Obsessive–compulsive disorder and the risk of subsequent mental disorders: A community study of adolescents and young adults
Patrizia D. Hofer MSc
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorKarina Wahl PhD
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorAndrea H. Meyer PhD
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorMarcel Miché Dipl-Psych
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorKatja Beesdo-Baum PhD
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
Search for more papers by this authorShiu F. Wong PhD
School of Psychology, The University of New South Wales, Kensington, NSW, Australia
Search for more papers by this authorJessica R. Grisham PhD
School of Psychology, The University of New South Wales, Kensington, NSW, Australia
Search for more papers by this authorHans-Ulrich Wittchen PhD
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig Maximilians Universitaet Munich, Munich, Germany
Search for more papers by this authorCorresponding Author
Roselind Lieb PhD
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Max Planck Institute of Psychiatry, Munich, Germany
Correspondence
Roselind Lieb, Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland.
Email: [email protected]
Search for more papers by this authorPatrizia D. Hofer MSc
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorKarina Wahl PhD
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorAndrea H. Meyer PhD
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorMarcel Miché Dipl-Psych
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Search for more papers by this authorKatja Beesdo-Baum PhD
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
Search for more papers by this authorShiu F. Wong PhD
School of Psychology, The University of New South Wales, Kensington, NSW, Australia
Search for more papers by this authorJessica R. Grisham PhD
School of Psychology, The University of New South Wales, Kensington, NSW, Australia
Search for more papers by this authorHans-Ulrich Wittchen PhD
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig Maximilians Universitaet Munich, Munich, Germany
Search for more papers by this authorCorresponding Author
Roselind Lieb PhD
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
Max Planck Institute of Psychiatry, Munich, Germany
Correspondence
Roselind Lieb, Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland.
Email: [email protected]
Search for more papers by this authorFunding information: Grant sponsor: German Federal Ministry of Education and Research (BMBF); Grant numbers: 01EB9405/6, 01EB9901/6, EB01016200, 01EB0140, and 01EB0440; Grant sponsor: Deutsche Forschungsgemeinschaft (DFG); Grant numbers: LA1148/1-1, WI2246/1-1, WI 709/7-1, and WI 709/8-1.
Abstract
Background
Comorbidity of obsessive–compulsive disorder (OCD) with other mental disorders has been demonstrated repeatedly. Few longitudinal studies, however, have evaluated the temporal association of prior OCD and subsequent mental disorders across the age period of highest risk for first onset of mental disorders. We examined associations between prior OCD and a broad range of subsequent mental disorders and simulated proportions of new onsets of mental disorders that could potentially be attributed to prior OCD, assuming a causal relationship.
Methods
Data from 3,021 14- to 24-year-old community subjects were prospectively collected for up to 10 years. DSM-IV OCD and other DSM-IV mental disorders were assessed with the Munich-Composite International Diagnostic Interview. We used adjusted time-dependent proportional hazard models to estimate the temporal associations of prior OCD with subsequent mental disorders.
Results
Prior OCD was associated with an increased risk of bipolar disorders (BIP; [hazard ratio, HR = 6.9, 95% confidence interval, CI, (2.8,17.3)], bulimia nervosa [HR = 6.8 (1.3,36.6)], dysthymia [HR = 4.4 (2.1,9.0)], generalized anxiety disorder (GAD; [HR = 3.4 (1.1,10.9)], and social phobia [HR = 2.9 (1.1,7.7)]). Of these outcome disorders, between 65 and 85% could be attributed to OCD in the exposed group, whereas between 1.5 and 7.7% could be attributed to OCD in the total sample.
Conclusions
This study provides strong evidence that prior OCD is associated with an increased risk of subsequent onset of BIP, bulimia nervosa, dysthymia, GAD, and social phobia among adolescents and young adults. Future studies should evaluate if early treatment of OCD can prevent the onset of these subsequent mental disorders.
REFERENCES
- Adam, Y., Meinlschmidt, G., Gloster, A. T., & Lieb, R. (2012). Obsessive-compulsive disorder in the community: 12-Month prevalence, comorbidity and impairment. Social Psychiatry and Psychiatric Epidemiology, 47, 339–349.
- Angst, J., Gamma, A., Endrass, J., Goodwin, R., Ajdacic, V., Eich, D., & Rössler, W. (2004). Obsessive-compulsive severity spectrum in the community: Prevalence, comorbidity, and course. European Archives of Psychiatry and Clinical Neuroscience, 254, 156–164.
- Beesdo-Baum, K., Knappe, S., Asselmann, E., Zimmermann, P., Brückl, T., Höfler, M., … Wittchen, H.-U. (2015). The “Early Developmental Stages of Psychopathology (EDSP) study”: A 20-year review of methods and findings. Social Psychiatry and Psychiatric Epidemiology, 50, 851–866.
- Buckner, J. D., Silgado, J., & Lewinsohn, P. M. (2010). Delineation of differential temporal relations between specific eating and anxiety disorders. Journal of Psychiatric Research, 44, 781–787.
- Canals, J., Hernandez-Martinez, C., Cosi, S., & Voltas, N. (2012). The epidemiology of obsessive-compulsive disorder in Spanish school children. Journal of Anxiety Disorders, 26, 746–752.
- Cederlöf, M., Lichtenstein, P., Larsson, H., Boman, M., Ruck, C., Landen, M., & Mataix-Cols, D. (2015). Obsessive-compulsive disorder, psychosis, and bipolarity: A longitudinal cohort and multigenerational family study. Schizophrenia Bulletin, 41, 1076–1083.
- Cederlöf, M., Thornton, L. M., Baker, J., Lichtenstein, P., Larsson, H., Ruck, C., … Mataix-Cols, D. (2015). Etiological overlap between obsessive-compulsive disorder and anorexia nervosa: A longitudinal cohort, multigenerational family and twin study. World Psychiatry, 14, 333–338.
- Cuzen, N. L., Stein, D. J., Lochner, C., & Fineberg, N. A. (2014). Comorbidity of obsessive-compulsive disorder and substance use disorder: A new heuristic. Human Psychopharmacology—Clinical and Experimental, 29, 89–93.
- de Graaf, R., Bijl, R. V., Spijker, J., Beekman, A. T. F., & Vollebergh, W. A. M. (2003). Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders—Findings from the Netherlands Mental Health Survey and Incidence Study. Social Psychiatry and Psychiatric Epidemiology, 38, 1–11.
- Fineberg, N. A., Hengartner, M. P., Bergbaum, C. E., Gale, T. M., Gamma, A., Ajdacic-Gross, V., … Angst, J. (2013). A prospective population-based cohort study of the prevalence, incidence and impact of obsessive-compulsive symptomatology. International Journal of Psychiatry in Clinical Practice, 17, 170–178.
- Fineberg, N. A., Hengartner, M. P., Bergbaum, C., Gale, T., Rössler, W., & Angst, J. (2013). Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: Impact, prevalence, socio-demographic and clinical characteristics. International Journal of Psychiatry in Clinical Practice, 17, 188–196.
- Fontenelle, I. S., Fontenelle, L. F., Borges, M. C., Prazeres, A. M., Range, B. P., Mendlowicz, M. V., & Versiani, M. (2010). Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Research, 179, 198–203.
- Goodwin, R. D. (2002). Anxiety disorders and the onset of depression among adults in the community. Psychological Medicine, 32, 1121–1124.
- Grabe, H. J., Meyer, C., Hapke, U., Rumpf, H. J., Freyberger, H. J., Dilling, H., & John, U. (2001). Lifetime-comorbidity of obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. European Archives of Psychiatry and Clinical Neuroscience, 251, 130–135.
- Heyman, I., Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2001). Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. British Journal of Psychiatry, 179, 324–329.
- Höfler, M., Brückl, T. M., Lieb, R., & Wittchen, H.-U. (2005). Calculating control variables with age at onset data to adjust for conditions prior to exposure. Social Psychiatry and Psychiatric Epidemiology, 40, 731–736.
- Hofmeijer-Sevink, M. K., Batelaan, N. M., van Megen, H. J. G. M., van den Hout, M. A., Penninx, B. W., van Balkom, A. J. L. M., & Cath, D. C. (2017). Presence and predictive value of obsessive-compulsive symptoms in anxiety and depressive disorders. Canadian Journal of Psychiatry, 63(2) 85–93. Advance online publication. https://doi.org/10.1177/0706743717711170
- Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358.
- Karno, M., Golding, J. M., Sorenson, S. B., & Burnam, M. A. (1988). The epidemiology of obsessive-compulsive disorder in 5 United States communities. Archives of General Psychiatry, 45, 1094–1099.
- Kessler, R. C., Aguilar-Gaxiola, S., Andrade, L., Bijl, R., Borges, G., Caraveo-Anduaga, J., … Ustun, T. B. (2001). Mental-substance comorbidities in the ICPE surveys. Psychiatria Fennica, 32, 62–79.
- Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20, 359–364.
- Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 768–768.
- Kessler, R. C., Ormel, J., Petukhova, M., McLaughlin, K. A., Green, J. G., Russo, L. J., … Ustun, T. B. (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry, 68, 90–100.
- Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder—Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60, 709–717.
- Kraemer, H. C., Kazdin, A. E., Offord, D. R., Kessler, R. C., Jensen, P. S., & Kupfer, D. J. (1997). Coming to terms with the terms of risk. Archives of General Psychiatry, 54, 337–343.
- Lieb, R., Isensee, B., von Sydow, K., & Wittchen, H.-U. (2000). The Early Developmental Stages of Psychopathology Study (EDSP): A methodological update. European Addiction Research, 6, 170–182.
- Lieb, R., Miché, M., Gloster, A. T., Beesdo-Baum, K., Meyer, A. H., & Wittchen, H.-U. (2016). Impact of specific phobia on the risk of onset of mental disorders: A 10-year prospective-longitudinal community study of adolescents and young adults. Depression and Anxiety, 33, 667–675.
- Meier, S. M., Bulik, C. M., Thornton, L. M., Mattheisen, M., Mortensen, P. B., & Petersen, L. (2015). Diagnosed anxiety disorders and the risk of subsequent anorexia nervosa: A Danish population register study. European Eating Disorders Review, 23, 524–530.
- Meier, S. M., Petersen, L., Mattheisen, M., Mors, O., Mortensen, P. B., & Laursen, T. M. (2015). Secondary depression in severe anxiety disorders: A population-based cohort study in Denmark. Lancet Psychiatry, 2, 515–523.
- Meier, S. M., Petersen, L., Pedersen, M. G., Arendt, M. C. B., Nielsen, P. R., Mattheisen, M., … Mortensen, P. B. (2014). Obsessive-compulsive disorder as a risk factor for schizophrenia: A nationwide study. JAMA Psychiatry, 71, 1215–1221.
- Nestadt, G., Samuels, J., Riddle, M. A., Liang, K. Y., Bienvenu, O. J., Hoehn-Saric, R., … Cullen, B. (2001). The relationship between obsessive-compulsive disorder and anxiety and affective disorders: Results from the Johns Hopkins OCD Family Study. Psychological Medicine, 31, 481–487.
- Öst, L. G., Riise, E. N., Wergeland, G. J., Hansen, B., & Kvale, G. (2016). Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. Journal of Anxiety Disorders, 43, 58–69.
- Peterson, B. S., Pine, D. S., Cohen, P., & Brook, J. S. (2001). Prospective, longitudinal study of tic, obsessive-compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 685–695.
- M. Porta (Ed.). (2014). A dictionary of epidemiology( 6th ed.). Oxford, England: Oxford University Press.
10.1093/acref/9780199976720.001.0001 Google Scholar
- Pujol, J., Soriano-Mas, C., Alonso, P., Cardoner, N., Menchon, J. M., Deus, J., & Vallejo, J. (2004). Mapping structural brain alterations in obsessive-compulsive disorder. Archives of General Psychiatry, 61, 720–730.
- Ravizza, L., Maina, G., & Bogetto, F. (1997). Episodic and chronic obsessive-compulsive disorder. Depression and Anxiety, 6, 154–158.
- Reed, V., Gander, F., Pfister, H., Steiger, A., Sonntag, H., Trenkwalder, C., … Wittchen, H.-U. (1998). To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research, 7, 142–155.
10.1002/mpr.44 Google Scholar
- Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 53–63.
- Shear, M. K., Bjelland, I., Beesdo, K., Gloster, A. T., & Wittchen, H. U. (2007). Supplementary dimensional assessment in anxiety disorders. International Journal of Methods in Psychiatric Research, 16, S52–S64.
- StataCorp. (2013). Stata statistical software: Release 13. College Station, TX: StataCorp LP.
- Therneau, T. M., & Grambsch, P. M. (2000). Modeling survival data: Extending the Cox model. New York, NY: Springer.
10.1007/978-1-4757-3294-8 Google Scholar
- Timpano, K. R., Rubenstein, L. M., & Murphy, D. L. (2012). Phenomenological features and clinical impact of affective disorders in OCD: A focus on the bipolar disorder and OCD connection. Depression and Anxiety, 29, 226–233.
- Torres, A. R., Moran, P., Bebbington, P., Brugha, T., Bhugra, D., Coid, J. W., … Prince, M. (2006). Obsessive-compulsive disorder and personality disorder: Evidence from the British National Survey of Psychiatric Morbidity 2000. Social Psychiatry and Psychiatric Epidemiology, 41, 862–867.
- Valderhaug, R., & Ivarsson, T. (2005). Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder. European Child & Adolescent Psychiatry, 14, 164–173.
- Valleni-Basile, L. A., Garrison, C. Z., Jackson, K. L., Waller, J. L., McKeown, R. E., Addy, C. L., & Cuffe, S. P. (1994). Frequency of obsessive-compulsive disorder in a community sample of young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 782–791.
- Weissman, M. M., Bland, R. C., Canino, G. J., Greenwald, S., Hwu, H. G., Lee, C. K., … Yeh, E. K. (1994). The Cross-National Epidemiology of obsessive-compulsive disorder. Journal of Clinical Psychiatry, 55, 5–10.
- Wittchen, H. U., Kessler, R. C., Pfister, H., & Lieb, R. (2000). Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatrica Scandinavica, 102, 14–23.
- Wittchen, H.-U., Lachner, G., Wunderlich, U., & Pfister, H. (1998). Test-retest reliability of the computerized DSM-IV version of the Munich Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology, 33, 568–578.
- Wittchen, H.-U., Perkonigg, A., Lachner, G., & Nelson, C. B. (1998). Early Developmental Stages of Psychopathology Study (EDSP): Objectives and design. European Addiction Research, 4, 18–27.
- Wittchen, H.-U., & Pfister, H. (1997). DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X- Lifetime); Interviewheft Querschnittuntersuchung (DIA-X- 12 Monate); Ergänzungsheft (DIA-X-12 Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt, Germany: Swets & Zeitlinger.
