Abstract
Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder characterized by two distinct phenomena: obsessions which are recurrent, intrusive thoughts, images or impulses, and/or compulsions which are repetitive covert or overt actions that are carried out to decrease anxiety. OCD commonly affects young adults, is associated with other comorbid mental illnesses and often has a large treatment gap (the proportion of individuals who have OCD and require care but do not receive treatment). OCD thus runs a chronic and disabling course which compromises an individual’s functioning and well-being and ultimately has a rather detrimental impact on the lives of both patients and their families. Researchers and clinicians are increasingly paying attention to humanistic outcomes to encompass broader indicators of disease burden and outcome, one of which is quality of life (QoL). In this review, we provide a summary of the current knowledge of QoL in OCD, its socio-demographic and clinical correlates, and the effects of therapeutic interventions on QoL among those with OCD. Overall, studies indicate that those with OCD had diminished QoL across all domains relative to normative comparison subjects. Patients with OCD scored better on QoL domains than patients with major depressive disorder (MDD), whereas they showed no difference or scored worse than patients with schizophrenia. Although research on socio-demographic correlates of QoL in OCD is largely contradictory, most studies suggest that symptom severity and comorbid depression or depressive symptoms are predictors of decreased QoL in OCD, with numerous studies showing this association across multiple domains associated with QoL. Studies assessing QoL as an outcome of treatment have found an improvement in QoL in people with OCD after treatment with pharmacotherapy or cognitive behavioural therapy with some studies suggesting that this improvement in QoL is correlated with improvement in symptoms. A few studies have also evaluated other forms of treatment like partial hospitalisation programmes and deep brain stimulation for those with treatment-resistant OCD and found that QoL scores improve with treatment. A major gap in the field is the lack of instruments that measure QoL specifically in patients with OCD. It is evident that OCD affects specific domains and thus there is a pressing need for the development of multidimensional instruments that are reliable and valid. There is also a need for studies assessing QoL in individuals with OCD among both clinical and community samples with adequate sample size to examine socio-demographic and clinical correlates simultaneously. These populations ought to be followed longitudinally to examine QoL with the clinical course of the illness, and to help establish temporal relationships. Studies that examine improvements in QoL with treatment need to be designed carefully: sample size requirements should be met, raters must be blinded, and randomly assigning subjects to different arms would ensure that some of the inherent biases in open-label studies are avoided. QoL is an important component that measures the impact of OCD on an individual and QoL goals must be incorporated as an outcome measure of therapeutic interventions.
Similar content being viewed by others
References
Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive–compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15:53–63.
McEvoy PM, Grove R, Slade T. Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2011;45:957–67.
Subramaniam M, Abdin E, Vaingankar JA, Chong SA. Obsessive-compulsive disorder: prevalence, correlates, help-seeking and quality of life in a multiracial Asian population. Soc Psychiatry Psychiatr Epidemiol. 2012;47(12):2035–43.
Fullana MA, Vilagut G, Rojas-Farreras S, et al. Obsessive-compulsive symptom dimensions in the general population: results from an epidemiological study in six European countries. J Affect Disord. 2010;124:291–9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, (4th edn. text revision). Washington, DC: American Psychiatric Association, 2000.
World Health Organisation. Projections of mortality and burden of disease, 2004–2030. http://www.who.int/healthinfo/global_burden_disease/projections/en/index.html. Accessed 21 Nov 2012.
Ayuso-Mateos JL. Global burden of obsessive-compulsive disorder in the year 2000. http://www.who.int/healthinfo/statistics/bod_obsessivecompulsive.pdf. Accessed 21 Nov 2012.
Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–66.
Cullen B, Samuels JF, Pinto A, et al. Demographic and clinical characteristics associated with treatment status in family members with obsessive-compulsive disorder. Depress Anxiety. 2008;25:218–24.
Torres A, Prince M, Bebbington P, et al. Obsessive-compulsive disorder: prevalence, comorbidity, impact, and held-seeking in the British National Psychiatric Morbidity Survey of 2000. Am J Psychiatry. 2006;163:1978–85.
Millet B, Kochman F, Gallarda T, et al. Phenomenological and comorbid features associated in obsessive-compulsive disorder: influence of age of onset. J Affect Disord. 2004;79(1–3):241–6.
Steketee G. Disability and family burden in OCD. Can J Psychiatry. 1997;42(9):919–28.
Geffken GR, Storch EA, Duke DC, et al. Hope and coping in family members of patients with obsessive-compulsive disorder. J Anxiety Disord. 2005;20(5):614–29.
Stengler-Wenzke K, Kroll M, Matschinger H, Angermeyer MC. Quality of life of relatives of patients with OCD. Compr Psychiatry. 2006;47(6):523–7.
Ramos-Cerqueira AT, Torres AR, Torresan RC, et al. Emotional burden in caregivers of patients with OCD. Depress Anxiety. 2008;25(12):1020–7.
Kozma CM, Reeder CE, Schulz RM. Economic, clinical, and humanistic outcomes: a planning model for pharmacoeconomic research. Clin Ther. 1993;15(6):1121–32.
Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157(5):669–82.
The WHOQOL Group. What quality of life? The WHOQOL Group. World Health Organization Quality of Life Assessment. World Health Forum. 1996;17:354–6.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Bullinger M, Andersson R, Cella D, Aaronsson N. Developing and evaluating cross-cultural instruments from minimum requirements to optimal models. Qual Life Res. 1993;2:451–9.
Ware JE, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.
The WHOQOL Group. Development of the WHOQOL: rationale and current status. Int J Mental Health. 1994;23(3):24–56.
The WHOQOL Group. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46:1569–85.
Group EuroQol. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.
Sheehan DV. The anxiety disease. New York: Scribner; 1983.
Schneier FR, Heckleman LR, Garfinkel R, et al. Functional impairment in social phobia. J Clin Psychiatry. 1994;55:322–31.
Weissman MM, Bothwell S. Assessment of social adjustment by patient self-report. Arch Gen Psychiatry. 1976;33:1111–5.
Hauschildt M, Jelinek L, Randjbar S, Hottenrott B, Moritz S. Generic and illness-specific quality of life in obsessive-compulsive disorder. Behav Cogn Psychother. 2010;38(4):417–36.
Koran LM. Quality of life in obsessive-compulsive disorder. Psychiatr Clin North Am. 2000;23(3):509–17.
Koran LM, Thienemann ML, Davenport R. Quality of life for patients with obsessive-compulsive disorder. Am J Psychiatry. 1996;153(6):783–8.
Moritz S, Rufer M, Fricke S, et al. Quality of life in obsessive-compulsive disorder before and after treatment. Compr Psychiatry. 2005;46(6):453–9.
Grabe HJ, Meyer C, Hapke U, et al. Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. Eur Arch Psychiatry Clin Neurosci. 2000;250(5):262–8.
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49(1):71–5.
Angst J, Gamma A, Endrass J, et al. Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course. Eur Arch Psychiatry Clin Neurosci. 2004;254(3):156–64.
Bech P, Angst J. Quality of life in anxiety and social phobia. Int Clin Psychopharmacol. 1996;11(Suppl 3):97–100.
Cramer V, Torgersen S, Kringlen E. Quality of life and anxiety disorders: a population study. J Nerv Ment Dis. 2005;193(3):196–202.
Calvocoressi L, Libman D, Vegso SJ, et al. Global functioning of inpatients with obsessive-compulsive disorder, schizophrenia, and major depression. Psychiatr Serv. 1998;49:379–81.
Vikas A, Avasthi A, Sharan P. Psychological impact of obsessive compulsive disorder on patients and their caregivers: a comparative study with depressive disorder. Int J Soc Psychiatry. 2011;57:45–56.
Srivastava S, Bhatia MS, Thawani R, Jhanjee A. Quality of life in patients with obsessive compulsive disorder: a longitudinal study from India. Asian J Psychiatr. 2011;4(3):178–82.
Bobes J, González MP, Bascarán MT, et al. Quality of life and disability in patients with obsessive-compulsive disorder. Eur Psychiatry. 2001;16(4):239–45.
Lehman AF. Measures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol. 1996;31(2):78–88.
Bystritsky A, Liberman RP, Hwang S, et al. Social functioning and quality of life comparisons between obsessive-compulsive and schizophrenic disorders. Depress Anxiety. 2001;14(4):214–8.
Stengler-Wenzke K, Kroll M, Matschinger H, Angermeyer MC. Subjective quality of life of patients with obsessive-compulsive disorder. Soc Psychiatry Psychiatr Epidemiol. 2006;41(8):662–8.
Solanki RK, Singh P, Midha A, et al. Disability and quality of life in schizophrenia and obsessive compulsive disorder: a cross-sectional comparative study. East Asian Arch Psychiatry. 2010;20(1):7–13.
Gururaj GP, Math SB, Reddy J, Chandrashekar CR. Family burden, quality of life and disability in obsessive compulsive disorder: an Indian perspective. J Postgrad Med. 2008;54:91–7.
Kugler BB, Lewin AB, Phares V, et al. Quality of life in obsessive-compulsive disorder: the role of mediating variables. Psychiatry Res. 2013;206:43–9. doi:10.1016/j.psychres.2012.10.006.
Lochner C, Mogotsi M, du Toit PL, et al. Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology. 2003;36(5):255–62.
Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005;162:1171–8.
Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–6.
Didie ER, Walters MM, Pinto A, et al. A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder. Ann Clin Psychiatry. 2007;19(3):181–6.
Franz M, Meyer T, Reber T, Gallhofer B. The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients. Qual Life Res. 2000;9(5):481–9.
Akdede BBK, Alptekin K, Akvardar Y, Kitis A. Quality of life in patients with obsessive-compulsive disorder: relations with cognitive functions and clinical symptoms. Turk J Psychiatry. 2005;16(1):13–9.
Kumar A, Sharma MP, Kandavel T, Janardhan Reddy YC. Cognitive appraisals and quality of life in patients with obsessive compulsive disorder. J Obsessive Compuls Relat Disord. 2012;1(4):301–5.
Hou SY, Yen CF, Huang MF, et al. Quality of life and its correlates in patients with obsessive-compulsive disorder. Kaohsiung J Med Sci. 2010;26(8):397–407.
Albert U, Maina G, Bogetto F, et al. Clinical predictors of health-related quality of life in obsessive-compulsive disorder. Compr Psychiatry. 2010;51(2):193–200.
Fontenelle IS, Fontenelle LF, Borges MC, et al. Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Res. 2010;179(2):198–203.
Eisen JL, Mancebo MA, Pinto A, et al. Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47(4):270–5.
Rodriguez-Salgado B, Dolengevich-Segal H, Arrojo-Romero M, et al. Perceived quality of life in obsessive-compulsive disorder: related factors. BMC Psychiatry. 2006;6:20.
Norberg MM, Calamari JE, Cohen RJ, Riemann BC. Quality of life in obsessive-compulsive disorder: an evaluation of impairment and a preliminary analysis of the ameliorating effects of treatment. Depress Anxiety. 2008;25(3):248–59.
Hollander E, Stein DJ, Fineberg NA, et al. Quality of life outcomes in patients with obsessive-compulsive disorder: relationship to treatment response and symptom relapse. J Clin Psychiatry. 2010;71(6):784–92.
Koran LM, Bromberg D, Hornfeldt CS, et al. Extended-release fluvoxamine and improvements in quality of life in patients with obsessive-compulsive disorder. Compr Psychiatry. 2010;51(4):373–9.
Saxena S, Ayers CR, Maidment KM, et al. Quality of life and functional impairment in compulsive hoarding. J Psychiatr Res. 2011;45(4):475–80.
Lehman AF. A quality of life interview for the chronically mentally ill. Eval Program Plann. 1988;11:51–62.
Sørensen CB, Kirkeby L, Thomsen PH. Quality of life with OCD. A self-reported survey among members of the Danish OCD Association. Nord J Psychiatry. 2004;58(3):231–6.
Beşiroğlu L, Cllli AS, Aşkin R. The predictors of health care seeking behavior in obsessive-compulsive disorder. Compr Psychiatry. 2004;45(2):99–108.
Goodman WK, Price LH, Rasmussen SA, et al. The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006–11.
Goodman WK, Price LH, Rasmussen SA, et al. The Yale–Brown obsessive compulsive scale. II. Validity. Arch Gen Psychiatry. 1989;46(11):1012–6.
Masellis M, Rector NA, Richter MA. Quality of life in OCD: differential impact of obsessions, compulsions, and depression comorbidity. Can J Psychiatry. 2003;48(2):72–7.
Stengler-Wenzke K, Kroll M, Riedel-Heller S, et al. Quality of life in obsessive-compulsive disorder: the different impact of obsessions and compulsions. Psychopathology. 2007;40(5):282–9.
Huppert JD, Simpson HB, Nissenson KJ, et al. Quality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety. 2009;26(1):39–45.
Moritz S. A review on quality of life and depression in obsessive-compulsive disorder. CNS Spectr. 2008;13(9 Suppl 14):16–22.
Besiroglu L, Uguz F, Saglam M, et al. Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder. J Affect Disord. 2007;102(1–3):73–9.
Cassin SE, Richter MA, Zhang KA, Rector NA. Quality of life in treatment-seeking patients with obsessive-compulsive disorder with and without major depressive disorder. Can J Psychiatry. 2009;54(7):460–7.
Tenney NH, Denys DA, van Megen HJ, et al. Effect of a pharmacological intervention on quality of life in patients with obsessive-compulsive disorder. Int Clin Psychopharmacol. 2003;18(1):29–33.
Dougherty DD, Jameson M, Deckersbach T, et al. Open-label study of high (30 mg) and moderate (20 mg) dose escitalopram for the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol. 2009;24(6):306–11.
Oliver JP, Huxley PJ, Priebe S, Kaiser W. Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Soc Psychiatry Psychiatr Epidemiol. 1997;32(2):76–83.
Volpato Cordioli A, Heldt E, Braga Bochi D, et al. Cognitive-behavioral group therapy in obsessive-compulsive disorder: a randomized clinical trial. Psychother Psychosom. 2003;72(4):211–6.
Diefenbach GJ, Abramowitz JS, Norberg MM, Tolin DF. Changes in quality of life following cognitive-behavioral therapy for obsessive-compulsive disorder. Behav Res Ther. 2007;45(12):3060–8.
Brown RA, Abrantes AM, Strong DR, et al. A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder. J Nerv Ment Dis. 2007;195(6):514–20.
Twohig MP, Hayes SC, Plumb JC, et al. A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. J Consult Clin Psychol. 2010;78(5):705–16.
Burckhardt SC, Wood SL, Schultz AA, Ziebarth DM. Quality of life of adults with chronic illness: a psychometric study. Res Nurs Health. 1989;12:347–54.
Klein B, Meyer D, Austin DW, Kyrios M. Anxiety online—a virtual clinic: preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. J Med Internet Res. 2011;13(4):e89.
Andersson E, Ljótsson B, Hedman E, et al. Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study. BMC Psychiatry. 2011;11:125.
Frisch MB, Clark MP, Rouse SV, et al. Predictive and treatment validity of life satisfaction and the quality of life inventory. Assessment. 2005;12(1):66–78.
Huff W, Lenartz D, Schormann M, et al. Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: outcomes after one year. Clin Neurol Neurosurg. 2010;112(2):137–43.
Pukrop R, Schlaak V, Möller-Leimkühler AM, et al. Reliability and validity of quality of life assessed by the Short-Form 36 and the Modular System for quality of life in patients with schizophrenia and patients with depression. Psychiatry Res. 2003;119(1–2):63–79.
Jung HH, Kim CH, Chang JH, et al. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: long-term follow-up results. Stereotact Funct Neurosurg. 2006;84(4):184–9.
Dougherty DD, Baer L, Cosgrove GR, et al. Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive compulsive disorder. Am J Psychiatry. 2002;159(2):269–75.
Stewart SE, Stack DE, Farrell C, et al. Effectiveness of intensive residential treatment (IRT) for severe, refractory obsessive-compulsive disorder. J Psychiatr Res. 2005;39(6):603–9.
Mundt JC, Marks IM, Shear MK, Greist JM. The work and social adjustment scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180:461–4.
Blais MA, Lenderking WR, Baer L, et al. Development and initial validation of a brief mental health outcome measure. J Pers Assess. 1999;73:359–73.
Bystritsky A, Saxena S, Maidment K, et al. Quality-of-life changes among patients with obsessive-compulsive disorder in a partial hospitalization program. Psychiatr Serv. 1999;50(3):412–4.
Acknowledgments
The authors would like to thank Ms Saleha Othman for her help in formatting this paper.
Conflict of interest
The authors have no conflict of interest to declare.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Subramaniam, M., Soh, P., Vaingankar, J.A. et al. Quality of Life in Obsessive-Compulsive Disorder: Impact of the Disorder and of Treatment. CNS Drugs 27, 367–383 (2013). https://doi.org/10.1007/s40263-013-0056-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40263-013-0056-z