Advertisement

Cognitive Therapy and Research

, Volume 36, Issue 6, pp 685–693 | Cite as

Initial Data Characterizing the Progression from Obsessions and Compulsions to Full-Blown Obsessive Compulsive Disorder

  • Meredith E. Coles
  • Ashley S. Hart
  • Casey A. Schofield
Original Article

Abstract

Most individuals who develop obsessive compulsive disorder (OCD) experience years of obsessions and/or compulsions preceding onset of the full-blown disorder (Angst in Current insights in obsessive compulsive disorder, Wiley, Chirchester, New York, Brisbane, 1994; Coles et al. in Behav Cogn Psychother 11:1–11, 2011; Pinto et al. in J Clin Psychiatry 67(5):703–711, 2006). However, little is known about experiences during this period and about factors that are involved in the generation of interference or distress that signals the onset of diagnosable OCD. Therefore, the current study was designed to provide data on the characteristics of the symptom phase of OCD and potential markers of the transition from symptoms to the full-blown disorder. Individuals that eventually developed full-blown OCD retrospectively reported that generalized anxiety, perfectionism, impaired work or school performance, social isolation, preoccupation with details and intolerance of uncertainty, frequently emerged after their initial OC symptoms but before full-criteria for OCD were met. Increases in stress level, the desire for things to feel ‘just right’, and the amount of attention paid to one’s thoughts were perceived as having played an important role in the transition to OCD. Additional data and theory development regarding the progression from symptoms to OCD is warranted.

Keywords

OCD Etiology Prodrome Course Obsessions Compulsions 

Notes

Acknowledgments

The authors thank Barbara Cornblatt for her valuable input regarding the development of this study.

References

  1. Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J., & Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: A prospective study. Behaviour Research and Therapy, 44(9), 1361–1374. doi: 10.1016/j.brat.2005.09.011.
  2. Albert, U., Maina, G., Bogetto, F., Chiarle, A., & Mataix-Cols, D. (2010). Clinical predictors of health-related quality of life in obsessive-compulsive disorder. Comprehensive Psychiatry, 51(2), 193–200. doi: 10.1016/j.comppsych.2009.03.004.PubMedCrossRefGoogle Scholar
  3. Angst, J. (1994). The epidemiology of obsessive compulsive disorder. In E. Hollander, J. Zohar, D. Marazatti, & B. Olivier (Eds.), Current insights in obsessive compulsive disorder. Chirchester, New York, Brisbane: Wiley.Google Scholar
  4. Bannon, S., Gonsalvez, C. J., Croft, R. J., & Boyce, P. M. (2002). Response inhibition deficits in obsessive-compulsive disorder. Psychiatry Research, 110(2), 165–174. doi: 10.1016/S0165-1781(02)00104-X.Google Scholar
  5. Bechdolf, A., Schultze-Lutter, F., & Klosterkötter, J. (2002). Self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and depressive relapses. European Psychiatry, 17(7), 384–393. doi: 10.1016/S0924-9338(02)00698-3.
  6. Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of beck depression inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. doi: 10.1207/s15327752jpa6703_13.PubMedCrossRefGoogle Scholar
  7. Bobes, J., González, M. P., Bascarán, M. T., Arango, C., Sáiz, P. A., & Bousoño, M. (2001). Quality of life and disability in patients with obsessive–compulsive disorder. European Psychiatry, 16(4), 239–245. doi: 10.1016/S0924-9338(01)00571-5.PubMedCrossRefGoogle Scholar
  8. Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., et al. (2008). Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in north America. Archives of General Psychiatry, 65(1), 28–37. doi: 10.1001/archgenpsychiatry.2007.3.PubMedCrossRefGoogle Scholar
  9. Chamberlain, S. R., Blackwell, A. D., Fineberg, N. A., Robbins, T. W., & Sahakian, B. J. (2005). The neuropsychology of obsessive compulsive disorder: The importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neuroscience and Biobehavioral Reviews, 29(3), 399–419. doi: 10.1016/j.neubiorev.2004.11.006.PubMedCrossRefGoogle Scholar
  10. Chamberlain, S. R., & Menzies, L. (2009). Endophenotypes of obsessive compulsive disorder: Rationale, evidence and future potential. Expert Review of Neurotherapeutics, 9(8), 1133–1146. doi: 10.1586/ern.09.36.PubMedCrossRefGoogle Scholar
  11. Chamberlain, S. R., Menzies, L., Hampshire, A., Suckling, J., Fineberg, N. A., del Campo, N., et al. (2008). Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives. Science, 321(5887), 421–422. doi: 10.1126/science.1154433.PubMedCrossRefGoogle Scholar
  12. Coles, M. E., & Horng, B. (2006). A prospective test of cognitive vulnerability to obsessive-compulsive disorder. Cognitive Therapy and Research, 30(6), 723–734. doi: 10.1007/s10608-006-9033-x.
  13. Coles, M. E., Schubert, J. R., & Johnson, E. (2011). Retrospective reports of the onset of obsessive compulsive disorder: Extending knowledge of the protracted symptom phase. Behavioural and Cognitive Psychotherapy, 11, 1–11.Google Scholar
  14. Coles, M. E., Pietrefesa, A. S., Schofield, C. A., & Cook, L. M. (2008). Predicting changes in obsessive compulsive symptoms over a six-month follow-up: A prospective test of cognitive models of obsessive compulsive disorder. Cognitive Therapy and Research, 32(5), 657–675. doi: 10.1007/s10608-007-9132-3.
  15. Correll, C. U., Penzner, J. B., Frederickson, A. M., Richter, J. J., Auther, A. M., Smith, C. W., et al. (2007). Differentiation in the preonset phases of schizophrenia and mood disorders: Evidence in support of a bipolar mania prodrome. Schizophrenia Bulletin, 33(3), 703–714. doi: 10.1093/schbul/sbm028.PubMedCrossRefGoogle Scholar
  16. de Bruijn, C., Beun, S., de Graaf, R., ten Have, M., & Denys, D. (2010). Subthreshold symptoms and obsessive-compulsive disorder: Evaluating the diagnostic threshold. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 40(6), 989–997. doi: 10.1017/S0033291709991012.Google Scholar
  17. Degonda, M., Wyss, M., Angst, J. (1993). The Zurich study. XVIII. Obsessive-compulsive disorders and syndromes in the general population. European Archives of Psychiatry and Clinical Neuroscience, 243, 16–22.Google Scholar
  18. DiNardo, P., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule lifetime version (ADIS-IV-L): Client interview schedules. New York, NY: Oxford University Press.Google Scholar
  19. DuPont, R. L., Rice, D. P., Miller, L. S., Shiraki, S. S., Rowland, C. R., & Harwood, H. J. (1996). Economic costs of anxiety disorders. Anxiety, 2, 167–172.PubMedCrossRefGoogle Scholar
  20. Eisen, J. L., Mancebo, M. A., Pinto, A., Coles, M. E., Pagano, M. E., Stout, R., et al. (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry, 47(4), 270–275. doi: 10.1016/j.comppsych.2005.11.006.PubMedCrossRefGoogle Scholar
  21. Fava, G. A., Savron, G., Rafanelli, C., Grandi, S., & Canestrari, R. (1996). Prodromal symptoms in obsessive-compulsive disorder. Psychopathology, 29(2), 131–134.PubMedCrossRefGoogle Scholar
  22. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1995). Structured clinical interview of DSM-IV. New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  23. Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: The obsessive-compulsive inventory. Psychological Assessment, 10(3), 206–214. doi: 10.1037/1040-3590.10.3.206.CrossRefGoogle Scholar
  24. Fullana, M. A., Mataix-Cols, D., Caspi, A., Harrington, H., Grisham, J. R., Moffitt, T. E., et al. (2009). Obsessions and compulsions in the community: Prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. The American Journal of Psychiatry, 166(3), 329–336. doi: 10.1176/appi.ajp.2008.08071006.PubMedCrossRefGoogle Scholar
  25. Holzer, J. C., Goodman, W. K., McDougle, C. J., & Baer, L. (1994). Obsessive-compulsive disorder with and without a chronic tic disorder: A comparison of symptoms in 70 patients. British Journal of Psychiatry, 164(0007-1250, 0007-1250), 469–473. doi: 10.1192/bjp.164.4.469.Google Scholar
  26. Howes, O. D., Lim, S., Theologos, G., Yung, A. R., Goodwin, G. M., & McGuire, P. (2011). A comprehensive review and model of putative prodromal features of bipolar affective disorder. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 41(8), 1567–1577. doi: 10.1017/S0033291710001790.
  27. Hou, S. Y., Yen, C. F., Huang, M. F., Wang, P. W., & Yeh, Y. C. (2010). Quality of life and its correlates in patients with obsessive compulsive disorder. The Kaohsiung Journal of Medical Sciences, 26(8), 397–407.PubMedCrossRefGoogle Scholar
  28. Kamath, P., Reddy, Y. C. J., & Kandavel, T. (2007). Suicidal behavior in obsessive-compulsive disorder. Journal of Clinical Psychiatry, 68(11), 1741–1750. doi: 10.4088/JCP.v68n1114.PubMedCrossRefGoogle Scholar
  29. Khanna, S., Rajendra, P. N., & Channabasavanna, S. M. (1988). Life events and onset of obsessive compulsive disorder. International Journal of Social Psychiatry, 34(4), 305–309. doi: 10.1177/002076408803400408.Google Scholar
  30. Lensi, P., Cassano, G. B., Correddu, G., Ravagli, S., & Kunovac, J. J. (1996). Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender-related differences. British Journal of Psychiatry, 169(1), 101–107. doi: 10.1192/bjp.169.1.101.PubMedCrossRefGoogle Scholar
  31. Mancebo, M. C., Greenberg, B., Grant, J. E., Pinto, A., Eisen, J. L., Dyck, I., et al. (2008). Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Comprehensive Psychiatry, 49(1), 43–50. doi: 10.1016/j.comppsych.2007.05.016.PubMedCrossRefGoogle Scholar
  32. Menzies, L., Achard, S., Chamberlain, S. R., Fineberg, N., Chen, C. H., delCampo, N., et al. (2007). Neurocognitive endophenotypes of obsessive-compulsive disorder. Brain, 130(Pt 12), 3223–3236.PubMedCrossRefGoogle Scholar
  33. Menzies, L., Chamberlain, S. R., Laird, A. R., Thelen, S. M., Sahakian, B. J., & Bullmore, E. T. (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: The orbitofrontal-striatal model revised. Neuroscience and Behavioral Reviews, 32, 525–549. doi: 10.1016/j.neubiorev.2007.09.005.Google Scholar
  34. Moller, P., & Husby, R. (2000). The initial prodrome in schizophrenia: Searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin, 26(1), 217–232.Google Scholar
  35. Morrison, A. P., French, P., Parker, S., Roberts, M., Stevens, H., Bentall, R. P., et al. (2007). Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophrenia Bulletin, 33(3), 682–687. doi: 10.1093/schbul/sbl042.PubMedCrossRefGoogle Scholar
  36. Morrison, A. P., French, P., Walford, L., Lewis, S. W., Kilcommons, A., Green, J., et al. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: Randomised controlled trial. British Journal of Psychiatry, 185(4), 291–297. doi: 10.1192/bjp.185.4.291.PubMedCrossRefGoogle Scholar
  37. Ozgurdal, S., van Haren, E., Hauser, M., Strohle, A., Bauer, M., Assion, H., et al. (2009) Early mood swings as symptoms of the bipolar prodrome: Preliminary results of a retrospective analysis. Psychopathology, 42, 337–342. doi: 10.1159/000232977.Google Scholar
  38. Pietrefesa, A. S., & Coles, M. E. (2009). Moving beyond an exclusive focus on harm avoidance in obsessive-compulsive disorder: Behavioral validation for the separability of harm avoidance and incompleteness. Behavior Therapy, 40(3), 251–259. doi: 10.1016/j.beth.2008.06.003.Google Scholar
  39. Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The brown longitudinal obsessive compulsive study: Clinical features and symptoms of the sample at intake. Journal of Clinical Psychiatry, 67(5), 703–711.PubMedCrossRefGoogle Scholar
  40. Pitman, R. K. (1987). A cybernetic model of obsessive-compulsive psychopathology. Comprehensive Psychiatry, 28(4), 334–343. doi: 10.1016/0010-440X(87)90070-8.
  41. Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40(6), 624–639. doi: 10.1016/S0005-7967(01)00028-6.CrossRefGoogle Scholar
  42. Rasmussen, S. A., & Eisen, J. L. (1990). Epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry, 51(2, Suppl), 10–13.Google Scholar
  43. Rasmussen, S. A., & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatry, 143, 317–322.Google Scholar
  44. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583. doi: 10.1016/0005-7967(85)90105-6.PubMedCrossRefGoogle Scholar
  45. Salkovskis, P. M. (1989). Obsessions and compulsions. Florence, KY, USA: Taylor & Frances/Routledge.Google Scholar
  46. Salkovskis, P., Shafran, R., Rachman, S., & Freeston, M. H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: Possible origins and implications for therapy and research. Behaviour Research and Therapy, 37(11), 1055–1072. doi: 10.1016/S0005-7967(99)00063-7.
  47. Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., et al. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38(4), 347–372. doi: 10.1016/S0005-7967(99)00071-6.
  48. Sobin, C., Prudic, J., Devanand, D. P., & Nobler, M. S. (1996). Who responds to electroconvulsive therapy? A comparison of effective and ineffective forms of treatment. British Journal of Psychiatry, 169(3), 322–328. doi: 10.1192/bjp.169.3.322.PubMedCrossRefGoogle Scholar
  49. Stein, M. B. (2009). Worrying about obsessions and compulsions. The American Journal of Psychiatry, 166(3), 271–273. doi: 10.1176/appi.ajp.2008.08121856.PubMedCrossRefGoogle Scholar
  50. Stein, M. B., Forde, D. R., Anderson, G., & Walker, J. R. (1997). Obsessive-compulsive disorder in the community: An epidemiologic survey with clinical reappraisal. The American Journal of Psychiatry, 154(8), 1120–1126.PubMedGoogle Scholar
  51. Steketee, G., Frost, R. O., & Cohen, I. (1998). Beliefs in obsessive-compulsive disorder. Journal of Anxiety Disorders, 12(6), 525–537. doi: 10.1016/S0887-6185(98)00030-9.PubMedCrossRefGoogle Scholar
  52. Summerfeldt, L. J. (2004). Understanding and treating incompleteness in obsessive-compulsive disorder. Journal of Clinical Psychology, 60(11), 1155–1168. doi: 10.1002/jclp.20080.Google Scholar
  53. Yung, A. R., & McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22(2), 353–370. doi: 10.1093/schbul/22.2.353.Google Scholar
  54. Yung, A. R., Phillips, L. J., Yuen, H. P., & McGorry, P. D. (2004). Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophrenia Research, 67(2–3), 131–142. doi: 10.1016/S0920-9964(03)00192-0.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Meredith E. Coles
    • 1
  • Ashley S. Hart
    • 2
  • Casey A. Schofield
    • 3
  1. 1.Department of PsychologyBinghamton UniversityBinghamtonUSA
  2. 2.Rhode Island HospitalBostonUSA
  3. 3.Brown UniversityProvidenceUSA

Personalised recommendations