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Obsessive–compulsive disorder in the community: 12-month prevalence, comorbidity and impairment

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Abstract

Background

Although subthreshold conditions are associated with impairment in numerous disorders, research on obsessive–compulsive disorder (OCD) below the diagnostic threshold of DSM-IV in the general population is limited.

Purpose

To estimate the DSM-IV 12-month prevalence, comorbidity and impairment of OCD, subthreshold OCD (i.e., fulfilling some but not all core DSM-IV criteria), and obsessive–compulsive symptoms (OCS) (i.e., endorsement of OCS without fulfilling any core DSM-IV criteria) in a general population sample.

Methods

Data from the German National Health Interview and Examination Survey–Mental Health Supplement (N = 4181, age 18–65 years), based on the standardized diagnostic Munich Composite International Diagnostic Interview.

Results

The 12-month prevalence of OCD was 0.7%, subthreshold OCD was 4.5%, and OCS was 8.3%. Subjects in all three groups showed higher comorbidity (odds ratios [ORs] ≥ 3.3), compared to those without OCS. The OCD, subthreshold OCD and OCS were all associated with increased odds of substance abuse/dependence-, mood-, anxiety- and somatoform disorders, with especially strong associations with possible psychotic disorder (ORs ≥ 4.1) and bipolar disorders (ORs ≥ 4.7). Participants in all three groups showed higher impairment (ORs ≥ 3.1) and health-care utilization (ORs ≥ 2.4), compared to those without OCS, even after controlling for covariates.

Conclusions

Individuals with subthreshold OCD and OCS, not currently captured by DSM-IV OCD criteria, nevertheless show substantial comorbidity, impairment and health-care utilization. This should be taken into account in future conceptualization and classification of OCD and clinical care.

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Acknowledgments

The GHS was supported by grant 01EH970/8 (German Federal Ministry of Research, Education and Science). Mental disorders were assessed in the mental health supplement of the GHS (Max-Planck Institute of Psychiatry, Munich, Germany; principal investigator: H.-U. Wittchen) and physical conditions and social variables in the core survey of the GHS (Robert Koch Institute, Berlin, Germany; principal investigators: B.-M. Kurth, W. Thefeld). A public use file from the data set can be ordered from F. Jacobi (jacobi@psychologie.tu-dresden.de). National Centre of Competence in Research "Swiss Etiological Study of Adjustment and Mental Health" was supported by grant 51A 240-104890 from the Swiss National Science Foundation.

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Correspondence to Roselind Lieb.

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Adam, Y., Meinlschmidt, G., Gloster, A.T. et al. Obsessive–compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Soc Psychiatry Psychiatr Epidemiol 47, 339–349 (2012). https://doi.org/10.1007/s00127-010-0337-5

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  • DOI: https://doi.org/10.1007/s00127-010-0337-5

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