With regard to absolute numbers, most persons with OCD (ie, 66 of 110 [60.0%]) died of natural causes of death. Thus, the escalation of deaths from diseases and medical conditions among persons with OCD is an important component of the observed excess mortality risk. Interestingly, the effects of comorbid anxiety disorders, depression, or substance use disorders on mortality risk due to natural causes among persons with OCD were less pronounced, despite the fact that most persons with these comorbidities died of natural causes. Severe psychiatric disorders have been shown to be associated with an increased risk of somatic comorbidity,25,26 and psychiatric patients might be underdiagnosed and undertreated for medical conditions.27 Physical complications and health problems have been described in relation to severe enduring OCD, as well as milder forms of the disorder.28–30 Other hazardous unhealthy lifestyles such as physical inactivity,31 increased smoking,32 unhealthy eating patterns,29,33 as well as stress and biological dysregulation,34–36 might have further contributed to the observed excess mortality among persons with OCD. In some cases, the compulsive thoughts and rituals themselves might become harmful.29 We also cannot
