A multilevel longitudinal study of obsessive compulsive symptoms in adolescence: male gender and emotional stability as protective factors
Stavropoulos et al. Ann Gen Psychiatry
A multilevel longitudinal study of obsessive compulsive symptoms in adolescence: male gender and emotional stability as protective factors
Vasilis Stavropoulos 0 1
Kathleen A. Moore 1
Helen Lazaratou 0
Dimitris Dikaios 0
Rapson Gomez 1
0 National and Kapodistrian University of Athens , Vas Sofias 72, 11528 Athens , Greece
1 Federation University Australia , Mount Helen, Ballarat, VIC , Australia
The severity of obsessive compulsive symptoms (OCS) is suggested to be normally distributed in the general population, and they appear to have an impact on a range of aspects of adolescent development. Importantly, there are individual differences regarding susceptibility to OCS. In the present repeated measures study, OCS were studied in relation to gender and emotional stability (as a personality trait) using a normative sample of 515 adolescents at ages 16 and 18 years. OCS were assessed with the relevant subscale of the SCL-90-R and emotional stability with the Five Factor Questionnaire. A three-level hierarchical linear model was calculated to longitudinally assess the over time variations of OCS and their over time links to gender and emotional stability, while controlling for random effects due to the nesting of the data. Experiencing OCS increased with age (between 16 and 18 years). Additionally, male gender and higher emotional stability were associated with lower OCS at 16 years and these remained stable over time. Results indicate age-related and between individual differences on reported OCS that need to be considered for prevention and intervention planning.
Obsessive compulsive symptoms; Adolescence; Gender; Development; Emotional stability
Background
Over the past two decades, significant emphasis has been
placed on understanding the etiology of obsessive
compulsive symptoms (OCS) [
1, 2
]. OCS entail recurrent and
persistent thoughts that are experienced as intrusive, but
which cannot be ignored (obsessions). Individuals often
engage in repetitive physical or mental acts
(compulsions) aimed at reducing or removing the stress induced
by the obsessions. The severity of OCS is suggested to be
normally distributed in the general population and often
constitutes a transient part of normal development (e.g.,
commonplace childhood rituals such as not walking on
pavement lines) [
3, 4
]. However, OCS over a specific
threshold may result in obsessive compulsive disorder
(OCD), which is a chronic psychiatric condition, with
potentially serious repercussions [
5
] OCD includes either
obsessions or compulsions or a combination of both. It
tends to compromise the quality of life and the well-being
of the individual in significant ways by causing distress
and interfering with everyday functioning [
1, 3
].
Research has advanced knowledge regarding the nature
and the etiology of OCS [
6
]. In particular, OCS have been
described as heterogeneous, varying across several
different dimensions (i.e., cleaning/contamination,
forbidden thoughts, symmetry/ordering-counting, hoarding/
acquiring and retaining objects) [
3, 7, 8
]. The broader
OCS dimensions (content of OCS) experienced by
individuals remain relatively stable over time (i.e.,
propensity to experience forbidden thoughts is likely to shift
from thoughts of violence to thoughts of religion, but is
less likely to shift from forbidden thoughts to hoarding
[
1, 9
]; however, the severity/intensity of OCS may vary
over developmental phases [1]. For instance, obsessions
related to fear and loss of others are typically higher in
childhood and sexual obsessions tend to present more
during adolescence [
10
]. Although there is consensus
that levels of OCS fluctuate over developmental phases,
there is a dearth of longitudinal studies that focus
specifically on factors associated with particular developmental
trajectories [
1
]. As it is considered a high-risk period for
the onset of OCS and the diagnosis of OCD,
explaining variations in the severity of OCS during adolescence
appears particularly important [
2
]. Also, identifying
factors that may contribute to higher OCS severity in
adolescents could provide useful clinical guidelines for more
effective prevention and treatment interventions.
Conceptual framework
To address these needs an integrative, multilevel
approach that blends elements and concepts from the
OCS literature and from the risk and resilience
framework was used [
4, 11, 12
]. Specifically, Abramowitz et al.
[
4
] contended that OCS may often constitute a part of
normal development that may be better approached
dimensionally, that is on a continuum from minimum to
maximum OCS, rather than categorically (presence vs
absence of OCS). In that context, pathological aspects of
OCS have been defined as extreme versions of normative
cognitive and emotional processes [
11
]. There is evidence
supporting a multidimensional model of OCD/OCS,
where the complex clinical presentation of OCD has
(...truncated)