Clinical significance of psychiatric comorbidity in children and adolescents with obsessive–compulsive disorder: subtyping a complex disorder

Abstract

A promising approach in relation to reducing phenotypic heterogeneity involves the identification of homogeneous subtypes of OCD based on age of onset, gender, clinical course and comorbidity. This study aims to assess the sociodemographic characteristics and clinical features of OCD patients in relation to gender and the presence or absence of another comorbid disorder. The sample comprised 112 children and adolescents of both sexes and aged 8-18 years, all of whom had a diagnosis of OCD. Overall, 67 % of OCD patients had one comorbid diagnosis, 20.5 % had two such diagnoses and 2.6 % had three comorbid diagnoses. The group of OCD patients with a comorbid neurodevelopmental disorder had significantly more family history of OCD in parents (p = .049), as compared with the no comorbidity group and the group with a comorbid internalizing disorder, and they also showed a greater predominance of males (p = .013) than did the group with a comorbid internalizing disorder. The group of OCD patients with internalizing comorbidity had a later age of onset of OCD (p = .001) compared with both the other groups. Although the initial severity was similar in all three groups, the need for pharmacological treatment and for hospitalization due to OCD symptomatology was greater in the groups with a comorbid neurodevelopmental disorder (p = .038 and p = .009, respectively) and a comorbid internalizing disorder (p = .008 and p = .004, respectively) than in the group without comorbidity. Our findings suggest that two subtypes of OCD can be defined on the basis of the comorbid pathology presented. The identification of different subtypes according to comorbidity is potentially useful in terms of understanding clinical variations, as well as in relation to treatment management and the use of therapeutic resources.

The Child Behavior Checklist—Obsessive-Compulsive Subscale Detects Severe Psychopathology and Behavioral Problems Among School-Aged Children

“…The more robust analysis (LR model) indicated that tic disorder, anxiety disorders grouped, and depression were strongly associated with the presence of OCS. These comorbidities resemble the pattern reported in full-blown pediatric OCD (Flament et al 1988;Zohar et al 1992;Heyman et al 2001;de Mathis et al 2008;Shams et al 2011;Canals et al 2012;Vivan Ade et al 2014;Voltas et al 2014;Ortiz et al 2015). OCS were significantly associated with functional impairment even when controlled by the pattern of comorbidities When considering the positive attributes and social aptitude, no associations were found.…”

“…Most studies point out equal distribution between boys and girls (Zohar et al 1992;Apter et al 1996;Essau et al 2000), but two studies reported OCS as more prevalent among girls (Brynska and Wolanczyk 2005;Vivan Ade et al 2014) whereas two others found OCS being more common in boys (Canals et al 2012;Jaisoorya et al 2015). Regarding psychiatric comorbidity, the most frequently co-occurring conditions are major depression, anxiety disorders, tics, Tourette syndrome, and attention-deficit/hyperactivity disorder (ADHD) (Zohar et al 1992;Heyman et al 2001;Peterson et al 2001;de Mathis et al 2008;Shams et al 2011;Canals et al 2012;Lebowitz et al 2012;Vivan Ade et al 2014;Ortiz et al 2015). The prevalence of overall comorbid conditions reported in juvenile OCS/OCD samples vary from 56% to 91% (Shams et al 2011;Lebowitz et al 2012;Vivan Ade et al 2014).…”

Register-based study of the incidence, comorbidities and demographics of obsessive-compulsive disorder in specialist healthcare

“…Comorbidity with other psychiatric and neurodevelopmental disorders is common in OCD and rates between 67 and 92% have been reported in clinical and population screening studies [ 20 – 24 ]. The most common comorbidities include anxiety and mood disorders, psychotic disorders, attention deficit hyperactivity disorder (ADHD) and tic disorders [ 5 , 20 – 24 ]. Comorbidity with tic disorders has particularly been associated with male predominance [ 22 – 24 ].…”

“…The most common comorbidities include anxiety and mood disorders, psychotic disorders, attention deficit hyperactivity disorder (ADHD) and tic disorders [ 5 , 20 – 24 ]. Comorbidity with tic disorders has particularly been associated with male predominance [ 22 – 24 ]. Up until now there are no register-based studies reporting overall gender-specific comorbidities in OCD.…”

Association of eating attitude with anxiety and depression levels in children and adolescents with obsessive–compulsive disorder

“…Epidemiological and population-based studies indicated that the prevalence of OCD in children and adolescents was between 1% and 4% with the mean of 2% [2,3]. It is very important to diagnose OCD in children and adolescents and related comorbidities and risk factors early, since it results in a significant deterioration in functionality, shows a chronic progression, and has a common comorbidity with many psychiatric disorders such as mood and eating disorders (EDs) [2,[4][5][6]. Similar to OCD, EDs also affect many aspects of the lifes of the children and adolescents.…”