Obsessive-compulsive little current knowledge about predictors on

Obsessive-compulsive disorder (OCD) is a chronic and
disabling mental disorder characterized by recurrent unwanted thoughts
(obsessions) and/or repetitive behavioural acts (compulsions). The lifetime
prevalence of OCD is approximately 1-3% (Ruscio, Stein, Chiu, & Kessler, 2010) and
OCD is listed by the Global Burden of Diseases as the 10th most
disabling medical disorder worldwide (Whiteford, Ferrari, Degenhardt, Feigin, & Vos,
2015). It
is known that OCD tends to wax and wane throughout one’s lifetime and that the
majority of people with OCD report a chronic course (Allen, King, & Hollander, 2003). Its chronic course is an important factor in the high disease burden
reported for OCD-patients, because it has been associated with poorer quality
of life (Hollander et al. 2016). Hence it is of great value to identify
patients who have the highest risk for chronic OCD, by evaluating predictors or
risk factors. If predictors for chronicity are known, they may yield possible
targets 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 is
limited. Several studies are published on remission, relapse and persistence in
long-term OCD, but the results of these studies varied. First of all, different
results 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 of
remission, 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 course
of OCD is available. Follow-up studies have so far suggested a couple of
predictors that might be associated with chronic OCD. For instance greater
functional impairment (Skoog & Skoog, 1999; Steketee et al., 1997), longer illness duration and greater
symptom 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 comorbid
obsessive-compulsive personality disorder (OCPD) (Garnaat et al., 2015; Eisen et al., 2013) have been associated with
a worse OCD course.


To be able to prevent people from developing chronic
OCD, it is necessary to first clarify the current state of knowledge on all
predictors of chronic OCD.  Therefore the
aim of the present study is to identify predictors and risk factors that are
associated with chronic OCD through a systematic review of the literature. This
leads to the following research question: “What are predictors for chronicity
in obsessive-compulsive disorder in adulthood?” It is hypothesized that no
isolated predictor will homogeneously be presented in the various studies and
that predominantly the clinical predictors lead to chronic OCD.