Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-23T20:25:02.929Z Has data issue: false hasContentIssue false

Risk factors prospectively associated with adult obsessive–compulsive symptom dimensions and obsessive–compulsive disorder

Published online by Cambridge University Press:  15 June 2011

J. R. Grisham*
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW, Australia
M. A. Fullana
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK Anxiety Unit (Hospital del Mar/IAPS) and Department of Psychiatry, Autonomous University of Barcelona, Spain
D. Mataix-Cols
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK
T. E. Moffitt
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK Department of Psychology and Neuroscience, Department of Psychiatry and Behavioral Sciences, Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA
A. Caspi
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK Department of Psychology and Neuroscience, Department of Psychiatry and Behavioral Sciences, Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA
R. Poulton
Affiliation:
Dunedin Multidisciplinary Health and Development Research Unit, Dunedin School of Medicine, University of Otago, New Zealand
*
*Address for correspondence: Dr J. R. Grisham, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. (Email: [email protected])

Abstract

Background

Very few longitudinal studies have evaluated prospective neurodevelopmental and psychosocial risk factors for obsessive–compulsive disorder (OCD). Furthermore, despite the heterogeneous nature of OCD, no research has examined risk factors for its primary symptom dimensions, such as contamination/washing.

Method

Potential risk factors for symptoms or diagnosis of OCD in adulthood and for specific adult obsessive–compulsive (OC) symptom dimensions were examined in the Dunedin Study birth cohort. The presence of obsessions and compulsions and psychological disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 26 and 32 years. Individuals with a diagnosis of OCD at either age (n=36) were compared to both a healthy control group (n=613) and an anxious control group (n=310) to determine whether associations between a risk factor and an OCD diagnosis were specific.

Results

Childhood neurodevelopmental, behavioral, personality and environmental risk factors were associated with a diagnosis of OCD and with OC symptoms at ages 26 and 32. Social isolation, retrospectively reported physical abuse and negative emotionality were specific predictors of an adult OCD diagnosis. Of note, most risk factors were associated with OC symptoms in adulthood and several risk factors predicted specific OCD dimensions. Perinatal insults were linked to increased risk for symmetry/ordering and shameful thoughts dimensions, whereas poor childhood motor skills predicted the harm/checking dimension. Difficult temperament, internalizing symptoms and conduct problems in childhood also predicted specific symptom dimensions and lower IQ non-specifically predicted increased risk for most dimensions.

Conclusions

The current findings underscore the need for a dimensional approach in evaluating childhood risk factors for obsessions and compulsions.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allsopp, M, Verduyn, C (1990). Adolescents with obsessive-compulsive disorder: a case note review of consecutive patients referred to a provincial regional adolescent psychiatry unit. Journal of Adolescence 13, 157169.CrossRefGoogle ScholarPubMed
Alsobrook, JP, Leckman, JF, Goodman, WK, Rasmussen, SA, Pauls, DL (1999). Segregation analysis of obsessive-compulsive disorder using symptom-based factor scores. American Journal of Medical Genetics 88, 669675.3.0.CO;2-N>CrossRefGoogle Scholar
Arnheim, D, Sinclair, W (1974). The Clumsy Child. Mosby: St Louis, MO.Google Scholar
Baer, L (1994). Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. Journal of Clinical Psychiatry 55, 1823.Google ScholarPubMed
Bayley, N (1969). Bayley Scales of Infant Development: Birth to Two Years. Psychological Corporation: New York.Google Scholar
Bejerot, S, Schlette, P, Ekselius, L, Adolfson, R, von Knorring, L (1998). Personality disorders and relation to personality dimensions measured by the Temperament and Character Inventory in patients with obsessive-compulsive disorder. Acta Psychiatrica Scandinavica 98, 243249.CrossRefGoogle Scholar
Bloch, MH, Landeros-Weisenberger, A, Rosario, MC, Pittenger, C, Leckman, JF (2008). Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry 165, 15321542.CrossRefGoogle ScholarPubMed
Bolton, D, Raven, P, Madronal-Luque, R, Marks, IM (2000). Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment. Behaviour Research and Therapy 38, 695708.CrossRefGoogle ScholarPubMed
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585599.CrossRefGoogle Scholar
Cannon, M, Caspi, A, Moffitt, TE, Harrington, H, Taylor, A, Murray, RM, Poulton, R (2002). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449456.CrossRefGoogle ScholarPubMed
Capstick, N, Seldrup, J (1977). Obsessional states. Acta Psychiatrica Scandinavica 56, 427431.CrossRefGoogle Scholar
Caspi, A, Begg, D, Dickson, N, Harrington, H, Langley, J, Moffitt, TE, Silva, PA (1997). Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study. Journal of Personality and Social Psychology 73, 10521063.CrossRefGoogle ScholarPubMed
Caspi, A, Silva, PA (1995). Temperamental qualities at age three predict personality traits in young adulthood: longitudinal evidence from a birth cohort. Child Development 66, 486498.CrossRefGoogle ScholarPubMed
Chamberlain, SR, Blackwell, AD, Fineberg, NA, Robbins, TW, Sahakian, BJ (2005). The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neuroscience and Biobehavioral Reviews 29, 399419.CrossRefGoogle ScholarPubMed
Chamberlain, SR, Fineberg, NA, Blackwell, AD, Robbins, TW, Sahakian, BJ (2006). Motor inhibition and cognitive flexibility in obsessive compulsive disorder and trichotillomania. American Journal of Psychiatry 163, 12821284.CrossRefGoogle ScholarPubMed
Church, AT (1994). Relating the Tellegen and five-factor models of personality structure. Journal of Personality and Social Psychology 67, 898909.CrossRefGoogle ScholarPubMed
Cohen, P, Cohen, J (1984). The clinician's illusion. Archives of General Psychiatry 41, 11781182.CrossRefGoogle ScholarPubMed
Costa, PT Jr., McCrae, RR (1985). NEO Five-Factor Inventory: Form S. Psychological Assessment Resources: Odessa, FL.Google Scholar
Craske, MG, Poulton, R, Tsao, JCI, Plotkin, D (2001). Paths to panic disorder/agoraphobia: an exploratory analysis from age 3 to 21 in an unselected birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry 40, 556563.CrossRefGoogle Scholar
Cromer, KR, Schmidt, NB, Murphy, DL (2007). An investigation of traumatic life events and obsessive-compulsive disorder. Behaviour Research and Therapy 45, 16831691.CrossRefGoogle ScholarPubMed
de Silva, P, Marks, M (1999). The role of traumatic experiences in the genesis of obsessive-compulsive disorder. Behaviour Research and Therapy 37, 941951.CrossRefGoogle ScholarPubMed
Douglass, HM, Moffitt, TE, Dar, R, McGee, R, Silva, P (1995). Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors. Journal of the American Academy of Child and Adolescent Psychiatry 34, 14241431.CrossRefGoogle Scholar
Eisen, JL, Goodman, WK, Keller, MB, Warshaw, MG, DeMarco, LM, Luce, DD, Rasmussen, SA (1999). Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. Journal of Clinical Psychiatry 60, 346351.CrossRefGoogle ScholarPubMed
Eisen, JL, Mancebo, MA, Pinto, A, Coles, ME, Pagano, ME, Stout, R, Rasmussen, SA (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry 47, 270275.CrossRefGoogle ScholarPubMed
Elander, J, Rutter, M (1996). Use and development of the Rutter Parents' and Teachers' scales. International Journal of Methods in Psychiatric Research 6, 6378.3.3.CO;2-M>CrossRefGoogle Scholar
Elley, WB, Irving, JC (1976). Revised socio-economic index for New Zealand. New Zealand Journal of Educational Studies 11, 2536.Google Scholar
Eysenck, HJ (1947). Dimensions of Personality. Praeger: New York.Google Scholar
Fontenelle, LF, Hasler, G (2008). The analytical epidemiology of obsessive-compulsive disorder: risk factors and correlates. Progress in Neuro-Psychopharmacology and Biological Psychiatry 32, 115.CrossRefGoogle ScholarPubMed
Fontenelle, LF, Mendlowicz, MV, Mattos, P, Versiani, M (2006). Neuropsychological findings in obsessive-compulsive disorder and its potential implications for treatment. Current Psychiatry Reviews 2, 1126.CrossRefGoogle Scholar
Freeman, JB, Leonard, HL (2000). Sexual obsessions in obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry 39, 141142.CrossRefGoogle ScholarPubMed
Fullana, MA, Mataix-Cols, D, Caspi, A, Harrington, H, Grisham, JR, Moffitt, TE, Poulton, R (2009). Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. American Journal of Psychiatry 166, 329336.CrossRefGoogle ScholarPubMed
Fullana, MA, Vilagut, G, Rojas-Farreras, S, Mataix-Cols, D, de Graaf, R, Demyttenaere, K, Haro, JM, de Girolamo, G, Lépine, JP, Matschinger, H, Alonso, J (2010). Obsessive-compulsive symptom dimensions in the general population: results from an epidemiological study in six European countries. Journal of Affective Disorders 124, 291299.CrossRefGoogle ScholarPubMed
Geller, DA, Wieland, N, Carey, K, Vivas, F, Petty, CR, Johnson, J, Reichert, E, Pauls, D, Biederman, J (2008). Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology 18, 373379.Google ScholarPubMed
Goldsmith, HH, Gottesman, II (1981). Origins of variation in behavioral style: a longitudinal study of temperament in young twins. Child Development 52, 91–103.CrossRefGoogle Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale–Brown Obsessive–Compulsive Scale. I. Development, use and reliability. Archives of General Psychiatry 46, 10061011.CrossRefGoogle ScholarPubMed
Gothelf, D, Aharonovsky, O, Horesh, N, Carty, T, Apter, A (2004). Life events and personality factors in children and adolescents with obsessive-compulsive disorder and other anxiety disorders. Comprehensive Psychiatry 45, 192198.CrossRefGoogle ScholarPubMed
Grabe, HJ, Ruhrmann, S, Spitzer, C, Josepeit, J, Ettelt, S, Buhtz, F, Hochrein, A, Schulze-Rauschenbach, S, Meyer, K, Kraft, S, Reck, C, Pukrop, R, Klosterkotter, J, Falkai, P, Maier, W, Wagner, M, John, U, Freyberger, HJ (2008). Obsessive-compulsive disorder and posttraumatic stress disorder. Psychopathology 41, 129134.CrossRefGoogle ScholarPubMed
Grisham, JR, Anderson, TM, Poulton, R, Moffitt, TE, Andrews, G (2009). Childhood neuropsychological deficits associated with adult obsessive-compulsive disorder. British Journal of Psychiatry 195, 138141.CrossRefGoogle ScholarPubMed
Grisham, JR, Anderson, TM, Sachdev, PS (2008). Genetic and environmental influences on obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience 258, 107116.CrossRefGoogle ScholarPubMed
Hasler, G, Pinto, A, Greenberg, BD, Samuels, J, Fyer, A, Pauls, DL, Knowles, JA, McCracken, JT, Piacentini, J, Riddle, MA, Rauch, SL, Rasmussen, SA, Willour, VL, Grados, MA, Cullen, B, Bienvenu, OJ III, Shugart, YY, Liang, KY, Rudolf, HS, Wang, Y, Ronquillo, J, Nestadt, G, Murphy, DL (2007). Familiality of factor-analysis-derived YBOCS dimensions in OCD-affected sibling pairs from the OCD collaborative genetics study. Biological Psychiatry 61, 617625.CrossRefGoogle ScholarPubMed
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, 324329.CrossRefGoogle ScholarPubMed
Hollander, E, Kaplan, A, Schmeidler, J, Yang, H, Li, D, Koran, LM, Barbato, LM (2005). Neurological soft signs as predictors of treatment response to selective serotonin reuptake inhibitors in obsessive-compulsive disorder. Journal of Neuropsychiatry and Clinical Neuroscience 17, 472477.CrossRefGoogle ScholarPubMed
Hollander, E, Schiffman, E, Cohen, B, Rivera-Stein, MA, Rosen, W, Gorman, JM, Fyer, A, Papp, L, Liebowitz, MR (1990). Signs of central nervous system dysfunction in obsessive-compulsive disorder. Archives of General Psychiatry 47, 2732.CrossRefGoogle ScholarPubMed
Ingram, IM (1961). Obsessional illness in mental hospital patients. Journal of Mental Science 107, 382402.CrossRefGoogle ScholarPubMed
Ivarsson, T, Winge-Westholm, C (2004). Temperamental factors in children and adolescents with obsessive-compulsive disorder (OCD) and in normal controls. European Child and Adolescent Psychaitry 13, 365372.CrossRefGoogle ScholarPubMed
Jaisoorya, TS, Janardhan Reddy, YC, Srinath, S, Thennarasu, K (2009). Sex differences in Indian patients with obsessive-compulsive disorder. Comprehensive Psychiatry 50, 7075.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.CrossRefGoogle ScholarPubMed
Khanna, S, Rajendra, PN, Channabasavanna, SM (1988). Life events and onset of obsessive compulsive disorder. International Journal of Social Psychiatry 34, 305309.CrossRefGoogle ScholarPubMed
Koenen, KC, Moffitt, TE, Roberts, AL, Martin, LT, Kubzansky, L, Harrington, H, Poulton, R, Caspi, A (2009). Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. American Journal of Psychiatry 166, 5057.CrossRefGoogle ScholarPubMed
Koran, LM, Thienemann, M, Davenport, R (1996). Quality of life for patients with obsessive-compulsive disorder. American Journal of Psychiatry 153, 783788.Google ScholarPubMed
Kusunoki, K, Sato, T, Taga, C, Yoshida, T, Komori, K, Narita, T, Hirano, S, Iwata, N, Ozaki, N (2000). Low novelty-seeking differentiates obsessive-compulsive disorder from major depression. Acta Psychiatrica Scandinavica 101, 403405.CrossRefGoogle ScholarPubMed
Labad, J, Menchon, JM, Alonso, P, Segalas, C, Jimenez, S, Jaurrieta, N, Leckman, JF, Vallejo, J (2008). Gender differences in obsessive-compulsive symptom dimensions. Depression and Anxiety 25, 832838.CrossRefGoogle ScholarPubMed
Leckman, JF, Pauls, DL, Heping, Z, Rosario-Campos, MC, Katsovitch, L, Kidd, KK, Pakstis, AJ, Alsobrook, JP, Robertson, MM, McMahon, WM, Walkup, JT, van de Wetering, BJM, King, RA, Cohen, DJ (2003). Obsessive-compulsive symptom dimensions in affected sibling pairs diagnosed with Gilles de la Tourette syndrome. American Journal of Medical Genetics 116B, 6068.Google ScholarPubMed
Leckman, JF, Rauch, SL, Mataix-Cols, D (2007). Symptom dimensions in obsessive-compulsive disorder: implications for the DSM-V. CNS Spectrums 12, 376387.CrossRefGoogle ScholarPubMed
Lensi, P, Cassano, G, Correddu, G, Ravagli, S, Kunovac, J, Akiskal, H (1996). Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender- related differences. British Journal of Psychiatry 169, 101107.CrossRefGoogle ScholarPubMed
Lewis, A (1935). Problems of obsessional illness. Proceedings of the Royal Society of Medicine 29, 325336.CrossRefGoogle Scholar
Lochner, C, du Toit, PL, Zungu-Dirwayi, N, Marais, A, van Kradenburg, J, Curr, B, Seedat, R, Niehaus, DJH, Stein, DJ (2002). Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controls. Depression and Anxiety 15, 6668.CrossRefGoogle ScholarPubMed
Lochner, C, Mogotsi, M, du Toit, PL, Kaminer, D, Niehaus, DJ, Stein, DJ (2003). Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology 36, 255262.CrossRefGoogle ScholarPubMed
Lyoo, IK, Lee, DW, Kim, YS, Kong, SW, Kwon, JS (2001). Patterns of temperament and character in subjects with obsessive-compulsive disorder. Journal of Clinical Psychiatry 62, 637641.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Alonso, P, Hernandez, R, Deckersbach, T, Savage, CR, Menchon, JM, Vallejo, J (2003). Relation of neurological soft signs to nonverbal memory performance in obsessive-compulsive disorder. Journal of Clinical and Experimental Neuropsychology 25, 842851.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Rauch, S, Manzo, P, Jenike, M, Baer, L (1999). Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry 156, 14091416.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Rosario-Campos, MC, Leckman, JF (2005). A multidimensional model of obsessive compulsive disorder. American Journal of Psychiatry 162, 228238.CrossRefGoogle ScholarPubMed
McCarthy, D (1972). Manual for the McCarthy Scales of Children's Abilities. Psychological Corporation: New York.Google Scholar
McKeon, J, Roa, B, Mann, A (1984). Life events and personality traits in obsessive-compulsive neurosis. British Journal of Psychiatry 144, 185189.CrossRefGoogle ScholarPubMed
Newman, DL, Moffitt, TE, Caspi, A, Magdol, L, Silva, PA, Stanton, WR (1996). Psychiatric disorder in a birth cohort of young adults: prevalence, comorbidity, clinical significance, and new case incidence from ages 11 to 21. Journal of Consulting and Clinical Psychology 64, 552562.CrossRefGoogle Scholar
Patrick, CJ, Curtin, JJ, Tellegen, A (2002). Development and validation of a brief form of the Multidimensional Personality Questionnaire. Psychological Assessment 14, 150163.CrossRefGoogle ScholarPubMed
Pauls, DL (2008). The genetics of obsessive compulsive disorder: a review of the evidence. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 148C, 133139.CrossRefGoogle ScholarPubMed
Pfohl, B, Black, D, Noyes, R, Kelley, M, Blum, N (1990). A test of the tridimensional personality theory: association with diagnosis and platelet imipramine binding in obsessive-compulsive disorder. Biological Psychiatry 28, 4146.CrossRefGoogle ScholarPubMed
Pitman, RK (1993). Posttraumatic obsessive-compulsive disorder: a case study. Comprehensive Psychiatry 34, 102107.CrossRefGoogle ScholarPubMed
Poulton, R, Caspi, A, Milne, BJ, Thomson, WM, Taylor, A, Sears, MR, Moffitt, TE (2002). Association between children's experience of socioeconomic disadvantage and adult health: a life-course study. Lancet 360, 16401645.CrossRefGoogle Scholar
Rachman, S (1994). Pollution of the mind. Behaviour Research and Therapy 32, 311314.CrossRefGoogle ScholarPubMed
Rachman, S (2004). Fear of contamination. Behaviour Research and Therapy 42, 12271255.CrossRefGoogle ScholarPubMed
Rasmussen, S, Tsuang, M (1986). Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatry 143, 317322.Google ScholarPubMed
Richter, MA, Summerfeldt, LJ, Joffe, RT, Swinson, RP (1996). The Tridimensional Personality Questionnaire in obsessive-compulsive disorder. Psychiatry Research 65, 185188.CrossRefGoogle ScholarPubMed
Riggs, DS (2000). Treatment of concurrent PTSD and OCD: a commentary on the case of Howard. Cognitive and Behavioral Practice 7, 130132.CrossRefGoogle Scholar
Robins, LN, Cottler, L, Bucholz, K, Compton, W (1995). Diagnostic Interview Schedule for DSM-IV. Washington University Press: St Louis, Missouri.Google Scholar
Rosenberg, DR, MacMillan, S (2002). Imaging and neurocircuitry of OCD. In Neuropsychopharmacology. The Fifth Generation of Progress (ed. Davis, K., Nemeroff, C. B., Coyle, J. and Charney, D.), pp. 16211646. Lippincott Williams & Wilkins: Baltimore.Google Scholar
Ruscio, AM, Stein, DJ, Chiu, WT, Kessler, RC (2008). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry 15, 5363.CrossRefGoogle ScholarPubMed
Samuels, J, Nestadt, G, Bienvenu, OJ III, Costa, PT, Riddle, MA, Liang, KY (2000). Personality disorders and normal personality dimensions in obsessive-compulsive disorder: results from the John Hopkins OCD Family Study. British Journal of Psychiatry 177, 457462.CrossRefGoogle Scholar
Santangelo, SL, Pauls, DL, Goldstein, JM, Faraone, SV, Tsuang, MT, Leckman, JF (1994). Tourette's syndrome: what are the influences of gender and comorbid obsessive-compulsive disorder? Journal of the American Academy of Child and Adolescent Psychiatry 33, 795804.CrossRefGoogle ScholarPubMed
Stanton, WR, McGee, R, Silva, A (1991). Indices of perinatal complications, family background, child rearing, and health as predictors of early cognitive and motor development. Pediatrics 88, 954959.Google ScholarPubMed
Stein, DJ, Denys, D, Gloster, AT, Hollander, E, Leckman, JF, Rauch, SL, Phillips, KA (2009). Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatric Clinics of North America 32, 665685.CrossRefGoogle ScholarPubMed
Tellegen, A (1982). Brief Manual for the Multidimensional Personality Questionnaire. University of Minnesota: Minneapolis.Google Scholar
Toro, J, Cervera, M, Osejo, E, Salamero, M (1992). Obsessive-compulsive disorder in children and adolescents: a clinical study. Journal of Child Psychology and Psychiatry 33, 10251037.CrossRefGoogle ScholarPubMed
Tükel, R, Ertekin, E, Batmaz, S, Alyanak, F, Sözen, A, Aslanta, B, Atl, H, Ozyildirim, I (2005). Influence of age of onset on clinical features in obsessive-compulsive disorder. Depression and Anxiety 21, 112117.CrossRefGoogle ScholarPubMed
Vasconcelos, MS, Sampaio, AS, Hounie, AG, Akkerman, F, Curi, M, Lopes, AC, Miguel, EC (2007). Prenatal, perinatal, and postnatal risk factors in obsessive–compulsive disorder. Biological Psychiatry 61, 301307.CrossRefGoogle ScholarPubMed
Wechsler, D (1974). Manual for the Wechsler Intelligence Scale for Children – Revised. Psychological Corporation: New York.Google Scholar
WHO (1999). The ‘Newly Defined’ Burden of Mental Problems. Fact sheet no. 217. World Health Organization: Geneva, Switzerland.Google Scholar
Zohar, AH, Ratzoni, G, Pauls, DL, Apter, A, Bleich, A, Kron, S, Rappaport, M, Weizman, A, Cohen, DJ (1992). An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 31, 10571061.CrossRefGoogle ScholarPubMed