Subthreshold symptoms and obsessive–compulsive disorder: evaluating the diagnostic threshold

Abstract

Having obsessions and compulsions is associated with substantial suffering and disability. Most subjects with obsessions and/or compulsions are not diagnosed with OCD according to the DSM-III-R criteria although these subjects generally display similar consequences to full-blown OCD subjects. We recommend that these subthreshold cases receive special attention in the development of DSM-V.

Obsessive–compulsive disorder in the community: 12-month prevalence, comorbidity and impairment

“…Our findings suggest that OCS without further sub-clinical features is indeed clinically meaningful, both in its own right and in the extremely common presentation with comorbid conditions. The 12-month prevalence of OCD found in this study (0.7%) corresponds to previous studies conducted on the general population, with ranges from 0.3 to 3.0% [2,7,9,23,31,37,50,53,57]. Twelve-month prevalence rates of 0.6 to 4.9% for subthreshold OCD that fulfill some but not all the required DSM-IV criteria of threshold OCD (4.5%) is likewise consistent with previous studies [3,9,22,53].…”

“…We were able to replicate previously reported strong associations between OCD and substance abuse/dependence [9,50], mood [8,10,22,31,50,57], anxiety [2,8,9,22,31,50,57] and somatoform disorders [22]. In addition, we also found strong associations between subthreshold OCD and these same disorders consistent with previous [16] four somatoform symptoms for males and six for females), pain disorder, hypochondriasis g Anorexia nervosa, atypical anorexia nervosa (all DSM-IV criteria for anorexia are met except D or all are met except A, but BMI \18.5), bulimia nervosa, atypical bulimia nervosa (all DSM-IV criteria for Bulimia met, except C criteria or except B criteria) h These associations are based on a small number of comorbid cases (B2)…”

“…We did not find gender differences regarding the 12-month prevalence rates of OCD, subthreshold OCD, and OCS, which is supported by several studies [8,9,31], but contradictory to some reports of gender differences in the prevalence of subthreshold OCD [23] or OCS [14,21].…”

“…research [2,3,9,22]. Unlike most studies, however, we additionally examined the association between OCS and these disorders.…”

“…To date, only three studies (see Table 1) have examined impairment and health care utilization in relation to subthreshold conditions of OCD, defined as fulfilling at least one but not all core DSM-III-R/IV criteria [9,23] or defined as the presence of obsessive-compulsive symptoms (OCS) according to DSM-IV as well as moderate distress [2]. These studies have found that the 12-month prevalence of subthreshold OCD was more frequent (0.6-4.9%) [3,9,22,53] than that of threshold OCD (0.3-3.0%) [2,7,9,23,31,37,50,53,57] in the general population and that the subthreshold conditions are strongly associated with more comorbidity, poorer functioning at work or in social activities and a greater use of health-care services [2,3,9,22,23].…”