Male Sex, Comorbid Psychiatric Conditions, Romantic Status Linked to Faster Progression to OCD

It takes an average of seven years for people who have some, but not all, symptoms of obsessive-compulsive disorder (subthreshold OCD) to develop full-blown OCD, according to a study in the Journal of Affective Disorders. The study also suggests that certain characteristics, such as male sex, the presence of other psychiatric conditions, and romantic status, may be associated with a faster transition from subthreshold OCD to OCD.

Emma M. Thompson, a Ph.D. candidate at Monash University in Australia, and colleagues examined data from 954 patients who were enrolled in treatment centers in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders between 2003 and 2009. The average age of the patients was 35 years; 358 were married, 520 were single, and 62 were divorced. Most were not working at the time of the assessment, and about half had a family history of OCD.

Every three years, consortium researchers interviewed and evaluated the patients using standardized assessment tools such as the Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV, among others. They found that males, patients with agoraphobia (fear of open or crowded places) without panic disorder, and patients with bipolar II disorder transitioned from subthreshold OCD to OCD in five years on average, compared with the overall average of seven years. Other characteristics associated with faster transition included greater severity of sexual/religious symptoms, lower severity of hoarding and general compulsive symptoms, and higher rates of current generalized anxiety disorder.

Patients whose symptoms were believed to be associated with their romantic status, such as being in love, starting an intimate relationship, or being about to wed, also transitioned from subthreshold OCD to OCD more quickly. The researchers wrote that it is difficult to speculate on the exact direction of the relationship between romantic status and transition to full-blown OCD. However, they noted that limerence, an involuntary state composed of intrusive romantic thoughts and concern over whether one’s romantic feelings are reciprocated, is associated with OCD.

“Rapid progression to the clinical level … may indicate the existence of a vulnerable population for whom the implementation of early interventions may be particularly relevant,” the researchers concluded.

For related information, see the American Journal of Psychiatry article “Cortical Abnormalities Associated With Pediatric and Adult Obsessive-Compulsive Disorder: Findings From the ENIGMA Obsessive-Compulsive Disorder Working Group.”

(Image: iStock/BartekSzewczyk)

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