Comparing two basic subtypes in OCD across three large community samples: a pure compulsive versus a mixed obsessive–compulsive subtype
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Due to its heterogeneous phenomenology, obsessive–compulsive disorder (OCD) has been subtyped. However, these subtypes are not mutually exclusive. This study presents an alternative subtyping approach by deriving non-overlapping OCD subtypes. A pure compulsive and a mixed obsessive–compulsive subtype (including subjects manifesting obsessions with/without compulsions) were analyzed with respect to a broad pattern of psychosocial risk factors and comorbid syndromes/diagnoses in three representative Swiss community samples: the Zurich Study (n = 591), the ZInEP sample (n = 1500), and the PsyCoLaus sample (n = 3720). A selection of comorbidities was examined in a pooled database. Odds ratios were derived from logistic regressions and, in the analysis of pooled data, multilevel models. The pure compulsive subtype showed a lower age of onset and was characterized by few associations with psychosocial risk factors. The higher social popularity of the pure compulsive subjects and their families was remarkable. Comorbidities within the pure compulsive subtype were mainly restricted to phobias. In contrast, the mixed obsessive–compulsive subtype had a higher prevalence and was associated with various childhood adversities, more familial burden, and numerous comorbid disorders, including disorders characterized by high impulsivity. The current comparison study across three representative community surveys presented two basic, distinct OCD subtypes associated with differing psychosocial impairment. Such highly specific subtypes offer the opportunity to learn about pathophysiological mechanisms specifically involved in OCD.
KeywordsObsessive–compulsive disorder Distinct subtypes Comorbidity Epidemiology
We thank all the participants who participated in the epidemiological surveys as well as all the interviewers who collected the data. The Zurich Study was supported by the Swiss National Science Foundation (Grant No. 32-50881.97). ZInEP was supported by a private donation. The donor had no further role in experimental design, collection, analysis and interpretation of data, the writing of this report, or the decision to submit this paper for publication. The PsyCoLaus study was and is supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (Grants 3200B0–105993, 3200B0-118308, 33CSCO-122661, 33CS30-139468, and 33CS30-148401).
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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