title: Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment.
abstract: BACKGROUND
  Although subthreshold conditions are associated with impairment in numerous disorders, research on obsessive-compulsive disorder (OCD) below the diagnostic threshold of DSM-IV in the general population is limited.
  
  
  OBJECTIVE
  To estimate the DSM-IV 12-month prevalence, comorbidity and impairment of OCD, subthreshold OCD (i.e., fulfilling some but not all core DSM-IV criteria), and obsessive-compulsive symptoms (OCS) (i.e., endorsement of OCS without fulfilling any core DSM-IV criteria) in a general population sample.
  
  
  METHODS
  Data from the German National Health Interview and Examination Survey-Mental Health Supplement (N = 4181, age 18-65 years), based on the standardized diagnostic Munich Composite International Diagnostic Interview.
  
  
  RESULTS
  The 12-month prevalence of OCD was 0.7%, subthreshold OCD was 4.5%, and OCS was 8.3%. Subjects in all three groups showed higher comorbidity (odds ratios [ORs] ≥ 3.3), compared to those without OCS. The OCD, subthreshold OCD and OCS were all associated with increased odds of substance abuse/dependence-, mood-, anxiety- and somatoform disorders, with especially strong associations with possible psychotic disorder (ORs ≥ 4.1) and bipolar disorders (ORs ≥ 4.7). Participants in all three groups showed higher impairment (ORs ≥ 3.1) and health-care utilization (ORs ≥ 2.4), compared to those without OCS, even after controlling for covariates.
  
  
  CONCLUSIONS
  Individuals with subthreshold OCD and OCS, not currently captured by DSM-IV OCD criteria, nevertheless show substantial comorbidity, impairment and health-care utilization. This should be taken into account in future conceptualization and classification of OCD and clinical care.
authors.affiliation: National Centre of Competence in Research Swiss Etiological Study of Adjustment and Mental Health (SESAM), University of Basel, Department of Psychology, Missionsstrasse 60/62, 4055, Basel, Switzerland.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Adam
authors.forename: Gunther
authors.initials: G
authors.lastname: Meinlschmidt
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Gloster
authors.forename: Roselind
authors.initials: R
authors.lastname: Lieb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D012720:Severity of Illness Index; D055815:Young Adult