Obsessions and compulsions common in young adults
A prospective longitudinal study from New Zealand has found that one in four adults in their early thirties experiences obsessions and compulsions. This study suggests that, for every patient with OCD, there are another ten with subthreshold symptoms.
The Dunedin study has followed up a complete cohort of 1,037 children born during a 12-month period in 1972-73. The drop-out rate is remarkably low: 96% of living members attended the most recent assessment at age 32.
The prevalence of obsessions and compulsions was assessed at ages 11, 26 and 32 using the Diagnostic Interview Schedule. Supplementary questions were asked to determine the resulting level of distress and disruption.
The one-year prevalence of any obsession or compulsion was 21% at age 26 and 25% at age 32. In contrast, the prevalence of OCD was only 2.3% and 1.8% respectively.
Obsessions and compulsions were more frequent in individuals with anxiety disorders (34-42%) or major depression (31-49%).
Obsessive-compulsive symptoms at age 11 substantially increased the risk of both obsessive-compulsive symptoms and OCD in adulthood.
The level of distress and disruption was highest for those with OCD and lowest for those with no psychiatric diagnosis. Nevertheless, 15% of the latter group found their obsessions emotionally upsetting and 25% found them time consuming (>1hr/day).
OCD is a clinically heterogeneous condition which has been subdivided into a number of potentially overlapping symptom dimensions.1
Of these, the dimension of harm obsessions/checking behaviours was found to be the most prevalent.
The authors suggest that screening followed by brief CBT interventions might both reduce symptoms and the risk of progression to OCD.
OCD itself often goes unrecognised. Patients may be reluctant to disclose their symptoms because of shame or embarrassment, and fears of stigmatisation. NICE therefore recommends that we should use a six-question screening questionnaire for patients who are at increased risk of OCD.2
Depression, in particular, commonly occurs in association with OCD3 and I think a case can be made for asking patients to complete the six-question screen at the same time as the PHQ-9.
Fullana MA, Mataix-Cols D, Caspi A et al. Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. Am J Psychiatry 2009; 166: 329-36Reviewer
Dr Phillip Bland