Subthreshold symptoms and obsessive–compulsive disorder: evaluating the diagnostic threshold

• Published in: Psychological medicine Vol. 40; no. 6; pp. 989 - 997
• Main Authors: de Bruijn, C., Beun, S., de Graaf, R., ten Have, M., Denys, D.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2010
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Comorbidity; Compulsion; Compulsions; Cross-Sectional Studies; Diagnostic and Statistical Manual of Mental Disorders; diagnostic threshold; Disability Evaluation; Female; Functional status; Health status; Health Surveys; Help seeking behavior; Humans; Incidence; Interview, Psychological; Male; Medical diagnosis; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Disorders - psychology; Mental health; Middle Aged; Morbidity; Nemesis; Netherlands; Neuroses; Obsession; obsessions; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - classification; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - epidemiology; Obsessive-Compulsive Disorder - psychology; Obsessive-compulsive disorders; Obsessive-Compulsive neuroses; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Social Adjustment; subclinical disorders; Symptoms; Vulnerability; Young Adult; Netherlands; Europe; obsessions; subclinical disorders; Compulsions; obsessive–compulsive disorders; diagnostic threshold; Social environment; Human; Obsessive compulsive disorder; obsessive-compulsive disorders; Anxiety disorder; Mental health; Nosology; Asymptomatic; Symptomatology; Criterion; Compulsion; Classification; Severity score; Diagnosis; Comparative study; Public health
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291709991012

In this study we compared subjects with obsessive and/or compulsive symptoms who did not meet all criteria for obsessive-compulsive disorder (OCD) (subthreshold subjects) to subjects with full-blown OCD and also to subjects without obsessions or compulsions. The data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the general Dutch population (n=7076). Using the Composite International Diagnostic Interview, Version 1.1 (CIDI 1.1), three groups were distinguished: subjects without lifetime obsessions or compulsions (94.2%), subthreshold subjects (4.9%) and subjects with full-blown OCD according to DSM-III-R (0.9%). These three groups were compared on various items, including psychological vulnerability, health and functional status, psychiatric co-morbidity and seeking treatment. Subthreshold and OCD subjects had similar scores on the majority of the items measured. Thus, there was little difference between subthreshold and OCD subjects in health, functional status, psychological vulnerability and psychiatric co-morbidity. However, OCD and subthreshold subjects scored worse on most of these items when compared to the controls without obsessions or compulsions. Having obsessions and compulsions is associated with substantial suffering and disability. Most subjects with obsessions and/or compulsions are not diagnosed with OCD according to the DSM-III-R criteria although these subjects generally display similar consequences to full-blown OCD subjects. We recommend that these subthreshold cases receive special attention in the development of DSM-V.