ROCZNIKI SOCJOLOGII RODZINY XII
UAM Poznań 2000
FAMILY FACTORS IN THE DEVELOPMENT
OF OBSESSIVE-COMPULSIVE DISORDERS IN YOUTH
Mi e c z y s ł a w Ra d o c h o ń s k i, An n a Ra d o c h o ń s k a, Li d i a Pe r e n c
ABSTRACT. Radochoński Mieczysław, Radochońska Anna, Perenc Lidia, Family factors in the deve lopment o f obsessive-compulsive disorders in youth(Czynnik rodzinny w rozwoju zaburzeń obsesyjno- nawykowych u młodzieży). Roczniki Socjologii Rodziny, XII, Poznań 2000. Adam Mickiewicz Uni versity Press, pp. 141-146. ISBN 83-232-1056-X. ISSN 0867-2059. Text in English.
Mieczysław Radochoński, Anna Radochońska, Lidia Perenc Wyższa Szkoła Pedagogiczna w Rzeszowie (Pedagogical University in Rzeszów), ul. Rejtana 16, 35-310 Rzeszów, Polska-Poland.
A ccording to diagnostic criteria described in classification D SM -IV (1994), the essential features o f O bsessive-C om pulsive D isorder (O C D ) are recurrent obses sions and com pulsions that are severe enough to be tim e consum ing (i.e. they take m ore than 1 hour a day) or cause m arked distress or significant im pairm ent in a person. The obsessions are defined as a persistent, intrusive, senseless thoughts and im pulses, while com pulsions are intentional and repetitive behaviors. A t som e point during the course o f the disorder, m ost o f the persons have recognized that the ob sessions and com pulsions are excessive and unreasonable. As a result, they m ake hard efforts in order to resist them . The m ost com m on obsessions are repeated thoughts about possible contam ination (e.g. becom ing contam inated by touching hands o f other people), repeated doubts (e.g. a person is uncertain w hether he/she left a door locked or turned o ff the gas stove), a need to keep things in a particular order (e.g. intense distress w hen objects are disordered in som e w ay) and sexual images. U sually the individuals w ith obsessions attem pt to ignore o r suppress such thoughts and im pulses or neutralize them w ith som e other thought or action. A n exam ple will som eone plagued by doubts about having locked the doors w ho at tem pts to neutralize them by checking several tim es in order to ensure h im se lf that it is properly closed (R adochoński 1996).
A ccording to epidem iological surveys carried out in various countries, the life tim e prevalence o f O C D is estim ated to be 1-3 % o f general population (K am o, G olding 1991; W eissm an et al. 1994). A lthough the disorder effects people o f all ages, it usually begins in adolescence or early adulthood. In som e cases it m ay be gin in childhood. M ean age at onset is different in m ales to that in fem ales (it is
144 MIECZYSŁAW RADOCHOŃSK.I, ANNA RADOCHOŃSKA, LIDIA PERENC
the num ber o f siblings in the fam ilies. The O C D fam ilies have on average 2.2 chil dren, w hile in control fam ilies the m ean num ber was 2.4. The com parison shows that the num bers o f siblings in both types o f fam ilies were not significantly differ ent (t = 1.67, p > 0.05).
RESU LTS
PR E V A L E N C E OF O C D SY M PTO M S IN TH E FA M ILIES
T able 3 presents distribution o f O C D sym ptom s in m em bers o f fam ilies in cluded to tw o exam ined groups. The prevalence o f definite O C D syndrom e was
T a b le 3 P rev a le n ce o f O C D sy m p to m s In relativ es
Relatives o f OCD Relatives o f control
Type o f symptoms persons (N=217) persons (N=231 ) P
N % N % obsessions: definite 26 12.0 8 3.4 0.01 probable 35 16.1 13 5.6 0.01 compulsions: definite 41 18.9 14 6.1 0.01 probable 54 24.9 28 12.1 0.01 OCD syndrome: definite 24 11.1 7 3.1 0.01 probable 32 14.7 15 6.5 0.02
significantly higher in first-degree relatives in the case group (11.1 % ) than in con trol group (3.1 %). V ery sim ilar proportion applies to prevalence o f probable O CD syndrom e (14.7 % vs. 6.5 %). The prevalence o f definite obsessions w as 12.0 % in case group and 3.4 % in control group, w hereas for probable obsessions respec tively 16.1 % and 5.6 %.
A lso m eaningful differences w ere found for the com pulsions: 18.9 % o f the O C D group relatives vs. 6.1 % o f the control group relatives w ere diagnosed with definite com pulsions. O n the other hand 24.9 % o f the O C D group relatives vs. 12.1 % o f the control group relatives had probable com pulsions. The occurrence o f the definite O C D syndrom e in the relatives o f the case group is alm ost 3.5 times greater than in control relatives (p < 0.01). This proportion indicates that first-degree relatives o f case group m et clinical criteria for O C D syndrom e significantly more often than first-degree relatives o f controls. In both groups a higher frequency o f com pulsions than obsessions was observed.
O btained data have revealed that the age o f onset o f obsessive-com pulsive sym ptom s in relatives ranged from 7 to 35 years. H ow ever the m edian age at onset o f sym ptom s in the O C D group w as about 13 years. M ore than 65 % o f probands
FAMILY FACTORS IN THE DEVELOPMENT OF OBSESSIVE-COMPULSIVE 145
from that group had onset by age 13 years and 90 % by age 16 years. There is some difference, although not significant, betw een the m ean age o f onset in girls (12.4 years) and boys (11.7 years) (t = 0.64; p > 0.05).
CO M M E N T
The study reported in this paper has revealed some interesting findings. First o f all, the O CD syndrome seems to be family determined. Close relatives o f persons diagnosed with O CD had a nearly 3.5-fold higher lifetime prevalence than relatives representing a general population. The obtained results are also significant when we take into consideration probable diagnoses. The existing difference in proportions between case and control relatives should be estimated from the vantage point o f prevalence rates o f O CD in general population. In this study prevalence rate in the control relatives was similar to those obtained in the already published epidemiological studies (W eissman et al. 1994). In other words, the findings o f this study are generally consistent with the most recent study on familial correlates o f OCD (Pauls et al. 1995).
A nother interesting finding w as that com pulsions are m ore specific to the fa milial correlates o f O C D than are obsessions. Indeed, first-degree relatives o f case probands are at higher risk for both obsessions and com pulsions, but frequency o f com pulsions is greater than obsessions. This finding m ay indicate a significant role o f heterogeneity for developm ent o f com pulsions.
We are aw are o f som e m ethodological lim itations o f our study. First o f all, the case group (persons w ith diagnosis o f O C D syndrom e) seem s to be not big enough). In order to obtain a representative sam ple o f O C D persons, w e would have had to screen thousands o f subjects w hat is, at the m om ent, a very difficult task. We have tried to m inim ize selection bias by including in the study all probands w ith O CD syndrom e w ho w ere available in selected high schools. The sam e objection could be form ulated about the selection o f control group. In order to reduce the likelihood o f a bias, we tried to select the control probands and their relatives (parents and siblings) from the sam e com m unity. This way the controls w ere repre sentative o f persons living in the com m unities in w hich the O C D persons lived.
The conclusion that O C D is fam ily determ ined is very im portant, w hen we consider its consequences, although it does not necessary m ean that the disorder is genetically transm itted. M ore detailed clarification o f contribution o f genetic and environm ental factors in its etiology and course requires further intensive studies.
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