The prevalence of aggressive obsessions in youth with obsessive-compulsive disorder: A meta-analysis

Despite obsessive-compulsive disorder (OCD) being a recognizable psychiatric disorder, certain presentations of OCD are still highly stigmatized and misidentified by healthcare professionals. Namely, aggressive obsessions, which include ego-dystonic, intrusive thoughts and fears of accidentally or intentionally harming the self or others, are vastly under researched. With current prevalence estimates for aggressive obsessions in pediatric OCD ranging anywhere from 30.8 % to 86 %, the primary aim of the current meta-analysis was to provide the first meta-analytic estimate of the worldwide prevalence of aggressive obsessions among youth with OCD. A secondary goal of this study was to quantify sources of heterogeneity that contribute to the variability in prevalence estimates to date. A systematic review was conducted in Covidence using the following online databases: PsycINFO, PubMed, and CINAHL. Of the 4218 articles imported and screened, 831 received a full-text review, with 27 studies (N = 3428) ultimately coded. Using a random-effects model, the aggregate lifetime prevalence rate of aggressive obsessions was found to be 65.1 % CI_95 % [57.3 %, 72.2 %], with prediction intervals ranging from 43.9 % to 81.7 %, and a current prevalence rate of 61.9 % CI_95 % [56.4 %, 67.0 %], with prediction intervals ranging from 37.0 % to 81.8 %. The presence of comorbidities and the type of diagnostic measure utilized were found to be significant moderators for current estimates. With over half of youth experiencing aggressive obsessions in their lifetime, continuing education is required for healthcare professionals to be able to identify and properly treat this common, but often overlooked, symptom dimension.