Autism spectrum disorders in adult outpatients with obsessive compulsive disorder in the UK

Abstract

Objectives: Patients with obsessive compulsive disorder (OCD) frequently show traits of autism spectrum disorders (ASD). This is one of the first studies to explore the clinical impact of the overlap between OCD and ASD as a categorical diagnosis.

Methods: A cross-sectional survey in 73 adult outpatients with DSM-IV OCD. Autistic traits were measured using the Autism-Spectrum Quotient (AQ). A clinical estimate ASD diagnosis was made by interview using DSM-IV-TR criteria. OCD patients with and without autistic traits or ASD were compared on demographic and clinical parameters and level of OCD treatment-resistance based on treatment history.

Results: Thirty-four (47%) patients scored above the clinical threshold on the AQ (≥26) and 21 (27.8%) met diagnostic criteria for ASD. These diagnoses had not been made before. Patients with autistic traits showed a borderline significant increase in OCD symptom-severity (Yale-Brown Obsessive Compulsive Scale (Y-BOCS); p = .054) and significantly increased impairment of insight (Brown Assessment of Beliefs Scale; p = .01). There was a positive correlation between AQ and Y-BOCS scores (p = .04), but not with OCD treatment resistance.

Conclusion: There is a high prevalence of previously undiagnosed ASD in patients with OCD. ASD traits are associated with greater OCD symptom-severity and poor insight.

Keywords:

• Autism spectrum disorders
• obsessive compulsive disorder
• autistic traits
• co-morbidity
• autistic spectrum disorder
• autism

Acknowledgements

We would like to acknowledge the contribution of the patients and the administrative staff in the Highly Specialised Obsessive Compulsive Disorders Service, Hertfordshire Partnership University NHS Foundation Trust. Special thanks to Dr. Keith O’Sullivan and Dr. David Wellsted at the University of Hertfordshire for their help with the analysis and Mr. Lasantha Wikramanayake for his contribution to the graphics.

Disclosure statement

In the past several years, Dr. Fineberg has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7), Shire. Dr. Fineberg has received honoraria for lectures at scientific meetings from Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists, British Association for Psychopharmacology (BAP). Dr. Fineberg has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioural Addiction, CINP, IFMAD, ECNP, BAP, World Health Organization, Royal College of Psychiatrists. Dr. Fineberg has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis.