Obsessive compulsive disorder—Five clinical questions and a suggested approach

Although major depressive disorder (MDD) has been consistently considered the most frequent complication of obsessive-compulsive disorder (OCD), little is known about the clinical characteristics of patients with both disorders. This study assessed 815 Brazilian OCD patients using a comprehensive psychiatric evaluation. Clinical and demographic variables, including OCD symptom dimensions, were compared among OCD patients with and without MDD. Our findings showed that prevalence rates of current MDD (32%) and lifetime MDD (67.5%) were similar for both sexes in this study. In addition, patients with comorbid MDD had higher severity scores of OCD symptoms. There was no preferential association of MDD with any particular OCD symptom dimension. This study supports the notion that depressed OCD patients present more severe general psychopathology.

Studies examining OC phenomena in schizophrenic and schizoaffective disorders have shown a prevalence of such phenomena in 1 to 60% of schizophrenic or schizoaffective patients. In this prospective study, about 10% of 150 male patients suffering from acute psychotic disorders (fulfilling DSM-IV criteria for Schizophrenia or Schizoaffective Disorder) were found to have OC symptoms. These symptoms showed no correlation to the type and severity of psychosis. As only 19% of the patients with obsessions and compulsions during acute psychosis showed an obsessive-compulsive personality disorder prior to their psychotic episodes, it may be concluded that there is no clear linkage between intrapsychotic OC phenomena and premorbid anancastic personality traits.

Standardized structured personality scales are now available that provide better reliability than do clinician interviews, but these are still imperfect. Use of these scales has shown that the majority of patients with obsessive compulsive disorder (OCD) have at least one Axis II personality disorder, with most falling in cluster C. Obsessive compulsive personality disorder, as described in DSM-III-R, is, in most samples studied, present in the minority of patients with OCD and is often less common than other personality disorders such as mixed, dependent, avoidant, and histrionic. There is evidence that, in some cases, obsessive compulsive personality disorder may be secondary to OCD. It now appears that schizotypal personality disorder, which is thought to be related genetically to schizophrenia, is the only consistent personality disorder predictor of poor outcome in OCD.

Obsessive compulsive disorder (OCD) is receiving increasing attention in the clinical research literature. This review briefly summarizes data concerning diagnosis, phenomenology, and epidemiology of OCD and examines other disorders that closely resemble OCD. In addition, the nosological and treatment implications of these data are discussed. We find that OCD is characterized by a focal anxiety point(s) reflected in obsessions and by behavioral or cognitive compulsions. The appearance of these characteristics in other disorders suggests some relation between them and, consequently, the treatment of these disorders may be enhanced by conceptualizing them as OCD “variants”.

This report explores the role played by DSM-III Major Depression in the Nonsuppressor status of a sample of 29 subjects suffering from DSM-III Obsessive Compulsive Disorder (OCD). Five subjects were found to be Nonsuppressors. Further analysis showed that it is likely that Nonsuppressor status depended upon the concomitant presence of Major Depression rather than upon the OCD itself.

The relationship between obsessive symptomatology and traits on the one hand, and adjustment on the other is examined in 94 patients with obsessive-compulsive disorder. Symptomatology, as measured by the Leyton Obsessional Inventory (LOI), was found to be significantly and positively correlated with maladjustment (occupational, leisure, sexual, intrafamillial, extrafamilial, social, and expressed self-satisfaction). Obsessional traits, as measured by the LOI, were found to be uncorrelated with maladjustment. The implication of the results for the theory that traits and symptoms represent a continuum and the generalizability of the findings to normals are discussed.