The clinical impact of mood disorder comorbidity on obsessive–compulsive disorder

  • R. TükelEmail author
  • H. Meteris
  • A. Koyuncu
  • A. Tecer
  • O. Yazıcı


The present study examines the effect of concomitant major depressive or bipolar disorder on clinical symptoms of patients with obsessive–compulsive disorder (OCD). Forty–nine patients classified as OCD without a mood disorder, 26 classified as OCD with bipolar disorder (OCD–BD) and 42 classified as OCD with major depressive disorder (OCD–MDD) according to DSM–IV diagnostic criteria were included in the study. The groups were compared with respect to demographic variables and scores obtained on various scales. The OCD–BD group had more symmetry/exactness obsessions and ordering/arranging compulsions, and a more episodic course of illness and had better insight compared to the other two groups. Levels of anxiety, depression, disability and obsessive–compulsive symptom severity were significantly higher in the OCDMDD group. The rate of social phobia was higher in OCD–BD patients, whereas the rates of generalized anxiety disorder and simple phobias were higher in OCDMDD group. These findings suggest that comorbidity of major depressive disorder may increase the severity of OCD symptoms. On the other hand, bipolar disorder comorbidity may constitute a subgroup which is characterized by a higher rate of episodic course and better insight.

Key words

obsessive–compulsive disorder mood disorders comorbidity episodic course 


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  1. 1.
    Akiskal HS, Walker P, Puzantian VR, King D, Rosenthal TL, Dranon M (1983) Bipolar outcome in the course of depressive illness: Phenomenologic, familial, and pharmacologic predictors. J Affect Disord 5:115–112PubMedCrossRefGoogle Scholar
  2. 2.
    Akiskal HS (2002) Classification, diagnosis and boundaries of bipolar disorders: A review. In:Maj M, Akiskal HS, Lopez–Ibor JJ, Sartorius N (eds) Bipolar disorder. John Wiley and Sons, West SussexGoogle Scholar
  3. 3.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn (DSM–IV). American Psychiatric Press, Washington, DCGoogle Scholar
  4. 4.
    Angst J, Dobler–Mikola A: The Zurich study, VI (1985) A continuum from depression to anxiety disorders? Eur Arch Psychiatry and Neurosci 235:179–186CrossRefGoogle Scholar
  5. 5.
    Angst J, Gamma A, Endrass J, Hantouche E, Goodwin R, Ajdacic V, Eich D, Rossler W (2005) Obsessive–compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes. Eur Arch Psychiatry Clin Neurosci 255:65–71PubMedCrossRefGoogle Scholar
  6. 6.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedGoogle Scholar
  7. 7.
    Bellodi L, Sciuto G, Diaferia G, Ronchi P, Smeraldi E (1992) Psychiatric disorders in the families of patients with obsessive–compulsive disorder. Psychiatry Res 42:111–120PubMedCrossRefGoogle Scholar
  8. 8.
    Chen YW, Dilsaver SC (1995) Comorbidity for obsessive compulsive disorder in bipolar and unipolar disorders. Psychiatry Res 59:57–64PubMedCrossRefGoogle Scholar
  9. 9.
    First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM–IV clinical version (SCID–I/CV). American Psychiatric Press, Washington DCGoogle Scholar
  10. 10.
    Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischman RL, Hill CL, Heninger GR, Charney DS (1989) The Yale–Brown obsessive compulsive scale (Y–BOCS): Development, use and reliability. Arch Gen Psychiatry 46:1006–1011PubMedGoogle Scholar
  11. 11.
    Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR, Charney DS (1989) The Yale–Brown obsessive compulsive scale (Y–BOCS): Validity. Arch Gen Psychiatry 46:1012–1016PubMedGoogle Scholar
  12. 12.
    Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychology 32:50–55Google Scholar
  13. 13.
    Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc Clin Psychology 6:278–296Google Scholar
  14. 14.
    Hecht H, Von Zerssen D, Krieg C, Possl J, Wittchen HU (1989) Anxiety and depression: Comorbidity, psychopathology and social functioning. Compr Psychiatry 30:420–433PubMedCrossRefGoogle Scholar
  15. 15.
    Kolada JL, Bland RC, Newman SC (1994) Obsessive compulsive disorder. Acta Psychiatr Scand 376:24–35Google Scholar
  16. 16.
    Kruger S, Cooke RG, Hasey GM, Jorna T, Persad E (1995) Comorbidity of obsessive compulsive disorder in bipolar disorder. J Affect Disord 34:117–120PubMedCrossRefGoogle Scholar
  17. 17.
    Lenane MC, Swedo SE, Leonard H, Pauls DL, Sceery W, Rapoport JL (1990) Psychiatric disorders in first degree relatives of children and adolescents with obsessive compulsive disorder. J Am Acad Child Adolesc Psychiatry 29:407–412PubMedGoogle Scholar
  18. 18.
    Lensi P, Cassano GB, Correddu G, Ravagli S, Kunovac JL, Akiskal HS (1996) Obsessive–compulsive disorder: familial–developmental history, symptomatology, comorbidity and course with special reference to gender–related differences. Br J Psychiatry 169:101–107PubMedCrossRefGoogle Scholar
  19. 19.
    Nestadt G, Samuels J, Riddle M, Bienvenu III OJ, Liang K–Y, LaBuda M, Walkup J, Grados M, Hoehn–Saric R (2000) A family study of obsessive–compulsive disorder. Arch Gen Psychiatry 57:358–363PubMedCrossRefGoogle Scholar
  20. 20.
    Neziroglu F, McKay D, Yaryura–Tobias JA, Stevens KP, Todaro J (1999) The overvalued idea scale: Development, reliability and validity in obsessive–compulsive disorder. Behav Res Ther 37:881–902PubMedCrossRefGoogle Scholar
  21. 21.
    Okasha A, Saad A, Khalil AH, el Dawla AS, Yehia N (1994) Phenomenology of obsessive compulsive disorder: A transcultural study. Compr Psychiatry 35:191–197PubMedCrossRefGoogle Scholar
  22. 22.
    Pauls DL, Alsobrook II JP, Goodman W, Rasmussen S, Leckman JF (1995) A family study of obsessive–compulsive disorder. Am J Psychiatry 152:76–84PubMedGoogle Scholar
  23. 23.
    Perugi G, Akiskal HS, Pfanner C, Presta S, Gemignani A, Milanfranchi A, Lensi P, Ravagli S, Cassano GB (1997) The clinical impact of bipolar and unipolar affective comorbidity on obsessive compulsive disorder. J Affect Disord 46:15–23PubMedCrossRefGoogle Scholar
  24. 24.
    Perugi G, Akiskal HS, Gemignani A, Pfanner C, Presta S, Milanfranchi A, Lensi P, Ravagli S, Maremmani I, Cassano GB (1998) Episodic course in obsessive–compulsive disorder. Eur Arch Psychiatry Clin Neurosci 248:240–244PubMedCrossRefGoogle Scholar
  25. 25.
    Rasmussen SA, Tsuang MT (1986) Clinical characteristics and family history in DSM–III obsessive–compulsive disorder. Am J Psychiatry 143:317–322PubMedGoogle Scholar
  26. 26.
    Rasmussen SA, Eisen JL (1988) Clinical and epidemiologic findings of significance to neuropharmacologic trials in OCD. Psychopharmacol Bull 24:466–470PubMedGoogle Scholar
  27. 27.
    Ravizza L, Maina G, Bogetto F (1997) Episodic and chronic obsessive– compulsive disorder. Depress Anxiety 6:154–158PubMedCrossRefGoogle Scholar
  28. 28.
    Roy MA, Neale MC, Pedersen NL, Mathe AA, Kendler KS (1995) A twin study of generalized anxiety disorder and major depression. Psychol Med 25:1037–1049PubMedCrossRefGoogle Scholar
  29. 29.
    Sheehan DV (1983) The Anxiety Disease. Scribner, New YorkGoogle Scholar
  30. 30.
    Shwartz CM, Shen WW (1998) Is episodic obsessive compulsive disorder bipolar? A report of four cases. J Affect Disord 56:61–66CrossRefGoogle Scholar
  31. 31.
    Spielberger CD, Gorsuch RL, Lushene RE (1970) Manual for state–trait anxiety inventory. Consulting Psychologists Press, CaliforniaGoogle Scholar
  32. 32.
    Stavrakaki C, Vargo B (1986) The relationships of anxiety and depression: A review of literature. Br J Psychiatry 149:7–16PubMedCrossRefGoogle Scholar
  33. 33.
    Strober M, Carlson G (1982) Bipolar illness in adolescents with major depression: Clinical, genetic, and psychopharmacologic predictors in a three–to four year prospective follow–up investigation. Arch Gen Psychiatry 39:549–555PubMedGoogle Scholar
  34. 34.
    Tükel R, Polat A, Özdemir Ö, Aksüt D, Türksoy N (2002) Comorbid conditions in obsessive–compulsive disorder. Compr Psychiatry 43:204–209PubMedCrossRefGoogle Scholar
  35. 35.
    Türksoy N, Tükel R, Özdemir Ö, Karalı A (2002) Comparison of clinical characteristics in good and poor insight obsessive–compulsive disorder. J Anxiety Disord 16:413–423PubMedCrossRefGoogle Scholar
  36. 36.
    Wittchen HU, Essau L (1989) Natural course and spontaneous remissions of untreated anxiety disorders. In:Hand I, Wittchen HU (eds) Panic and phobias. Springer Verlag, BerlinGoogle Scholar
  37. 37.
    Wittchen HU, Zhao S, Kessler RC, Eaton WW (1994) DSM–III–R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 51:355–364PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • R. Tükel
    • 1
    Email author
  • H. Meteris
    • 1
  • A. Koyuncu
    • 1
  • A. Tecer
    • 1
  • O. Yazıcı
    • 1
  1. 1.Istanbul University, Istanbul Faculty of MedicineDepartment of PsychiatryCapa IstanbulTurkey

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