TITLE:
Understanding Behavioral Manifestations of Obsessive-Compulsive Disorder in People with Intellectual Disabilities—A Qualitative Study
AUTHORS:
Lena Grüter, Matthias Grünke
KEYWORDS:
People with Intellectual Disabilities, Obsessive-Compulsive Disorder, Compulsive Behavior, Diagnostics, Differential Diagnosis
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.14 No.2,
February
27,
2024
ABSTRACT: Background: There is limited knowledge
about obsessive-compulsive disorder (OCD) in people with intellectual
disabilities (IDs). This paper describes the manifestation of
compulsive behaviors associated with OCD at the behavioral level in people
with ID in institutionalized settings. The aim was to gain nuanced insight into
appropriate understanding and classification in this specific context, and
derive implications for research and practice. Methods: Individual cases of people with ID (n = 7) were studied to assess compulsive
symptoms through two days of on-site
observation of the person with ID within the institution, guided group discussions (n = 28), and semi-structured interviews
with key informants and caregivers of the person with ID (n = 20). Caregiver
ratings of the compulsive behavior checklist were compiled. Data were analyzed using qualitative content analysis. Results: All forms of OCD were present. Characteristics of
compulsive behaviors in people with ID
at the behavioral level includedless complex and more obvious compulsive acts, immediate responses,
signs of tension, motor restlessness, facial expression changes, repetition, need for predictability, time-consuming behaviors, and aggressive
reactions when these acts were interrupted. Some of the compulsive behaviors
corresponded to the ICD-11 OCD code 6B20, and others to compulsions as a psychological symptom
(MB23.4). Conclusions: OCD may manifest atypically at the behavioral level in people with ID, posing significant challenges for accurate
classification due to symptom ambiguity. Follow-up differential diagnostic studies are needed to more accurately
identify and differentiate OCD symptoms in people with ID. Further,
disorder-specific guidelines for recognizing OCD in people with ID are needed for institutionalized settings
without psychiatric-psychotherapeutic expertise.