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

ABSTRACT

Purpose:
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.

Methods:
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.

Conclusion:
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.

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    • "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). "
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