Longitudinal assessment of symptom and subtype categories in obsessive–compulsive disorder

Abstract

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36+/-8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes--autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.

Cognitive therapy for autogenous and reactive obsessions: Clinical and cognitive outcomes at post-treatment and 1-year follow-up

“…The rate of patients with autogenous obsessions was nearly half the rate of patients with reactive obsessions, approximately 25% of the whole sample. These data are comparable to those obtained in the Besiroglu et al (2007) study.…”

“…A naturalistic study designed to assess whether the initial assignment of OCD patients to Autogenous or Reactive groups changed over time found no shifts between these two subgroups during the course of the study (a mean of 36 months). In contrast, significant shifts were observed in OCD symptom subtypes assessed by the Y-BOCS-CL (Besiroglu et al, 2007).…”

“…Hypothesized differences between autogenous and reactive obsessions have received support in studies with non-clinical samples (Belloch, Morillo, & García Soriano, 2007;Lee, Lee, Kim, Kwon, & Telch, 2005;Moulding, Kyrios, Doron, & Nedeljkovic, 2007), as well as with OCD patients (Belloch, Morillo, & García Soriano, 2006;Besiroglu et al, 2007;. Moreover, the temporal stability of these two OCD subtypes seems to be better than what is found by categorizing patients on the basis of their symptom content as assessed with the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-CL).…”

The predictive value of interpersonal schemas, perfectionism, and thought action-fusion in obsessive-compulsive disorder / Obsesif-kompulsif bozuklukta kişilerarası şemalar, mükemmeliyetçilik ve düşünce-eylem kaynaşmasının yordayıcı rolü

“…Obsessive-compulsive disorder consists of clinically heterogeneous symptoms and practical validity of distinct nosological clusters, the concept of which has been examined in many studies (2,52). Nevertheless, from an etiological perspective, possible relations or discriminations among symptoms concerning the individual differences such as personality, cognitive schemas or beliefs, attachment styles that possibly influence symptom severity and type, have received little attention.…”

Is a Psychodynamic Perspective Relevant to the Clinical Management of Obsessive–Compulsive Disorder?

“…Clinical subtypes are stable over time, and different subtypes respond differently to treatment (Besiroglu et al, 2007). Neurotransmitter, genetic, and clinical variability suggest that OCD is a heterogeneous disorder (Mataix-Cols, Conceicau do Rosario Campos, & Leckman, 2005;Nestadt et al, 2003).…”