Obsessive-compulsive disorder in the community : 12-month prevalence, comorbidity and impairment

Although subthreshold conditions are associated with impairment in numerous disorders, research on obsessive-compulsive disorder (OCD) below the diagnostic threshold of DSM-IV in the general population is limited. Estimate the DSM-IV 12-month prevalence, comorbidity and impairment of OCD, subthreshold OCD (i.e., fulfilling some but not all core DSM-IV criteria), and obsessive-compulsive symptoms (OCS) (i.e., endorsement of OCS without fulfilling any core DSM-IV criteria) in a general population sample. Data from the German National Health Interview and Examination Survey - Mental Health Supplement (N = 4181, age 18-65 years), based on the standardized diagnostic interview Munich Composite International Diagnostic Interview. The 12-month prevalence of OCD was 0.7%, subthreshold OCD was 4.5%, and OCS was 8.3%. Subjects in all three groups showed higher comorbidity (odds ratios [ORs] € ≥ 3.3), compared to those without OCS. OCD, subthreshold OCD and OCS were all associated with increased odds of substance abuse/dependence-, mood-, anxiety- and somatoform disorders, with especially strong associations with possible psychotic disorder (ORs € ≥ 4.1) and bipolar disorders (ORs € ≥ 4.7). Participants in all three groups showed higher impairment (ORs € ≥ 3.1) and health-care utilization (ORs € ≥ 2.4), compared to those without OCS, even after controlling for covariates. Individuals with subthreshold OCD and OCS, not currently captured by DSM-IV OCD criteria, nevertheless show substantial comorbidity, impairment and health-care utilization.