Retrospective reports of the development of obsessive compulsive disorder: Extending knowledge of the protracted symptom phase

Background: In contrast to a wealth of research on the treatment of Obsessive Compulsive Disorder (OCD), there is a relative paucity of work examining how OCD begins. Available data suggest that there is often a slow progression from the onset of symptoms to meeting criteria for a diagnosis of OCD. Aims: The current study sought to add to existing data documenting the slow-development of OCD, and to extend previous findings by examining potential moderators of this symptom phase and to examine patients' explanations for the transition from symptoms to disorder. Method: One hundred and ninety-nine individuals with OCD reported on the start of their symptoms and the disorder via an internet-based survey. Results: Over two-thirds of respondents reported that the development of their OCD was gradual. Further, participants reported having experienced obsessions and/or compulsions for an average of 5 years before experiencing full-blown OCD. This extended symptom phase was observed in individuals with early- and late-onset OCD, with an even more protracted symptom phase in the later group. Female gender and onset of compulsions prior to obsessions were also associated with slower progression to full-blown OCD. Finally, explanations for the transition from symptoms to disorder suggest that changes in daily routines and general stress may be particularly important in this transition for individuals that develop clinical OCD at age 18 or later. Conclusions: Existence of a protracted symptom phase may present opportunities for elucidating risk factors for OCD disease progression and a window of opportunity for indicated prevention programs.