Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-16T16:15:50.620Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  07 September 2009

C. de Bruijn ,
S. Beun ,
R. de Graaf ,
M. ten Have  and
D. Denys
C. de Bruijn*
Affiliation:
Sint Franciscus Gasthuis, GGZ Delfland, Rotterdam, The Netherlands
S. Beun
Affiliation:
University Medical Centre of Utrecht, The Netherlands
R. de Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
M. ten Have
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
D. Denys
Affiliation:
Academic Medical Centre, Amsterdam, The Netherlands
*
*Address for correspondence: C. de Bruijn, M.D., Ph.D., Sint Franciscus Gasthuis, Kleiweg 100, 3045 PM Rotterdam, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In this study we compared subjects with obsessive and/or compulsive symptoms who did not meet all criteria for obsessive–compulsive disorder (OCD) (subthreshold subjects) to subjects with full-blown OCD and also to subjects without obsessions or compulsions.

Method

The data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the general Dutch population (n=7076). Using the Composite International Diagnostic Interview, Version 1.1 (CIDI 1.1), three groups were distinguished: subjects without lifetime obsessions or compulsions (94.2%), subthreshold subjects (4.9%) and subjects with full-blown OCD according to DSM-III-R (0.9%). These three groups were compared on various items, including psychological vulnerability, health and functional status, psychiatric co-morbidity and seeking treatment.

Results

Subthreshold and OCD subjects had similar scores on the majority of the items measured. Thus, there was little difference between subthreshold and OCD subjects in health, functional status, psychological vulnerability and psychiatric co-morbidity. However, OCD and subthreshold subjects scored worse on most of these items when compared to the controls without obsessions or compulsions.

Conclusion

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.

Keywords

Compulsionsdiagnostic thresholdobsessionsobsessive–compulsive disorderssubclinical disorders
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 6 , June 2010 , pp. 989 - 997
Copyright
Copyright © Cambridge University Press 2009

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

Aaronson, NK, Muller, M, Cohen, PD, Essink-Bot, ML, Fekkes, M, Sanderman, R, Sprangers, MA, te Velde, A, Verrips, E (1998). Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. Journal of Clinical Epidemiology 51, 1055–1068.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, text revision (DSM-III-TR). American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Batelaan, N, De Graaf, R, Van Balkom, A, Vollebergh, W, Beekman, A (2007). Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder. Psychological Medicine 37, 247–256.CrossRefGoogle ScholarPubMed
Bijl, RV, Ravelli, A, van Zessen, G (1998 a). Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 33, 587–595.CrossRefGoogle ScholarPubMed
Bijl, RV, van Zessen, G, Ravelli, A, de Rijk, C, Langendoen, Y (1998 b). The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design. Social Psychiatry and Psychiatric Epidemiology 33, 581–586.CrossRefGoogle ScholarPubMed
Chern, JY, Wan, TTH, Pyles, M (2000). The stability of health status measurement (SF-36) in a working population. Journal of Outcome Measures 4, 461–481.Google Scholar
Cottler, LB, Robins, LN, Grant, BF, Blaine, J, Towle, LH, Wittchen, HU, Satorius, N (1991). The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA field trial. British Journal of Psychiatry 159, 653–658.CrossRefGoogle ScholarPubMed
Crino, R, Slade, T, Andrews, G (2005). The changing prevalence and severity of obsessive-compulsive disorder criteria from DSM-III to DSM-IV. American Journal of Psychiatry 162, 876–882.CrossRefGoogle ScholarPubMed
Cuijpers, P, de Graaf, R, van Dorsselaer, S (2004). Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. Journal of Affective Disorders 79, 71–79.CrossRefGoogle ScholarPubMed
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 160, 346–351.CrossRefGoogle Scholar
Evers, AV, van Vliet-Mulder, JC, Groot, CJ (2000). Documentation of Tests and Test Research in the Netherlands: Part 2 Test Research [in Dutch]. Van Gorcum: Assen.Google Scholar
Fontenelle, LF, Mendlowicz, MV, Versiani, M (2006). The descriptive epidemiology of obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 30, 327–337.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, 329–336.CrossRefGoogle ScholarPubMed
Grabe, HJ, Meyer, Ch, Hapke, U, Rumpf, HJ, Freyberger, HJ, Dilling, H, John, U (2000). Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. European Archives of Psychiatry and Clinical Neuroscience 250, 262–268.CrossRefGoogle ScholarPubMed
Hollander, E (1997). Obsessive-compulsive disorder: the hidden epidemic. Journal of Clinical Psychiatry 58 (Suppl. 12), 3–6.Google ScholarPubMed
Jacobi, F, Wittchen, HU, Holting, C, Höfler, M, Pfister, H, Müller, N, Lieb, R (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological Medicine 34, 597–611.CrossRefGoogle ScholarPubMed
Karno, M, Golding, JM, Sorenson, SB, Burnam, MA (1998). The epidemiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry 45, 1094–1099.CrossRefGoogle Scholar
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kim, MS, Jang, KM, Kim, BN (2009). The neuropsychological profile of a subclinical obsessive-compulsive sample. Journal of the International Neuropsychological Society 15, 286–290.CrossRefGoogle ScholarPubMed
Komiti, AA, Jackson, HJ, Judd, FK, Cockram, AM, Kyrios, M, Yeatman, R, Murray, G, Hordern, C, Wainwright, K, Allen, N, Singh, B (2001). A comparison of the Composite International Diagnostic Interview (CIDI-Auto) with clinical assessment in diagnosing mood and anxiety disorders. Australian and New Zealand Journal of Psychiatry 35, 224–230.CrossRefGoogle ScholarPubMed
Mohammadi, MR, Ghanizadeh, A, Rahgozar, M, Noorbala, AA, Davidian, H, Afzali, HM, Naghavi, HR, Yazdi, SAB, Saberi, SM, Mesgarpour, B, Akhondzadeh, S, Alaghebanrad, J, Tehranidoost, M (2004). Prevalence of obsessive-compulsive disorder in Iran. BMC Psychiatry 4, 2.CrossRefGoogle ScholarPubMed
Peters, L, Andrews, G (1995). Procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) in the anxiety disorders. Psychological Medicine 25, 1269–1280.CrossRefGoogle ScholarPubMed
Ruscio, AM, Stein, DJ, Chiu, WT, Kessler, RC (in press). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry.Google Scholar
Skoog, G, Skoog, I (1999). A 40-year follow-up of patients with obsessive-compulsive disorder. Archives of General Psychiatry 56, 121–127.CrossRefGoogle ScholarPubMed
Stein, MB, Forde, DR, Anderson, G, Walker, JR (1997). Obsessive-compulsive disorder in the community: an epidemiologic survey with clinical reappraisal. American Journal of Psychiatry 154, 1120–1126.Google ScholarPubMed
Steketee, G, Eisen, J, Dyck, I, Warshaw, M, Rasmussen, S (1999). Predictors of course in obsessive-compulsive disorder. Psychiatry Research 89, 229–238.CrossRefGoogle ScholarPubMed
Rasmussen, SA, Eisen, JL (1998) The epidemiology and clinical features of obsessive-compulsive disorder. In Obsessive-Compulsive Disorders: Practical Management, 3rd edn (Jenike, M. A., Baer, L. and Minichiello, W. E.), Mosby, Inc.: St Louis.Google Scholar
Reddy, YC, D'Souza, SM, Shetti, C, Kandavel, T, Deshpande, S, Badamath, S, Singisetti, S (2005). An 11- to 13-year follow-up of 75 subjects with obsessive-compulsive disorder. Journal of Clinical Psychiatry 66, 744–749.CrossRefGoogle ScholarPubMed