Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders

a Department of Psychiatry , Columbia University , New York , USA.
Cognitive behaviour therapy 01/2013; 42(1). DOI: 10.1080/16506073.2012.751124
Source: PubMed


Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously.

A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale--Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures.

Main results:
Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission.

Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases.

Download full-text


Available from: Chad Wetterneck
  • Source
    • "We identified 41 studies that met our screening criteria of treatment of OCD in either an inpatient, day-patient or residential unit setting. Of these, 22 were excluded for failing to meet one of the criteria: one because patients were from an outpatient service (Olatunji et al., 2013); three for not using the Y-BOCS as an outcome measure (Kwee, Duivenvoorden, Trijsburg, & Thiel, 1986; Ruppert, Zaudig, Hauke, Thora, & Reinecker, 2001; Van den Hout, Emmelkamp , Kraaykamp, & Griez, 1988); four because they used the Y-BOCS self-report version (Cole Monaghan et al., 2015; Grøtte et al., 2015; Pozza, Coradeschi, & Dèttore, 2013; Simpson et al., 2013), two because they were adolescent services (Arai, Ichikawa, Ejiri, & Watanabe, 2006; Bjorgvinsson et al., 2008); two because they reported on treatment outcomes for an eating disorders service, with only some patients having comorbid OCD (Cumella, Kally, & Wall, 2007; Olatunji, Tart, Shewmaker, Wall, & Smits, 2010); one for having a sample size of two patients (Carmin & Wiegartz, 2000); or nine patients (Drummond, Pillay, Kolb, & Rani, 2007); one for being a review rather than a research study (Winkelmann & Hohagen, 1995); two because they did not include CBT as part of the treatment (Haghighi et al., 2013; Shafti & Kaviani , 2015); one for not including data on post-treatment Y-BOCS scores (Brennan et al., 2014); and one as it was unpublished (Alosso, 2012). Finally, two articles were excluded as they included data from the same cohorts reported by other papers (Stewart et al., 2009; Stewart, Yen, Stack, & Jenike, 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Little data exist to inform the treatment of severe or treatment refractory obsessive-compulsive disorder (OCD) in an inpatient or residential setting. We aimed to determine effect size of inpatient, residential or day-patient program in people with OCD. Studies were selected if they were conducted in an inpatient, day-patient or residential setting; were using the Yale Brown Obsessive Compulsive Scale (Y-BOCS) as an outcome measure; treatment included cognitive behavior therapy; it involved adult patients; and had a sample size of at least 20. We identified 19 studies with a total of 2306 participants at admission. We extracted the mean and standard deviation pre-admission and at discharge. The overall reduction was 10.7 points (95% CI: 9.8-11.5, z=24.2 p<0.001) with an effect size, Hedges g, of 1.87. Being married or cohabiting consistently predicted better outcomes, and symptoms of hoarding or comorbid alcohol misuse consistently predicted worse outcomes. Clients with severe or treatment refractory OCD can make significant improvements with intensive residential or inpatient therapy but little is known either about its long term benefits or cost effectiveness compared with an alternative. Programs are offered internationally with a variety of inclusion criteria. We discuss how such programs might be optimized.
    Full-text · Article · Nov 2015 · Journal of Obsessive-Compulsive and Related Disorders
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anorexia nervosa (AN) is a severe illness with high rates of relapse. Exposure and Response Prevention for AN (AN-EXRP) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety. The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration, at a pivotal moment when treatment goals shift toward relapse prevention. A randomized controlled trial was conducted to compare AN-EXRP with a comparison condition, Cognitive Remediation Therapy (CRT). Hospitalized patients with AN (n = 32) who had achieved weight restoration to a BMI > 18.5 kg/m(2) received 12 sessions of either AN-EXRP or CRT. Outcome was assessed by change in caloric intake in an objective assessment of eating behavior. The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment, while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [t(28) = 2.5, p = .02]. Improvement in intake was significantly associated with improvement in eating-related anxiety (Spearman's ρ = 0.40, p = .03). These data demonstrate that AN-EXRP, compared to a credible comparison intervention, is associated with better caloric intake in a laboratory meal over time in AN. Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinically significant change. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:174-180).
    No preview · Article · Mar 2014 · International Journal of Eating Disorders
  • [Show abstract] [Hide abstract]
    ABSTRACT: This report describes a multidisciplinary residential treatment approach for adolescents with eating disorders. It presents data on treatment efficacy and analyzes long term follow-up results focusing on nutritional and behavioral interventions delivered in a systematic residential setting. Residents were evaluated at admission, discharge, and follow-up (M=24 months post-discharge) using a panel of well-established psychological measures (EDE-Q, BDI, YBOC, STAI). The results showed both statistically and clinically significant reductions in eating disorder symptomology between admission and discharge. At the end of residential treatment, symptoms of anxiety, depression and obsessive compulsive behaviors had decreased to within the norms of non-diseased populations, and there was little regression from discharge to follow-up. Weight gains were also sustained after discharge. These results indicate that a multidisciplinary model to treat eating disorders in a residential setting is an effective approach to treat these disorders and further supports the need to grow residential care in behavioral health settings.
    No preview · Article · Mar 2014 · Journal of Groups in Addiction & Recovery
Show more