Sex differences in the phenotypic expression of obsessive-compulsive disorder: an exploratory study from Brazil

Comparison of autogenous and reactive type obsessive-compulsive disorders in terms of clinical characteristics: A meta-analysis study

Obsessive-compulsive disorder (OCD) has been divided into two subgroups autogenous and reactive types, based on obsessive symptoms. To our knowledge, no meta-analysis study compares sociodemographic and clinical characteristics. Investigation of the differences between the two groups in terms of these basic characteristics may provide information about the accuracy of this classification. This is the first meta-analysis to examine gender, age at onset and some clinical differences between patients with autogenous and reactive OCD. Electronic bibliographic databases of Scopus and PubMed were searched up to March 2024. Random effect models were conducted for this meta-analysis. The analysis was carried out using the standardized mean difference as the outcome measure. Publication bias was evaluated using the Begg and Eggers funnel plot, and fail-safe N calculation using the Rosenthal approach. The current meta-analysis summarizes the data from primary studies comparing the gender rates, age at onset of OCD, severity of obsessive-compulsive symptoms, and severity of depression and anxiety symptoms between autogenous and reactive types of OCD. The results of this study showed that the rate of male gender was higher in the autogenous type OCD. In addition, increased severity of anxiety, and depression were associated with autogenous type OCD. There was no significant difference between groups regarding the severity of obsessive-compulsive symptoms. Age of OCD onset findings were insignificant, but excluding an outlier study suggested earlier onset in autogenous type OCD. These results support the distinction between autogenous and reactive type OCD.

Early-onset obsessive-compulsive disorder: Sociodemographic and clinical characterization of a large outpatient cohort

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition characterized by a wide variety of phenotypic expressions. Several studies have reinforced the hypothesis of OCD heterogeneity by proposing subtypes based on predominant symptomatology, course, and comorbidities. Early-onset OCD (EO) could be considered a neurodevelopmental subtype of OCD, with evidence of distinct neurocircuits supporting disease progression. To deepen the heterogeneous nature of the disorder, we analyzed sociodemographic and clinical differences between the EO and late-onset (LO) subtypes in a large outpatient cohort.

METHODS

Two hundred and eighty-four patients diagnosed with OCD were consecutively recruited from the OCD Tertiary Clinic at Luigi Sacco University Hospital in Milan. Sociodemographic and clinical variables were analyzed for the entire sample and compared between the two subgroups (EO, age <18 years [n = 117,41.2 %]; LO: late-onset, age ≥18 years [n = 167, 58.8 %]).

RESULTS

The EO group showed a higher frequency of male gender (65 % vs 42.5 %, p < .001), and a higher prevalence of Tic and Tourette disorders (9.4 % vs 0 %, p < .001) compared to the LO group. Additionally, in the EO subgroup, a longer duration of untreated illness was observed (9.01 ± 9.88 vs 4.81 ± 7.12; p < .001), along with a lower presence of insight (13.8 % vs. 7.5 %, p < .05).

CONCLUSIONS

The early-onset OCD subtype highlights a more severe clinical profile compared to the LO group. Exploring distinct manifestations and developmental trajectories of OCD can contribute to a better definition of homogeneous subtypes, useful for defining targeted therapeutic strategies for treatment.

Gender-related romantic attachment and serum oxytocin level difference in adult patients with obsessive compulsive disorder

Background

Given the scarcity of data on gender-related romantic attachment changes and the potential role of oxytocin (OT) in the pathophysiology of obsessive-compulsive illness (OCD), the current study aimed to assess gender-related differences in romantic attachment characteristics and their relationship to serum oxytocin in a set of forty OCD cases compared with a similar group of healthy controls .Simultaneously examining the gender differences in serum oxytocin levels in OCD patients, the diagnosis of OCD patients was determined using DSM-5 criteria, and the severity of OCD was determined using the Y-BOCS rating scale. All of the patients were drug-free and not depressed. The romantic attachment was assessed using the “Experiences in Close Relationship” Questionnaire. Standard ELISA kits were used to assess plasma OT levels.

Results

Regarding romantic attachments, patients with obsessive compulsive disorder scored higher on the anxiety and avoidance domains than controls with no significant gender difference. Serum oxytocin was higher in patients with OCD than in healthy controls, indicating a possible underlying pathophysiology of the illness. Also, there was a significant gender difference, with female patients having higher serum oxytocin and symptoms severity being negatively associated.

Conclusions

Taken together, these findings propose that OT may play a role in OCD pathophysiology with gender specificity. Also, OCD associated with insecure romantic attachment.

Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis

Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs. Systematic Review Registration: Unique Identifier: CRD42020215904.

Psychiatric comorbidities of obsessive-compulsive disorder: A series of systematic reviews and meta-analyses

OBJECTIVE

Although there is a growing number of studies on psychiatric comorbidities of obsessive-compulsive disorder (OCD), controversy remains about the strength of associations between some disorders. We present a series of systematic reviews and meta-analyses examining four psychiatric disorders frequently associated with OCD-depression, bipolar disorder, substance abuse disorder and psychosis.

METHODS

Three electronic databases were searched up to May 2017; PsycINFO, Medline, and Web of Science. Meta-analyses using random effects models were conducted.

RESULTS

The meta-analyses found strong associations between all comorbidities and OCD, particularly for depression. In addition, a series of systematic reviews were conducted giving information about the characteristics of these psychiatric associations.

CONCLUSION

It is probable that these disorders share common etiological factors, and thus trans-diagnostic processes must be addressed when offering treatment. Clinical implications of these findings are discussed with suggestions for further research in the area.

Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates

Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.

Are There Familial Patterns of Symptom Dimensions in Obsessive-Compulsive Disorder?

Background: Obsessive-compulsive disorder (OCD) is a heterogeneous illness, and emerging evidence suggests that different symptom dimensions may have distinct underlying neurobiological mechanisms. We aimed to look for familial patterns in the occurrence of these symptom dimensions in a sample of families with at least two individuals affected with OCD. Methods: Data from 153 families (total number of individuals diagnosed with DSM-5 OCD = 330) recruited as part of the Accelerator Program for Discovery in Brain Disorders using Stem Cells (ADBS) was used for the current analysis. Multidimensional Item Response Theory (IRT) was used to extract dimensional scores from the Yale-Brown Obsessive-Compulsive Scale (YBOCS) checklist data. Using linear mixed-effects regression models, intra-class correlation coefficients (ICC), for each symptom dimension, and within each relationship type were estimated. Results: IRT yielded a four-factor solution with Factor 1 (Sexual/Religious/Aggressive), Factor 2 (Doubts/Checking), Factor 3 (Symmetry/Arranging), and Factor 4 (Contamination/Washing). All except for Factor 1 were found to have significant ICCs, highest for Factor 3 (0.41) followed by Factor 4 (0.29) and then Factor 2 (0.27). Sex-concordant dyads were found to have higher ICC values than discordant ones, for all the symptom dimensions. No major differences in the ICC values between parent-offspring and sib-pairs were seen. Conclusions: Our findings indicate that there is a high concordance of OCD symptom dimensions within multiplex families. Symptom dimensions of OCD might thus have significant heritability. In view of this, future genetic and neurobiological studies in OCD should include symptom dimensions as a key parameter in their analyses.

Social losses predict a faster onset and greater severity of obsessive-compulsive disorder

BACKGROUND

While stressful life events increase the risk of developing a range of psychiatric disorders, including obsessive-compulsive disorder (OCD), their ability to precipitate specific obsessive-compulsive symptoms' dimensions is unknown. Here we aimed to evaluate the potential role of three different types of stressful life events, herein termed losses (death of a loved one, termination of a romantic relationship and severe illness) in predicting the speed of progression from subclinical to clinical OCD and the severity of specific OCD dimensions in a large multicentre OCD sample.

METHODS

Nine hundred and fifty-four OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used, including the Structured Clinical Interview for DSM-IV Axis I Disorders, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Yale OCD Natural History Questionnaire. Regression models investigated the interaction between types of loss and gender to predict speed of progression from subclinical obsessive-compulsive symptoms to OCD, and the severity of five symptom dimensions.

RESULTS

While termination of a relationship was associated with a faster speed of progression from subthreshold to clinical OCD, the death of a loved one was associated with increased severity of hoarding symptoms. There was also an interaction between gender and experiences of death, which predicted a faster speed of progression to OCD in males.

CONCLUSIONS

Stressful life events have the ability to accelerate the progression from subclinical to clinical OCD, as well as impact the severity of specific OCD dimensions. Gender also plays a role in both the progression and severity of symptoms. These findings suggest that stressful life events may represent a marker to identify individuals at risk of progressing to clinical OCD.

Reduced anterior cingulate glutamate of comorbid skin-picking disorder in adults with obsessive-compulsive disorder

BACKGROUND

Obsessive Compulsive Disorder (OCD) is characterized by hyperactivity in a network of forebrain structures, including the anterior cingulate cortex (ACC). Convergent evidence suggests that glutamatergic dysfunction may contribute to the disorder. Skin picking disorder (SPD) was listed as one of the obsessive-compulsive and related disorders, which is often comorbid with OCD and share overlapping phenomenology and pathophysiology. However, potential confounding effects between the two diagnostic effects on neurotransmitter levels remain largely unexamined.

METHODS

We examined the pregenual anterior cingulate cortex (pACC) glutamate and other neurochemicals in 62 subjects using a single-voxel acquisition 1H MRS at 3Tesla; of these, 47 subjects yielded usable measurements of both glutamate and glutamine and were included in the analysis (17 medicated with OCD alone, 13 medicated with comorbid OCD + SPD, 17 healthy control).

RESULTS

OCD with comorbid SPD showed significantly lower pACC glutamate than in patients without SPD (p = 0.001) or control subjects (p = 0.035). OCD without SPD subjects showed pACC glutamate levels indistinguishable from controls (p = 0.501). In the OCD with SPD subjects, glutamate was correlated with Y-BOCS total score in female patients (n = 9, r = 0.69, p = 0.041).

LIMITATIONS

The main limitation of the study was the cross-sectional data. Our patients were on SSRI medication which may have modified the effect of SPD and OCD interaction on glutamate activity.

CONCLUSION

Our results suggest that alterations of the glutamatergic system may play an important role in the pathophysiology of a subgroup of OCD and reduced pACC glutamate may be a biomarker of a distinct subset of OCD patients.

Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India

Obsessive-compulsive disorder (OCD) is phenotypically heterogeneous. Gender is an important factor mediating this heterogeneity. We examined gender differences in a large sample (n = 945) of OCD patients under a multi-centric study in India. Cross-sectional assessments were done on consecutive adult (>18 years) treatment-seeking patients with a DSM-5 diagnosis of OCD. Subjects were assessed on Structured Clinical Interview for DSM-5-Research Version for comorbid psychiatric illnesses, Yale Brown Obsessive Compulsive Scale for OCD phenomenology and symptom severity, Brown Assessment of Beliefs Scale for insight, Beck's Depression Inventory for severity of depressive symptoms, and the Obsessive Beliefs Questionnaire. On multivariate backward Wald logistic regression analysis, males (59.7%) had more years of education, had a higher rate of checking compulsions and comorbid substance use disorders. Women were more likely to be married, more commonly reported precipitating factors, had a higher rate of hoarding compulsions and comorbid agoraphobia. Findings from this large study validate gender as an important mediator of phenotypic heterogeneity in OCD. The mechanistic basis for these differences might involve complex interactions between biological, cultural and environmental factors.

Fear extinction in an obsessive-compulsive disorder animal model: Influence of sex and estrous cycle

Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition that affects men and women equally, but with a sexually dimorphic pattern of development. Reproductive cycle events can influence symptom severity of OCD in females, indicating that ovarian hormones or their interaction with distinct neurotransmitter systems may play a role in OCD pathophysiology. Clinical studies and animal models have confirmed the importance of the serotonergic (5-HT) system in the neurobiology and treatment of OCD. Accordingly, the non-selective 5-HT2c agonist, meta-chlorophenylpiperazine (mCPP), exacerbates symptoms in untreated OCD patients. In rodents, it evokes repetitive behaviors that engage brain areas that are homologous with those found to be dysfunctional in OCD patients. These regions, including the medial prefrontal and anterior cingulate cortices, are also involved in fear inhibition, which is impaired in OCD. Here, we treated rats with mCPP (0.5 and 3.0 mg/kg) to evaluate its influence on self-grooming behavior and assess potential fear extinction retention deficits, taking into account sex differences and females' estrous cycle. We found that mCPP exacerbated grooming in male and female rats, irrespective of the estrous cycle phase. Fear extinction retention, however, was impaired only in females. Moreover, females undergoing fear extinction training during the metestrus/diestrus phases of the estrous cycle were more sensitive to the impairments induced by mCPP. Our results indicate that mCPP can induce OCD-like symptoms, exacerbating self-grooming and impairing fear extinction. It suggests that changes in 5-HT signaling through 5-HT2c receptors may have an important role in the OCD pathophysiology and that the influence of gonadal hormones in OCD should be further investigated.

Epidemiology and comorbidity of obsessive-compulsive disorder in late adolescence: a cross-sectional study in senior high schools in Greece

OBJECTIVE

The aim of this study was to examine the epidemiology, comorbidity and use of health services of obsessive-compulsive disorder (OCD) and subclinical obsessive-compulsive symptoms in late adolescence.

METHODS

A total of 2427 adolescents attending senior high schools in Greece were selected for a detailed psychiatric interview using the revised clinical interview schedule (CIS-R). Use of alcohol, nicotine and cannabis, and several socio-demographic and socio-economic variables were also assessed.

RESULTS

The prevalence of OCD was 1.39% (95% confidence interval [CI]: 1.05-1.84) while that of subclinical obsessive-compulsive symptoms was 2.77% (2.22-3.45). There was a female preponderance for subclinical symptoms. Financial difficulties of the family was the only socio-demographic variable that was significantly associated with OCD but not with subclinical symptoms. The pattern of comorbidity was similar for both conditions but milder in the subclinical form. About one in three reported use of general health services and one in ten use of psychiatric services.

CONCLUSIONS

OCD and subclinical obsessive-compulsive symptoms were relatively common. Comorbidity with other psychiatric disorders and use of substances was considerable even in subclinical status, but use of specialised health services was small. Clinical and research implications are discussed.

Ovarian Sex Hormones Modulate Compulsive, Affective and Cognitive Functions in A Non-Induced Mouse Model of Obsessive-Compulsive Disorder

There is currently a lack of understanding of how surgical menopause can influence obsessions, compulsions and associated affective and cognitive functions in female obsessive-compulsive disorder (OCD) patients. Early menopause in women due to surgical removal of ovaries not only causes dramatic hormonal changes, but also may induce affective and cognitive disorders. Here, we tested if surgical removal of ovaries (ovariectomy, OVX), which mimics surgical menopause in humans, would result in exacerbation of compulsive, affective and cognitive behaviors in mice strains that exhibit a spontaneous compulsive-like phenotype. Female mice from compulsive-like BIG, non-compulsive SMALL and randomly-bred Control strains were subjected to OVX or sham-surgery. After 7 days animals were tested for nest building and marble burying to measure compulsive-like behavior. The elevated plus maze and open field tests measured anxiety-like behaviors, while memory was assessed by the novel object recognition. Acute OVX resulted in exacerbation of compulsive-like and anxiety-like behaviors in compulsive-like BIG mice. No significant effects of OVX were observed for the non-compulsive SMALL and Control strains. Object recognition memory was impaired in compulsive-like BIG female mice compared to the Control mice, without an effect of OVX on the BIG mice. We also tested whether 17 β-estradiol (E2) or progesterone (P4) could reverse the effects of OVX. E2, but not P4, attenuated the compulsive-like behaviors in compulsive-like BIG OVX female mice. The actions of the sex steroids on anxiety-like behaviors in OVX females were strain and behavioral test dependent. Altogether, our results indicate that already existing compulsions can be worsened during acute ovarian deprivation concomitant with exacerbation of affective behaviors and responses to hormonal intervention in OVX female mice can be influenced by genetic background.

Adult obsessive-compulsive disorder and quality of life outcomes: A systematic review and meta-analysis

In the current literature, there are no meta-analyses assessing quality of life (QOL) in patients with obsessive-compulsive disorder (OCD). Knowledge of QOL domains mainly impaired in OCD could provide specific areas for intervention. The current meta-analysis assessed differences in global, work and social, family, and emotional QOL outcomes between patients with OCD and heathy controls. Age, gender and OCD severity were examined as moderators. Case-control studies were included if patients with primary OCD were compared with controls on QOL outcomes. Electronic databases (1966-October 2014) were searched. Thirteen case-control studies were included (n=26,015). Patients with OCD had significantly lower scores on QOL relative to controls, with moderate effect sizes on global QOL and large effect size on work and social, emotional and family QOL outcomes. Studies using higher percentages of female patients and patients with less severe OCD symptoms reported significantly lower QOL outcomes for patients with OCD than controls. Studies comparing patients with OCD and patients with other psychiatric disorders were not included. Treatments should address QOL in OCD, particularly emotional QOL. Additional strategies targeting QOL should be implemented for female patients with less severe OCD symptoms.

Factors Associated with Depression in Obsessive-Compulsive Disorder: A Cross-Sectional Study

INTRODUCTION

Major depressive disorder (MDD) is the most frequent comorbid psychiatric condition associated with obsessive-compulsive disorder (OCD). This study aimed to evaluate the prevalence of current depression in OCD, differences in socio-demographic and clinical characteristics, and obsessive-compulsive symptoms between OCD patients with and without depression. Additionally, factors associated with comorbid depression were investigated in our study.

METHODS

In total, 140 OCD patients, of which 63 were OCD patients with MDD (OCD+MDD, n=63) and 77 were OCD patients without depression (OCD-MDD, n=77) were included in the study. All patients were diagnosed with OCD using the Structured Clinical Interview for DSM-IV. The Yale-Brown Obsessive-Compulsive Scale, Beck Anxiety Scale, and Beck Depression Scale were administered to all patients. After the socio-demographic and clinical variables and scales were accomplished, the OCD patients divided into two groups as OCD with or without depression and we compared their mean scores of the variables and scales. Univariate analyses were followed by logistic regression.

RESULTS

There were no significant differences in age, gender, marital status, period without treatment, profession, medical and family history, and social support between the two groups. Anxiety, depression, and obsession and compulsion scores were significantly higher in the OCD+MDD group. The avoidance, insight, instability, and retardation scores of the OCD+MDD group were also significantly higher than those of the OCD-MDD group.

CONCLUSION

Our study suggests that many factors are strongly associated with depression in OCD. Positive correlations between poor insight, severity of obsession and compulsion, and stressful life events during the last six months increased the risk of depression in OCD. Our study suggests that high level of avoidance, instability and retardation, history of suicidal attempt, and delayed treatment are other notable factors associated with the development of depression in OCD.

Predictive value of familiality, stressful life events and gender on the course of obsessive-compulsive disorder

BACKGROUND

Familiality, stressful life events (SLE) and gender significantly affect the onset of obsessive-compulsive disorder (OCD). However, their combined impact on the probability of OCD chronicity is largely unknown. With the objective of clarifying their predictive value, we tested a model of interaction effects between these influences.

METHODS

A sample of 449 patients with OCD was systematically assessed for familial loading, exposure to stressful life events, gender and course of the disease at the OCD referral unit at Bellvitge University Hospital. Multiple ordinal logistic regression was used to test interaction models.

RESULTS

Familiality presented a main negative association with chronicity (OR=0.83, CI97.5%=0.70-0.98). This association was additively moderated by both exposure to SLE before onset and gender, and showed a positive slope among female patients not exposed to SLE before onset (Familiality*SLEbo: OR=0.69, CI97.5%=0.47-1; Familiality*gender: OR=1.30, CI97.5%=0.91-1.84).

LIMITATIONS

The findings are based on cross-sectional data. Assessment of course is based on a retrospective measure, which may imply the possibility of overestimation of chronicity.

CONCLUSIONS

The predictive value of familiality on the course of OCD is only partially informative as both SLEbo and gender modify the association. When other risk factors are included in the model, familiality may predict decreased chances of chronicity. The mediation effects identified could explain the discrepancies found in previous research on this topic. Increased chances of presenting a chronic course of OCD may be found in association with familial vulnerability among female patients not exposed to SLEbo.

Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.

Characterizing impulsivity profile in patients with obsessive-compulsive disorder

OBJECTIVE

Impulsivity represents a key dimension in obsessive-compulsive disorder (OCD), in relation to outcome and course. It can be assessed through the Barratt Impulsiveness Scale (BIS), which explores three main areas: attentional, motor, and nonplanning. Present study was aimed to assess level of impulsivity in a sample of OCD patients, in comparison with healthy controls, using the BIS.

METHODS

Seventy-five OCD outpatients, 48 of them having psychiatric comorbidities and 70 healthy controls, were assessed through the BIS, and their scores were analyzed using Student's t-test for independent samples, on the basis of demographic and clinical characteristics.

RESULTS

BIS total scores were significantly higher (P: 0.01) in patients compared to controls, with no difference between pure and comorbid patients. Attentional impulsivity scores were significantly higher than controls in patients with pure (P < 0.001) and comorbid OCD (P < 0.001), without differences among them. Patients with multiple OC phenotypes showed higher, though statistically non significant, total and attentional scores, compared to single phenotype patients. In addition, patients with comorbid major depressive disorder had higher, though statistically non significant, total and attentional scores, compared to patients with comorbid bipolar disorder, generalized anxiety disorder, and other disorders.

CONCLUSIONS

Present findings showed higher impulsivity levels in OCD patients versus controls, particularly in the attentional area, and ultimately suggest a potential cognitive implication.

Gender differences in obsessive-compulsive disorder: findings from a large Indian sample

AIM

Gender has been considered as one of the possible factors mediating phenotypic expression of obsessive-compulsive disorder (OCD). We examined gender differences in a large sample of subjects with OCD from India with respect to socio-demographic parameters, symptom characteristics, and comorbidity patterns.

METHODS

Consecutive patients (n=545) who consulted a specialty OCD clinic over 5 years at a large psychiatric hospital in India were evaluated.

RESULTS

Men (n=332) compared to women (n=213) with OCD had an earlier onset (p<0.001), higher frequency of sexual (p<0.001) and religious obsessions (p=0.001) pathological doubts (p<0.001) and checking (p<0.001) and repeating compulsions (p<0.001), and a greater tendency to have comorbid social phobia (p=0.006). Women compared to men were more likely to be married, had a higher frequency of fear of contamination (p=0.017), comorbid depression (p=0.014) and greater suicidal risk (p=0.003).

CONCLUSIONS

Our study provides further evidence for gender related differences in clinical features of obsessive-compulsive disorder. Our findings are only partly comparable with results from studies across the world possibly due to various biological and cultural factors mediating the phenotypic expression of OCD across the genders. There is a need to examine the biological basis for these gender differences.

Is compulsive buying related to materialism, depression or temperament? Findings from a sample of treatment-seeking patients with CB

The aim of the present work was to examine the influence of reactive and regulatory temperament on compulsive buying (CB) in a sample of 102 patients (79 women, 23 men) with clinical CB. All participants answered the Compulsive Buying Scale (CBS), the Behavioral Inhibition System and Behavioral Activation System Scales (BIS/BAS), and the Effortful Control subscale (ATQ-EC) of the Adult Temperament Questionnaire-Short Form. Based on previous studies demonstrating that depression and materialism are linked with CB, in addition, the Patient Health Questionnaire depression scale (PHQ-9) and the Materialistic Values Scale (MVS) were administered. CBS scores were significantly correlated with the MVS, PHQ-9, and BAS scores. The findings of the hierarchical regression analysis, however, indicated that in the present sample of treatment-seeking patients the only significant association was found between CB and depression. The results highlight the prominent role of depression in CB. There is a need for longitudinal studies in order to answer the question whether depression is the cause or the consequence of CB.

Late-onset obsessive-compulsive disorder: risk factors and correlates

BACKGROUND

While a great amount of attention has been paid to early-onset obsessive-compulsive disorder (OCD), there is a dearth of studies on patients showing OCD for the first time at later stages of life. In this study, we aimed at determining possible risk factors/correlates for OCD onset at or after age 40, here termed late-onset OCD.

METHOD

A series of models including several potential variables associated with late onset OCD were tested using a monolayer neural network. To this regard, data from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (CTOC) (n = 1001) was employed. For the purposes of this study, we considered a diagnosis of late onset OCD to be present whenever distress and interference associated with OCD symptoms emerged at or after age 40. Different nested models were compared through the Akaike Criteria keeping the variables with p value ≤0.05.

RESULTS

Late-onset OCD occurred in 8.6% of the sample. A model including female sex, a history of chronic (>10 years) subclinical obsessive-compulsive symptoms, the co-occurrence of posttraumatic stress disorder (PTSD) after age 40, and a history of recent pregnancy in self or significant others was able to explain a sizeable proportion of late-onset OCD. The general performance of this model, represented by the Maximum Likelihood R2, was 29.4%.

CONCLUSION

Our results suggest that late-onset OCD is more likely to occur in females, in individuals with long periods of subclinical obsessive-compulsive symptoms, and in association with a major traumatic event occurring after age 40 and a history of recent pregnancy in self or in significant others.

Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study

OBJECTIVES

To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender.

METHODS

Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring ≥ 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version - K-SADS-PL).

RESULTS

The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3 ± 3.8) and symmetry (85.3%; 5.9 ± 3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006).

CONCLUSIONS

OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD.

Clinical features of pure obsessive-compulsive disorder

OBJECTIVE

Psychiatric comorbidity is the rule in obsessive-compulsive disorder (OCD); however, very few studies have evaluated the clinical characteristics of patients with no co-occurring disorders (non-comorbid or "pure" OCD). The aim of this study was to estimate the prevalence of pure cases in a large multicenter sample of OCD patients and compare the sociodemographic and clinical characteristics of individuals with and without any lifetime axis I comorbidity.

METHOD

A cross-sectional study with 955 adult patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Assessment instruments included the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, The USP-Sensory Phenomena Scale and the Brown Assessment of Beliefs Scale. Comorbidities were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses were followed by logistic regression.

RESULTS

Only 74 patients (7.7%) presented pure OCD. Compared with those presenting at least one lifetime comorbidity (881, 92.3%), non-comorbid patients were more likely to be female and to be working, reported less traumatic experiences and presented lower scores in the Y-BOCS obsession subscale and in total DY-BOCS scores. All symptom dimensions except contamination-cleaning and hoarding were less severe in non-comorbid patients. They also presented less severe depression and anxiety, lower suicidality and less previous treatments. In the logistic regression, the following variables predicted pure OCD: sex, severity of depressive and anxious symptoms, previous suicidal thoughts and psychotherapy.

CONCLUSIONS

Pure OCD patients were the minority in this large sample and were characterized by female sex, less severe depressive and anxious symptoms, less suicidal thoughts and less use of psychotherapy as a treatment modality. The implications of these findings for clinical practice are discussed.

Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder

The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and "compulsive" buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups.

Presence of obsessive compulsive symptoms in first-episode schizophrenia or related disorders is associated with subjective well-being and quality of life

AIM

The study aims to evaluate whether the presence of obsessive compulsive symptoms (OCS) in first-episode schizophrenia patients is associated with subjective well-being or quality of life.

METHODS

This study used a cross-sectional study of consecutively diagnosed patients with a first episode of schizophrenia or related disorder.

RESULTS

There were 23 out of 198 (12%) consecutively assessed patients that reported co-morbid OCS. Co-morbid OCS were associated with a lower mean total score on a subjective well-being scale (P ≤ 0.001), especially on the social integration subscale (P = 0.002) and emotional regulation subscale (P = 0.008), and lower scores on subjective aspects of quality of life (P = 0.043), especially concerning mental health (P = 0.001) and physical health (P = 0.002).

CONCLUSION

These results support the clinical relevance of OCS co-morbidity in schizophrenia or related disorders and the need for research into specific interventions.

Symmetry Concerns as a Symptom of Body Dysmorphic Disorder

Symmetry obsessions are a common symptom of obsessive-compulsive disorder (OCD) and have several demographic and clinical correlates. Appearance-related symmetry concerns appear common in body dysmorphic disorder (BDD); however, no published studies have examined this topic. This study examined the clinical features, prevalence, and correlates of symmetry concerns involving physical appearance in two BDD samples (N=160 and N=115). More than 25% of participants in each sample reported symmetry concerns for a body part with which they were preoccupied (total of 18 body parts in sample 1 and 18 in sample 2). In sample 1, BDD participants with appearance-related symmetry concerns were older than those without appearance-related symmetry concerns. In sample 2, those with appearance-related symmetry concerns reported poorer mental health-related quality of life, were more likely to have experienced lifetime suicidal ideation, had better BDD-related insight, and were less likely to have a lifetime eating disorder. In both samples, participants with appearance-related symmetry concerns were more likely to have lifetime OCD but not OCD-related symmetry obsessions. Thus, symmetry is a common appearance concern in BDD that is associated with comorbid OCD but not with OCD symmetry concerns specifically, suggesting that symmetry concerns may have a different mechanism/pathophysiology in BDD versus OCD.

An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: a multicentre study

OBJECTIVE

In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD.

METHODS

This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown obsessive-compulsive scale, as well as with the Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI).

RESULTS

We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR=1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001).

CONCLUSION

Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels.

Gender differences in obsessive-compulsive disorder: a literature review

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a heterogeneous condition, in which subtypes have been proposed. Previous studies suggested that gender plays a relevant role in OCD phenotypic expression. This study aimed to review the literature on gender differences in clinical, genetic or familial aspects of OCD.

METHOD

A conventional review was conducted, including all papers that investigated demographic, clinical, and genetic aspects of OCD according to gender. The search was based on data available in Medline and PsycINFO databases in the last 20 years, using as keywords: obsessive-compulsive disorder; and: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females.

RESULTS

Sixty three of 487 phenotypical and genetics studies were selected. Most studies indicate that male patients are more likely than females to be single, present early onset of symptoms and chronic course of the disorder, greater social impairment, more sexual-religious and aggressive symptoms, and greater comorbidity with tic and substance use disorders. Female patients present more contamination/cleaning symptoms and greater comorbidity with eating and impulse-control disorders. Genetic and family studies are inconclusive, but suggest that gender may play a role in the disease expression.

CONCLUSIONS

Gender is a relevant factor that should be taken into account when evaluating OCD patients. More studies are necessary to determine whether in fact it defines a homogeneous and particular group in OCD.

Skin picking and trichotillomania in adults with obsessive-compulsive disorder

The objective of this study was to compare patients with obsessive-compulsive disorder (OCD) associated with pathologic skin picking (PSP) and/or trichotillomania, and patients with OCD without such comorbidities, for demographic and clinical characteristics. We assessed 901 individuals with a primary diagnosis of OCD, using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I disorders. Diagnoses of PSP and trichotillomania were made in 16.3% and 4.9% of the sample, respectively. After the logistic regression analysis, the following factors retained an association with OCD-PSP/trichotillomania: younger (odds ratio [OR] = 0.979; P = .047), younger at the onset of compulsive symptoms (OR = 0.941; P = .007), woman (OR = 2.538; P < .001), with a higher level of education (OR = 1.055; P = .025), and with comorbid body dysmorphic disorder (OR = 2.363; P = .004). These findings support the idea that OCD accompanied by PSP/trichotillomania characterizes a specific subgroup.

Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: an exploratory study of 1001 patients

A substantial number of patients with obsessive-compulsive disorder (OCD) report compulsions that are preceded not by obsessions but by subjective experiences known as sensory phenomena. This study aimed to investigate the frequency, severity, and age at onset of sensory phenomena in OCD, as well as to compare OCD patients with and without sensory phenomena in terms of clinical characteristics. We assessed 1,001 consecutive OCD patients, using instruments designed to evaluate the frequency/severity of OC symptoms, tics, anxiety, depression, level of insight and presence/severity of sensory phenomena. All together, 651 (65.0%) subjects reported at least one type of sensory phenomena preceding the repetitive behaviors. Considering the sensory phenomena subtypes, 371 (57.0%) patients had musculoskeletal sensations, 519 (79.7%) had externally triggered "just-right" perceptions, 176 (27.0%) presented internally triggered "just right," 144 (22.1%) had an "energy release," and 240 (36.9%) patients had an "urge only" phenomenon. Sensory phenomena were described as being as more severe than were obsessions by 102(15.7%) patients. Logistic regression analysis showed that the following characteristics were associated with the presence of sensory phenomena: higher frequency and greater severity of the symmetry/ordering/arranging and contamination/washing symptom dimensions; comorbid Tourette syndrome, and a family history of tic disorders. These data suggest that sensory phenomena constitute a poorly understood psychopathological aspect of OCD that merits further investigation.

Compulsive buying in bipolar disorder: is it a comorbidity or a complication?

BACKGROUND

The objective of this study was to investigate the frequency of compulsive buying in bipolar disorder (BD), to compare it with healthy controls, and to search if there is a difference between bipolar cases with and without compulsive buying in terms of sociodemographic qualities, temperament, clinical characteristics and comorbid diagnoses.

METHODS

One-hundred outpatient cases diagnosed as BD according to DSM-IV were evaluated consecutively. Following the diagnosis interview (SCID-I and II) the subjects completed the mood disorders registry form, Compulsive Buying Scale and TEMPS-A.

RESULTS

Compulsive buying scores were higher in bipolar patients than healthy controls (p<0.001). Cases with compulsive buying revealed higher cyclothymic and irritable temperament scores than other bipolar patients (p=0.029 vs 0.045). Premenstrual syndrome and postpartum onset were more frequent, while psychotic symptoms were less in compulsive buyer bipolar patients (p=0.002, 0.009 vs 0.034). Severity of episode was lower (p=0.01), number of episodes was higher (p=0.009). Acute onset and remission before and after maintenance treatment were more frequent in patients with compulsive buying (p=0.011 and p=0.011). Full remission between episodes was 100%. Cases with axis-1 and axis-2 comorbidities demonstrated higher compulsive buying scores (p=0.025 and 0.005).

LIMITATIONS

Treatment regimen differences between patients are a limitation of the study.

CONCLUSIONS

This is the first study to relate compulsive buying with the clinical characteristics of BD. Our results reveal that compulsive buying in BD occurs together with mood episodes which are not very severe, but frequent and with abrupt onset.

Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: a practical clinical trial

Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores ≥ 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n=70) or fluoxetine (n=88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p=0.875). Patients presented a mean of 2.7 psychiatric comorbidities, and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p=0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p=0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.

Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness

Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N=20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.

Symptom dimensions in OCD: item-level factor analysis and heritability estimates

To reduce the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) for genetic, clinical and translational studies, numerous factor analyses of the Yale-Brown Obsessive Compulsive Scale checklist (YBOCS-CL) have been conducted. Results of these analyses have been inconsistent, likely as a consequence of small sample sizes and variable methodologies. Furthermore, data concerning the heritability of the factors are limited. Item and category-level factor analyses of YBOCS-CL items from 1224 OCD subjects were followed by heritability analyses in 52 OCD-affected multigenerational families. Item-level analyses indicated that a five factor model: (1) taboo, (2) contamination/cleaning, (3) doubts, (4) superstitions/rituals, and (5) symmetry/hoarding provided the best fit, followed by a one-factor solution. All 5 factors as well as the one-factor solution were found to be heritable. Bivariate analyses indicated that the taboo and doubts factor, and the contamination and symmetry/hoarding factor share genetic influences. Contamination and symmetry/hoarding show shared genetic variance with symptom severity. Nearly all factors showed shared environmental variance with each other and with symptom severity. These results support the utility of both OCD diagnosis and symptom dimensions in genetic research and clinical contexts. Both shared and unique genetic influences underlie susceptibility to OCD and its symptom dimensions.

Obsessive-compulsive disorder in postmenopausal women: prevalence, clinical features, and comorbidity

OBJECTIVE

Studies about obsessive-compulsive disorder (OCD) during the postmenopausal period have been insufficient. The purpose of the current study was therefore to examine the prevalence rate, clinical characteristics, and comorbidity of OCD in postmenopausal women.

METHODS

A total of 269 consecutive postmenopausal women admitted to a gynaecology outpatient clinic were included in the study. OCD and comorbid disorders was diagnosed by means of the Structured Clinical Interview for DSM-IV. The Yale-Brown Obsessive- Compulsive Scale was used to determine the types of obsessions and compulsions.

RESULTS

The prevalence rate of OCD was 7.1% in the sample. Two women (0.7%) reported that OCD developed during the postmenopausal period. The most common obsessions were contamination and symmetry/exactness, whereas the most common compulsions were cleaning/washing and checking. OCD was unrelated to variables examined in the present study. The comorbidity rate of other psychiatric disorders was 63.2% in OCD patients. The most common comorbid disorder was generalized anxiety disorder.

CONCLUSIONS

OCD was not rare in postmenopausal women admitted to a gynaecology outpatient clinic. In addition, OCD appears to be frequently comorbid with depressive or other anxiety disorders in the postmenopausal period.

Early onset obsessive-compulsive disorder with and without tics

INTRODUCTION

Research suggests that obsessive-compulsive disorder (OCD) is not a unitary entity, but rather a highly heterogeneous condition, with complex and variable clinical manifestations.

OBJECTIVE

The aims of this study were to compare clinical and demographic characteristics of OCD patients with early and late age of onset of obsessive-compulsive symptoms (OCS); and to compare the same features in early onset OCD with and without tics. The independent impact of age at onset and presence of tics on comorbidity patterns was investigated.

METHODS

Three hundred and thirty consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD were evaluated: 160 patients belonged to the "early onset" group (EOG): before 11 years of age, 75 patients had an "intermediate onset" (IOG), and 95 patients were from the "late onset" group (LOG): after 18 years of age. From the 160 EOG, 60 had comorbidity with tic disorders. The diagnostic instruments used were: the Yale-Brown Obsessive Compulsive Scale and the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS), Yale Global Tics Severity Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders-patient edition. Statistical tests used were: Mann-Whitney, full Bayesian significance test, and logistic regression.

RESULTS

The EOG had a predominance of males, higher frequency of family history of OCS, higher mean scores on the "aggression/violence" and "miscellaneous" dimensions, and higher mean global DY-BOCS scores. Patients with EOG without tic disorders presented higher mean global DY-BOCS scores and higher mean scores in the "contamination/cleaning" dimension.

CONCLUSION

The current results disentangle some of the clinical overlap between early onset OCD with and without tics.