ABSTRACT
OBJECTIVE: The goal of this study was to compare the clinical and functional status and the trauma-related characteristics of PTSD patients with comorbid OCD whose onset predated the index traumatic event (pre-traumatic OCD) with those of PTSD patient whose comorbid OCD only emerged after the exposure to the traumatic event (post-traumatic OCD). METHODS: Sixty-three individuals with PTSD and comorbid OCD were evaluated with the Structured Clinical Interview for DSM-IV AXIS I Disorders and completed the Posttraumatic Stress Disorder Checklist - Civilian Version, the Beck Depression Inventory, the Beck Anxiety Inventory, the Trauma History Questionnaire and the 36-Item Short-Form Health Survey. RESULTS: A history of childhood abuse was significantly more frequent among PTSD patients with pre-traumatic OCD (45.2%) than among their counterparts with post-traumatic OCD (16%). PTSD patients with pre-traumatic OCD had higher rates of psychiatric comorbidity in general and showed a lower functional health status in a physical domain (SF-36 Role Limitation due to Physical Health). In contrast, PTSD patients with post-traumatic OCD had a decreased functional health status in a psychological domain (SF-36 Emotional Well Being). The effect sizes were in the medium to large range. CONCLUSIONS: A history of child abuse may be an important, but often neglected, factor accounting for clinical, functional, and trauma-related differences between pre-traumatic and posttraumatic OCD in PTSD patients.
Subject(s)
Child Abuse/psychology , Health Status , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Adolescent , Adult , Child , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/diagnosis , Psychiatric Status Rating Scales , Retrospective Studies , Risk Factors , Stress Disorders, Post-Traumatic/diagnosis , Surveys and QuestionnairesABSTRACT
Childhood abuse and PTSD are independently associated with severe psychiatric comorbidity. We hypothesized that among patients with adult-onset PTSD, a history of child abuse was associated with increased prevalence and severity of comorbid mental disorders. Participants were 109 adult treatment-seeking patients, 23.9% of whom had a history of childhood sexual, physical or emotional abuse. The socio-demographic characteristics and comorbidity profile of PTSD patients with and without history of child abuse were compared using the two-tailed t-test and the chi-square test. PTSD patients with a history of child abuse had significantly higher average PCL-C hyperarousal [21.8 (SDâ¯=â¯3.6) vs 19.8 (SDâ¯=â¯3.5)] and BDI [35.7 (SDâ¯=â¯9.2) vs 29.1 (SDâ¯=â¯13.9)] scores, a significantly increased average number of lifetime [4.85 (SDâ¯=â¯1.43) vs 3.93 (SDâ¯=â¯1.33)] and current [4.46 (SDâ¯=â¯1.24) vs 3.75 (SDâ¯=â¯1.32)] comorbid disorders, and a greater prevalence of lifetime (73.1% vs 44.6%) and current (79.2% vs 46.7%) panic disorder/agoraphobia and of psychotic symptoms (73.1% vs 30.1%). All effect sizes were in the medium to large range. Adult-onset PTSD patients with a history of child abuse may represent a subgroup with a more severe form of the disorder that is associated with a more serious clinical course, treatment resistance and poorer outcome.
