Richter Margaret A, Summerfeldt Laura J, Antony Martin M, Swinson Richard P
Anxiety Disorders Clinic, Centre for Addiction and Mental Health, Clarke Division, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Depress Anxiety. 2003;18(3):118-27. doi: 10.1002/da.10126.
In light of current interest in an obsessive-compulsive spectrum of disorders, this study sought to determine whether comorbidity patterns support the unique relationship hypothesized between these conditions and obsessive-compulsive disorder (OCD). Comparisons were made of lifetime rates of several proposed spectrum conditions in individuals with one of three anxiety disorder principal diagnoses (OCD, social phobia, or panic disorder [PD], N=277). Spectrum conditions examined included tic-related disorders, trichotillomania, skin picking, and eating disorders, with analyses performed on rates both of clinical disorder alone, and clinical and subclinical manifestations jointly. The OCD group was found to differ from both other groups in showing 1) a greater proportion of individuals affected with any lifetime spectrum condition, 2) a greater number of lifetime spectrum conditions affecting each individual, and 3) a greater proportion of individuals having a lifetime history of multiple spectrum conditions. Analyses for specific spectrum conditions indicated differences among the anxiety disorder groups for all spectrum categories except eating disorders, though only in the case of tic-related conditions did OCD differ significantly from both comparison groups. For the other conditions, dissimilar patterns of differences were observed among the three groups, particularly when subclinical manifestations were included. These findings have conceptual and clinical implications, including 1) the salience of tic-related disorders in the OC spectrum, 2) the possibility that the relationship between spectrum conditions and anxiety disorders may take several different forms, and 3) the need for refinement of the hypothesized spectrum.
鉴于当前对强迫症谱系障碍的关注，本研究旨在确定共病模式是否支持这些病症与强迫症（OCD）之间假设的独特关系。对患有三种焦虑症主要诊断之一（强迫症、社交恐惧症或惊恐障碍[PD]，N = 277）的个体中几种提议的谱系病症的终生患病率进行了比较。所检查的谱系病症包括抽动相关障碍、拔毛癖、皮肤搔抓和进食障碍，并对单独的临床病症以及临床和亚临床症状的患病率进行了分析。结果发现，强迫症组与其他两组的不同之处在于：1）患有任何终生谱系病症的个体比例更高；2）影响每个个体的终生谱系病症数量更多；3）有多种谱系病症终生病史的个体比例更高。对特定谱系病症的分析表明，除进食障碍外，所有谱系类别在焦虑症组之间均存在差异，不过仅在抽动相关病症方面，强迫症与两个对照组均有显著差异。对于其他病症，三组之间观察到不同的差异模式，尤其是当纳入亚临床症状时。这些发现具有概念和临床意义，包括：1）抽动相关障碍在强迫症谱系中的显著性；2）谱系病症与焦虑症之间的关系可能有几种不同形式的可能性；3）对假设的谱系进行细化的必要性。
