Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

New York State Psychiatric Institute, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 08/2011; 49(8):453-8. DOI: 10.1016/j.brat.2011.04.004
Source: PubMed

ABSTRACT Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.

Download full-text


Available from: Anthony Pinto, Sep 29, 2015
16 Reads
  • Source
    • "reported a poorer response to both pharmacological and behavioural treatment for OCD in the presence of OCPD (Cavedini et al., 1997; Pinto et al., 2011), others did not find OCPD to be a predictor of poorer response to treatment of OCD (Baer et al., 1992; Fricke et al., 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: There are ongoing uncertainties in the relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). This study aimed to test the proposition that OCPD may be a marker of severity of OCD by comparing groups of OCD individuals with and without OCPD on a number of variables. Method: A total of 148 adults with a principal diagnosis of OCD were administered the Mini International Neuropsychiatric Interview, Yale-Brown Obsessive-Compulsive Scale, Sheehan Disability Scale, Vancouver Obsessional Compulsive Inventory and Symptom Checklist 90-Revised. Participants with a DSM-IV diagnosis of OCPD were compared with those without OCPD. Results: Some 70 (47.3%) participants were diagnosed with OCPD. The groups of participants with and without OCPD did not differ significantly with respect to any of the demographic variables, clinician-rated severity of OCD, levels of disability and mean age of onset of OCD. All self-rated OCD symptom dimensions except for contamination and checking were significantly more prominent in participants with OCPD, as were all self-rated dimensions of psychopathology. Participants with OCPD had significantly more frequent hoarding compulsions and obsessions involving a need to collect and keep objects. Of Axis I disorders, only panic disorder was significantly more frequent in participants with OCPD than in those without OCPD. Conclusions: A high frequency of OCPD among individuals with OCD suggests a strong, although not necessarily a unique, relationship between the two conditions. This finding may also be a consequence of the blurring of the boundary between OCD and OCPD by postulating that hoarding and hoarding-like behaviours characterise both disorders. Results of this study do not support the notion that OCD with OCPD is a marker of clinician-rated severity of OCD. However, individuals with OCPD had more prominent OCD symptoms, they were more distressed and exhibited various other psychopathological phenomena more intensely, which is likely to complicate their treatment.
    Australian and New Zealand Journal of Psychiatry 06/2012; 47(1). DOI:10.1177/0004867412450645 · 3.41 Impact Factor
  • Source
    • "Pinto, Liebowitz, Foa and Simpson (2011) found in a sample of individuals with OCD that having a diagnosis of OCPD was a predictor of poorer outcome to exposure and response prevention. Pinto et al. (2011), tested each criteria of OCPD separately regarding treatment outcome, and found that perfectionism predicted poorer treatment outcome over and above all other criteria. Research has also examined the link between OCPD and eating disorders. "
    Revista de Psicopatología y Psicología Clínica 02/2012; 17(3):279. DOI:10.5944/rppc.vol.17.num.3.2012.11844 · 0.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hoarding is a serious mental health problem that poses a profound public health risk and carries significant health and functioning problems. Hoarding is characterized by difficulty discarding, excessive acquiring, and substantial clutter that is impairing and costly to the individual, the family, and the community. Recent research suggests that hoarding may be a syndrome distinct from OCD that is more often associated with major depression, generalized anxiety, and social phobia. To address poor outcomes following medication and behavioral treatments developed for OCD, a recent waitlist controlled trial tested a specialized office-based cognitive behavioral treatment (CBT) with home visits for hoarding. This CBT model of hoarding posits deficits in information processing, maladaptive beliefs about and attachments to possessions that provoke distress and avoidance, as well as positive emotional responses to saving and acquiring that reinforce these behaviors. The 26-session individual CBT included in-home and office assessments, motivational enhancement, collaborative model-building, training in organizing and problem solving skills, non-acquisition and sorting exposures, cognitive therapy, and relapse prevention. After 12 sessions CBT led to significantly more improvement in hoarding than did waitlist. Those who completed 26 sessions showed significant reductions in hoarding symptoms and large effect sizes. The purpose of this study is to present the follow-up outcome data and predictors of durable gains. Of 37 clients treated with CBT for hoarding, 25 completed 12-month follow-up assessments. The follow-up sample was similar to the completer sample: 80% female, 88% White, 40% married or living with partner, 44% unemployed, disabled or retired; the average age was 50. Scores on standardized measures (Saving Inventory Revised, SI-R; Hoarding Rating Scale Interview, HRS-I) were analyzed using General Linear Model Repeated Measures design examining time (pretreatment, post-treatment, follow-up). There was a significant main effect for time on the SI-R total (F (2, 17) = 14.034, p=.001, partial eta squared=.438) and on the HRS -I (F (2,23) = 32.857, p=.001, partial eta square=.578), indicating large effects. Pairwise comparisons showed that significant improvements between pretest and post-test were sustained at follow-up. At follow-up, therapists rated 58% of patients much or very much improved on clinical global improvement ratings while 76% of patients rated themselves in these categories. Predictors of follow-up outcomes will be presented. CBT with specialized components appears to be a promising intervention for hoarding, a condition traditionally thought to be resistant to treatment. Results suggest the durability of significant reductions in hoarding symptoms following this 26-session CBT treatment. Greater understanding of predictors of outcomes has the potential to direct efforts to improve CBT methods for hoarding. Ongoing research is examining hoarding intervention enhancements that may extend access to treatment, reduce costs, and enhance outcomes for this underserved population.
    Society for Social Work and Research Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy; 01/2012
Show more