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Obsessive–compulsive disorder: subclassification based on co-morbidity

Published online by Cambridge University Press:  02 December 2008

G. Nestadt ,
C. Z. Di ,
M. A. Riddle ,
M. A. Grados ,
B. D. Greenberg ,
A. J. Fyer ,
J. T. McCracken ,
S. L. Rauch ,
D. L. Murphy  and
S. A. Rasmussen
...Show all authors
G. Nestadt*
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
C. Z. Di
Affiliation:
Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
M. A. Riddle
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
M. A. Grados
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
B. D. Greenberg
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA
A. J. Fyer
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons at Columbia University, New York, NY, USA
J. T. McCracken
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
S. L. Rauch
Affiliation:
Departments of Psychiatry and Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
D. L. Murphy
Affiliation:
Laboratory of Clinical Science, NIMH, NIH, Bethesda, MD, USA
S. A. Rasmussen
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA
B. Cullen
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
A. Pinto
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons at Columbia University, New York, NY, USA
J. A. Knowles
Affiliation:
Department of Psychiatry, Keck Medical School, University of Southern California, Los Angeles, CA, USA
J. Piacentini
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
D. L. Pauls
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
O. J. Bienvenu
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
Y. Wang
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
K. Y. Liang
Affiliation:
Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
J. F. Samuels
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
K. Bandeen Roche
Affiliation:
Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
*
*Address for correspondence: Dr G. Nestadt, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 109, Baltimore, MD 21287, USA. (Email: gnestadt@jhmi.edu)
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Abstract

Background

Obsessive–compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes.

Method

Seven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated.

Results

Two and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive–compulsive personality disorder (OCPD) features, high scores on the ‘taboo’ factor of OCD symptoms, and low conscientiousness.

Conclusions

OCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors.

Keywords

Latent classOCDsubtypes

Information

Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 9 , September 2009 , pp. 1491 - 1501
Copyright
Copyright © 2008 Cambridge University Press

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