A comparison was also drawn between the most prevalent symptoms in our sample and those of other studies performed in India, England and Jerusalem. Contamination obsessions were the most frequent in all studies. However, the similarities of the contents of obsessions between Moslems and Jews, as compared with Hindus and Christians, signify the role played by cultural and religious factors in the presentation of OCD. The obsessional contents of the samples from Egypt and Jerusalem were similar, dealing mainly with matters of religion, cleanliness and dirt. Common themes between the Indian and British samples, on the other hand, were mostly related to orderliness and aggressive issues (Akhtar et al., 1975; Greenberg, 1984; Khanna and Channabasavanna, 1988; Pollitt, 1957).
Another cultural characteristic of Egyptian psychiatric patients is reflected in the Y-BOCS rating of the severity of OCD in our sample. The majority of patients rated between moderate and severe, and the total Y-BOCS score was severe in most of the cases, indicating high tolerance for psychiatric morbidity before seeking help. Native healers, religious people, friends and family elders are the primary caregivers for psychologically disordered individuals. When those interventions fail, seeking out the general practitioner, and then the psychiatrist, are the next resorts.
A surprising finding in our study was the fact that none of the patients had excellent insight into their disorder. Insight was mildly affected in 26% of cases, moderately affected in 50% and severely affected in 14.4%. This contrasts with the historically accepted characteristics of OCD--that patients recognize the absurdity of their obsessions and compulsions. However, our findings echo those of Lelliott et al. (1988), who found that one-third of their 49 ritualizers perceived their obsessive thoughts as rational and believed that rituals warded off some unwanted or feared event. The more bizarre the obsessive belief, the more strongly it was defended, and 12% made no attempt at all to resist the obsession.
Regarding the comorbidity of OCD with other psychiatric disorders, our results showed that one-third of patients had an associated depressive disorder and another third had various other diagnoses. The remaining one-third of patients did not show any psychiatric comorbidities (Okasha et al., 1994). These results can be compared to those obtained by Rasmussen and Eisen (1992), who found that two-thirds of their sample also had major depressive disorder.
Another study was conducted to determine the prevalence of obsessive-compulsive symptoms (OCS) among Egyptian students (Okasha et al., 2001). The multistage, stratified, random sample of students came from the El Abasseya educational area in Cairo. The tools used in this study included the General Health Questionnaire for screening of psychiatric morbidity and the Arabic Obsessive Scale for obsessive traits. The Y-BOCS was used to determine the profile of OCS and the ICD-10 was used for diagnosis of OCD. Prevalence rates for psychiatric morbidity, obsessive traits and OCS were 51.7%, 26.2% and 43.1%, respectively. Obsessive-compulsive symptoms were more prevalent among younger students, females and first-born participants. Aggressive, contamination and religious obsessions and cleaning compulsions were the most common. Nineteen percent of participants with OCS fulfilled ICD-10 criteria for OCD. This work presented data from a field study among adolescents in secondary schools and university students between the ages of 15 and 24. The prevalence of probable minor psychiatric morbidity was 51.7%. This high prevalence rate could be explained by the many biological and social factors that are associated with adolescence and early adulthood. This is especially true in a country such as Egypt, where the socioeconomic situation prolongs the duration of dependence on family and where attempts at independent living are met with major challenges (mostly economic). Furthermore, the last two years of school in the Egyptian educational system determine the student's future career, mainly whether or not they can have a university education. This is a crucial indicator of social status, even in the absence of economic resources.
In another study, we looked at the prevalence of OCS in a sample of Egyptian psychiatric patients (Okasha et al., 2000). Obsessions can occur in many psychiatric disorders, or they may constitute the entire illness. This is referred to as an obsessional state. The relationship of OCS to different psychiatric disorders still remains controversial. This work was undertaken to study the co-occurrence and phenomenology of OCS with other psychiatric disorders.
We examined a sample of 372 psychiatric outpatients and 308 controls using the Arabic version of the Y-BOCS checklist. Participants were additionally assessed by the obsession symptom section of the Present State Examination, the Eysenck rigidity scale and the religious orientation scale. Obsessive-compulsive symptoms were found to be significantly higher in psychiatric patients than in the non-psychiatric controls. Eighty-three percent of patients with neurotic, stress-related and somatoform disorders; 51% of patients with mood disorders; and 47% of patients with schizophrenia, schizotypal and delusional disorders were found to have OCS in their symptomatology. Furthermore, the data suggest that OCS in psychiatric patients has a distinct phenomenology from that in controls. The results did not, however, reveal a relationship between OCS and either rigidity or religious orientation.
The higher prevalence of OCS in the clinical psychiatric population (62.4%) tends to confirm the validity of the subsyndromal forms of OCD. All the symptoms in the Y-BOCS checklist were significantly more prevalent in the clinical population than in the general population, except for hoarding-saving obsessions. This suggests that OCS in the clinical population differs from that in the general population. It remains an issue for future exploration whether those subgroups would require treatment. However, the 62.4% prevalence of OCS in our clinical population could be compared to the study done by Hantouche and Bourgeois (1995), who found OCS in 17% of their clinical population.