Symptom Dimensions in Obsessive-Compulsive Disorder: Phenomenology and Treatment Outcomes with Exposure and Ritual Prevention

Center for Mental Health Disparities, Department of Psychological and Brain Sciences, University of Louisville, Louisville, Ky., USA.
Psychopathology (Impact Factor: 2.08). 04/2013; 46:365-376. DOI: 10.1159/000348582
Source: PubMed


Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. Currently, the cognitive-behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP); however, clinical impression and some empirical data suggest that certain OCD symptoms are more responsive to treatment than others.

Prior work identifying symptom dimensions within OCD is discussed, including epidemiological findings, factor analytic studies, and biological findings. Symptom dimensions most reliably identified include contamination/cleaning, doubt about harm/checking, symmetry/ordering, and unacceptable thoughts/mental rituals. The phenomenology of each of these subtypes is described and research literature is summarized, emphasizing the differential effects of EX/RP and its variants on each of these primary symptom dimensions.

To date it appears that EX/RP is an effective treatment for the various OCD dimensions, although not all dimensions have been adequately studied (i.e. symmetry and ordering).

Modifications to treatment may be warranted for some types of symptoms. Clinical implications and directions for future research are discussed.

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Available from: Monnica T Williams
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    • "). While much research has been conducted on certain symptom dimensions, relatively less research has been conducted examining sexual obsessions (Williams et al., 2013). This may be because the corresponding compulsions are often covert and the taboo nature of such thoughts (Williams et al., 2011b, 2013). "
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    ABSTRACT: Although sexual obsessions in obsessive-compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions in OCD are particularly distressing due to the ego-dystonic nature of the obsessions and, often, stigma surrounding a same-sex orientation. The purpose of this study was to better understand distress in people suffering from sexual orientation obsessions in OCD. Data were collected online (n = 1,176) and subjects were 74.6 % male, 72.0 % heterosexual, and 26.4 % with an OCD diagnosis from a professional. The survey consisted of 70 novel questions that were assessed using a principal components analysis and the items separated into six components. These components were then correlated to distress among those with a prior OCD diagnosis and sexual orientation obsessions. Results indicated that sexual orientation obsessions in OCD were related to severe distress, including suicidal ideation. Implications of these findings and future directions for research are discussed.
    Full-text · Article · Apr 2015 · Archives of Sexual Behavior
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    • "In particular, UTs are often considered more difficult to treat and exhibit some features that are distinct from other symptom dimensions (Brakoulias et al., 2013; Williams et al., 2013). For instance, due to their egodystonic nature, these types of thoughts may be perceived as repulsive, morally reprehensible, or apt to be indicative of other significant pathology (e.g., being violent, delusional, sexually deviant). "
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    ABSTRACT: Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.
    Full-text · Article · Feb 2015 · Cognitive Behaviour Therapy
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    • "Scores greater than or equal to 16 were required for study entry, which indicates clinically significant OCD symptoms. The Y-BOCS severity scale has excellent psychometric properties, including reliability and construct validity (Goodman & Price, 1992; Goodman et al., 1989; Williams, Wetterneck, Thibodeau, & Duque, 2013; Woody, Steketee, & Chambless, 1995). "
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    ABSTRACT: Objective Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients. Method The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n = 87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. Results The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β = .27, p = .02) and hoarding dimensions (β = .23, p = .04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. Conclusions EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.
    Full-text · Article · Aug 2014 · Journal of Anxiety Disorders
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