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Abstract
Obsessive-compulsive (OCD) and delusional disorders (DD) have been recognised with increased frequency in recent years, and the propensity of some OCD subjects to become deluded has become a focus of interest. This study reports illness-specific demography along with measures of symptom severity and tests to assess schizotypal ideation, dysfunctional attitudes, attributional and attention bias in 30 patients with OCD, 29 with DD, 16 with OCD with delusions (OC-DD) and a 30-subject control group (CG). Obsessional features appeared before delusions in the OC-DD group, suggesting that OCD was the primary pathology. Delusions were more likely in subjects obsessional about one rather than multiple themes. There was some support for proposals that depression and schizotypy may bring out delusions in OCD and some evidence for the utility of categorising OCD according to the number of obsessions a subject has.
Key Words
Obsessive-compulsive disorder. Delusions
Comorbidity
Introduction
In recent years, obsessive-compulsive (OCD) and delusional disorders (DD) have been recognised more commonly, and there has been a re-emergence of 19th century proposals that the two conditions may be linked [1]. Where once obsessionality in the context of a paranoid disorder was taken to indicate that obsessions could be prodromal for schizophrenia [2], obsessionality is not now seen in this way, and there has been renewed interest in delusional developments in obsessive conditions [3, 4]. Rasmussen and Eisen [5] reported that 30 of 250 OCD patients had delusions, hallucinations and/or thought disorder. They divided their `psychotic' obsessionals into four groups: those meeting criteria for both OCD and schizophrenia (7/30), for OCD and schizotypal personality with magical thinking (8/30), for OCD and DD (8/30) and for OCD with `transient obsessional delusions' (7/30). The first two groups they termed the schizophrenia spectrum and the latter two the OCD with delusions group. They subsequently identified 67 psychotic obsessionals in a sample of 475 OCD patients of whom 27 were schizophrenia spectrum patients [6].
The group of patients with OCD and delusions has been the subject of less research to date. In a sample of 430 OCD patients from 7 North American clinics, over 60% clearly feared harmful consequences of not ritualising, and while most questioned the senselessness of their obsessions, 4% were certain and 25% almost certain that their...