Elsevier

Psychiatry Research

Volume 158, Issue 2, 15 March 2008, Pages 217-225
Psychiatry Research

Early-onset obsessive–compulsive disorder and personality disorders in adulthood

https://doi.org/10.1016/j.psychres.2006.08.003Get rights and content

Abstract

Obsessive–compulsive disorder (OCD) often emerges in childhood or adolescence. The aim of the present study was to evaluate whether adult patients with prepuberal onset differ from subjects with later onset in terms of personality disorder comorbidity. The Structured Clinical Interview for DSM-IV Axis II Disorders was used to assess 148 patients with a principal diagnosis of OCD according to the Structured Clinical Interview for DSM-IV Axis I Disorders. The following two subgroups of subjects were selected according to the age at onset of symptomatology: patients with an early-onset (≤ 10 years), and patients with a later onset (≥ 17 years). Of the 148 patients screened for the present study, 33 (22.3%) had an early onset and 13 69 (46.6%) had a later onset. With regard to personality disorders, early-onset patients showed more OC personality disorders (OCPD) than later onset patients. Our finding suggests that OCD in childhood increases the risk for developing OCPD in adulthood, or that early-onset OCD and OCPD share a common pathogenesis.

Introduction

Obsessive–compulsive disorder (OCD) affects around 2–3% of the general population and often emerges in childhood or adolescence: in clinical studies, approximately 60% of adult patients refer to the onset of the disorder before the age of 25 years, and about one third to one half before the age 15 years (Rasmussen and Eisen, 1990).

Studies performed in adult samples suggested that OCD patients with an early onset differ from their adult-onset counterparts regarding clinical and biological features. Clinical studies have found child-onset OCD associated to a male gender predominance (Fontenelle et al., 2003, Jaisoorya et al., 2003), a greater overall severity in terms of a greater number of clinically significant obsessions and compulsions (Sobin et al., 1999, Fontenelle et al., 2003, Millet et al., 2004) and a greater degree of severity according to scores on the Yale-Brown Obsessive-Compulsive Scale (Rosario-Campos et al., 2001, Fontenelle et al., 2003, Jaisoorya et al., 2003), a specific form of symptomatology with a higher frequency of repetition of rituals (e.g., need to touch, tap or rub, rituals involving blinking or staring) (Sobin et al., 2000, Fontenelle et al., 2003, Millet et al., 2004), a higher tic/Tourette comorbidity (Jaisoorya et al., 2003, Millet et al., 2004) and a greater familial loading (Nestadt et al., 2000, Pauls et al., 1995). Also, some biological characteristics seem to be specifically associated with early-onset OCD: neuroimaging studies showed greater dysfunction in the striatum of child-onset than of adult-onset OCD patients (Luxenberg et al., 1988, Rosenberg et al., 1997), as well as a decreased regional cerebral blood flow in the left anterior cingulate and in the right orbitofrontal cortex (Busatto et al., 2001). Another study (Morer et al., 2006) has demonstrated higher streptococcal antibody titers and a greater number of previous episodes of tonsillitis in the serum of adult OCD patients who had their onset in childhood, bolstering the theory that some cases of childhood-onset OCD might be caused by autoimmune problems.

These clinical and biological findings thus corroborate previous reports that child-onset OCD has special characteristics that might identify it as a specific subtype of OCD. For this reason, it is of interest to learn whether early- and late-onset OCD are different in terms of comorbid personality disorders. Furthermore, some studies performed on children with depression, anxiety and conduct disorder report that an Axis I disorder that has its onset during childhood may predate a personality disorder in adulthood (Lewinsohn et al., 1997, Kasen et al., 2001, Wewetzer et al., 2001, Ramklint et al., 2003); the two follow-up studies performed in children with OCD that examined personality status at follow-up seem to converge in suggesting that OCD during childhood increases the frequency of personality disorders with contrasting results on specific Axis II diagnoses (Thomsen and Mikkelsen, 1993, Wewetzer et al., 2001).

Surprisingly, no systematic investigation regarding the association of OCD with personality disorders according to the age at onset has been performed: the only one study that evaluated personality disorders in adult patients with OCD according to age at onset found a significantly higher prevalence of schizotypal and borderline personality disorders in adults with onset at or before age 15 compared with those with a later onset (Hemmings et al., 2004). Unfortunately, this study did not report the prevalence rates of other personality disorders. Moreover, the authors might not have properly identified a homogeneous early-onset subgroup for at least two reasons: first, they considered the onset of the disorder and not the onset of first symptoms; second, the choice of age 15 as a cut-off point may be too high to investigate early-onset OCD as suggested by other authors (Rosario-Campos et al., 2001).

The aim of the present study was to investigate whether adult patients with OCD with prepuberal onset differ from subjects with later onset in terms of personality disorder comorbidity.

Section snippets

Subjects

Subjects for this study were recruited from all patients with a principal diagnosis of OCD consecutively referred to the Mood and Anxiety Disorders Unit, Department of Neurosciences, University of Turin (Italy) over a period of 5 years (January 2000–February 2005).

Inclusion criteria were that patients had a principal diagnosis of OCD according to DSM-IV, had a minimum total score of 16 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), were at least 18 years of age, and were willing to

Results

A total group of 148 patients with OCD were screened for the present study. Their age at onset of symptoms was defined and confirmed by external corroboration, and their personality status was examined by means of the SCID-II; onset of symptoms at or before age 10 characterized 33 patients (22.3%) (early-onset group) and onset of symptoms at or after age 17 characterized 69 patients (46.6%) (late-onset group). The remaining 46 subjects (31.8%) were excluded from the following analysis.

Discussion

The aim of the present study was to investigate whether adult patients with prepuberal onset OCD differ from subjects with later onset in terms of personality disorder comorbidity. The total sample of patients screened for the investigation (n = 148) appeared to be representative of a typical adult OCD population: the gender distribution, the marital status, the age at and the type of onset, the clinical course, and the mean illness severity assessed with the Y-BOCS were consistent with the

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