title: Five-year course of obsessive-compulsive disorder: predictors of remission and relapse.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD.
  
  
  METHODS
  A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as part of the Brown Longitudinal Obsessive Compulsive Study, a prospective, naturalistic study of treatment-seeking adults with primary OCD. OCD symptoms were assessed annually over the 5-year follow-up period using the Longitudinal Interval Follow-Up Evaluation.
  
  
  RESULTS
  Thirty-nine percent of participants experienced either a partial (22.1%) or a full (16.9%) remission. Two OCD symptom dimensions impacted remission. Participants with primary obsessions regarding overresponsibility for harm were nearly twice as likely to experience a remission (P < .05), whereas only 2 of 21 participants (9.5%) with primary hoarding achieved remission. Other predictors of increased remission were lower OCD severity (P < .0001) and shorter duration of illness (P < .0001). Fifty-nine percent of participants who remitted subsequently relapsed. Participants with obsessive-compulsive personality disorder were more than twice as likely to relapse (P < .005). Participants were also particularly vulnerable to relapse if they experienced partial remission versus full remission (70% vs 45%; P < .05).
  
  
  CONCLUSIONS
  The contributions of OCD symptom categories and comorbid obsessive-compulsive personality disorder are critically important to advancing our understanding of the prognosis and ultimately the successful treatment of OCD. Longer duration of illness was also found to be a significant predictor of course, highlighting the critical importance of early detection and treatment of OCD. Furthermore, having full remission as a treatment target is an important consideration for the prevention of relapse in this disorder.
authors.affiliation: Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA. jane_eisen@brown.edu
authors.forename: Jane L
authors.initials: JL
authors.lastname: Eisen
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Sibrava
authors.forename: Christina L
authors.initials: CL
authors.lastname: Boisseau
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mancebo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.forename: Anthony
authors.initials: A
authors.lastname: Pinto
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D001526:Behavioral Symptoms / Q000175:diagnosis*; D015897:Comorbidity; D003192:Compulsive Behavior / Q000175:diagnosis*; D003193:Compulsive Personality Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors
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