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Risk factors prospectively associated with adult obsessive–compulsive symptom dimensions and obsessive–compulsive disorder

  • J. R. Grisham (a1), M. A. Fullana (a2) (a3), D. Mataix-Cols (a2), T. E. Moffitt (a4) (a5), A. Caspi (a4) (a5) and R. Poulton (a6)...

Very few longitudinal studies have evaluated prospective neurodevelopmental and psychosocial risk factors for obsessive–compulsive disorder (OCD). Furthermore, despite the heterogeneous nature of OCD, no research has examined risk factors for its primary symptom dimensions, such as contamination/washing.


Potential risk factors for symptoms or diagnosis of OCD in adulthood and for specific adult obsessive–compulsive (OC) symptom dimensions were examined in the Dunedin Study birth cohort. The presence of obsessions and compulsions and psychological disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 26 and 32 years. Individuals with a diagnosis of OCD at either age (n=36) were compared to both a healthy control group (n=613) and an anxious control group (n=310) to determine whether associations between a risk factor and an OCD diagnosis were specific.


Childhood neurodevelopmental, behavioral, personality and environmental risk factors were associated with a diagnosis of OCD and with OC symptoms at ages 26 and 32. Social isolation, retrospectively reported physical abuse and negative emotionality were specific predictors of an adult OCD diagnosis. Of note, most risk factors were associated with OC symptoms in adulthood and several risk factors predicted specific OCD dimensions. Perinatal insults were linked to increased risk for symmetry/ordering and shameful thoughts dimensions, whereas poor childhood motor skills predicted the harm/checking dimension. Difficult temperament, internalizing symptoms and conduct problems in childhood also predicted specific symptom dimensions and lower IQ non-specifically predicted increased risk for most dimensions.


The current findings underscore the need for a dimensional approach in evaluating childhood risk factors for obsessions and compulsions.

Corresponding author
*Address for correspondence: Dr J. R. Grisham, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. (Email:
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Allsopp M, Verduyn C (1990). Adolescents with obsessive-compulsive disorder: a case note review of consecutive patients referred to a provincial regional adolescent psychiatry unit. Journal of Adolescence 13, 157169.
Alsobrook JP, Leckman JF, Goodman WK, Rasmussen SA, Pauls DL (1999). Segregation analysis of obsessive-compulsive disorder using symptom-based factor scores. American Journal of Medical Genetics 88, 669675.
Arnheim D, Sinclair W (1974). The Clumsy Child. Mosby: St Louis, MO.
Baer L (1994). Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. Journal of Clinical Psychiatry 55, 1823.
Bayley N (1969). Bayley Scales of Infant Development: Birth to Two Years. Psychological Corporation: New York.
Bejerot S, Schlette P, Ekselius L, Adolfson R, von Knorring L (1998). Personality disorders and relation to personality dimensions measured by the Temperament and Character Inventory in patients with obsessive-compulsive disorder. Acta Psychiatrica Scandinavica 98, 243249.
Bloch MH, Landeros-Weisenberger A, Rosario MC, Pittenger C, Leckman JF (2008). Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry 165, 15321542.
Bolton D, Raven P, Madronal-Luque R, Marks IM (2000). Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment. Behaviour Research and Therapy 38, 695708.
Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585599.
Cannon M, Caspi A, Moffitt TE, Harrington H, Taylor A, Murray RM, Poulton R (2002). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449456.
Capstick N, Seldrup J (1977). Obsessional states. Acta Psychiatrica Scandinavica 56, 427431.
Caspi A, Begg D, Dickson N, Harrington H, Langley J, Moffitt TE, Silva PA (1997). Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study. Journal of Personality and Social Psychology 73, 10521063.
Caspi A, Silva PA (1995). Temperamental qualities at age three predict personality traits in young adulthood: longitudinal evidence from a birth cohort. Child Development 66, 486498.
Chamberlain SR, Blackwell AD, Fineberg NA, Robbins TW, Sahakian BJ (2005). The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neuroscience and Biobehavioral Reviews 29, 399419.
Chamberlain SR, Fineberg NA, Blackwell AD, Robbins TW, Sahakian BJ (2006). Motor inhibition and cognitive flexibility in obsessive compulsive disorder and trichotillomania. American Journal of Psychiatry 163, 12821284.
Church AT (1994). Relating the Tellegen and five-factor models of personality structure. Journal of Personality and Social Psychology 67, 898909.
Cohen P, Cohen J (1984). The clinician's illusion. Archives of General Psychiatry 41, 11781182.
Costa PT Jr., McCrae RR (1985). NEO Five-Factor Inventory: Form S. Psychological Assessment Resources: Odessa, FL.
Craske MG, Poulton R, Tsao JCI, Plotkin D (2001). Paths to panic disorder/agoraphobia: an exploratory analysis from age 3 to 21 in an unselected birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry 40, 556563.
Cromer KR, Schmidt NB, Murphy DL (2007). An investigation of traumatic life events and obsessive-compulsive disorder. Behaviour Research and Therapy 45, 16831691.
de Silva P, Marks M (1999). The role of traumatic experiences in the genesis of obsessive-compulsive disorder. Behaviour Research and Therapy 37, 941951.
Douglass HM, Moffitt TE, Dar R, McGee R, Silva P (1995). Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors. Journal of the American Academy of Child and Adolescent Psychiatry 34, 14241431.
Eisen JL, Goodman WK, Keller MB, Warshaw MG, DeMarco LM, Luce DD, Rasmussen SA (1999). Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. Journal of Clinical Psychiatry 60, 346351.
Eisen JL, Mancebo MA, Pinto A, Coles ME, Pagano ME, Stout R, Rasmussen SA (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry 47, 270275.
Elander J, Rutter M (1996). Use and development of the Rutter Parents' and Teachers' scales. International Journal of Methods in Psychiatric Research 6, 6378.
Elley WB, Irving JC (1976). Revised socio-economic index for New Zealand. New Zealand Journal of Educational Studies 11, 2536.
Eysenck HJ (1947). Dimensions of Personality. Praeger: New York.
Fontenelle LF, Hasler G (2008). The analytical epidemiology of obsessive-compulsive disorder: risk factors and correlates. Progress in Neuro-Psychopharmacology and Biological Psychiatry 32, 115.
Fontenelle LF, Mendlowicz MV, Mattos P, Versiani M (2006). Neuropsychological findings in obsessive-compulsive disorder and its potential implications for treatment. Current Psychiatry Reviews 2, 1126.
Freeman JB, Leonard HL (2000). Sexual obsessions in obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry 39, 141142.
Fullana MA, Mataix-Cols D, Caspi A, Harrington H, Grisham JR, Moffitt TE, Poulton R (2009). Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. American Journal of Psychiatry 166, 329336.
Fullana MA, Vilagut G, Rojas-Farreras S, Mataix-Cols D, de Graaf R, Demyttenaere K, Haro JM, de Girolamo G, Lépine JP, Matschinger H, Alonso J (2010). Obsessive-compulsive symptom dimensions in the general population: results from an epidemiological study in six European countries. Journal of Affective Disorders 124, 291299.
Geller DA, Wieland N, Carey K, Vivas F, Petty CR, Johnson J, Reichert E, Pauls D, Biederman J (2008). Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology 18, 373379.
Goldsmith HH, Gottesman II (1981). Origins of variation in behavioral style: a longitudinal study of temperament in young twins. Child Development 52, 91–103.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS (1989). The Yale–Brown Obsessive–Compulsive Scale. I. Development, use and reliability. Archives of General Psychiatry 46, 10061011.
Gothelf D, Aharonovsky O, Horesh N, Carty T, Apter A (2004). Life events and personality factors in children and adolescents with obsessive-compulsive disorder and other anxiety disorders. Comprehensive Psychiatry 45, 192198.
Grabe HJ, Ruhrmann S, Spitzer C, Josepeit J, Ettelt S, Buhtz F, Hochrein A, Schulze-Rauschenbach S, Meyer K, Kraft S, Reck C, Pukrop R, Klosterkotter J, Falkai P, Maier W, Wagner M, John U, Freyberger HJ (2008). Obsessive-compulsive disorder and posttraumatic stress disorder. Psychopathology 41, 129134.
Grisham JR, Anderson TM, Poulton R, Moffitt TE, Andrews G (2009). Childhood neuropsychological deficits associated with adult obsessive-compulsive disorder. British Journal of Psychiatry 195, 138141.
Grisham JR, Anderson TM, Sachdev PS (2008). Genetic and environmental influences on obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience 258, 107116.
Hasler G, Pinto A, Greenberg BD, Samuels J, Fyer A, Pauls DL, Knowles JA, McCracken JT, Piacentini J, Riddle MA, Rauch SL, Rasmussen SA, Willour VL, Grados MA, Cullen B, Bienvenu OJ III, Shugart YY, Liang KY, Rudolf HS, Wang Y, Ronquillo J, Nestadt G, Murphy DL (2007). Familiality of factor-analysis-derived YBOCS dimensions in OCD-affected sibling pairs from the OCD collaborative genetics study. Biological Psychiatry 61, 617625.
Heyman I, Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R (2001). Prevalence of obsessive–compulsive disorder in the British nationwide survey of child mental health. British Journal of Psychiatry 179, 324329.
Hollander E, Kaplan A, Schmeidler J, Yang H, Li D, Koran LM, Barbato LM (2005). Neurological soft signs as predictors of treatment response to selective serotonin reuptake inhibitors in obsessive-compulsive disorder. Journal of Neuropsychiatry and Clinical Neuroscience 17, 472477.
Hollander E, Schiffman E, Cohen B, Rivera-Stein MA, Rosen W, Gorman JM, Fyer A, Papp L, Liebowitz MR (1990). Signs of central nervous system dysfunction in obsessive-compulsive disorder. Archives of General Psychiatry 47, 2732.
Ingram IM (1961). Obsessional illness in mental hospital patients. Journal of Mental Science 107, 382402.
Ivarsson T, Winge-Westholm C (2004). Temperamental factors in children and adolescents with obsessive-compulsive disorder (OCD) and in normal controls. European Child and Adolescent Psychaitry 13, 365372.
Jaisoorya TS, Janardhan Reddy YC, Srinath S, Thennarasu K (2009). Sex differences in Indian patients with obsessive-compulsive disorder. Comprehensive Psychiatry 50, 7075.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.
Khanna S, Rajendra PN, Channabasavanna SM (1988). Life events and onset of obsessive compulsive disorder. International Journal of Social Psychiatry 34, 305309.
Koenen KC, Moffitt TE, Roberts AL, Martin LT, Kubzansky L, Harrington H, Poulton R, Caspi A (2009). Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. American Journal of Psychiatry 166, 5057.
Koran LM, Thienemann M, Davenport R (1996). Quality of life for patients with obsessive-compulsive disorder. American Journal of Psychiatry 153, 783788.
Kusunoki K, Sato T, Taga C, Yoshida T, Komori K, Narita T, Hirano S, Iwata N, Ozaki N (2000). Low novelty-seeking differentiates obsessive-compulsive disorder from major depression. Acta Psychiatrica Scandinavica 101, 403405.
Labad J, Menchon JM, Alonso P, Segalas C, Jimenez S, Jaurrieta N, Leckman JF, Vallejo J (2008). Gender differences in obsessive-compulsive symptom dimensions. Depression and Anxiety 25, 832838.
Leckman JF, Pauls DL, Heping Z, Rosario-Campos MC, Katsovitch L, Kidd KK, Pakstis AJ, Alsobrook JP, Robertson MM, McMahon WM, Walkup JT, van de Wetering BJM, King RA, Cohen DJ (2003). Obsessive-compulsive symptom dimensions in affected sibling pairs diagnosed with Gilles de la Tourette syndrome. American Journal of Medical Genetics 116B, 6068.
Leckman JF, Rauch SL, Mataix-Cols D (2007). Symptom dimensions in obsessive-compulsive disorder: implications for the DSM-V. CNS Spectrums 12, 376387.
Lensi P, Cassano G, Correddu G, Ravagli S, Kunovac J, Akiskal H (1996). Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender- related differences. British Journal of Psychiatry 169, 101107.
Lewis A (1935). Problems of obsessional illness. Proceedings of the Royal Society of Medicine 29, 325336.
Lochner C, du Toit PL, Zungu-Dirwayi N, Marais A, van Kradenburg J, Curr B, Seedat R, Niehaus DJH, Stein DJ (2002). Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controls. Depression and Anxiety 15, 6668.
Lochner C, Mogotsi M, du Toit PL, Kaminer D, Niehaus DJ, Stein DJ (2003). Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology 36, 255262.
Lyoo IK, Lee DW, Kim YS, Kong SW, Kwon JS (2001). Patterns of temperament and character in subjects with obsessive-compulsive disorder. Journal of Clinical Psychiatry 62, 637641.
Mataix-Cols D, Alonso P, Hernandez R, Deckersbach T, Savage CR, Menchon JM, Vallejo J (2003). Relation of neurological soft signs to nonverbal memory performance in obsessive-compulsive disorder. Journal of Clinical and Experimental Neuropsychology 25, 842851.
Mataix-Cols D, Rauch S, Manzo P, Jenike M, Baer L (1999). Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry 156, 14091416.
Mataix-Cols D, Rosario-Campos MC, Leckman JF (2005). A multidimensional model of obsessive compulsive disorder. American Journal of Psychiatry 162, 228238.
McCarthy D (1972). Manual for the McCarthy Scales of Children's Abilities. Psychological Corporation: New York.
McKeon J, Roa B, Mann A (1984). Life events and personality traits in obsessive-compulsive neurosis. British Journal of Psychiatry 144, 185189.
Newman DL, Moffitt TE, Caspi A, Magdol L, Silva PA, Stanton WR (1996). Psychiatric disorder in a birth cohort of young adults: prevalence, comorbidity, clinical significance, and new case incidence from ages 11 to 21. Journal of Consulting and Clinical Psychology 64, 552562.
Patrick CJ, Curtin JJ, Tellegen A (2002). Development and validation of a brief form of the Multidimensional Personality Questionnaire. Psychological Assessment 14, 150163.
Pauls DL (2008). The genetics of obsessive compulsive disorder: a review of the evidence. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 148C, 133139.
Pfohl B, Black D, Noyes R, Kelley M, Blum N (1990). A test of the tridimensional personality theory: association with diagnosis and platelet imipramine binding in obsessive-compulsive disorder. Biological Psychiatry 28, 4146.
Pitman RK (1993). Posttraumatic obsessive-compulsive disorder: a case study. Comprehensive Psychiatry 34, 102107.
Poulton R, Caspi A, Milne BJ, Thomson WM, Taylor A, Sears MR, Moffitt TE (2002). Association between children's experience of socioeconomic disadvantage and adult health: a life-course study. Lancet 360, 16401645.
Rachman S (1994). Pollution of the mind. Behaviour Research and Therapy 32, 311314.
Rachman S (2004). Fear of contamination. Behaviour Research and Therapy 42, 12271255.
Rasmussen S, Tsuang M (1986). Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatry 143, 317322.
Richter MA, Summerfeldt LJ, Joffe RT, Swinson RP (1996). The Tridimensional Personality Questionnaire in obsessive-compulsive disorder. Psychiatry Research 65, 185188.
Riggs DS (2000). Treatment of concurrent PTSD and OCD: a commentary on the case of Howard. Cognitive and Behavioral Practice 7, 130132.
Robins LN, Cottler L, Bucholz K, Compton W (1995). Diagnostic Interview Schedule for DSM-IV. Washington University Press: St Louis, Missouri.
Rosenberg DR, MacMillan S (2002). Imaging and neurocircuitry of OCD. In Neuropsychopharmacology. The Fifth Generation of Progress (ed. Davis K., Nemeroff C. B., Coyle J. and Charney D.), pp. 16211646. Lippincott Williams & Wilkins: Baltimore.
Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2008). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry 15, 5363.
Samuels J, Nestadt G, Bienvenu OJ III, Costa PT, Riddle MA, Liang KY (2000). Personality disorders and normal personality dimensions in obsessive-compulsive disorder: results from the John Hopkins OCD Family Study. British Journal of Psychiatry 177, 457462.
Santangelo SL, Pauls DL, Goldstein JM, Faraone SV, Tsuang MT, Leckman JF (1994). Tourette's syndrome: what are the influences of gender and comorbid obsessive-compulsive disorder? Journal of the American Academy of Child and Adolescent Psychiatry 33, 795804.
Stanton WR, McGee R, Silva A (1991). Indices of perinatal complications, family background, child rearing, and health as predictors of early cognitive and motor development. Pediatrics 88, 954959.
Stein DJ, Denys D, Gloster AT, Hollander E, Leckman JF, Rauch SL, Phillips KA (2009). Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatric Clinics of North America 32, 665685.
Tellegen A (1982). Brief Manual for the Multidimensional Personality Questionnaire. University of Minnesota: Minneapolis.
Toro J, Cervera M, Osejo E, Salamero M (1992). Obsessive-compulsive disorder in children and adolescents: a clinical study. Journal of Child Psychology and Psychiatry 33, 10251037.
Tükel R, Ertekin E, Batmaz S, Alyanak F, Sözen A, Aslanta B, Atl H, Ozyildirim I (2005). Influence of age of onset on clinical features in obsessive-compulsive disorder. Depression and Anxiety 21, 112117.
Vasconcelos MS, Sampaio AS, Hounie AG, Akkerman F, Curi M, Lopes AC, Miguel EC (2007). Prenatal, perinatal, and postnatal risk factors in obsessive–compulsive disorder. Biological Psychiatry 61, 301307.
Wechsler D (1974). Manual for the Wechsler Intelligence Scale for Children – Revised. Psychological Corporation: New York.
WHO (1999). The ‘Newly Defined’ Burden of Mental Problems. Fact sheet no. 217. World Health Organization: Geneva, Switzerland.
Zohar AH, Ratzoni G, Pauls DL, Apter A, Bleich A, Kron S, Rappaport M, Weizman A, Cohen DJ (1992). An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 31, 10571061.
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