follow-up (Goodwin et al., 1969;Coryell et al., 1981). However, more recent clinical studies have found that 10% or more of patients with OCD attempt suicide over their lifetimes (Torres et al., 2011;Torresan et al., 2013), and several meta-analyses have reported a mean lifetime prevalence of attempted suicide in OCD of about 14% (Albert et al., 2019;Angelakis et al., 2015;Pellegrini et al., 2020). In addition, several population-based studies have found that the lifetime history of attempted suicide was substantially greater in individuals with OCD than in those with anxiety disorders (Hollander et al., 1996(Hollander et al., /1997Torres et al., 2006;Ten Have et al., 2013). ...
... The majority of individuals with OCD have lifetime co-occurrence of other psychiatric disorders, especially major depression and anxiety disorders (Brakoulias et al., 2017;Ruscio et al., 2010;Sharma et al., 2021). Several clinical and epidemiologic studies have found that lifetime suicide attempt in OCD-affected individuals is substantially greater in those with lifetime co-occurrence of other psychiatric disorders (Torres et al., 2006;Torres et al., 2011;Dell'Osso et al., 2018). Major depression is a major risk factor for attempted suicide in OCD (Agne et al., 2022;Alonso et al., 2010;Benatti et al., 2021;Kamath et al., 2007;Torres et al., 2011; it has been reported that 85% of OCD-affected individuals who have attempted suicide have a current or past major depression (Kamath et al., 2007), and 98% have had a major depressive episode (Torres et al., 2011). ...
... Several clinical and epidemiologic studies have found that lifetime suicide attempt in OCD-affected individuals is substantially greater in those with lifetime co-occurrence of other psychiatric disorders (Torres et al., 2006;Torres et al., 2011;Dell'Osso et al., 2018). Major depression is a major risk factor for attempted suicide in OCD (Agne et al., 2022;Alonso et al., 2010;Benatti et al., 2021;Kamath et al., 2007;Torres et al., 2011; it has been reported that 85% of OCD-affected individuals who have attempted suicide have a current or past major depression (Kamath et al., 2007), and 98% have had a major depressive episode (Torres et al., 2011). In addition, bipolar disorder, alcohol use disorder, other substance use disorders, anxiety disorders, and post-traumatic stress disorder (PTSD) have been found to be moderately or strongly associated with lifetime suicide attempt in OCD (Perugi et al., 1997;Hantouche et al., 2003;Angelakis et al., 2015;Gentil et al., 2009;Fontenelle et al., 2012;Albert et al., 2019;Cervin et al., 2022). ...
Background:
Little is known about specific obsessive-compulsive clinical features associated with lifetime history of suicide attempt in individuals with obsessive-compulsive disorder (OCD) and major depression.
Methods:
The study sample included 515 adults with OCD and a history of major depression. In exploratory analyses, we compared the distributions of demographic characteristics and clinical features in those with and without a history of attempted suicide and used logistic regression to evaluate the association between specific obsessive-compulsive clinical features and lifetime suicide attempt.
Results:
Sixty-four (12%) of the participants reported a lifetime history of suicide attempt. Those who had attempted suicide were more likely to report having experienced violent or horrific images (52% vs. 30%; p < 0.001). The odds of lifetime suicide attempt were more than twice as great in participants with versus without violent or horrific images (O.R. = 2.46, 95%, CI = 1.45-4.19; p < 0.001), even after adjustment for other risk correlates of attempted suicide, including alcohol dependence, post-traumatic stress disorder, parental conflict, excessive physical discipline, and number of episodes of depression. The association between violent or horrific images and attempted suicide was especially strong in men, 18-29 year olds, those with post-traumatic stress disorder, and those with particular childhood adversities.
Conclusions:
Violent or horrific images are strongly associated with lifetime suicide attempts in OCD-affected individuals with a history of major depression. Prospective clinical and epidemiological studies are needed to elucidate the basis of this relationship.
... Ölüm nedenleri arasında özkıyımın engellenebilir olması bu fenomeni daha önemli bir hale getirmektedir (6). OKB'de özkıyıma yönelik risk faktörleri pek bilinmemektedir (7). Özellikle bipolar bozukluk ve majör depresyon komorbiditesi özkıyıma aracılık edebilir (7)(8)(9). ...
... OKB'de özkıyıma yönelik risk faktörleri pek bilinmemektedir (7). Özellikle bipolar bozukluk ve majör depresyon komorbiditesi özkıyıma aracılık edebilir (7)(8)(9). 582 hasta ile yapılan bir araştırmada yaygın anksiyete bozukluğu, majör depresif bozukluk (MDB), dürtü kontrol bozukluğu ve travma sonrası stres bozukluğu (TSSB), eştanısının özkıyım düşüncesi ve planıyla; distimik bozukluğun ise özkıyım düşüncesi ve planı; travmatik deneyimlerin özkıyım düşüncesi ile ilişkili olduğu tespit edilmiştir (7). Bekarlık ve aile içerisinde özkıyımın varlığı ile girişimi; sosyoekonomik düzeyin daha düşük olması ve dini uğraşıların yokluğuyla özkıyım düşüncesi arasında anlamlı ilişki gösterilmiştir (7,9). ...
... Özellikle bipolar bozukluk ve majör depresyon komorbiditesi özkıyıma aracılık edebilir (7)(8)(9). 582 hasta ile yapılan bir araştırmada yaygın anksiyete bozukluğu, majör depresif bozukluk (MDB), dürtü kontrol bozukluğu ve travma sonrası stres bozukluğu (TSSB), eştanısının özkıyım düşüncesi ve planıyla; distimik bozukluğun ise özkıyım düşüncesi ve planı; travmatik deneyimlerin özkıyım düşüncesi ile ilişkili olduğu tespit edilmiştir (7). Bekarlık ve aile içerisinde özkıyımın varlığı ile girişimi; sosyoekonomik düzeyin daha düşük olması ve dini uğraşıların yokluğuyla özkıyım düşüncesi arasında anlamlı ilişki gösterilmiştir (7,9). ...
Objective: Data on the relationship between alcohol use disorder and suicide in patients with obsessive-compulsive disorder (OCD) are limited. The aim of this study was to investigate our hypothesis that there may be a relationship between alcohol use disorder and suicide in patients with OCD. Method: The study included 92 patients with OCD. General sociodemographic and clinical characteristics of the patients were evaluated. Yale-Brown Obsession Compulsion Scale (Y-BOCS) and Beck Suicidal Ideation Scale were administered to OCD patients. Results: The sample consisted of 54 women and 38 men. The rate of past suicide attempts was 19.6%. 16 patients were comorbid with Alcohol Use Disorder. Smoking, family history of mental illness and Beck Suicidal Ideation Scale score were significantly higher in the group with Alcohol Use Disorder. Smoking, alcohol use, family history of mental illness and Beck Suicidal Ideation Scale score were significantly higher in the group with suicide attempt. Conclusion: The results of this study showed that comorbid alcohol use disorder may be associated with past suicidal thoughts and attempts in patients with OCD. It may be appropriate to follow up OCD patients with alcohol use disorder more frequently in terms of suicide.
... Obsessions, but not compulsions, have been suggested to be uniquely associated with suicidal ideation and suicide attempts (Pellegrini et al., 2020). Having been exposed to sexual abuse (Khosravani et al., 2017) and having comorbid post-traumatic stress disorder (PTSD), depression, substance use disorders (Gentil et al., 2009;Torres et al., 2011), and intermittent explosive disorder (Agne et al., 2020) have also been linked to suicidality in OCD. ...
... Factor analytic work has consistently shown that OCD symptoms can be organized under a few broad symptom dimensions, which are thought to have evolutionary roots and partially distinct etiologies (Iervolino et al., 2011;Mataix-Cols et al., 2005). Research on OCD symptom dimensions and suicidality has suggested that sexual and religious obsessions (sometimes referred to as taboo obsessions) may be specifically linked to an increased risk of suicidal thoughts and behaviors (Demirkol et al., 2019;Khosravani et al., 2017;Krebs et al., 2021;Torres et al., 2011); however, this link has not been found in all studies (Agne et al., 2020). ...
... We used this refined model to test the hypothesis that taboo obsessions explain a meaningful part of the variance in suicidality in a large cohort of individuals with OCD. Extending previous research (Khosravani et al., 2017;Krebs et al., 2021;Torres et al., 2011), we found that taboo obsessions were uniquely associated with suicidality, even after rigorously accounting for other symptom dimensions, sociodemographic factors, psychiatric comorbidity, and overall OCD symptom severity in a two-step, exploratory-confirmatory design. ...
Individuals with obsessive-compulsive disorder (OCD) more often think about, attempt, and die by suicide than individuals from the general population. Sexual and religious obsessions (i.e., taboo obsessions) have been linked to increased risk of suicidality, but it is unclear if they explain additional risk over and above other risk factors. We refined the recently proposed multidimensional hierarchical model of OCD and explored how each symptom dimension in the model was associated with suicidality in a random half (n = 500) of a well-characterized cohort of patients with OCD. Symptom dimensions and other risk factors significantly associated with suicidality were included in a confirmatory multivariable model conducted with the other half of the sample (n = 501). The predictive confirmatory model accounted for 19% of the variance in suicidality. Taboo obsessions, the general OCD factor (i.e., having many different OCD symptoms at the same time), lifetime major depression, and lifetime substance use disorders significantly predicted suicidality in this model. Lifetime major depression explained most unique variance in suicidality (5.6%) followed by taboo obsessions and the general OCD factor (1.9% each). Taboo obsessions explain a small but significant proportion of variance in suicidality and should be considered an independent risk factor for suicidality in patients with OCD.
... There are inconsistent findings regarding the associations between various clinical features and sociodemographic variables of OCD, like the gender of patients [5], age of onset [11], OCD symptoms dimensions, OCD severity, history of suicide attempts, and presence of other psychiatric comorbidities with suicidal behavior. Several studies have reported that sexual-religious [12,13] and aggressive obsessions were associated with suicidality in patients with OCD. ...
... Ego-dystonic suicidal thoughts are defined as common aggressive obsessive thoughts and should be distinguished from real suicidal ideation [14]. Some other studies have reported that washing-contamination [5], and symmetry-ordering [12] were associated with suicidal ideations. OCD severity significantly predicted suicidal ideation [8,11,12,[15][16][17]. ...
... Some other studies have reported that washing-contamination [5], and symmetry-ordering [12] were associated with suicidal ideations. OCD severity significantly predicted suicidal ideation [8,11,12,[15][16][17]. Major depressive disorder [5,16,17] and anxiety disorders [11,12,18] were reported to be associated with current suicidal ideations. ...
Background: There are many controversies about the frequency and burden of suicidality in patients with Obsessive-Compulsive Disorder (OCD).
Objectives: This study was done to determine the prevalence and risk factors of current suicidal ideations in patients with OCD.
Materials & Methods: In this cross-sectional study, 258 outpatients with OCD (Yale-Brawn Obsessive Compulsive Scale, Y-BOCS ≥16) referring to two psychiatry clinics in Guilan, Iran, from March 2018 to September 2019 were evaluated. Suicidality score of the Brief Psychiatric Rating Scale (BPRS) ≥4 was considered for current suicidal ideation at the first visit. Beck Scale for Suicidal Ideation (BSSI) was used to evaluate the intensity of suicidal ideations a week before evaluation. Simple linear and binary logistic regression analyses were used to analyze data by SPSS v. 20.
Results: Current suicidal ideation was found in 22.1% of patients. The previous history of suicide attempt (BPRS, P
... S uicide is a major global public health problem, involving more than 800,000 deaths every year worldwide (World Health Organization, 2014). Many studies have shown that obsessive-compulsive disorder (OCD), which is characterized by obsessions and compulsions (American Psychiatric Association, 2013), is a risk factor for suicidality (Angelakis et al., 2015;Balci and Sevincok, 2010;Brakoulias et al., 2017;Chaudhary et al., 2016;Gupta et al., 2014;Kamath et al., 2007;Torres et al., 2011). In addition, patients with psychiatric disorders and comorbid OCD showed higher suicidal risk compared with those without comorbid OCD (Chen and Dilsaver, 1995;Dold et al., 2018;Overbeek et al., 2002;Quarantini et al., 2011). ...
... In patients with OCD, suicidal risk was found to be higher if they had associated depression, hopelessness, and anxiety (Alonso et al., 2010;Balci and Sevincok, 2010;Brakoulias et al., 2017;Gupta et al., 2014;Hung et al., 2010;Kamath et al., 2007;Quarantini et al., 2011;Torres et al., 2011). Furthermore, suicidal risk was higher in patients with OCD who had more severe obsessions and compulsions (Balci and Sevincok, 2010;Hung et al., 2010), and certain themes of obsessions and compulsions seemed to relate more strongly to suicidal risk (Alonso et al., 2010;Balci and Sevincok, 2010;Torres et al., 2011). ...
... In patients with OCD, suicidal risk was found to be higher if they had associated depression, hopelessness, and anxiety (Alonso et al., 2010;Balci and Sevincok, 2010;Brakoulias et al., 2017;Gupta et al., 2014;Hung et al., 2010;Kamath et al., 2007;Quarantini et al., 2011;Torres et al., 2011). Furthermore, suicidal risk was higher in patients with OCD who had more severe obsessions and compulsions (Balci and Sevincok, 2010;Hung et al., 2010), and certain themes of obsessions and compulsions seemed to relate more strongly to suicidal risk (Alonso et al., 2010;Balci and Sevincok, 2010;Torres et al., 2011). According to a systematic review and meta-analysis, which found a moderate to highly significant association between suicidality and OCD, obsessions were found to correlate more strongly with suicidality than compulsions (Angelakis et al., 2015). ...
In this study, we defined obsessive thoughts (OT) as bothersome, unpleasant thoughts about oneself that keep entering the mind against one's will, and compulsive behavior (CB) as behavior that a person repeats against his or her wishes. The study included 12,532 adults selected randomly through a one-person-per-household method. Each subject selected underwent a face-to-face interview using the Korean version of the Composite International Diagnostic Interview with a questionnaire that examines lifetime suicide attempts (LSAs). Among the participants, 341 (2.74%) had OT and 639 (5.14%) had CB. The highest LSA rate was in subjects with both OT and CB, followed by those with either OT or CB; subjects with neither OT nor CB had the lowest LSA rate. In a multivariate logistic regression analysis of OT and CB, OT, ordering, and rituals of repeating words were significantly associated with LSAs. In subjects with OT and CB, those with MDD had a significantly higher risk of LSAs compared with those without, and MDD with both OT and CB showed odds of approximately 27-fold (adjusted odds ratio, 27.24; 13.29-55.82; p < 0.0001) compared with those without MDD, OT, or CB. OT and CB were associated with increased risk of LSAs, and comorbid MDD further increased LSAs.
... The relationship between depressive symptoms and suicide in OCD patients was investigated, and a positive correlation was found between the severity of depressive symptoms, suicidal ideation, and lifelong suicide attempts. 32,33 Considering the role of accompanying anxiety disorders in suicidal behavior, especially generalized anxiety disorders, increases the risk of suicidal ideation and lifelong suicide attempt. 32 In addition, the accompanying anxiety disorder may play a preventive role for fatal suicide attempt. ...
... 32,33 Considering the role of accompanying anxiety disorders in suicidal behavior, especially generalized anxiety disorders, increases the risk of suicidal ideation and lifelong suicide attempt. 32 In addition, the accompanying anxiety disorder may play a preventive role for fatal suicide attempt. 34 In our study, accompanying symptoms were classified as depressive, anxious, and somatic, and all 3 symptom dimensions were found to be significantly higher in the OCD group than in the control group. ...
Background
Although an association has been newly reported between obsessive-compulsive disorder (OCD) and an increased risk of suicide, there are only a limited number of studies investigating suicide-related factors in OCD patients. The aim of this study is to evaluate the relationship between dysfunctional metacognitive activity, difficulty in emotion regulation, anxiety, depression, somatization symptom severity, and suicide probability in OCD patients by comparing them with a control group.
Methods
Difficulties in Emotion Regulation Scale, Metacognition Scale, Suicide Probability Scale, and Patient Health Questionnaire Somatic, Anxiety, and Depression Symptom Scale were administered to 70 OCD patients and 70 healthy controls. The Dimensional Obsession Compulsion Scale was administered to assess OCD symptom dimensions among OCD patients.
Results
Dysfunctional metacognition, difficulty in emotion regulation, probability of suicide, depression, anxiety, and somatization symptoms were significantly higher in OCD patients compared to the control group (P < .05). Suicide probability was found to be positively correlated with depression, difficulty in emotion regulation, impulsivity dimension, metacognition, cognitive confidence dimension, contamination, cleaning, and symmetry scores among OCD symptom dimensions (P < .05).
Conclusion
Recognizing the factors that were found to be associated with suicide probability in individuals with OCD may be of great importance in identifying patients at higher suicide risk.
... Alonso, Segalàs, Real, Pertusa, Labad, Jiménez-Murcia, et al. (2010) stated that the severity of the unacceptable thought dimension was similar in the patient groups with and without suicidal attempt, and the symmetry dimension was more severe in patients who had attempted suicide. Various studies have reported that sexual, religious or aggressive obsessions and unacceptable thought dimension are related to suicidal ideation and suicide attempt (Albert et al., 2018;Balci & Sevincok, 2010;Nagy et al., 2020;Torres, Ramos-Cerqueira, Ferrão, Fontenelle, Do Rosário, & Miguel, 2011). However, systematic meta-analysis of 61 studies found that any type of obsession and compulsion was not associated with suicidal behavior. ...
... Balci and Sevincok (2010) suggested that there is a significant correlation between the severity of depressive symptoms and current suicidal ideation. Moreover, Torres et al. (2011) stated that the diagnosis of comorbid major depressive disorder is a predictor of suicidal ideation and suicidal plan in OCD. A recent systematic review reported that depressive symptom severity was associated with increased rates of suicide in OCD (Pellegrini et al., 2020). ...
The risk of suicide is higher in obsessive-compulsive disorder (OCD) than in the general population. There are several risk factors associated with suicidality in OCD. Distress tolerance is the capacity to experience and withstand negative psychological states. The aim of this study was to investigate the relationship between distress tolerance and suicidality in OCD. This study was conducted on 83 patients diagnosed with OCD. OCD-related data were obtained with the Yale Brown Obsession Compulsion Scale (YBOCS) and the Dimensional Obsession Compulsion Scale (DOCS). Suicide Probability Scale (SPS) was used to assess suicide risk. Distress Tolerance Scale (DTS) was used to measure the level of distress tolerance. Severity of anxiety and depression symptoms was assessed with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The proportion of patients with a history of attempted suicide at any point in their lives was 13.3%. As a result of the regression analysis, DTS score, YBOCS score, BDI score, history of suicide attempt, and having a diagnosis of any personality disorder were associated with SPS score. Decreased DT capacity was associated with increased suicide probability. Distress tolerance capacity is a predictive factor for suicide probability in OCD. Suicidality in OCD is an important clinical entity that requires attention. Close monitoring of patients with risk factors that increase the likelihood of suicide may provide an opportunity for early intervention. Psychological interventions aimed at increasing DT capacity may be useful in reducing the suicide probability.
... Regarding socio-demographic and clinical features related to different thresholds of SI (lifetime SI or lifetime SSI), our findings are supported by existing literature that underlines a relationship between comorbid mood disorders, greater severity of depressive and/or anxiety symptoms and current/lifetime SI. 5 In the last years some authors suggested that the presence of comorbid disorders, such as comorbid mood disorders, may represents a mediating factor between OCD and suicidality, due to the greater OCD severity, distress and functional impairment of these subjects. 30,31 However, it is not clear whether the depressive symptoms act as a confounder or as a factor in the causal pathway between OCD and suicide. ...
... 41,42 Our study also suggests that measuring the DUI during the initial evaluation of individuals with OCD may be useful in personalizing the approach to patients (e.g. more frequent visits, aggressive treatment, active inquiry about suicidal ideation with a dimensional approach). Concerning the OCD symptoms profiles, the majority of the studies highlighted an association between the unacceptable thoughts symptoms dimension and SI, 30,43 while only Gupta and collaborators 9 found the washing dimension related to SI. In our study, washing compulsions were associated to a greater intensity of SI/lifetime SB. ...
Objectives:
Obsessive-Compulsive Disorder has recently been found to be associated with an increased risk of suicide; however, prevalence rates of both suicidal ideation and attempts vary considerably, being the phenomenon mainly categorically evaluated. Our aims were to evaluate the prevalence of suicidal ideation (SI) and behaviors (SB) using a dimensional approach.
Methods:
129 patients with OCD were enrolled. Suicidality was assessed through the administration of the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of SI, severe SI, and SB.
Results:
Lifetime prevalence of SI and SB were 64.3% and 16.3%. Lifetime SI was associated with the number of stressful life events, the duration of illness, HAM-D scores, family history for mood disorders. A positive family history for OCD was associated with lower probability of lifetime SI. Severe SI was related to a greater severity of the highest stressful life event, HAM-D scores and a longer duration of untreated illness. The probability of lifetime SB was related to the HAM-A scores, symmetry obsessions, washing and checking compulsions. The probability of lifetime Non-Suicidal Self-Injurious Behaviors was related to HAM-A scores.
Conclusions:
The recognition of predictors of SI/SB is crucial to identify those patients at greater risk.
... She believes that this is the underlying cause of her suicidality, which prompted her to seek medical attention. There is scarce evidence examining the relationship between suicide and individuals presenting with OCD and prominent hoarding symptoms [23][24][25][26][27][28]. And as we did not discern HD as a standalone diagnosis until recently, there are even fewer studies evaluating the risk of suicide in patients with HD without comorbid OCD [14,29]. ...
... This suggests that people with HD may try to attempt suicide without thinking of their actions or consequences. However, we must also consider that some of these research studies included subjects with OCD as the primary diagnosis [24][25][26][27][28]. ...
Hoarding Disorder is a syndrome marked by persistent difficulty in discarding items due to a perceived need to save the objects, regardless of value or worth. Consequently, a large number of items accumulate in residential spaces, which leads to significant distress with impaired social/occupational functioning. This diagnosis is commonly seen in association with depression and obsessive-compulsive disorder and has recently achieved recognition as a standalone diagnosis. Response to treatment among patients with hoarding disorder is variable, with some individuals experiencing associated suicidality. This case report details a 77-year-old female with a history of major depressive disorder, who was found to have hoarding symptoms at the time of hospital admission. The patient was provided with cognitive behavioral therapy and numerous psychotropic agents were added to the treatment plan. Over the course of 8-weeks of psychopharmacological management, the patient showed minimal improvement of symptomatology, with a PHQ-9 score change from 27 to 24. The purpose of this case report is to recognize the lack of sufficient evidence for appropriate pharmacologic and psychotherapeutic management for patients with hoarding disorder. Most of the scientific literature on the efficacy of pharmacotherapy in hoarding disorder was conducted in obsessive-compulsive disorder patients with a prominent hoarding component. Also, most of the studies analyzing the effectiveness of cognitive behavioral therapy in hoarding disorder demonstrated varying benefit. Moreover, our goal in this report is to increase the awareness of hoarding disorder as a potential cause of suicidality. Take-home message: Currently, we do not have sufficient evidence for the effective management of hoarding disorder. Moreover, future studies are necessary to investigate a more direct relationship between this syndrome and suicidality.
... Therefore, the current study analysed data from a large sample of adult OCD patients to investigate whether transformation obsessions and/or compulsions are associated with specific clinical characteristics. Based on the literature, it was hypothesised that OCD patients with transformation obsessions would be characterised by an earlier age at onset of the OCS, higher frequency of males (Monzani et al., 2015;Volz and Heyman, 2007), higher severity of OCS (Catapano et al., 2010), poorer insight (Catapano et al., 2010), a progressive course (Van Oudheusden et al., 2018), increased suicidality reports (Massons et al., 2017;Torres et al., 2011), higher severity of 'sensory phenomena' (Fontenelle et al., 2008), higher frequencies of family history of psychosis and/or disorders associated with bodily distortions (Buchanan et al., 2011;Catapano et al., 2010) and a later age at final OCD diagnosis (Volz and Heyman, 2007). Finally, based on the findings by Monzani et al. (2015), it was hypothesised that OCD patients and transformation obsessions would report an increased severity of fear of harm/taboo thoughts when compared with OCD patients without transformation obsessions. ...
... This supports the initial findings of Monzani et al. (2015), whereby transformation obsessions were found to load onto a 'forbidden thoughts' factor that included obsessions that were sexual or religious in nature. Notably, the sexual/religious dimension has been identified as being associated with several concerning outcomes in OCD patients, including higher suicidality, greater severity of OCD symptoms, and lower responses to general Cognitive Behavioural Therapy (CBT) treatment methods (Thorsen et al., 2018;Torres et al., 2011). Transformation obsessions can be speculatively linked to religious obsessions through the shared elevated involvement of thought-action fusion, magical ideation and a preoccupation with the occurrence of supernatural/impossible events (Coughtrey et al., 2013;Zysk et al., 2015). ...
Background
The obsession of turning into another person (transformation obsessions [TO]), and its related compulsions have been initially conceptualised as a form of mental contamination. Nevertheless, it has remained understudied in the current obsessive-compulsive disorder (OCD) literature. In parallel, disturbances of the self have been identified as markers of prodromal psychosis in patients with schizophrenia. Based on the later association, this study aimed to investigate the sociodemographic and clinical correlates of TO.
Methods
In all, 1001 OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used to compare 48 OCD patients with TO with 953 OCD patients without TO. A repression model investigated the relationships between the presence of current TO and statistically significant univariate test outcomes.
Results
Participants with TO presented an overall younger age, a longer period of time between the onset of the OCD symptoms and an OCD diagnosis, greater severity of the sexual/religious dimension and increased suicidality symptoms.
Conclusions
These results indicate that TO may be better conceptualised as a form of forbidden/taboo thoughts rather than contamination. While no significant associations with psychotic features (e.g. decreased insight) were observed, TO patients displayed increased suicidality, overall younger age and a significantly larger disparity between seeking treatment and OCD diagnosis. This demonstrates that further clinical awareness and research into TO as an OCD symptom is most needed.
... Besides the possibility of misdiagnosis, the relevance of the intersection between PTSD and OCD lies in the fact that some specific aspects of the comorbidity could interfere with the treatment response or adherence, 12 as the association to a lower level of insight, 13 higher levels of OCS severity, 10 higher suicidality 10,[14][15][16] and higher prevalence of psychotic features, 17 including dissociation. [18][19][20][21] But, unexpectedly, Shavitt et al (2010), found that OCD patients with PTSD presented a greater magnitude of response when compared with OCD without PTSD patients in specific OCD symptom dimensions. ...
... suicide attempts, 27,3% of current suicidal ideation, and 47,3% of lifetime suicidal ideation. 51 Severity of obsessions, some specific content of obsessions (eg.: unacceptable thoughts, sexual/religious) comorbid disorders (e.g.: substance use, intermittent explosive disorder), depressive/anxious symptoms, history of suicidality increased the risk, 14,51,[116][117] whereas compulsions had a comparatively protective effect. 51 Thus, both PTSD and OCD are strongly related to suicidality, although the reasons and risk factors may be diverse for both disorders. ...
Introduction:
Although Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, what may lead to misdiagnosis and to wrong therapeutical decisions. This scoping review explores the psychopathological similitudes and differences of both disorders.
Methods:
It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and included articles published in Portuguese, English or Spanish in the last 50 years in the PubMed database. Case-reports were excluded.
Results:
Fifty-three studies with different designs were included (30(56.5%) were cross-sectional; 8 (15.1%) were case control; 1 (1.9%) was cohort; 3 (5.7%) were clinical trials; 9 (17.0%) were reviews/systematic reviews; and 2 (3.8%) were meta-analysis.). The main described interfaced psychopathological aspects by the included studies were flashbacks x obsessions; avoidant behavior; depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection of clinical features seems to be on the extrinsic psychopathological dimension.
Conclusions:
The psychopathological symptoms core (intrinsic characteristics) is distinctly different, since flashbacks and obsessions are consequences of predominant diverse defective mental function: the former from memory, the last from thought. In the same way, the avoidant behaviors are derived from different purposes and inner necessities.
... Among these dimensions, responsibility for harm and unacceptable thoughts play an important role in the maintenance of OCD (Abramowitz et al., 2006;Arntz et al., 2007;Neal et al., 2017) and are associated with poor treatment outcomes Mataix-Cols et al., 2002;Shetti et al., 2005;Steketee et al., 2019;Williams et al., 2014). In addition, the responsibility for harm and unacceptable thoughts dimensions are more strongly related to suicidality than other OC symptom dimensions above and beyond depression and OCD severity (Albert et al., 2019;Balci & Sevincok, 2010;De Berardis et al., 2015;DeVylder et al., 2012;Kim et al., 2016;Krebs et al., 2020;Rajabi Khamesi et al., in press;Torres et al., 2011;Velloso et al., 2016). ...
... The results of the current study showed that, among the OC symptom dimensions, responsibility for harm and unacceptable obsessional thoughts as well as OCD severity indirectly affected suicidal ideation through stress responses in reaction to the pandemic, specifically traumatic stress symptoms and compulsive checking, after controlling for covariates of general depression and anxiety, comorbidity, and lifetime suicide attempts. These results are consistent with prior findings showing the significant role of these same OC symptom dimensions and OCD severity in suicidality, including suicidal ideation (e.g., Albert et al., 2019;Balci & Sevincok, 2010;De Berardis et al., 2015;DeVylder et al., 2012;Kim et al., 2016;Krebs et al., 2020;Rajabi Khamesi et al., in press;Torres et al., 2011;Velloso et al., 2016). Further, the present findings are consistent with the results of previous studies reporting the relationships between COVID-19 and suicidal ideation in patients with OCD (Benatti, Albert, et al., 2020). ...
Suicidal ideation is prevalent in patients with obsessive‐compulsive disorder (OCD); but, during COVID‐19 it may be increased. The present study aimed to examine the effects of obsessive‐compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID‐19 in a clinical sample of patients with OCD. In a cross‐sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID‐19‐related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID‐19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID‐19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.
... Among these dimensions, responsibility for harm and unacceptable thoughts play an important role in the maintenance of OCD (Abramowitz et al., 2006;Arntz et al., 2007;Neal et al., 2017) and are associated with poor treatment outcomes Mataix-Cols et al., 2002;Shetti et al., 2005;Steketee et al., 2019;Williams et al., 2014). In addition, the responsibility for harm and unacceptable thoughts dimensions are more strongly related to suicidality than other OC symptom dimensions above and beyond depression and OCD severity (Albert et al., 2019;Balci & Sevincok, 2010;De Berardis et al., 2015;DeVylder et al., 2012;Kim et al., 2016;Krebs et al., 2020;Rajabi Khamesi et al., in press;Torres et al., 2011;Velloso et al., 2016). ...
... The results of the current study showed that, among the OC symptom dimensions, responsibility for harm and unacceptable obsessional thoughts as well as OCD severity indirectly affected suicidal ideation through stress responses in reaction to the pandemic, specifically traumatic stress symptoms and compulsive checking, after controlling for covariates of general depression and anxiety, comorbidity, and lifetime suicide attempts. These results are consistent with prior findings showing the significant role of these same OC symptom dimensions and OCD severity in suicidality, including suicidal ideation (e.g., Albert et al., 2019;Balci & Sevincok, 2010;De Berardis et al., 2015;DeVylder et al., 2012;Kim et al., 2016;Krebs et al., 2020;Rajabi Khamesi et al., in press;Torres et al., 2011;Velloso et al., 2016). Further, the present findings are consistent with the results of previous studies reporting the relationships between COVID-19 and suicidal ideation in patients with OCD (Benatti, Albert, et al., 2020). ...
Suicidal ideation is prevalent in patients with obsessive‐compulsive disorder (OCD); but, during COVID‐19 it may be increased. The present study aimed to examine the effects of obsessive‐compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID‐19 in a clinical sample of patients with OCD. In a cross‐sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID‐19‐related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID‐19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID‐19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.
... OCD encompasses a number of relatively independent symptom dimensions (Bloch et al., 2008;Mataix-Cols et al., 2005;Mataix-Cols et al., 2008), which have distinct aetiologies, neural substrates, and clinical correlates (Iervolino et al., 2011;Mataix-Cols et al., 2005;Mataix-Cols et al., 2008). There is some suggestion that suicidality may be especially linked to taboo obsessions, such as sexual, aggressive, and religious obsessions (Balci and Sevincok, 2010;Khosravani et al., 2017;Kim et al., 2016;Storch et al., 2015;Torres et al., 2011;Velloso et al., 2016), but findings have been mixed and further clarification is needed (Pellegrini et al., in press). ...
... Our findings therefore indicate that such "taboo obsessions" are robustly linked with suicidality across developmental stages. This is consistent with previous studies showing that taboo obsessions are associated with suicidality among OCD patients (Balci and Sevincok, 2010;Khosravani et al., 2017;Kim et al., 2016;Storch et al., 2015;Torres et al., 2011;Velloso et al., 2016). We also found that symptoms relating to symmetry and ordering (e.g., arranging things in a special order) were positively associated with suicidality at age 18 but not age 24. ...
Background
: Obsessive-compulsive disorder (OCD) has been linked with elevated risk of suicidality. However, most previous studies have been cross-sectional, and little is known about the aetiology of the association between obsessive-compulsive symptoms (OCS) and suicidality in young adults.
Methods
: Participants were members of the Child and Adolescent Twin Study in Sweden, at ages 18 (n=9,162) and 24 (n=3,466). Twins completed self-report measures, including assessment of OCS, suicidal ideation, and suicidal attempts. Logistic regression models tested concurrent and prospective associations of total OCS and OCS dimensions with suicidality, with and without adjustment for depression and anxiety symptoms. Genetic models tested the extent to which the main phenotypic associations were accounted for by genetic and environmental influences.
Results
: Total OCS were significantly associated with concurrent reports of suicidality at age 18 and 24, even when controlling for depressive and anxiety symptoms. Taboo obsessions (e.g., sexual and aggressive thoughts) were more robustly associated with suicidality than other OCS dimensions, and prospectively predicted suicidality symptoms over time, even when controlling for baseline suicide attempts. Genetic factors accounted for most of the concurrent and longitudinal covariance between OCS and suicidality, with substantial non-shared environmental influences.
Limitations
: We relied on self-report measures and did not include diagnostic assessment of OCD.
Conclusions
: OCS, particularly taboo obsessions, are associated with significantly elevated risk of suicidality in late adolescence and early adulthood. This relationship is explained by a combination of common genetic liability and non-shared environmental effects, suggesting that effective OCS treatment might reduce suicidality risk in this group.
... Несмотря на современные доказательные данные, исторически считалось, что пациенты с ОКР имеют низкий риск совершения попыток суицида [10]. Обозначенные противоречивые результаты относительно связи между ОКР и попытками самоубийства объяснялись тем, что для пациентов с данным синдромом характерна тенденция регулировать свои агрессивные импульсы, избегать ситуации в высокой вероятностью причинения вреда, ущерба, фиксировать и контролировать суицидальные мысли и соответствующее поведение, особенно при наличии сопутствующих расстройств [11]. ...
... Despite the current evidence, historically OCD patients have been considered to have a low risk of attempting suicide [10]. The indicated conflicting results regarding the relationship between OCD and suicide attempts were explained by the fact that patients with this syndrome tend to regulate their aggressive impulses, avoid situations with a high probability of causing harm or damage, record and control suicidal thoughts and corresponding behavior, especially in the presence of concomitant disorders [11]. ...
... 23 Comorbidity of the two conditions may be particularly problematic with patients suffering reduced levels of functioning 11 and increased risk of suicide. 24 Additionally, the effect of substances is variable. Among individuals with OCD, use of stimulants may exacerbate OCD symptoms, 25 while opiates may alleviate those symptoms. ...
Obsessive-Compulsive Disorder (OCD) and Major Depressive Disorder (MDD) are prevalent psychiatric conditions, each affecting a substantial portion of the global population. When these conditions coexist with a Substance Use Disorder (SUD), the complexity of the clinical presentation is heightened. Herein, we describe two cases of individuals who have comorbid OCD and/or MDD and substance use disorder that highlight the importance of addressing the coexisting psychiatric illness when treating the SUD. These cases highlight the importance of tailored, multidisciplinary care, offering a potential therapeutic strategy based on medications for comprehensive recovery in individuals facing complex comorbid disorders. An integrated treatment approach, encompassing both psychiatric and substance treatment perspectives, is imperative.
... These results were in line with previous research. For example, the literature showed impulse control disorders correlated with suicide ideation and suicide attempts (Torres et al., 2011). So, we expected that intermittent explosive disorder (as an impulse control disorder with aggressive symptoms) would play a critical role in suicide attempts and suicide ideation. ...
This study aimed to evaluate the network structure of suicidality and its relation with internalizing and externalizing symptoms in patients with obsessive-compulsive disorder (OCD). A total of 754 patients with OCD were recruited. The mean age of all participants was 33.19, with a standard deviation of 10.65. Additionally, 43.9% of participants were female. We used the Scale for Suicide Ideation (SSI), Externalizing Spectrum Inventory–Brief Form (ESI-BF), Yale-Brown Obsessive-Compulsive Scale, and Inventory of Depression and Anxiety Symptoms-II (IDAS-II) to estimate the network structure. Patients were also questioned about their prior failed suicide attempts and categorized into groups based on their history of suicide attempts. We created Directed Acyclic Graphs (DAG) to examine potential causal paths and utilized Markov Random Fields (MRFs) to demonstrate predictive linkages. The MRFs revealed that impulsivity, impatience, urgency, panic symptoms, and age were directly related to suicide ideation severity in both groups. However, general depression was linked to suicide ideation only among patients without a history of suicide attempts. Additionally, traumatic intrusions were linked to suicide ideation only among patients with a history of suicide attempts. The DAG model predicted that suicide ideation causes externalizing symptoms, while internalizing symptoms predicted suicide ideation in both groups. These findings suggest that specific internalizing and externalizing symptoms in patients with or without a history of suicide attempts may contribute to suicidality. Thus, suicide attempt history, as well as internalizing and externalizing symptoms, should be carefully monitored in patients with OCD.
... Furthermore, when adjusting for the intensity of suicidal intent, we observed that having only a family of origin as a social network was positively associated with obsessive-compulsive symptoms characterized by persistent, ego-dystonic, and distressing thoughts or impulses. This may be due to the vulnerability factors associated with being single and not having children, which contribute to current and lifetime suicidal ideation in individuals troubled by obsessive thinking and compulsive behaviors [68,69]. On one hand, the association between paranoid ideation symptoms (such as hostility, suspiciousness, and delusions) and the intensity of suicidal intent experienced by female inmates may be due to heightened perceptions of harm and concerns about victimization [70], which are more pronounced within the specific context of women's prison. ...
(1) Background: Suicide is the main cause of death in Italian prisons. The largest number of inmates who killed themselves was recorded during three years of the COVID-19 pandemic. This study aimed to explore psychosocial risk factors for suicide among inmates incarcerated before and after the onset of COVID-19. (2) Methods: At prison reception, inmates underwent clinical interviews and were assessed using the Blaauw Scale and Suicide Assessment Scale. Psychological distress, measured by the Symptom Checklist-90-R, was compared between inmates admitted before and after COVID-19. Regression analyses were run to examine psychosocial vulnerabilities associated with suicidal intent in newly incarcerated individuals at risk of suicide. (3) Results: Among the 2098 newly admitted inmates (93.7% male) aged 18 to 87 years (M = 39.93; SD = 12.04), 1347 met the criteria for suicide risk, and 98 exhibited high suicidal intent. Inmates who entered prison after the onset of COVID-19 were older and had fewer social relationships. They had a higher prevalence of recidivism and substance abuse, along with elevated levels of psychological distress. An increase in perceived loss of control, anergia, obsessive-compulsive symptoms, phobic anxiety, and paranoid ideation emerged as the factors most strongly associated with high suicidal intent. (4) Conclusions: These findings support the value of psychosocial screening in promptly identifying inmates at risk of suicide, enabling the implementation of targeted, multi-professional interventions. Future research should replicate these results, with a focus on longitudinal studies that monitor the same inmates throughout their incarceration period.
... For instance, it may be challenging to differentiate symptoms of OCD from those of other disorders, and the presence of other disorders may impact the effectiveness of treatment for OCD. [8] Discussion on the chronic nature of OCD OCD is generally a chronic disorder, meaning that it persists over a long period. While symptoms can wax and wane over time, most individuals with OCD require long-term management to control their symptoms. ...
This comprehensive review examines the current challenges in the diagnosis and treatment of obsessivecompulsive disorder (OCD), a complex psychiatric condition affecting a significant portion of the global population. The challenges in diagnosis, including delayed diagnosis, stigma, misdiagnosis, underdiagnosis, and the difficulties posed by comorbidity, are discussed in depth. Further, the review highlights the obstacles in OCD treatment, such as suboptimal responses to first-line treatments, medication side effects, difficulties accessing treatment, and the heterogeneity of OCD. The paper includes illustrative case studies that shed light on the real-world implications of these challenges. Promising strategies and future directions to overcome these challenges are also explored, emphasizing the need for early and accurate diagnosis, enhanced treatment efficacy, improved access to care, and continuous research to deepen our understanding of OCD. Ultimately, this review advocates for a multi-faceted approach that includes improved diagnostic tools, personalized treatment plans, digital therapy platforms, and robust policies to improve mental health coverage. Despite the current challenges, advancements in understanding OCD and in the development of diagnostic tools and treatments provide an optimistic view of the future of OCD diagnosis and treatment.
... as compared with the general population. Predictors of greater suicide risk are the severity of OCD, the symptom dimension of unacceptable thoughts, comorbidAxis I disorders, the severity of comorbid depressive and anxiety symptoms, a history of suicidality, and some emotion-cognitive factors such as alexithymia and hopelessness(Agne et al., 2022;Torres et al., 2011;Umberto et al., 2019). ...
Introduction:
Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile.
Objectives:
The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients.
Methods:
This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight.
Results:
Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation.
Conclusion:
Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
... Cultural components and other sociodemographic variables have thus far not appeared to mediate significant correlations with SI. 22,27,53 Being unmarried has been identified from various studies but requires further replication to affirm its role. 31,54 Marital status may be indicative of other factors (such as social disconnectedness, age, etc) and therefore may be an indirect marker. Being female and having higher parental education may operate as protective variables, but findings are contradictory. ...
Suicidal ideation (SI) is understudied in obsessive-compulsive disorder (OCD). Nonetheless, evidence suggests increased risk for SI in individuals with OCD compared to the general population. Understanding the relationship between SI and OCD involves investigating risk factors associated with SI. Furthering knowledge of links is essential for enhancing outcomes and decreasing experiences of SI through improving treatment interventions. Additionally, increasing awareness of factors that lead SI to suicide attempts (SA) is vital. To best illustrate the current state of knowledge, this scoping review examines risk factors for SI, including symptom profiles or phenotypes, comorbid diagnoses, sociodemographic and lifestyle factors, childhood trauma, and genetic and familial contributions. Important treatment considerations for targeting SI within the context of OCD are detailed with respect to the current evidence for psychotherapy, pharmacology, brain stimulation, and neurosurgery. Gaps in the literature and future directions are identified, broadly with respect to studies examining the treatment of SI within the context of OCD, particular OCD phenotypes, and factors influencing SI in pediatric OCD. Due to the relative novelty of this area of exploration, many unknowns persist regarding onset of SI in OCD, factors contributing to the maintenance of SI in OCD, and relevant treatment protocols. Findings suggest that individuals with previous SI or SA, history of childhood trauma, significant life stress, and psychiatric comorbidities, particularly depression, should be closely monitored and screened for SI.
... Suicide is an important cause of death for persons with various mental health conditions such as depression (G. K. Brown et al., 2000), borderline personality disorder (Black et al., 2004), obsessive-compulsive disorder (Torres et al., 2011), post-traumatic stress disorder (Schafer et al., 2022) or schizophrenia (Caldwell & Gottesman, 1990). Among a large group of patients with schizophrenia spectrum disorders, 13% died of suicide (Moreno-Kustner et al., 2021). ...
Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community-based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic, and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (OR). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self-harm behavior (OR 7.9), and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5), and self-harm behavior (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.
... To complicate the process of differentiating between SO and SI, a substantial proportion of people with OCD have been found to experience SI (Angelakis et al., 2015;Hellberg et al., 2022;Torres et al., 2007Torres et al., , 2011. For instance, in one sample, approximately 27% of psychiatric patients with OCD reported previous suicide attempts (Kamath et al., 2007). ...
Suicidal obsessions (SO) can be challenging to distinguish from suicidal ideation (SI). This can be in part due to low familiarity with diverse presentations of OCD, as well as the limited scope of common measurement tools for assessing suicide-themed thoughts within a cognitive, affective, and behavioral framework. Inaccurate assessment increases the risk of misdiagnosis and inappropriate treatment, which are critical to prevent. Therefore, we present a practical guide with a case example highlighting potential cognitive, affective, and behavioral criteria to consider in differentiating SO from SI, grounded upon a cognitive-behavioral framework and the extant literature regarding the phenomenology and assessment of OCD and suicidality. Through illustrative figures we also demonstrate examples of SO and SI with resulting cognitive, affective, and behavioral responses, and how they functionally interrelate with each other. We conclude with suggestions for future research validating the criteria provided in this guide. In summary, using this evidence-based guide to assess suicide-themed thoughts, emotions, and behaviors may help clinicians accurately distinguish between SO and SI, in turn optimizing interventions for their clients.
... Suicidality appears relatively common in paediatric OCD where one small study with 54 patients found 13% with clinically significant suicidal ideation [53]. In adults with OCD, 16 to 63% experience suicidal ideation, with as many as 25% reporting at least one prior suicide attempt [54][55][56]. To avoid risks of confounding effects, we do not allow concomitant treatment with antidepressant medication. ...
Abstract Background Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. Methods This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8–17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient
... Suicide attempts and suicidal ideation have different prevalence rates in different regions of the world. The prevalence rates of Suicide idea and suicide attempt in the whole population are 27.5% and 4.3% (20) in Turkey, 20% and 10% (21) in Brazil and 15.2% and 3.2% in Korea, respectively. In a meta-analysis study in China (22), the prevalence rate of suicide attempt was 2.94% (23) and in Mexico 2.7% (24). ...
Objective: After accidents and disasters, people suffer from mental disorders due to physical, economic and social injuries. These include anxiety, stress, depression, suicidal ideation, and suicide attempts. Due to the fact that some of these measures can endanger a person’s life, as a result, it is important to pay attention to these psychological factors. Accordingly, the present study was conducted to investigate the prevalence of suicidal ideation and suicide attempt after disaster in the world.
Methods: The present study was a systematic review and meta-analysis of the prevalence of suicidal ideation and suicide attempt after disaster in the world. Accordingly, all English-language articles published from the beginning of 2000 to the end of 2019 were extracted through searches in the databases of Scopus, Web of Science, PubMed, Cochrane Library, Science Direct and Google scholar and then evaluated. Statistical analysis of data was performed using fixed and random effects model in meta-analysis, Cochran test and meta-regression.
Results: A total of 33 studies with a sample size of 61,180 people entered the meta-analysis process. Accordingly, the prevalence of suicidal ideation was estimated at 12.9% (CI95%: 10.3% -15.5%) in the whole population, 5.2% (CI95%: 2.9% - 7.4%) in male and 15.8% (CI95%: 10.0% - 21.6%) in female. Moreover, the prevalence of suicide attempt after disasters was estimated at 8.8% (CI95%: 6.6% - 11.0%).
Conclusion: Based on the findings of the present study, the prevalence of suicidal ideation and suicide attempt after disaster is high. Due to the fact that many people in the world are exposed to disasters every year, relatively many people deal with suicidal ideation or suicide attempts.
... Hence, OCD sufferers never want to act on the obsession, but wish to stop thinking about it. Due to their persistent and distressing nature, sexual obsessions almost triple the likelihood for suicide (Osso et al. 2012;Torres et al. 2011), Although sexual intrusive thoughts rarely produce sexual arousal (Gordon 2002), they often urge sufferers to repeatedly scan their genitals for signs of sexual excitement. Due to such over-focus, individuals might feel tingling, nervous feelings on their genitals. ...
This study is broadly an exploration of how people who suffer from sexual orientation OCD (SO-OCD) and gender identity OCD (GI-OCD) use language to construct their identity, and how that process is framed by (hetero)normative idealogies.
Instead of writing the abstract of the study (which you can find on page 4), I will highlight the different chapters that might be the most interesting for different readers:
PSYCHOLOGISTS WORKING ON OCD should especially read:
- CHAPTER 1 where I review the literature on OCD, and especially section 1.4 where I identify the gap my project fills.
- CHAPTER 3 where I operationalize the concept of the feared self not as a fixed cognitive construct, but one that is discursively negotiated through language.
- CHAPTERS 6-9 a detailed analysis of OCD sufferers' language use and how they construct their identity by distancing themselves from their feared self.
- CHAPTER 10 is really where my argument comes together. I interpret the linguistic findings from chapters 6-7 through queer theory and Foucauldian self-governmentality. I especially argue that by distancing from a feared self, OCD sufferers run towards what I call an "idealized pure self" that is always and only the identity they wish to embody. This idealized self is constituted by a strong adherence to heteronormative understandings of gender and sexuality. The idea of a "pure self" is inscribed withing a sociocultural frame that has constructed sexuality as the locus of the "true self".
In addition, I challenge the assumption that homophobia is the sociocultural factors causing SO-OCD. I demonstrate that this assumption doesn't account for LGBTQA+ OCD sufferers who obsess about being not LGBTQA+. As such, I suggest to conceptualize OCD not as a fear of "becoming" something that is socially taboo, but rather as a fear of "losing" something that is socially cherished. This fear of becoming or losing are two sides of the same coin that are shaped by (hetero)normative Discourses. Thus, the sociocultural factor shaping SO-/GI-OCD fears is argued to be tied to the notion of normativity.
- CHAPTER 11: summarizes the whole study and section 11.3 explicitly states the contributions to the research on OCD
SOCIOLINGUISTS INTERESTED IN LANGUAGE, GENDER, SEXUALITY & CORPUS LINGUISTICS should read:
- Chapter 2 reviews Foucault's work on self-governmentality, queer theory and how all of this can be operationalized through linguistics
- One of the major contributions of my thesis to sociolinguistics is a methodological one. In fact, I triangulated corpus-assisted discourse analysis with ethnographic approaches. Chapter 4 describes how I constructed a forum and conducted a 18 month long ethnography (or netnography), and CHAPTER 5 describes the methodic steps in my analysis.
- CHAPTERS 6-9 are a detailed accounts of my participants' language use.
- CHAPTER 10 interprets the findings through queer theory (see above), and section 10.5 suggests an additional way to conceptualize normativity in the field of language, gender and sexuality.
- CHAPTER 11 gives a summary of everything, and sections 11.4 and 11.5 explicitly highlight the contributions to sociolinguistics and avenues for future research.
... OKB, bu tanıya sahip olanların yanı sıra bu bireylerin yakınlarının da yaşam kalitesinde azalmaya ve psikososyal fonksiyonlarında bozulmaya yol açmaktadır (4,5). Bununla birlikte OKB tanısı olanların intihar düşünceleri veya intihar girişimi açısından risk altında olduğu belirtilmektedir (6). ...
INTRODUCTION[|]This study aims to examine the relationship between partner focused and romantic relationship obsessive compulsive with ruminative thinking style, body image, social appearance anxiety. The second aim of the study is to examine the sociodemographic variables thought to be related to relationship centered and partner focused obsessive compulsive symptoms.[¤]METHODS[|]The data has been collected via internet from 689 individuals who were in a romantic relationship between the ages of 18-30. For the aim of collecting information, demographic information form, Partner Related Obsessive Compulsive Scale, Relationship Obsessive Compulsive Inventory, Ruminative Thought Style Questionnaire, Social Appearance Anxiety Scale and Body-Cathexis Scale have been used. [¤]RESULTS[|]According to the performed structural equation modelling, it has been observed that ruminative thinking style predicts the relationship centered and partner focused obsessive compulsive symptoms and sub-dimensions positively. Body image and social appearance anxiety positively predict the partner focused obsessive compulsive symptoms and its sub-dimensions. Furthermore, it was found that partner focused obsessive compulsive symptoms positively predict relationship centered obsessive compulsive symptoms.[¤]DISCUSSION AND CONCLUSION[|]In this study, it was concluded that the model created with ruminative thinking style, body image and social appearance anxiety, which is thought to be effective in revealing partner focused and romantic relationship obsessive compulsive symptoms is an acceptable model. It is thought that investigating the structures that may be effective in revealing the symptoms will serve to better understand this obsessive compulsive disorder (OCD) subtype and overall OCD and contribute to the diagnosis / treatment of this area.[¤]
... Suicidality. The questions used to assess suicidality were the same employed by Torres et al. (2011) and have been used in subsequent studies investigating suicidality from the same group (e.g. (Velloso et al., 2016). ...
Despite generalized anxiety disorder (GAD) being one of the most prevalent comorbidities in obsessive-compulsive disorder (OCD), few studies have researched its impact on the OCD phenotype. The present study investigated how the sociodemographic and clinical profile of people with OCD with comorbid GAD differs from people with OCD without comorbid GAD. We hypothesised that the phenotype of the comorbid group would be closely related to GAD, in that it would more likely be female, have an earlier age at onset of OCD, and show an increased severity of fear-related OCD symptoms (aggressive, sexual/religious, and contamination dimensions), more avoidant behaviours, greater suicidality, more severe anxiety symptoms, and increased rates of comorbid anxiety and mood disorders. The study included 867 participants with OCD, with GAD being comorbid in 33.56%. Mann-Whitney U tests, chi-square tests with continuity correction, and logistic regressions were performed. Results showed that comorbid GAD was uniquely associated with an increased number of avoidant behaviours, greater anxiety severity, panic disorder without agoraphobia, social phobia, specific phobia, and type II bipolar disorder. These results illustrate the clinical severity associated with this comorbidity and highlight markers that can aid diagnosis of GAD in OCD. Future studies should investigate whether this comorbidity has an impact on the treatment of OCD.
... Examining the relationship between obsessive symptoms and childhood traumas, we found that aggression and sexual obsessions were more common in patients with suicide attempts. These results are consistent with the findings of other studies, in which current suicide ideas or suicidal behaviors in OCD are often associated with the severity of OCD symptoms such as aggression, symmetry or order and sexual or religious obsessions (18,38,39). In OCD patients who attempted suicide, these dimensions may be associated with the feeling of guilt. ...
Objective: The aim of this research is to determine the differences in childhood traumas and the probability of suicide in
obsessive-compulsive disorder (OCD) patients with and without suicide attempts.
Method: Sixty-five OCD patients without suicide attempt history and 39 OCD patients with a history of suicide attempts were
included in the study. To measure the clinical variables The Childhood Trauma Questionnaire (CTQ), Suicide Probability Scale,
Yale-Brown Obsessive-Compulsive Scale and Beck Depression Inventory were applied.
Results: We found that the OCD group with suicide attempts was significantly higher than the OCD group without a suicide
attempt due to emotional neglect, physical neglect, sexual abuse, and CTQ total scores. Aggression and sexual obsessions were
higher in the OCD group who has attempted suicide. Obsessive-compulsive symptoms, depression and insight scores of OCD
patients with suicide attempts were worse than OCD patients without suicide attempts. Also, correlations were observed
between childhood traumas and suicidal probability scores.
Conclusion: This study showed that childhood traumas may be a contributing factor to suicide probability and attempt in
patients with OCD. Moreover, this study reveals that the current probability of suicide is a higher risk in OCD patients who had
previously attempted suicide in the past.
Keywords: Childhood trauma, lifetime suicide attempt, obsessive-compulsive disorder, suicide
... Moreover, there is evidence that the risk of suicidal behaviour must be explored, particularly in those with symptoms in the sexual/religious dimension. 15 Likewise, individuals with obsessive thoughts from different symptom dimensions might avoid the disclosure of sexual obsessions, even after disclosing other types of intrusive thoughts, because they are perceived as less acceptable: Cathey (2013) found that the disclosure of an intrusive thought relating to a sexual theme was associated with more social rejection than the disclosure of a contamination-related intrusive thought. 3 Thus, it is important that healthcare providers normalise these types of concerns when interviewing OCD patients: Steinberg,14 in a study about stigmatising attitudes in clinicians, found that, when engaging with professionals with cognitive-behavioural backgrounds, participants were more likely to socially reject or be concerned about individuals with obsessions related with contamination, harming, and sexual obsessions than those with scrupulous obsessions, and that they would be less likely to reveal sexual obsessions to others if they were experiencing those rather than the other three types of obsessions. ...
In obsessive-compulsive disorder, pedophilia-themed obsessions-distressing intrusive thoughts about being sexually attracted to, or sexually abusing, children-are the most distressing for patients and the most misdiagnosed among healthcare professionals. Our aim is to present a case report highlighting the role stigma plays in delaying treatment, the clinical challenges in the diagnosis, and in the treatment of pedophilia-themed obsessive-compulsive disorder, in order to address the lack of literature on the subject. The case concerns a 33-year-old man with suicidal thoughts associated with the unbearable suffering caused by pedophilia-themed obsessions he had been having over the previous decade, without ever asking for help. This situation was highly disabling, leaving him mostly isolated in his bedroom. After the differential diagnosis was made, a treatment plan combining pharmacological and cognitive-behavioural therapy was implemented. After 18 months he showed a degree of remission that made it possible for him to apply for a job.
Although obsessive compulsive disorder (OCD) features maladaptive decision-making, previous research that examined economic decision-making in OCD has yielded inconsistent results. Here, we examined whether unmedicated adults with OCD ( n = 268) differ from healthy control subjects (HCSs; n = 256) on two measures of decision-making about potential rewards: (a) delay discounting, the tendency to prefer rewards sooner rather than later, even if the delayed reward is larger, and (b) risk tolerance, the willingness to gamble for uncertain rewards when the risk is known. Data were collected in Brazil, India, the Netherlands, South Africa, and the United States as part of the Global OCD study. After controlling for age, sex, education, socioeconomic status, IQ, and site, individuals with OCD did not differ from HCSs in either delay discounting or risk tolerance. However, patients with OCD who reported more anxiety and depression showed higher delay discounting, or a relative preference for immediate rewards.
The Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) took obsessive-compulsive disorder (OCD) and its related disorders out of anxiety disorders and created a new category to reflect evidence of their differences from anxiety disorders. Hoarding and excoriation disorders were new diagnoses added to DSM-5, having been recognized as separate disorders rather than symptoms of other anxiety or personality disorders since the publication of DSM-IV. OCD and hoarding disorder are among the more commonly recognized psychiatric problems by the public. Popular television shows now feature characters with these diseases, and reality shows like Hoarders center around the all-too shocking problems that such behaviors can create. While these disorders occur less frequently in geriatric patients, the impact these disorders can have on older adults can be more devastating than in younger adults. Older patients are more medically and physically vulnerable, more prone to social isolation, and problems such as hoarding can reach such devastating proportions as to result in the loss of house and home or severe medical consequences. This chapter focuses on five main diagnoses: OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation (skin-picking) disorder. We will discuss their diagnoses, disease course, and management. At the end of the chapter, we focus on two case studies intended to highlight how someone with the featured disorder may present along with important considerations in their workup and management.
Introduction:
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that affects a significant number of individuals worldwide. Major depressive disorder (MDD) is among the most common comorbidities reported in people with OCD. The emergence of MDD in individuals with OCD can be attributed to the increased severity of OCD symptoms and their profound impact on daily functioning. Depressive symptoms can also modify the course of OCD.
Areas covered:
In this review, the authors explore potential shared neurobiological mechanisms that may underlie both OCD and MDD, such as disturbed sleep patterns, immunological dysregulations, and neuroendocrine changes. Furthermore, they address the challenges clinicians face when managing comorbid OCD and MDD. The authors also discuss a range of treatment options for OCD associated with MDD, including augmentation strategies for serotonin reuptake inhibitors (e.g. aripiprazole), psychotherapy (especially CBT/EPR), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and deep brain stimulation (DBS).
Expert opinion:
Although there is no 'rule of thumb' or universally acceptable strategy in the treatment of OCD comorbid with MDD, many clinicians, including the authors, tend to adopt a unique transdiagnostic approach to the treatment of OCD and related disorders, focusing on strategies known to be effective across diagnoses. Nevertheless, the existing 'cisdiagnostic approaches' still retain importance, i.e. specific therapeutic strategies tailored for more severe forms of individual disorders.
Objective:
Coronavirus disease, one of the most disastrous epidemics, has caused a worldwide crisis, and the containment measures applied to decelerate the progression of the pandemic can increase the risk of obsessive-compulsive disorder (OCD). Identifying vulnerable groups in this area can lead us to better resource expenditure, and therefore, this systematic review aims to make a comparison between males and females to determine which of the two groups was most affected by the COVID-19 pandemic regarding OCD. Also, a meta-analysis was designed to investigate the prevalence of OCD during the COVID-19 pandemic.
Methods:
A comprehensive search was conducted among three databases (Medline, Scopus, Web of Science) until August 2021 which resulted in 197 articles, and 24 articles met our inclusion criteria.
Results:
Overall, more than half of the articles stated the role of gender in OCD during the COVID-19 pandemic. Several articles emphasized the role of the female gender, and some others the role of the male gender. The meta-analysis revealed a 41.2% overall prevalence of OCD during the COVID pandemic and 47.1% and 39.1% OCD prevalence for female and male genders respectively. However, the difference between the two genders was not statistically significant.
Conclusion:
It seems that females are at greater risk of OCD during the COVID-19 pandemic. In the following groups, the female gender may have acted as a risk factor: under-18 years students, hospital staff, and the studies in the Middle East. In none of the categories, male gender was clearly identified as a risk factor.
Suicidality in obsessive compulsive disorder (OCD) is underestimated, and it is important for clinicians to understand the factors that contribute to suicidal ideation. The present study aimed to estimate a network of the core clinical symptoms of OCD including obsessions, compulsions, and obsessive-compulsive (OC) symptom dimensions, depressive symptoms, and psychological traits, and to examine which symptoms contribute to suicidal ideation in patients with a primary diagnosis of obsessive-compulsive disorder.
Methods:
A total of 444 patients with OCD were assessed with the Yale-Brown Obsessive Compulsive Scale, the Montgomery-Asberg Depression Rating Scale, and various other measures. Network analysis was conducted to estimate the network of obsessive-compulsive and depressive symptoms, psychological traits including alexithymia and impulsivity, and demographic covariates. Symptoms directly related to suicidal ideation in the network were examined for their relative contribution to suicidal ideation.
Results:
Suicidal ideation was directly related to degree of control over compulsive behaviors, distress associated with compulsive behaviors, time spent performing compulsive behaviors, and unacceptable thoughts, along with depressive symptoms and alexithymia. In the network of OC and depressive symptoms, the most central symptoms among the former were interference due to compulsive behaviors and interference due to obsessive thoughts, and among the latter were pessimistic thoughts and reported sadness.
Conclusion:
The findings suggest that along with depressive symptoms and alexithymia, compulsions and unacceptable thoughts dimension may contribute to suicidality, and thus, should be carefully monitored in patients with OCD. This article is protected by copyright. All rights reserved.
Background
Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depressive and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally.
Methods
Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined.
Results
Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed.
Conclusions
Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.
Background
A growing body of evidence suggest individuals with obsessive-compulsive disorder (OCD) are at an increased risk for suicidal thoughts and behaviors (SITB). However, the literature on suicidality in OCD remains limited. Thus, the present study examined the prevalence and predictors of suicidality in a sample of adults seeking treatment for OCD.
Methods
A total of 687 patients seeking care through a network of intensive treatment centers consented to participate. Participants completed validated self-report questionnaires of depression and OCD symptom severity, as well as psychodiagnostic interviews.
Results
Almost half of the participants reported current suicidal ideation. The presence of a comorbid diagnosis was associated with increased likelihood of more severe SITB. Specifically, the presence of a co-occurring anxiety, depressive, or bipolar mood disorder predicted increased severity of SITB. In addition, obsession severity was positively associated with suicidality, while compulsion severity negatively predicted the severity of SITB. Regarding OCD symptom dimensions, repugnant thoughts emerged as a significant predictor of SITB severity.
Conclusions
SITB is a prevalent concern in treatment-seeking patients with OCD. Clinicians are encouraged to assess and consider the treatment implications of SITB, particularly among patients with co-occurring mood and anxiety disorders, or symptoms involving taboo thought content. Future directions and theoretical considerations are discussed.
Despite being a significantly disabling condition, the risk associated with obsessive-compulsive disorder (OCD) is commonly underestimated in clinical practice.
To shed more light on the suicidality in OCD, this systematic review was piloted, aiming to provide more insight into actual suicide risk and potential predictors of suicidal behaviour in OCD patients.
Introduction
Obsessive-compulsive disorder (OCD), characterized by repetitive anxiety-inducing intrusive thoughts and compulsive behaviors, is associated with higher suicide ideation and suicide attempts than the general population. This study investigates the prevalence and the correlates of current suicide risk in adult outpatients in an international multisite cross-sectional sample of OCD outpatients.
Methods
Data were derived from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network’s cross-sectional data set (N=409). Current suicide risk (assessed by Item C of the MINI) and diagnoses of psychiatric disorders were based on DSM-IV. Chi-squared test for categorical variables and t-test for continuous variables were used to make statistical inferences about main features associated with current suicide risk. P<0.05 was considered as statistically significant.
Results
The prevalence of current suicidal risk was 15.9%, with equal likelihood in sociodemographic variables, including age and gender. Increased rates of major depression and generalized anxiety disorder were associated to higher current suicide risk. Current suicide risk was also associated with higher severity of OCD, depressive comorbidity and higher levels of disability. There were no significant differences in treatment correlates—including type of treatment and psychiatric hospitalizations—between the groups of individuals with and without current suicide risk.
Conclusion
Our findings suggest that current suicide risk is common in patients with OCD and associated with various forms of pathology. Our work also provides further empirical data to support what is already known clinically: a worse clinical picture characterized by a high severity of OCD, high distress related to obsessions and compulsions, and the presence of comorbidities such as major depression and generalized anxiety disorder should be considered as relevant risk factors for suicide risk.
Introduction
Previous meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive Related Disorders (OCRDs).
Objectives
This meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates.
Methods
Our protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates.
Results
Thirty-nine studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4–47.8), 37.2% (CI:23.8–51.6) and 66.1% (CI:53.5–77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8–37.6), 18.4% (CI:10.2–28.3) and 38.3% (CI:35.0–41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9–22.8) and 40.4% (CI:35.7–45.3), respectively (no data available for lifetime suicidal ideation).
Conclusions
The OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.
Objectives:
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients.
Methods:
We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses.
Results:
Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients.
Conclusion:
Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD.
Practitioner points:
Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.
Background
Suicidal ideations were reported in many studies among patient with obsessive-compulsive disorder (OCD); this study aimed to evaluate the prevalence and factors associated with current suicidal ideations among Egyptian patients with obsessive-compulsive disorder (OCD). A consecutive sample of 120 Egyptian OCD patients was included in the study. OCD was diagnosed using the structured clinical interview for DSM-V axis Ι disorders, clinical version (SCID-I-CV). Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was also applied to the patients. Presence of current suicidal ideations was assessed using Scale for Suicidal Ideation (SSI).
Results
Twenty eight (23.3%) of the OCD patients reported presence of current suicidal ideations, religious obsessions OR = 3.53, P = 0.009, and presence of comorbid major depressive disorder OR = 1.77, P = 0.04.
Conclusion
Religious obsessions and comorbid major depressive disorder were found to be significant predictors for the current suicidal ideations in patients with OCD; however, religious obsessions were the strongest predictor. Religious obsessions should be evaluated and treated to decrease the risk of suicidal thoughts in Egyptian OCD patients.
Aim: Obsessive-compulsive disorder (OCD) is associated with suicide risk, but controversy remains about the frequency and burden of suicidality in OCD. This study aimed to identify the relationship between anxiety sensitivity and suicidal idea in patients with OCD.
Methods: This controlled study included 36 OCD patients and 36 healthy controls. All individuals were evaluated with Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index-3 (ASI-3) and Suicide Probability Scale (SPS). Demographic data were obtained from each patient.
Results: Seventy-two individuals with a mean age of 31.89 (9.69) years were included in this study. No significant differences were found between the groups with regards to individual and family histories of suicide attempt and the presence of other chronic diseases (P>0.05 for each). The patients had significantly higher BDI, BAI and ASI-3 scores than the controls (P>0.05 for each). There were significant correlations between BDI, BAI, ASI-3 and SPS desperation, suicide ideation scores, hostility scores and total scores (P
OBJETIVO: O transtorno obsessivo-compulsivo acomete entre 1,6 a 3,1% da população. Em virtude de uma maior compreensão do sofrimento associado aos sintomas, aumentaram os estudos e o interesse no bem-estar geral e na qualidade de vida dos portadores. MÉTODO: Foi realizada uma revisão bibliográfica de trabalhos que investigaram a qualidade de vida em portadores de transtorno obsessivo-compulsivo. A busca foi feita nas bases de dados Medline, SciELO e PsychoInfo, utilizando como palavras-chave quality of life e obsessive-compulsive disorder. Foram selecionados 27 artigos que abordaram o tema, sendo descritas as áreas mais afetadas pelo transtorno, bem como a sua relação com a qualidade de vida foram descritas. Também foram apresentados efeitos de tratamentos na qualidade de vida dos pacientes. RESULTADOS: Os relacionamentos sociais e familiares, seguidos pelo desempenho ocupacional (capacidade para trabalhar e estudar), foram as áreas mais afetadas pelo transtorno e, apesar de melhorarem com tratamento, permanecem insatisfatórios. As obsessões foram associadas a prejuízos mais significativos na qualidade de vida do que as compulsões (rituais). CONCLUSÕES: Apesar das limitações, os estudos mostram evidências do comprometimento da qualidade de vida de indivíduos com transtorno obsessivo-compulsivo, sendo este comparável ao de pacientes com esquizofrenia. Pesquisas futuras com diferentes delineamentos são necessárias para estabelecer resultados mais consistentes.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
Few case series studies have addressed the issue of treatment response in patients with obsessive-compulsive disorder (OCD) and comorbid post-traumatic stress disorder (PTSD), and there are no prospective studies addressing response to conventional treatment in OCD patients with a history of trauma (HT). The present study aimed to investigate, prospectively, the impact of HT or PTSD on two systematic, first-line treatments for OCD. Two hundred and nineteen non-treatment-resistant OCD outpatients were treated with either group cognitive-behavioral therapy (GCBT n = 147) or monotherapy with a selective serotonin reuptake inhibitor (SSRI n = 72). Presence of HT and PTSD were assessed at intake, as part of a broader clinical and demographical baseline characterization of the sample. Severity and types of OCD symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Dimensional YBOCS (DYBOCS), respectively. Depression and anxiety symptoms were measured with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Both treatments had 12-week duration. Treatment response was considered as a categorical [35% or greater reduction in baseline YBOCS scores plus a Clinical Global Impression-Improvement rating of better (2) or much better (1)] and continuous variable (absolute number reduction in baseline YBOCS scores). Treatment response was compared between the OCD + HT group versus the OCD without HT group and between the OCD + PTSD group versus the OCD without PTSD group. Parametric and non-parametric tests were used when indicated. Data on HT and PTSD were available for 215 subjects. Thirty-eight subjects (17.67% of the whole sample) had a positive HT (OCD + HT group) and 22 subjects (57.89% of the OCD + HT group and 10.23% of the whole sample) met full DSM-IV criteria for PTSD. The OCD + HT and OCD without HT groups presented similar response to GCBT (60% of responders in the first group and 63% of responders in the second group, p = 1.00). Regarding SSRI treatment, the difference between the response of the OCD + HT (47.4%) and OCD without HT (22.2%) groups was marginally significant (p = 0.07). In addition, the OCD + PTSD group presented a greater treatment response than the OCD without PTSD group when treatment response was considered as a continuous variable (p = 0.01). The age when the first trauma occurred had no impact on treatment response. In terms of specific OCD symptom dimensions, as measured by the DYBOCS, OCD treatment fostered greater reductions for the OCD + PTSD group than for the OCD without PTSD group in the scores of contamination obsessions and cleaning compulsions, collecting and hoarding and miscellaneous obsessions and related compulsions (including illness concerns and mental rituals, among others). The OCD + PTSD group also presented a greater reduction in anxiety scores than the OCD without PTSD group (p = 0.003). The presence of HT or PTSD was not related to a poorer treatment response in this sample of non-treatment-resistant OCD patients. Unexpectedly, OCD patients with PTSD presented a greater magnitude of response when compared with OCD without PTSD patients in specific OCD symptom dimensions. Future studies are needed to clarify if trauma and PTSD have a more significant impact on the onset and clinical expression of OCD than on the conventional treatment for this condition, and whether OCD stemming from trauma would constitute a subtype of OCD with a distinct response to conventional treatment.
To our knowledge, no prospective, population-based study in existence examines predictive associations between early or middle childhood psychopathologic disorders and later completed suicides.
To study predictive associations between childhood psychopathologic disorders at the age of 8 years and later completed suicides and severe suicide attempts.
Birth cohort study of individuals 8 to 24 years old.
Finland.
The sample includes 5302 Finnish people born in 1981 who were examined at the age of 8 years to gather information about psychopathologic conditions, school performance, and family demographics from parents, teachers, and children.
National register-based lifetime information about completed suicides and suicide attempts that prompted hospital admission.
Of all 24 deaths among males between 8 and 24 years of age, 13 were suicides, whereas of 16 deaths among females, only 2 were suicides. Fifty-four males and females (1%) had either completed suicide or made a serious suicide attempt, defined as a suicide attempt that prompted hospital admission. Of 27 males with completed or serious suicide attempts, 78% screened positive on parent or teacher Rutter scales at the age of 8 years, whereas of 27 females only 11% screened positive. Among males, completed or serious suicide attempt outcome was predicted at the age of 8 years by living in a nonintact family; psychological problems as reported by the primary teacher; or conduct, hyperkinetic, and emotional problems. However, self-reports of depressive symptoms at the age of 8 years did not predict suicide outcome. No predictive associations between the study variables measured at the age of 8 years and suicide outcome were found among females. Male suicide outcome was predicted most strongly by comorbid conduct and internalizing problems.
Most males who completed suicide and/or made serious suicide attempts in adolescence or early adulthood had psychiatric problems by the age of 8 years, indicating a trajectory that persists throughout their lives. However, female severe suicidality is not predicted by psychopathologic disorders at the age of 8 years. The results give additional support to the importance of early detection and treatment of psychiatric problems in males.
It is unclear how many people in the community have obsessions and compulsions and associated levels of interference. It is also unknown what variables predict help-seeking for these symptoms, whether they are developmentally stable, and whether they increase the risk of mental disorders.
The authors analyzed data from the prospective longitudinal Dunedin study of an unselected birth cohort. The presence of obsessions and compulsions and mental disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 11, 26, and 32. Data on interference and help-seeking were obtained at ages 26 and 32.
Obsessions and compulsions were frequent in individuals with mental disorders other than obsessive-compulsive disorder (OCD) and among people without mental disorders. Even in the latter group, these symptoms caused significant interference. The presence of anxiety/depression and of obsessions (particularly aggressive and shameful thoughts), but not compulsions, was associated with help-seeking. Harm/checking was the most prevalent symptom dimension. Symptom dimensions were temporally stable and associated with increased comorbidity. Obsessive-compulsive symptoms at age 11 predicted a high risk of an adult OCD diagnosis as well as elevated adult symptom dimensions.
Obsessions and compulsions are common in the adult population, have their roots in childhood, and are associated with interference, risk for disorders, and help-seeking. Subclinical obsessions and compulsions should be taken into account in research, intervention, and DSM-V.
To describe the recruitment of patients, assessment instruments, implementation, methods and preliminary results of The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, which includes seven university sites.
This cross-sectional study included a comprehensive clinical assessment including semi-structured interviews (sociodemographic data, medical and psychiatric history, disease course and comorbid psychiatric diagnoses), and instruments to assess obsessive-compulsive (Yale-Brown Obsessive-Compulsive Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale), depressive (Beck Depression Inventory) and anxious (Beck Anxiety Inventory) symptoms, sensory phenomena (Universidade de São Paulo Sensory Phenomena Scale), insight (Brown Assessment Beliefs Scale), tics (Yale Global Tics Severity Scale) and quality of life (Medical Outcome Quality of Life Scale Short-form-36 and Social Assessment Scale). The raters' training consisted of watching at least five videotaped interviews and interviewing five patients with an expert researcher before interviewing patients alone. The reliability between all leaders for the most important instruments (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale) was measured after six complete interviews.
Inter-rater reliability was 96%. By March 2008, 630 obsessive-compulsive disorder patients had been systematically evaluated. Mean age (+/-SE) was 34.7 (+/-0.51), 56.3% were female, and 84.6% Caucasian. The most prevalent obsessive compulsive symptom dimensions were symmetry and contamination. The most common comorbidities were major depression, generalized anxiety and social anxiety disorder. The most common DSM-IV impulsive control disorder was skin picking.
The sample was composed mainly by Caucasian individuals, unmarried, with some kind of occupational activity, mean age of 35 years, onset of obsessive-compulsive symptoms at 13 years of age, mild to moderate severity, mostly of symmetry, contamination/cleaning and comorbidity with depressive disorders. The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders has established an important network for standardized collaborative clinical research in obsessive-compulsive disorder and may pave the way to similar projects aimed at integrating other research groups in Brazil and throughout the world.
A representative sample of 456 persons from the normal population aged 22 and 23 years was used to study the overlap of depression with anxiety disorders. The 1-year prevalence rate for major depression (DSM-III), minor depression, and anxiety disorder together was 16.4%. The observed cases of major depression occurred in 36% with anxiety disorder, the cases with minor depression in 60%. On the level of symptoms assessed by a semistructured clinical interview and on the level of self-assessed items of the symptom check list SCL-90, the overlap was even greater. The main finding was that subjects with both diagnoses, depression and anxiety disorder, were more severely affected in general. Discriminant analyses of the SCL-90 scales together with the qualitative distribution of SCL items characterizing depression, anxiety, or phobia, did not disprove the hypothesis of a continuum.
The health-related quality of life of patients with obsessive-compulsive disorder was compared to published norms for the general U.S. population and for patients with either depressive disorders or diabetes.
Sixty medication-free outpatients with moderate to severe obsessive-compulsive disorder were evaluated by using the Structured Clinical Interview for DSM-III-R and the Yale-Brown Obsessive Compulsive Scale. Health-related quality of life was measured with the self-rated Medical Outcomes Study 36-Item Short-Form Health Survey.
The instrumental role performance and social functioning of the patients with obsessive-compulsive disorder were worse than those of the general population and of diabetes patients. The more severe the obsessive-compulsive disorder, the lower were the patients' social functioning scores, even after depression ratings were controlled for; scores on instrumental role performance did not correlate with severity of obsessive-compulsive disorder. The ratings of the obsessive-compulsive disorder patients on physical health domains resembled those of the general population and exceeded those of the diabetes patients. The general health and physical health ratings of the obsessive-compulsive disorder patients exceeded those of the depressed patients. In mental health domains, after adjustment for differences in gender distribution, quality of life ratings were similar for the patients with obsessive-compulsive disorder and those with depressive disorders.
Moderate to severe obsessive-compulsive disorder is associated with impaired social functioning and impaired instrumental role performance, but only impairment in social functioning is linearly related to severity of obsessive-compulsive disorder.
General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied.
Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis.
Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt.
Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
Utilizing a prospectively designed community sample, we set out to estimate the rate of newly-incident suicidal ideation and attempts (non-fatal suicide behaviour) in a community sample, to evaluate antecedent sociodemographic characteristics and psychiatric disorders, and to assess use of mental health services in relation to non-fatal suicide behaviour.
Prospectively-gathered data was utilized from 3481 continuing participants in the 13-year follow-up of the Baltimore sample of the NIMH Epidemiologic Catchment Area survey interviewed in 1981, 1982 and 1993/6.
The incidence of suicide attempts was estimated at 148.8 per 100,000 person-years and ideation at 419.9 per 100,000 person-years. Persons in the youngest age group, in the lowest socioeconomic status, and previously married persons were at increased risk for non-fatal suicide behaviour during the follow-up interval. Persons who reported suicidal ideation at baseline were more likely to report having attempted suicide at follow-up (RR = 6.09, 95% CI 2.58-14.36). Psychiatric disorders, especially depression and substance abuse, were associated with new-onset of non-fatal suicidal behaviour. While persons who reported newly-incident suicidal behaviour were more likely to report use of mental health services, few said that suicidal ideation or attempts were the reason for the visits.
Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.
Previous reports of suicide risk in patients with anxiety disorders have been inconsistent.
Using the FDA database, we assessed suicide and suicide attempt risk among patients, participating in recent clinical trials evaluating new anti-anxiety medications, with diagnosis of panic disorder (PD), social anxiety disorder or social phobia (SP), generalized anxiety disorder (GAD), post traumatic stress disorder (PTSD), and obsessive compulsive disorder (OCD).
Overall, among 20076 participating anxious patients, 12 committed suicide and 28 attempted suicide. The annual suicide risk rate was 193/100000 patients and annual suicide attempt risk was 1350/100000 patients.
Clinical trial data have limited applicability to clinical practice. Participants in clinical trials are a highly selected, nonrepresentative sample of the clinical population. A number of patients never complete clinical trials and thus data are based on a limited sub-sample. These trials were not primarily designed to assess suicide risk.
Suicide risk in patients with anxiety disorders is higher than previously thought. Patients with anxiety disorders warrant explicit evaluation for suicide risk.
Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions comes from studies of psychiatric comorbidity, functional brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD.
One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer- versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation.
The patients studied were phenomenologically comparable (including the presence of 'pure' obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the 'hoarding' dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the 'sexual/religious obsessions' factor predicted poorer outcome with BT, especially when computer-guided.
BT is especially indicated for OCD patients with aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients' adherence and response to treatment.
Objective: The aim of the present study was to examine the association between trauma and posttraumatic stress disorder (PTSD) and substance use disorders and to examine the correlates of substance use disorder plus PTSD comorbidity in the Australian general population. Method: Data were collected from a stratified sample of 10,641 participants as part of the Australian National Survey of Mental Health and Well-Being. A modified version of the Composite International Diagnostic Interview was used to determine the presence of DSM-IV anxiety, affective, and substance use disorders and ICD-10 personality disorders. Results: Substance use disorder plus PTSD was experienced by a significant minority of the Australian general population (0.5%). Among those with PTSD, the most common substance use disorder was an alcohol use disorder (24.1%), whereas among those with a substance use disorder, PTSD was most common among individuals with an opioid use disorder (33.2%). Consistent with U.S. clinical literature, individuals with substance use disorder plus PTSD experience significantly poorer physical and mental health and greater disability than those with substance use disorder alone. In contrast, individuals with PTSD alone and those with substance use disorder plus PTSD shared a remarkably similar clinical profile. Conclusions: It is important that individuals entering treatment for substance use disorder or PTSD be assessed for this comorbidity. The addition of either disorder may present complications that need to be considered for the provision of appropriate treatment. Further research is necessary to ascertain which treatments are most effective in treating comorbid substance use disorder plus PTSD.
The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.
Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy, showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.
Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
This study investigates lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiological Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder) comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed.
Background:
General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied.
Methods:
Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis.
Results:
Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt.
Conclusions:
Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
Our objective was to determine whether the presence of an anxiety disorder was a risk factor for future suicide attempts. Data were drawn from the 13-year follow-up Baltimore Epidemiological Catchment Area survey (n=1,920). Multiple logistic regression analysis was used to determine the association between baseline anxiety disorders (social phobia, simple phobia, obsessive-compulsive disorder, panic attacks, or agoraphobia) and subsequent onset suicide attempts. The presence of one or more anxiety disorders at baseline was significantly associated with subsequent onset suicide attempts (adjusted odds ratio 2.20, 95% confidence interval 1.04–4.64) after controlling for sociodemographic variables and all baseline mental disorders assessed in the survey. These findings suggest that anxiety disorders are independent risk factors for suicide attempts, and underscore the importance of anxiety disorders as a serious public health problem. Depression and Anxiety 0:1–5, 2007. Published 2007 Wiley-Liss.
Obsessive compulsive disorder (OCD) patients often have lifetime comorbid anxiety and depressive disorders. Incidence of lifetime OCD in other anxiety disorder patients, however, has not been fully investigated. In the current study, a structured diagnostic interview was administered to 454 patients with OCD, panic agoraphobia, or social phobia. Results indicated a relatively high level of lifetime anxiety disorders in OCD subjects but a much lower rate of lifetime OCD in other anxiety-disorder patients. Lifetime depression was not found to be different across the groups. The results are discussed in terms of possible vulnerability factors associated with OCD.
Several risk factors for suicide have been identified. We assessed the relative risks and population attributable risks of suicide associated with various socioeconomic factors and with previous mental illness that necessitated hospital admission. Our aim was to assist in the choice of potential strategies for preventing suicide in the general population.
We did a population-based nested case-control study based on register data. Data were collected on a random 5% sample of the Danish population aged 16-78 years during a 15-year period (1980-94) and analysed with conditional logistic regression.
811 cases of suicide were found and 79871 controls were chosen in this population. Unemployment, low income, being single, and a history of mental illness necessitating hospital admission were associated with increased risk of suicide. However, in the multivariate analysis, the strongest risk factor was mental illness necessitating hospital admission; risk of suicide was especially high during admission (relative risk 62.6 [95% CI 41.1-95.4]) and during the year after discharge (6.51 [5.03-8.44]). The effect of socioeconomic variables decreased after adjustment for history of mental illness. The population attributable risk associated with mental illness necessitating admission to hospital was 44.6% (43.6-45.5); the attributable risks associated with the other factors were 3.0% (1.4-6.6) for unemployment and 10.3% (6.13-16.9) for being single.
Suicide prevention aimed at patients who are admitted to hospital with mental disorders and improved detection and treatment of mental disorders in the general population may be the most efficient strategy to decrease risk of suicide. Reports of high relative risk and attributable risk associated with unemployment and other socioeconomic risk factors may be confounded and overestimated owing to the lack of adjustment for the association with mental disorders.
Previous findings suggested a unique role that depression symptoms might play in the comorbid relationship between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). However, the nature of this role remains unclear. Thus, the current study examined ways in which OCD and PTSD symptoms vary as a function of depression, as well as the mediating role of depression in the OCD-PTSD relationship, in 104 individuals seeking treatment for refractory OCD. Findings revealed that depressed individuals in the treatment-refractory OCD sample report higher levels of overall obsessing and greater severity of PTSD. In addition, depression appeared to mediate the relation between OCD and PTSD. Implications of findings are discussed.
Depressive disorders greatly increase suicide risk; however, little is known about the contribution of comorbid anxiety disorders or anxiety symptoms to the risk of suicide death among depressed patients. We examined whether depressed veterans with comorbid anxiety had higher risks of suicide death.
Using VA administrative databases we identified 887,859 patients with depression. We then used univariate and multivariate logistic regression, controlling for demographics and substance use disorders, to determine the odds ratios of completed suicide associated with individual comorbid anxiety disorders, the presence of any comorbid anxiety disorder, the prescription of an antianxiety medication, or the prescription of a high dose of an antianxiety medication.
In multivariate analyses, the odds of completed suicide were significantly increased for patients with panic disorder (OR 1.26, 95% CI: 1.04-1.53), generalized anxiety disorder (OR 1.27, 95% CI: 1.09-1.47), and anxiety disorder, not otherwise specified (OR 1.25, 95% CI: 1.12-1.38). The odds of completed suicide were also greater among patients who received any antianxiety medication (OR 1.71, 95% CI: 1.55-1.88), and were further increased among those who received high dose treatment (OR 2.26, 95% CI: 1.98-2.57). Odds of completed suicide were decreased among patients with comorbid posttraumatic stress disorder (OR 0.87, 95% CI: 0.77-0.97), and there was no statistically significant relationship between social phobia, obsessive-compulsive disorder, and all other anxiety disorders and suicide.
These findings emphasize the importance of comorbid anxiety disorders and symptoms in increasing suicide risk among depressed patients and may inform suicide prevention efforts among these patients.