Obsessive-compulsive disorder (OCD) is a chronic anddisabling mental disorder characterized by recurrent unwanted thoughts(obsessions) and/or repetitive behavioural acts (compulsions). The lifetimeprevalence of OCD is approximately 1-3% (Ruscio, Stein, Chiu, & Kessler, 2010) andOCD is listed by the Global Burden of Diseases as the 10th mostdisabling medical disorder worldwide (Whiteford, Ferrari, Degenhardt, Feigin, & Vos,2015).
Itis known that OCD tends to wax and wane throughout one’s lifetime and that themajority of people with OCD report a chronic course (Allen, King, & Hollander, 2003). Its chronic course is an important factor in the high disease burdenreported for OCD-patients, because it has been associated with poorer qualityof life (Hollander et al. 2016).
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Hence it is of great value to identifypatients who have the highest risk for chronic OCD, by evaluating predictors orrisk factors. If predictors for chronicity are known, they may yield possibletargets for preventive interventions to prevent chronicity in OCD. Despite the clinical relevance of chronicity in OCD,literature published on predictors of chronic obsessive-compulsive disorder islimited. Several studies are published on remission, relapse and persistence inlong-term OCD, but the results of these studies varied. First of all, differentresults are found on the frequency of chronic OCD, ranging from 24% (Reddy et al., 2005)to 98% (Rasmussen & Tsuang, 1986). Also, different results are found in previous studies on rates ofremission, varying between .
25 to .76, and rates of relapse, varying between.25 and .60 (Eisen et al., 1999; Catapano et al.
, 2006; Marcks, Weisberg, Dyck, & Keller, 2011). Furthermore, little current knowledge about predictors on the courseof OCD is available. Follow-up studies have so far suggested a couple ofpredictors that might be associated with chronic OCD. For instance greaterfunctional impairment (Skoog & Skoog, 1999; Steketee et al., 1997), longer illness duration and greatersymptom severity (Eisen et al.
, 2013)were predictive of chronicity. Earlier age of onset (Skoog & Skoog, 1999) and specific comorbidities, such as comorbid major depressive disorder(MDD) (Steketee et al., 1997; Marcks et al., 2011) and comorbidobsessive-compulsive personality disorder (OCPD) (Garnaat et al., 2015; Eisen et al., 2013) have been associated witha worse OCD course.
To be able to prevent people from developing chronicOCD, it is necessary to first clarify the current state of knowledge on allpredictors of chronic OCD. Therefore theaim of the present study is to identify predictors and risk factors that areassociated with chronic OCD through a systematic review of the literature. Thisleads to the following research question: “What are predictors for chronicityin obsessive-compulsive disorder in adulthood?” It is hypothesized that noisolated predictor will homogeneously be presented in the various studies andthat predominantly the clinical predictors lead to chronic OCD.