A 2-Year Prospective Follow-Up Study of the Course of Obsessive-Compulsive Disorder

Abstract

Background Surprisingly little is known about the long-term course of obsessive-compulsive disorder (OCD). This prospective study presents 2-year course findings, as well as predictors of course, from the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the observational course of OCD in a large clinical sample. Method The sample included 214 treatment-seeking adults with DSM-IV OCD at intake who identified OCD as the most problematic disorder over their lifetime. Subjects were enrolled from 2001–2004. At annual interviews, data on weekly OCD symptom status were obtained using the Longitudinal Interval Follow-Up Evaluation. Probabilities of full remission and partial remission over the first 2 years of collected data and potential predictors of remission were examined. Results The probability of full remission from OCD was 0.06, and the probability of partial remission was 0.24. Of the 48 subjects whose OCD symptoms partially or fully remitted, only 1 relapsed within the first 2 years. Earlier age at onset of OCD, greater severity of symptoms at intake, older age at intake, and being male were associated with a decreased likelihood of remission. Insight, diagnostic comorbidity, and treatment were not found to be associated with the likelihood of achieving full or partial remission. Conclusions Though one-quarter of the sample had periods of subclinical OCD symptoms during the prospective period, full remission was rare, consistent with the view of OCD as a chronic and persistent illness. Age at onset, OCD symptom severity, current age, and sex emerged as potent predictors of course.

Differential parental influence in the familial aggregation of obsessive compulsive disorder

“…OCD symptoms and severity were evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), a reliable and valid 10-item rater-administered scale and the Y-BOCS Symptom Checklist (Goodman, Price, Rasmussen, Mazure, Delgado et al, 1989; Goodman, Price, Rasmussen, Mazure, Fleischmann et al, 1989). Axis I diagnoses and Y-BOCS total scores in this study have been found to have good to excellent interrater reliability as reported by Eisen et al (2010).…”

Remission of obsessive-compulsive disorders and syndromes; evidence from a prospective community cohort study over 30 years

“…Marcks et al (2011) examined OCD patients with a history of least one other anxiety disorder and also found a lower remission rate in depressed patients, though unlike Marcks et al (2011) or Eisen et al (2010) we did not see a relationship with marital status or gender, respectively. In our second paper (Fineberg et al 2012b), we draw attention to the high comorbidity between OCD and anxiety or affective -especially bipolar I and bipolar II -disorder and the impact of this comorbidity on increasing the duration of illness, OC symptom severity, various aspects of psychosocial impairment and suicidal behaviour.…”

“…A separate analysis of depressive and anxiety states within the Zurich cohort showed that those not receiving treatment had fewer symptoms than those who had ever been treated, suggesting this may a general phenomenon in psychiatry (Angst et al 2010). In contrast to other studies (Eisen et al 2010), early onset of symptoms was not associated with poorer remission whereas increased duration of illness was. The results of childhood OCD treatment studies performed in specialist centres (Nakatani et al 2011) have produced encouraging outcomes and suggest that the prognosis for early-onset OCD may be at least as good as that for adults if timely and appropriate treatment is obtained.…”

Predicting Course of Illness in Patients With Severe Obsessive-Compulsive Disorder

“…Greater functional impairment predicts lower probability of remission 6,8 , earlier age of onset 6,9 relates to more chronic course, and longer duration predicts lower probability of remission 4 . Greater symptom severity has also been linked to lower probability of remission 4,9 . Specific comorbidities have been associated with worse course of OCD, though number of Axis I comorbidities does not predict course 4,9 .…”