Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis
- Helen Blair Simpson, MD, PhD
Helen Blair Simpson, MD, PhD
- Professor of Psychiatry
- Columbia University Medical Center, College of Physicians and Surgeons, Columbia University
Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress, and by repetitive mental or behavioral acts (compulsions) that the individual feels driven to perform, either in response to an obsession or according to rules that he or she believes must be applied rigidly.
OCD typically starts in childhood or adolescence, persists throughout a person’s life, and produces substantial impairment in functioning due to the severe and chronic nature of the illness.
The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of OCD are described here. Pharmacotherapy, psychotherapy, and deep brain stimulation for OCD are discussed separately. OCD in children and adolescents and OCD in pregnant and postpartum women are also discussed separately. (See "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Psychotherapy for obsessive-compulsive disorder in adults" and "Deep brain stimulation for treatment of obsessive-compulsive disorder" and "Obsessive-compulsive disorder in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Obsessive-compulsive disorder in pregnant and postpartum women".)
Obsessive-compulsive disorder (OCD) among adults in the United States has an estimated 12-month prevalence of 1.2 percent and an estimated lifetime prevalence of 2.3 percent [1,2]. Females are affected at a slightly higher rate than males in adulthood, although males are more commonly affected in childhood [2,3].
Comorbidities — The most common psychiatric disorders found to co-occur in adults with OCD are as follows.
- Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617.
- Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 2010; 15:53.
- Weissman MM, Bland RC, Canino GJ, et al. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry 1994; 55 Suppl:5.
- Pinto A, Eisen JL. Personality features of OCD and spectrum conditions. In: The Oxford Handbook of Obsessive Compulsive and Spectrum Disorders, Steketee G (Ed), Oxford University Press, New York 2012.
- Gomes de Alvarenga P, de Mathis MA, Dominguez Alves AC, et al. Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study. CNS Spectr 2012; 17:87.
- Bienvenu OJ, Samuels JF, Wuyek LA, et al. Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med 2012; 42:1.
- Achim AM, Maziade M, Raymond E, et al. How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 2011; 37:811.
- Pallanti S, Grassi G, Sarrecchia ED, et al. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Front Psychiatry 2011; 2:70.
- Kaye WH, Bulik CM, Thornton L, et al. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004; 161:2215.
- Milad MR, Rauch SL. Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends Cogn Sci 2012; 16:43.
- Pauls DL, Abramovitch A, Rauch SL, Geller DA. Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective. Nat Rev Neurosci 2014; 15:410.
- Stewart SE, Yu D, Scharf JM, et al. Genome-wide association study of obsessive-compulsive disorder. Mol Psychiatry 2013; 18:788.
- Qin H, Samuels JF, Wang Y, et al. Whole-genome association analysis of treatment response in obsessive-compulsive disorder. Mol Psychiatry 2016; 21:270.
- Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry 2004; 9:900.
- Singer HS, Gilbert DL, Wolf DS, et al. Moving from PANDAS to CANS. J Pediatr 2012; 160:725.
- McGuinness M, Blissett J, Jones C. OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behav Cogn Psychother 2011; 39:285.
- Guglielmi V, Vulink NC, Denys D, et al. Obsessive-compulsive disorder and female reproductive cycle events: results from the OCD and reproduction collaborative study. Depress Anxiety 2014; 31:979.
- Fostick L, Nacasch N, Zohar J. Acute obsessive compulsive disorder (OCD) in veterans with posttraumatic stress disorder (PTSD). World J Biol Psychiatry 2012; 13:312.
- Coetzer BR. Obsessive-compulsive disorder following brain injury: a review. Int J Psychiatry Med 2004; 34:363.
- Figee M, Wielaard I, Mazaheri A, Denys D. Neurosurgical targets for compulsivity: what can we learn from acquired brain lesions? Neurosci Biobehav Rev 2013; 37:328.
- Alonso P, Cuadras D, Gabriëls L, et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. PLoS One 2015; 10:e0133591.
- Brown LT, Mikell CB, Youngerman BE, et al. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg 2016; 124:77.
- Monteiro P, Feng G. Learning From Animal Models of Obsessive-Compulsive Disorder. Biol Psychiatry 2016; 79:7.
- de Wit SJ, Alonso P, Schweren L, et al. Multicenter voxel-based morphometry mega-analysis of structural brain scans in obsessive-compulsive disorder. Am J Psychiatry 2014; 171:340.
- Maia TV, Cooney RE, Peterson BS. The neural bases of obsessive-compulsive disorder in children and adults. Dev Psychopathol 2008; 20:1251.
- Insel TR, Mueller EA, Alterman I, et al. Obsessive-compulsive disorder and serotonin: is there a connection? Biol Psychiatry 1985; 20:1174.
- Koo MS, Kim EJ, Roh D, Kim CH. Role of dopamine in the pathophysiology and treatment of obsessive-compulsive disorder. Expert Rev Neurother 2010; 10:275.
- Pittenger C, Bloch MH, Williams K. Glutamate abnormalities in obsessive compulsive disorder: neurobiology, pathophysiology, and treatment. Pharmacol Ther 2011; 132:314.
- Wu K, Hanna GL, Rosenberg DR, Arnold PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol Biochem Behav 2012; 100:726.
- Foa EB, Kozak MJ, Goodman WK, et al. DSM-IV field trial: obsessive-compulsive disorder. Am J Psychiatry 1995; 152:90.
- Shavitt RG, de Mathis MA, Oki F, et al. Phenomenology of OCD: lessons from a large multicenter study and implications for ICD-11. J Psychiatr Res 2014; 57:141.
- Gillan CM, Robbins TW. Goal-directed learning and obsessive-compulsive disorder. Philos Trans R Soc Lond B Biol Sci 2014; 369.
- Angelakis I, Gooding P, Tarrier N, Panagioti M. Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clin Psychol Rev 2015; 39:1.
- Obsessive Compulsive Cognitions Working Group. Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory--Part 2: Factor analyses and testing of a brief version. Behav Res Ther 2005; 43:1527.
- Phillips KA, Pinto A, Menard W, et al. Obsessive-compulsive disorder versus body dysmorphic disorder: a comparison study of two possibly related disorders. Depress Anxiety 2007; 24:399.
- Catapano F, Perris F, Fabrazzo M, et al. Obsessive-compulsive disorder with poor insight: a three-year prospective study. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:323.
- Grant JE, Mancebo MC, Pinto A, et al. Late-onset obsessive compulsive disorder: clinical characteristics and psychiatric comorbidity. Psychiatry Res 2007; 152:21.
- Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder [see commetns]. Arch Gen Psychiatry 1999; 56:121.
- Ravizza L, Maina G, Bogetto F. Episodic and chronic obsessive-compulsive disorder. Depress Anxiety 1997; 6:154.
- Eisen JL, Pinto A, Mancebo MC, et al. A 2-year prospective follow-up study of the course of obsessive-compulsive disorder. J Clin Psychiatry 2010; 71:1033.
- Simpson HB, Huppert JD, Petkova E, et al. Response versus remission in obsessive-compulsive disorder. J Clin Psychiatry 2006; 67:269.
- Stewart SE, Geller DA, Jenike M, et al. Long-term outcome of pediatric obsessive-compulsive disorder: a meta-analysis and qualitative review of the literature. Acta Psychiatr Scand 2004; 110:4.
- Huppert JD, Simpson HB, Nissenson KJ, et al. Quality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety 2009; 26:39.
- Koran LM, Thienemann ML, Davenport R. Quality of life for patients with obsessive-compulsive disorder. Am J Psychiatry 1996; 153:783.
- Bobes J, González MP, Bascarán MT, et al. Quality of life and disability in patients with obsessive-compulsive disorder. Eur Psychiatry 2001; 16:239.
- Rachman S, de Silva P. Abnormal and normal obsessions. Behav Res Ther 1978; 16:233.
- Salkovskis PM, Harrison J. Abnormal and normal obsessions--a replication. Behav Res Ther 1984; 22:549.
- 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.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry 1989; 46:1012.
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46:1006.
- Steketee G, Frost R, Bogart K. The Yale-Brown Obsessive Compulsive Scale: interview versus self-report. Behav Res Ther 1996; 34:675.
- Huppert JD, Walther MR, Hajcak G, et al. The OCI-R: validation of the subscales in a clinical sample. J Anxiety Disord 2007; 21:394.
- Storch EA, Kaufman DA, Bagner D, et al. Florida Obsessive-Compulsive Inventory: development, reliability, and validity. J Clin Psychol 2007; 63:851.
- Abramowitz JS, Deacon BJ, Olatunji BO, et al. Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychol Assess 2010; 22:180.
- Genetic factors
- Environmental factors
- CLINICAL MANIFESTATIONS
- ASSESSMENT AND DIAGNOSIS
- Specifiers for OCD in DSM-5
- - Patient’s degree of insight into the illness
- - Tic-related
- Differential diagnosis
- - Anxiety disorders
- Generalized anxiety disorder
- Specific phobia
- Social anxiety disorder
- - Hoarding disorder
- - Major depressive disorder
- - Tic disorders
- - Psychotic disorders
- - Obsessive-compulsive personality disorder
- - Other disorders
- Severity rating scales
- SUMMARY AND RECOMMENDATIONS