Remission of obsessive-compulsive disorders and syndromes; evidence from a prospective community cohort study over 30 years

Abstract

Objective. Studies suggest that obsessive-compulsive disorder (OCD) is an unremitting disorder. We report a prospective, longitudinal investigation into OCD and sub-diagnostic OC syndrome (OCS) over a 30-year period to determine the extent to which individuals with clinically relevant OC symptomatology cumulatively remit, as well as the remission latency. Methods. Five hundred and ninety-one participants drawn from the general population of Zurich, Switzerland, participated in a series of seven interviews over a period of 30 years. Results. Median duration for OCD, OCS and unimpairing OC symptoms was 16, 14 and 6 years, respectively, suggesting a better prognosis for remission for less severe illness. Individuals with a longer duration of illness, greater number of OC-burdened years and those seeking professional help experienced significantly delayed remission. In addition, these factors together with the presence of comorbid anxiety disorders were associated with significantly reduced remission rates. We found a trend towards statistical significance for comorbid affective disorders and reduced remission rates. Conclusions. Our findings suggest a lack of diagnostic stability over the long-term and a high chance of eventual remission, albeit often after several years of illness, for obsessive-compulsive syndromes including OCD. However, roughly one-third of OCD cases do not remit by 50 years of age.