An 11- to 13-year follow-up of 75 subjects with obsessive-compulsive disorder

There is a paucity of data on the long-term course and outcome of obsessive-compulsive disorder (OCD). Available data suggest that OCD runs a chronic course with waxing and waning severity. However, most previous studies included severely ill patients who were often clinically referred and hospitalized. The present study reports the course and outcome of OCD in patients who were largely outpatient, self-referred, and drug-naive.

Seventy-five of the 105 subjects (71%) with DSM-IV-diagnosed OCD were followed up 11 to 13 years after initial consultation in 1991 and 1992 at a major psychiatric hospital in India. A majority were self-referred (N = 63, 84%), drug-naive (N = 54, 72%), and outpatients (N = 60, 80%). The follow-up evaluations were carried out by experienced clinicians using various scales and structured instruments. The course and outcome were determined according to predefined criteria. Multinomial logistic regression analysis was performed to identify potential predictors of outcome.

A majority of subjects were adequately treated with medications (N = 57, 76%). Out of 75 subjects, only 18 subjects (24%) had clinical OCD. Overall, 57 subjects (76%) had a favorable outcome: 32 subjects (43%) had no OCD and 25 (33%) had subclinical OCD. Mixed OCD and any Axis I lifetime comorbidity predicted "clinical OCD" outcome.

Outcome of OCD is better than generally assumed, and the findings of this study offer a new perspective on the long-term outcome of OCD. Poor outcome in previous studies may have been due to the inclusion of severely and chronically ill patients.