Clinically meaningful differences between juvenile and adult participants were also found. Compared to adults, juveniles were more likely to be male, recall an earlier age at OCD onset, and have different lifetime comorbidity patterns. Significant outcomes were that children were less likely than either adolescent or adults to report aggressive obsessions and mental rituals.
The glaring - and possibly only -- distractions that I see with this study are that groups are ill matched. There is a large range of ages even amongst each group (children ranged between 6-12 whilst adolescents ranged between 13-18); they were ill-matched in OCD symptoms too; there were far less children than adolescents; and adults more than doubled the size of the juvenile and children group combined. Self-reported OCD symptom could have been produced by an alternate factor (another determinant) that was not taken into account. What could have been taken then as start of symptom could have been, in reality, commencement of something else, or symptom could have been instigated by some element peculiar to the individual's background, situation, personality, or other confounding influence. More so, the reverse could as equally be true in that overt manifestation of symptom appeared only later, whilst covert had been in existence much earlier.
In short, there are observed differences between the groups, with groups being drastically top-heavy and non-equivalent to one another in number; the observed effect may be due to these differences rather than as the result of the experimental study.
Effect of OCD on caregivers
The disorder has an overwhelming impact on the caregiver and immediate family and friends who may spend much of their time caring for the patient and preventing him from harming himself (Hollander & Wong 1998). In severe cases, ritualizing can take the entire day and the individual may suffer, for instance, extensive skin damage from excessive hand washing or hand-rubbing.
To assess the effect on the caregiver, Tolin et al. (2008) conducted an Internet survey amongst participants who reported hoarding behavior. Self-identified hoarding participants (N =864, 94% female, 65% of these met research criteria for clinically relevant compulsive hoarding) and a sample of family members of those who hoarded (N = 655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an Internet survey. Questions were partially derived from the National Comorbidity Survey (NCS), and participants were compared to NCS participants. According to researchers, results suggested that compulsive hoarding represents a "profound public health burden in terms of occupational impairment, poor physical health, and social service involvement" (p.1). Problems included the fact that the sample was conducted from over 8,000 individuals who had contacted researchers during the last 3 years for information about compulsive hoarding. Other factors might have influenced the diagnosis. Particularly considering the fact that participants were self-reported hoarders, it is by no means certain that they reliably met the criteria of OCD even though reliable instrumentation was used. Secondly, a second group -- family members - was approached regarding hoarding behavior of a family member who hoarded. The individual in question (the family member himself) was not approached in this case. It is difficult, therefore, without direct contact with the specific individual, to know whether family members were accurate in their diagnosis despite internal consistency of the measure. Although instrumentation - the Hoarding Rate Scale Interview is recorded to have high internal validity -- self-report is nonetheless questionable. Moreover, the selection method itself could have interacted with maturation and history (several participants had approached researched at least 3 years earlier) thus biasing the study.
A more egregious concern is that data was matched against the NCS, a stratified, multistage area probability sample of mental disorders in persons aged 15 to 54 years in the United States from 1990 -- 1992. Yet, the NCS was conducted more than 15 years ago on a different population (this population, for instance, consisted of primarily females), in a different environment, using different recruitment methods and methodology. The online atmosphere may have introduced confounding elements and distractions. To compare results, as researchers did, to the results obtained from the NCS survey is, consequently, erroneous.
Another problem with the questionnaires -- and one that is relevant to certain other studies mentioned here aside from the one above - is that recognition of OCD may require direct questions, as the patient is often embarrassed to divulge symptoms, and may not always be aware of their fullest extent. Moreover, people with hoarding symptoms may not see their hoarding as a problem (Tolin, 2008). The current best-validated instrument is the Yale-Brown obsessive-compulsive scale (Y-BOCS), which exists in both an adult and a child version (Goodman et al., 1984).
OCD and quality of life
It is inevitable that OCD affects the quality of life not only of the individual but also of involved caretakers. Absorption with ritualizing and obsessions take up much of the person's daily life and effect significant impairment in occupational and social activity as well as in his habitual life functioning. Moreover, children can drop out of education, and several patients do, in fact, become virtually housebound. The World Health Organization (*), in fact, reports OCD as ranking amongst the 20 most disabling diseases. The egodystronic quality of the obsessions and ritual, too, interrupts individuals from completing even mundane acts.
In 2009, Huppert et al. administered multiple measures that assessed quality of life (QOL) and functional impairment to 66 OCD patients who had previously consented for a clinical trial, and to 36 age and sex matched individuals who denied any psychiatric history in order to discover whether OCD is conclusively associated with interference in QOL and functional impairment. Results confirm that OCD was associated with significantly lower QOL and functional impairment compared to healthy controls.
Adult outpatients with OCD were contacted approximately 6 years after they had enrolled in a multi-site clinical trial for an assessment that occurred by phone or in person. Only 105 of the original 122 participants were located, and have these 32 refused or had disappeared from the program in the meantime. Other factors led to only 66 participants out of the original 122 participating. These were matched to 36 healthy controls on sex, age, and ethnicity.
The obvious confounding factors here are maturation and history as results, indeed, indicated that only slightly over half of the original participants were enabled to rejoin and that great differences had happened to others (and presumable to them too) in the meantime. Experimental attrition, consequently, occurred. That, and the non-functional equivalence between the two groups (theoretically a great spectrum of differences can occur besides age, sex, and ethnicity), result in the study losing much of its internal reliability. QOL is hard to measure and many other elements could have affected by history variables (by variables that happened to participants over time) rather than to OCD itself.
Similar disqualifications are indicated with Mancebo et al.'s (2009) study where the prevalence and clinical correlates of substance use disorders (SUDs) were examined in a clinical sample of OCD. As part of their intake interview into a longitudinal observational study of the course of OCD, 323 participants completed a battery of standardized measures. Twenty-seven percent of the sample met lifetime criteria for a SUD. 70% of participants with comorbid SUDs reported that OCD preceded SUD onset by at least one year. Here, too, the study was an observational follow-up study, and interviews elapsed over a significant period of time -- between June 2001 and December 2005. Maturational and history concerns (as well as attrition) could easily have occurred. Another glaring feature was that more than half (55%) of the members were female whilst the sample was predominantly (95%) Caucasian. Their use of substance abuse may have been correlated to other factors, and external events, as well as that of individuals changing over the span of time, could have led to observed results.
Conclusion and Ongoing Research
Psychologists are unsure whether to retain designation of OCD as being an anxiety disorder. Too many studies point to the atypicality, peculiarity, and uniqueness of this disorder; although similar, for instance, to BDD it is shares marked incongruities. OCD seems to have a distinct neurobiology and heritability although it is respondent to psychological treatment (such as CBT) that involve modification of anxiety disorder.
Altered functioning of specific brain regions is implicated in the disease and early environmental and family risk factors may play a part too (Skoog & Skoog, 1999). It seems clear that OCD affects not only daily QOL of themselves but of caregivers too. Specific onset of OCD remains problematic, although it is likely that it, generally, commences during the pre-adolescent, adolescent years. That OCD can lead to other destructive conduct (such ass substance abuse is clear).
Conclusively, classification of the disorder remains one of the occupations that researchers have with this field. Identification of meaningful subgroups may lead to more respondent and effective treatments particularly for patients who are resilient to existent interventions.