[Modern typology of symptoms and obsessive-compulsive syndromes: results of a large French study of 615 patients].

OBJECTIVES: The most common strategy to search for homogenous subgroups of Obsessive-Compulsive Disorder (OCD) patients has been based on the OCD symptoms themselves as a classifying variables. The purpose of this study was to: expand recognition of major clinical OCD subtypes in a large cohort of patients recruited from the national french survey: "Screening-Understanding-Treating OCD"; reproduce preliminary data coming from a US collaborative study on OCD sub-types [Baer L, J Clin Psychiatry, 1994; 55 (3):18-23].
METHOD: From 731 OCD/OCS (OC disorder or syndromes) patients recruited in the phase 1 of the national french survey, complete collected data on the Y-BOCS Symptom Checklist (YBOCS-CL) were obtained in 615 patients and on the OCD spectrum inventory in 646 patients. Principal components analysis (PCA) was firstly applied on major symptom categories of the YBOCS-CL, and next on each individual symptom. Gender effect on clinical aspects of OCD was also explored by comparative descriptive analysis.
RESULTS: The first PCA on major symptoms categories confirmed the grouping of all categories in three major factors, named as following: Facteur 1 = "Predominantly Compulsive" (loaded with items of symmetry, order, hoarding, repeting, counting, checking); Facteur 2 = "Predominantly Obsessive" (loaded with aggression, violent, religious, sexual obsessions) and Facteur 3 = "Mixed" (with contamination and somatic obsessions and washing compulsions). Our data seemed to be very close to US collaborative study that had found in a sample of 107 OCD patients, the presence of the same three major clinical factors. The second PCA applied on all YBOCS-CL individual items had provided interesting items groupings, suggesting a reorganization and re-labelling of YBOCS-CL symptoms categories. Therefore, a new presentation of the YBOCS-CL can be proposed with a more clinical relevance than the original version. Results from OC spectrum inventory showed high comorbidity rate with many of OCD related disorders. Finally, a gender influence on OC clinical manifestations was observed, especially more severity and higher rate of difficult OC-subtypes in male patients. The french national survey data on OC symptoms sub-typing and clustering showed a "natural" groupings of OC symptom categories which add more validity to the subtypes proposed by ICD-10 (based on syndromal predominance : obsessions, compulsions or mixed). These sub-categories are not part of the DSM III-R, neither of the new version of DSM IV!