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Towards the correlates of stressful life events as precipitants of obsessive-compulsive disorder: a systematic review and metanalysis

Published online by Cambridge University Press:  30 April 2024

Verônica Hühne Open the ORCID record for Verônica Hühne [Opens in a new window] ,
Samara dos Santos-Ribeiro ,
Maria E. Moreira-de-Oliveira ,
Gabriela B. de Menezes  and
Leonardo F. Fontenelle
Verônica Hühne
Affiliation:
Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
Samara dos Santos-Ribeiro
Affiliation:
Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
Maria E. Moreira-de-Oliveira
Affiliation:
Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
Gabriela B. de Menezes
Affiliation:
Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
Leonardo F. Fontenelle*
Affiliation:
Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
*
Corresponding author: Leonardo F. Fontenelle; Email: lfontenelle@gmail.com
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Abstract

Obsessive-compulsive disorder (OCD) is a prevalent condition with multifactorial etiology involving genetic and environmental factors. The present study aims to summarize the correlates of stressful life events (SLEs) in OCD by reviewing studies comparing OCD associated or not with SLEs before its onset. To do so, a systematic review was performed by searching PubMed, Web of Science, Scopus, and PsycINFO databases for studies published between the database’s inception and November 27, 2023. Studies including individuals whose OCD was precipitated or not by SLEs (SLEs OCD and NSLEs OCD, respectively) were assessed. Effect sizes or odds ratios were then calculated to identify the strength of association between SLEs and clinical characteristics, such as gender, age of onset, family history of OCD, severity of OCD symptoms, depressive symptoms, and mood comorbidities among patients with OCD. Out of the 4083 records initially identified, 5 studies met the inclusion criteria and 3 were comparable through a meta-analysis. Notably, the analyses were limited by the small number of studies available in the literature. The meta-analysis demonstrated SLEs OCD to be associated with female gender, later OCD onset, and increased comorbidity rates with mood disorders. Despite the cross-sectional nature of the reviewed studies, women may be more vulnerable to develop a later onset of OCD following SLEs, which may also lead to mood disorders. Caution is needed to avoid prematurely classifying this presentation as a distinct subtype of OCD.

Keywords

Obsessive-compulsive disorderstressful life eventsOCD coursesystematic reviewtrauma

Information

Type
Review
Information
CNS Spectrums , Volume 29 , Issue 4 , August 2024 , pp. 252 - 260
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596.Google Scholar
Nestadt, G, Grados, M, Samuels, JF. Genetics of obsessive-compulsive disorder. Psychiatr Clin North Am. 2010;33(1):141–158. doi:10.1016/j.psc.2009.11.001.CrossRefGoogle ScholarPubMed
Brander, G, Pérez-Vigil, A, Larsson, H, Mataix-Cols, D. Systematic review of environmental risk factors for obsessive-compulsive disorder: a proposed roadmap from association to causation. Neurosci Biobehav Rev. 2016;65:36–62. doi:10.1016/j.neubiorev.2016.03.011.CrossRefGoogle ScholarPubMed
Fontenelle, LF, Cocchi, L, Harrison, BJ, Miguel, EC, Torres, AR. Role of stressful and traumatic life events in obsessive-compulsive disorder. Neuropsychiatry (London). 2011;1(1):61–69. doi:10.2217/npy.10.1.CrossRefGoogle Scholar
Horowitz, MJ. Intrusive and repetitive thoughts after experimental stress. Arch Gen Psychiatry. 1975;32(11):1457. doi:10.1001/archpsyc.1975.01760290125015.CrossRefGoogle ScholarPubMed
Destrée, L, Albertella, L, Torres, AR, et al. Social losses predict a faster onset and greater severity of obsessive-compulsive disorder. J Psychiatr Res. 2020;130:187–193. doi:10.1016/j.jpsychires.2020.07.027.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Boman, M, Monzani, B, et al. Population-based, multigenerational family clustering study of obsessive-compulsive disorder. JAMA Psychiatry. 2013;70(7):709–717. doi:10.1001/jamapsychiatry.2013.3.CrossRefGoogle ScholarPubMed
Taylor, S. Early versus late onset obsessive–compulsive disorder: evidence for distinct subtypes. Clin Psychol Rev. 2011;31(7):1083–1100. doi:10.1016/j.cpr.2011.06.007.CrossRefGoogle ScholarPubMed
Pauls, DL, Abramovitch, A, Rauch, SL, Geller, DA. Obsessive–compulsive disorder: an integrative genetic and neurobiological perspective. Nat Rev Neurosci. 2014;15(6):410–424. doi:10.1038/nrn3746.CrossRefGoogle ScholarPubMed
Cromer, KR, Schmidt, NB, Murphy, DL. An investigation of traumatic life events and obsessive-compulsive disorder. Behav Res Ther. 2007;45(7):1683–1691. doi:10.1016/j.brat.2006.08.018.CrossRefGoogle ScholarPubMed
American Psychiatric Association. DSM-5 – Manual Diagnóstico e Estatístico de Transtornos Mentais; 2014. niip.com.br/wp-content/uploads/2018/06/Manual-Diagnosico-e-Estatistico-de-Transtornos-Mentais-DSM-5-1-. Accessed 30 November, 2020.Google Scholar
Adams, TG, Kelmendi, B, Brake, CA, Gruner, P, Badour, CL, Pittenger, C. The role of stress in the pathogenesis and maintenance of obsessive-compulsive disorder. Chronic Stress. 2018;2:2470547018758043. doi:10.1177/2470547018758043.CrossRefGoogle ScholarPubMed
Cohen, S, Murphy, MLM, Prather, AA. Ten surprising facts about stressful life events and disease risk. Annu Rev Psychol. 2019;70(1):577–597. doi:10.1146/annurev-psych-010418-102857.CrossRefGoogle ScholarPubMed
Dohrenwend, BP. Inventorying stressful life events as risk factors for psychopathology: toward resolution of the problem of intracategory variability. Psychol Bull. 2006;132(3):477–495. doi:10.1037/0033-2909.132.3.477.CrossRefGoogle ScholarPubMed
Auxéméry, Y. Post-traumatic psychiatric disorders: PTSD is not the only diagnosis. Presse Med. 2018;47(5):423–430. doi:10.1016/j.lpm.2017.12.006.CrossRefGoogle Scholar
Fostick, L, Nacasch, N, Zohar, J. Acute obsessive compulsive disorder (OCD) in veterans with posttraumatic stress disorder (PTSD). World J Biol Psychiatry. 2012;13(4):312–315. doi:10.3109/15622975.2011.607848.CrossRefGoogle ScholarPubMed
Fontenelle, LF, Cocchi, L, Harrison, BJ, et al. Towards a post-traumatic subtype of obsessive-compulsive disorder. J Anxiety Disord. 2012;26(2):377–383. doi:10.1016/j.janxdis.2011.12.001.CrossRefGoogle ScholarPubMed
Araújo, AXGD, Fontenelle, LF, Berger, W, et al. Pre-traumatic vs post-traumatic OCD in PTSD patients: are differences in comorbidity rates and functional health status related to childhood abuse? Compr Psychiatry. 2018;87:25–31. doi:10.1016/j.comppsych.2018.08.012.CrossRefGoogle ScholarPubMed
Barzilay, R, Patrick, A, Calkins, ME, Moore, TM, Gur, RC, Gur, RE. Association between early-life trauma and obsessive compulsive symptoms in community youth. Depress Anxiety. 2019;36(7):586–595. doi:10.1002/da.22907.CrossRefGoogle ScholarPubMed
You, S, Conner, KR. Stressful life events and depressive symptoms. J Nerv Ment Dis. 2009;197(11):829–833. doi:10.1097/NMD.0b013e3181be7841.CrossRefGoogle ScholarPubMed
Paykel, ES. Life events and affective disorders. Acta Psychiatr Scand Suppl. 2003;108(418):61–66. doi:10.1034/j.1600-0447.108.s418.13.x.CrossRefGoogle Scholar
Paykel, ES. Which depressions are related to life stress? Acta Neuropsychiatr. 2002;14(4):167–172. doi:10.1034/j.1601-5215.2002.140402.x.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI. Principal and additional DSM-IV disorders for which outpatients seek treatment. Psychiatr Serv. 2000;51(10):1299–1304. doi:10.1176/appi.ps.51.10.1299.CrossRefGoogle ScholarPubMed
Kendler, KS, Karkowski, LM, Prescott, CA. Stressful life events and major depression: risk period, long-term contextual threat, and diagnostic specificity. J Nerv Ment Dis. 1998;186(11):661–669. doi:10.1097/00005053-199811000-00001.CrossRefGoogle ScholarPubMed
Bos, EH, Bouhuys, AL, Geerts, E, van Os, TWDP, Ormel, J. Stressful life events as a link between problems in nonverbal communication and recurrence of depression. J Affect Disord. 2007;97(1–3):161–169. doi:10.1016/j.jad.2006.06.011.CrossRefGoogle ScholarPubMed
Paykel, ES. Suicide attempts and recent life events. Arch Gen Psychiatry. 1975;32(3):327. doi:10.1001/archpsyc.1975.01760210061003.CrossRefGoogle ScholarPubMed
Shaik, S, Rajkumar, RP, Menon, V, Gender, SS. Life events, and depression: an exploratory study. Indian J Psychol Med. 2017;39(3):330–335. doi:10.4103/0253-7176.207339.CrossRefGoogle ScholarPubMed
Weber, K, Giannakopoulos, P, Herrmann, FR, et al. Stressful life events and neuroticism as predictors of late‐life versus early‐life depression. Psychogeriatrics. 2013;13(4):221–228. doi:10.1111/psyg.12024.CrossRefGoogle ScholarPubMed
Mitchell, PB, Parker, GB, Gladstone, GL, Wilhelm, K, Austin, MP. Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype. J Affect Disord. 2003;73(3):245–252. doi:10.1016/S0165-0327(01)00479-7.CrossRefGoogle ScholarPubMed
Serafini, G, Gonda, X, Canepa, G, Geoffroy, PA, Pompili, M, Amore, M. Recent stressful life events in euthymic major depressive disorder patients: sociodemographic and clinical characteristics. Front Psychiatry. 2020;11. doi:10.3389/fpsyt.2020.566017.Google ScholarPubMed
Muscatell, KA, Slavich, GM, Monroe, SM, Gotlib, IH. Stressful life events, chronic difficulties, and the symptoms of clinical depression. J Nerv Ment Dis. 2009;197(3):154–160. doi:10.1097/NMD.0b013e318199f77b.CrossRefGoogle ScholarPubMed
Destrée, L, Albertella, L, Jobson, L, et al. The association between stressful experiences and OCD symptoms in young adults at transdiagnostic risk. J Affect Disord. 2023;328:128–134. doi:10.1016/j.jad.2023.02.059.CrossRefGoogle ScholarPubMed
Poletti, M, Gebhardt, E, Pelizza, L, Preti, A, Raballo, A. Neurodevelopmental antecedents and sensory phenomena in obsessive compulsive disorder: a systematic review supporting a phenomenological-developmental model. Psychopathology. 2023;56(4):295–305. doi:10.1159/000526708.CrossRefGoogle ScholarPubMed
Vidal-Ribas, P, Stringaris, A, Rück, C, Serlachius, E, Lichtenstein, P, Mataix-Cols, D. “Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study”: Erratum. Eur Psychiatry. 2015;30(5):664. doi:10.1016/j.eurpsy.2015.02.004.CrossRefGoogle Scholar
Fontenelle, LF, Destrée, L, Brierley, M-E, Thompson, EM, Yücel, M, Albertella, L. Are different stressful or traumatic life events related to types of obsessive-compulsive and related disorders? An online study. J Affect Disord Reports. 2021;5:100170 doi:10.1016/j.jadr.2021.100170.CrossRefGoogle Scholar
Boals, A. Trauma in the eye of the beholder: objective and subjective definitions of trauma. J Psychother Integr. 2018;28(1):77–89. doi:10.1037/int0000050.CrossRefGoogle Scholar
Dykshoorn, KL. Trauma-related obsessive–compulsive disorder: a review. Heal Psychol Behav Med. 2014;2(1):517–528. doi:10.1080/21642850.2014.905207.CrossRefGoogle ScholarPubMed
McLaren, S, Crowe, SF. The contribution of perceived control of stressful life events and thought suppression to the symptoms of obsessive-complusive disorder in both non-clinical and clinical samples. J Anxiety Disord. 2003;17(4):389–403. doi:10.1016/S0887-6185(02)00224-4.CrossRefGoogle Scholar
Follette, V, Palm, KM, Pearson, AN. Mindfulness and trauma: implications for treatment. J Ration Cogn Ther. 2006;24(1):45–61. doi:10.1007/s10942-006-0025-2.CrossRefGoogle Scholar
Thompson, RW, Arnkoff, DB, Glass, CR. Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, Abus. 2011;12(4):220–235. doi:10.1177/1524838011416375.CrossRefGoogle ScholarPubMed
Huhne, V, Santos-ribeiro, S, Moreira-de-oliveira, ME, De Menezes, GB, Leonardo, F. International prospective register of systematic reviews: presence of stressful life events[CMT7] in people diagnosed with obsessive compulsive disorder: a systematic review. Citation Review question Participants/population Intervention (s), exposure (s) C. 2020:1–4.Google Scholar
Page, MJ, McKenzie, JE, Bossuyt, PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.CrossRefGoogle ScholarPubMed
Moola, S, Munn, Z, Tufanaru, C, Aromataris, E, Sears, K, Sfetcu, R, Currie, M, Qureshi, R, Mattis, P, KMP-F, Lisy. Checklist for case control studies. In: Aromataris, EMZ, ed. JBI Manual for Evidence Synthesis; 2020. https://synthesismanual.jbi.global. Accessed 09 February, 2023.Google Scholar
Borenstein, M. Comprehensive meta‐analysis software. In: Systematic Reviews in Health Research. Chichester: Wiley; 2022:535–548. doi:10.1002/9781119099369.ch27.CrossRefGoogle Scholar
Andrade, C. Understanding relative risk, odds ratio, and related terms: as simple as it can get. J Clin Psychiatry. 2015;76(07):e857–e861. doi:10.4088/JCP.15f10150.CrossRefGoogle Scholar
Higgins, JPT. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560. doi:10.1136/bmj.327.7414.557.CrossRefGoogle ScholarPubMed
Real, E, Labad, J, Alonso, P, et al. Stressful life events at onset of obsessive-compulsive disorder are associated with a distinct clinical pattern. Depress Anxiety. 2011;28(5):367–376. doi:10.1002/da.20792.CrossRefGoogle ScholarPubMed
Rosso, G, Albert, U, Asinari, GF, Bogetto, F, Maina, G. Stressful life events and obsessive–compulsive disorder: clinical features and symptom dimensions. Psychiatry Res. 2012;197(3):259–264. doi:10.1016/j.psychres.2011.10.005.CrossRefGoogle ScholarPubMed
Real, E, Gratacòs, M, Labad, J, et al. Interaction of SLC1A1 gene variants and life stress on pharmacological resistance in obsessive–compulsive disorder. Pharmacogenomics J. 2013;13(5):470–475. doi:10.1038/tpj.2012.30.CrossRefGoogle ScholarPubMed
Real, E, Subirà, M, Alonso, P, et al. Brain structural correlates of obsessive–compulsive disorder with and without preceding stressful life events. World J Biol Psychiatry. 2016;17(5):366–377. doi:10.3109/15622975.2016.1142606.CrossRefGoogle ScholarPubMed
Murayama, K, Nakao, T, Ohno, A, et al. Impacts of stressful life events and traumatic experiences on onset of obsessive-compulsive disorder. Front Psychiatry. 2020;11:561266. doi:10.3389/fpsyt.2020.561266.CrossRefGoogle ScholarPubMed
Woody, SR, Steketee, G, Chambless, DL. Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale. Behav Res Ther. 1995;33(5):597–605. doi:10.1016/0005-7967(94)00076-V.CrossRefGoogle ScholarPubMed
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;38(1):98–103. doi:10.1001/archpsyc.1981.01780260100011.Google Scholar
Paykel, ES, Prusoff, BA, Uhlenhuth, EH. Scaling of life events. Arch Gen Psychiatry. 1971;25(4):340–347. doi:10.1001/archpsyc.1971.01750160052010.CrossRefGoogle ScholarPubMed
Miguel, EC, Leckman, JF, Rauch, S, et al. Obsessive-compulsive disorder phenotypes: implications for genetic studies. Mol Psychiatry. 2005;10(3):258–275. doi:10.1038/sj.mp.4001617.CrossRefGoogle ScholarPubMed
Sharma, E, Sundar, AS, Thennarasu, K, Reddy, YCJ. Is late-onset OCD a distinct phenotype? Findings from a comparative analysis of “age at onset” groups. CNS Spectr. 2015;20(5):508–514. doi:10.1017/S1092852914000777.CrossRefGoogle ScholarPubMed
Frydman, I, do Brasil, PE, Torres, AR, et al. Late-onset obsessive-compulsive disorder: risk factors and correlates. J Psychiatr Res. 2014;49:68–74. doi:10.1016/j.jpsychires.2013.10.021.CrossRefGoogle ScholarPubMed
Bhattacharyya, S, Khanna, S. Late onset OCD. Aust N Z J Psychiatry. 2004;38(6):477–478. doi:10.1111/j.1440-1614.2004.01397.x.CrossRefGoogle ScholarPubMed
Narayanaswamy, JC, Viswanath, B, Veshnal Cherian, A, Bada Math, S, Kandavel, T, Janardhan Reddy, YC. Impact of age of onset of illness on clinical phenotype in OCD. Psychiatry Res. 2012;200(2–3):554–559. doi:10.1016/j.psychres.2012.03.037.CrossRefGoogle ScholarPubMed
Fontenelle, L, Marques, C, Versiani, M. The effect of gender on the clinical features and therapeutic response in obsessive-compulsive disorder Efeito do gênero nas características clínicas e resposta terapêutica do transtorno obsessivo-compulsivo. Rev Bras Psiquiatr. 2002;24711(1):7–11.10.1590/S1516-44462002000100005CrossRefGoogle Scholar
Benatti, B, Celebre, L, Girone, N, et al. Clinical characteristics and comorbidity associated with female gender in obsessive-compulsive disorder. J Psychiatr Res. 2020;131:209–214. doi:10.1016/j.jpsychires.2020.09.019.CrossRefGoogle ScholarPubMed
Armstrong, JL, Ronzitti, S, Hoff, RA, Potenza, MN. Gender moderates the relationship between stressful life events and psychopathology: findings from a national study. J Psychiatr Res. 2018;107:34–41. doi:10.1016/j.jpsychires.2018.09.012.CrossRefGoogle ScholarPubMed
Paykel, ES. Contribution of life events to causation of psychiatric illness. Psychol Med. 1978;8(2):245–253. doi:10.1017/S003329170001429X.CrossRefGoogle ScholarPubMed
Kendler, KS, Karkowski, LM, Prescott, CA. Causal relationship between stressful life events and the onset of major Depression. Am J Psychiatry. 1999;156(6):837–841. doi:10.1176/ajp.156.6.837.CrossRefGoogle ScholarPubMed
Kessler, RC. The effects of stressful life. Annu Rev Psychol. 1997;48:191–214.10.1146/annurev.psych.48.1.191CrossRefGoogle ScholarPubMed
Bolhuis, K, Mcadams, TA, Monzani, B, et al. Aetiological overlap between obsessive-compulsive and depressive symptoms: a longitudinal twin study in adolescents and adults. Psychol Med. 2014;44(7):1439–1449. doi:10.1017/S0033291713001591.CrossRefGoogle ScholarPubMed
Murphy, DL, Moya, PR, Fox, MA, Rubenstein, LM, Wendland, JR, Timpano, KR. Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity. Philos Trans R Soc B Biol Sci. 2013;368(1615):20120435. doi:10.1098/rstb.2012.0435.CrossRefGoogle ScholarPubMed
Rosario-Campos, MC, Leckman, JF, Curi, M, et al. A family study of early-onset obsessive-compulsive disorder. Am J Med Genet Part B Neuropsychiatr Genet. 2005;136B(1):92–97. doi:10.1002/ajmg.b.30149.CrossRefGoogle ScholarPubMed
Albert, U, Maina, G, Ravizza, L, Bogetto, F. An exploratory study on obsessive-compulsive disorder with and without a familial component: are there any phenomenological differences? Psychopathology. 2002;35(1):8–16. doi:10.1159/000056210.CrossRefGoogle Scholar
Aldinger, F, Schulze, TG. Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry Clin Neurosci. 2017;71(1):6–17. doi:10.1111/pcn.12433.CrossRefGoogle ScholarPubMed
Beyer, JL, Kuchibhatla, M, Cassidy, F, Krishnan, KRR. Stressful life events in older bipolar patients. Int J Geriatr Psychiatry. 2008;23(12):1271–1275. doi:10.1002/gps.2062.CrossRefGoogle ScholarPubMed
Horesh, N, Apter, A, Zalsman, G. Timing, quantity and quality of stressful life events in childhood and preceding the first episode of bipolar disorder. J Affect Disord. 2011;134(1–3):434–437. doi:10.1016/j.jad.2011.05.034.CrossRefGoogle ScholarPubMed
Hosang, GM, Fisher, HL, Cohen-Woods, S, McGuffin, P, Farmer, AE. Stressful life events and catechol-O-methyl-transferase (COMT) gene in bipolar disorder. Depress Anxiety. 2017;34(5):419–426. doi:10.1002/da.22606.CrossRefGoogle ScholarPubMed
Koenders, MA, Giltay, EJ, Spijker, AT, Hoencamp, E, Spinhoven, P, Elzinga, BM. Stressful life events in bipolar I and II disorder: cause or consequence of mood symptoms? J Affect Disord. 2014;161:55–64. doi:10.1016/j.jad.2014.02.036.CrossRefGoogle ScholarPubMed
Sam, SP, Nisha, A, Varghese, PJ. Stressful life events and relapse in bipolar affective disorder: a cross-sectional study from a tertiary care center of Southern India. Indian J Psychol Med. 2019;41(1):61–67. doi:10.4103/IJPSYM.IJPSYM_113_18.CrossRefGoogle ScholarPubMed
Subramanian, K, Sarkar, S, Kattimani, S, Philip Rajkumar, R, Penchilaiya, V. Role of stressful life events and kindling in bipolar disorder: converging evidence from a mania-predominant illness course. Psychiatry Res. 2017;258:434–437. doi:10.1016/j.psychres.2017.08.073.CrossRefGoogle ScholarPubMed
Fontenelle, LF, Albertella, L, Brierley, ME, et al. Correlates of obsessive-compulsive and related disorders symptom severity during the COVID-19 pandemic. J Psychiatr Res. 2021;143:471–480. doi:10.1016/j.jpsychires.2021.03.046.CrossRefGoogle ScholarPubMed
de Loof, C, Zandbergen, J, Lousberg, H, Pols, H, Griez, E. The role of life events in the onset of panic disorder. Behav Res Ther. 1989;27(4):461–463. doi:10.1016/0005-7967(89)90017-X.CrossRefGoogle ScholarPubMed
Sarkhel, S, Praharaj, SK, Sinha, VK. Role of life events in obsessive compulsive disorder. Isr J Psychiatry Relat Sci. 2011;48(3):182–185. https://www.scopus.com/inward/record.uri?eid=2-s2.0-80755136716&partnerID=40&md5=811af9821159a0bad49f56d5baacb96e. Accessed 29 November, 2020.Google ScholarPubMed
Gothelf, D, Aharonovsky, O, Horesh, N, Carty, T, Apter, A. Life events and personality factors in children and adolescents with obsessive-compulsive disorder and other anxiety disorders. Compr Psychiatry. 2004;45(3):192–198. doi:10.1016/j.comppsych.2004.02.010.CrossRefGoogle ScholarPubMed
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