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Am J Psychiatry 1997; 154:1120-1126
Copyright © 1997 by American Psychiatric Association
Obsessive-compulsive disorder in the community: an epidemiologic survey with clinical reappraisal
MB Stein, DR Forde, G Anderson and JR Walker
Department of Psychiatry, University of California, San Diego, La Jolla 92093-0603, USA. mstein@ucsd.edu
OBJECTIVE: To examine the prevalence of obsessive-compulsive symptoms and
DSM-IV obsessive-compulsive disorder (OCD), the authors conducted a
telephone survey of 2,261 adults in four regions of Canada. METHOD: Trained
lay interviewers administered a modified version of the OCD section of the
Comprehensive International Diagnostic Interview. A subsample of
respondents with probable cases and probable subclinical cases of OCD was
then blindly reinterviewed by research personnel experienced in the
assessment of OCD, using the Structured Clinical Interview for DSM-IV and
the Yale-Brown Obsessive Compulsive Scale, to confirm the diagnosis and
gauge the severity of OCD. RESULTS: The weighted 1-month prevalence of OCD
in the entire sample according to the lay interviews was 3.1%. Upon
clinical reappraisal, the 1-month prevalence estimate of OCD dropped to
0.6%; an additional 0.6% had subclinical OCD. The mean Yale-Brown Obsessive
Compulsive Scale score of the individuals with OCD was 19.0 (SD = 4.6,
median = 21); for those with subclinical OCD, the mean score was 15.4 (SD =
2.4, median = 14). Common reasons for overdiagnosis of OCD by the lay
interviewers were inappropriate labeling of worries or concerns as
obsessions and overestimating the degree of interference or distress
attributable to obsessive-compulsive symptoms. CONCLUSIONS: OCD, while
hardly a rare condition, may be somewhat less prevalent than had been
believed on the basis of previous surveys. Additional studies are needed to
substantiate these findings and to delineate precisely the extent of
disability and reduced quality of life attributable to OCD (and OCD
variants) in the community.
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