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

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: Modifications to treatment may be warranted for some types of symptoms. Clinical implications and directions for future research are discussed.

The Association of Anger with Symptom Subtypes in Severe Obsessive-Compulsive Disorder Outpatients

“…Moreover, our findings are of clinical relevance, as they may help psychiatrists in setting up personalized psychotherapeutic and psychopharmacological treatments targeted for specific subgroups of OCD patients. As shown by Williams et al [35], certain obsession subtypes are more responsive to treatment - mainly cognitive-behavioral therapy with exposure and ritual prevention - than others. Treatment appears to be more effective for symmetry/exactness, whereas anger and aggressiveness seem to be more difficult to address, thus they should always be investigated and properly assessed.…”

Excessive nest building is a unique behavioural phenotype in the deer mouse model of obsessive–compulsive disorder

“…Furthermore, being clinically heterogeneous, OCD is characterised by a range of phenotypically different symptom types (Williams et al, 2013). Four major obsessive-compulsive symptom dimensions have been described, namely: (a) contamination obsessions and washing compulsions; (b) responsibility for harm obsessions and checking compulsions; (c) symmetry obsessions and ordering compulsions; and (d) unacceptable thoughts (e.g.…”

Neuropsychological differences between obsessive-compulsive washers and checkers: A systematic review and meta-analysis

“…Patients with predominant washing symptoms seem to be at increased risk of eating disorders whereas patients with predominant checking behavior and aggressive obsessions are at higher risk for comorbid major depression and generalized anxiety disorder (Hasler et al, 2005). The OCD symptom dimensions are regarded as predictors of treatment response to serotonin reuptake inhibitors (Mataix-Cols, Rauch, Manzo, Jenike, & Baer, 1999) and cognitive behavioral therapy (Mataix-Cols, Marks, Greist, Kobak, & Baer, 2002), since patients with predominant washing symptoms need more therapy sessions when they primarily feel disgust compared to checkers as stated in the review by Williams, Mugno, Franklin, and Faber (2013). Although these prior studies provide evidence that OCD patients with either predominant washing or checking symptoms differ from each other in genetic, structural and functional neurobiological features as well as in comorbidity and treatment response, it remains unclear whether they also differ in their neuropsychological functioning.…”