Am J Psychiatry 1997; 154:826-831
Copyright © 1997 by American Psychiatric Association
Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study
E Nelson and J Rice
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
OBJECTIVE: This study examined the 1-year temporal stability of a National
Institute of Mental Health Diagnostic Interview Schedule (DIS) lifetime
diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment
Area (ECA) study. METHOD: In that study, 20,862 individuals, aged 18 years
and over, at five sites were evaluated by lay interviewers using the DIS
(wave 1). All of those who were available 12 months later were
reinterviewed (wave 2). In the present study, the temporal stability of
wave 1 obsessive-compulsive disorder diagnoses at wave 2 was examined, as
well as relationships with comorbid diagnoses. The consistency of reports
of "new-onset" illness was also examined. Factors contributing to these
measures were evaluated. RESULTS: The temporal stability of the diagnosis
of obsessive-compulsive disorder was very low. Subjects with a stable
diagnosis of obsessive-compulsive disorder had a higher rate of both
obsessions and compulsions, an earlier age at onset, and more comorbid
anxiety, affective, and alcohol abuse/dependence disorders at initial
assessment. The originally reported 1-year incidence estimates for
obsessive-compulsive disorder primarily reflect data from subjects at wave
2 who reported the onset of symptoms as preceding the wave 1 interview.
Older and less-educated subjects had significantly higher error rates in
reporting onset. CONCLUSIONS: The DIS diagnosis of obsessive-compulsive
disorder has poor validity, leaving the true incidence and prevalence of
the disorder unknown. Older and less- educated subjects require special
attention in the design of instruments for use with community samples.
