Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder

Objective: This study aimed to examine correlates of occupational disability in a large, clinical sample of individuals with a primary diagnosis of obsessive-compulsive disorder (OCD). Methods: A total of 238 individuals with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were interviewed at entry into an observational study of the course of OCD. Primary was defined as the diagnosis that patients identified as the most problematic over their lifetime. Results: At the time of interview, 38% of the sample reported being unable to work for psychiatric reasons. Obsessive-compulsive disorder with occupational disability was associated with greater functional impairment in completing household duties, social functioning, and quality of life. Few differences in treatments received were found among individuals with and without occupational disability. Although the number of years on psychotropic medications was similar among the 2 groups, those with disability had been on a greater number of serotonin-reuptake inhibitors over their lifetime. Half of individuals with occupational disability had entered cognitive-behavioral therapy at some point, but only one third had received at least 13 sessions. Regression analyses revealed that OCD severity was the most powerful predictor of occupational disability, followed by depression severity and presence of a lifetime substance use disorder. Conclusions: A substantial proportion of individuals in our sample were unable to work. Cognitive-behavioral therapy was underutilized, and reasons for this remain unclear. Comorbid depression and substance use disorders present additional risk factors for disability. Further advances in biologic and psychosocial treatments are needed to improve functioning and the overall prognosis of the disorder.