The impact of trauma and post-traumatic stress disorder on the treatment response of patients with obsessive-compulsive disorder

Abstract

Few case series studies have addressed the issue of treatment response in patients with obsessive-compulsive disorder (OCD) and comorbid post-traumatic stress disorder (PTSD), and there are no prospective studies addressing response to conventional treatment in OCD patients with a history of trauma (HT). The present study aimed to investigate, prospectively, the impact of HT or PTSD on two systematic, first-line treatments for OCD. Two hundred and nineteen non-treatment-resistant OCD outpatients were treated with either group cognitive-behavioral therapy (GCBT n = 147) or monotherapy with a selective serotonin reuptake inhibitor (SSRI n = 72). Presence of HT and PTSD were assessed at intake, as part of a broader clinical and demographical baseline characterization of the sample. Severity and types of OCD symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Dimensional YBOCS (DYBOCS), respectively. Depression and anxiety symptoms were measured with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Both treatments had 12-week duration. Treatment response was considered as a categorical [35% or greater reduction in baseline YBOCS scores plus a Clinical Global Impression-Improvement rating of better (2) or much better (1)] and continuous variable (absolute number reduction in baseline YBOCS scores). Treatment response was compared between the OCD + HT group versus the OCD without HT group and between the OCD + PTSD group versus the OCD without PTSD group. Parametric and non-parametric tests were used when indicated. Data on HT and PTSD were available for 215 subjects. Thirty-eight subjects (17.67% of the whole sample) had a positive HT (OCD + HT group) and 22 subjects (57.89% of the OCD + HT group and 10.23% of the whole sample) met full DSM-IV criteria for PTSD. The OCD + HT and OCD without HT groups presented similar response to GCBT (60% of responders in the first group and 63% of responders in the second group, p = 1.00). Regarding SSRI treatment, the difference between the response of the OCD + HT (47.4%) and OCD without HT (22.2%) groups was marginally significant (p = 0.07). In addition, the OCD + PTSD group presented a greater treatment response than the OCD without PTSD group when treatment response was considered as a continuous variable (p = 0.01). The age when the first trauma occurred had no impact on treatment response. In terms of specific OCD symptom dimensions, as measured by the DYBOCS, OCD treatment fostered greater reductions for the OCD + PTSD group than for the OCD without PTSD group in the scores of contamination obsessions and cleaning compulsions, collecting and hoarding and miscellaneous obsessions and related compulsions (including illness concerns and mental rituals, among others). The OCD + PTSD group also presented a greater reduction in anxiety scores than the OCD without PTSD group (p = 0.003). The presence of HT or PTSD was not related to a poorer treatment response in this sample of non-treatment-resistant OCD patients. Unexpec...

Role of stressful and traumatic life events in obsessive–compulsive disorder

“…Shavitt et al found that patients who reported a history of trauma were more frequently rated as an SRI responder (47.4%) compared with patients without a history of trauma (22.2%) [54]. On the other hand, in this same study, patients with and without a history of trauma did not differ in terms of their response to cognitive behavioral group therapy (60 vs 63% response, respectively).…”

“…Only one study [54] has attempted to assess the impact of traumatic events on the treatment response of OCD patients to serotonin re uptake inhibitors (SRIs) and cognitive behavioral group therapy in a prospective manner. Shavitt et al found that patients who reported a history of trauma were more frequently rated as an SRI responder (47.4%) compared with patients without a history of trauma (22.2%) [54].…”

Towards a post-traumatic subtype of obsessive–compulsive disorder

“…Additionally, the fact that greater rates of aggressive, sexual/religious, and hoarding OC symptoms were found in post-traumatic OCD is also consistent with previous studies linking forbidden thoughts (Fullana et al, 2010), and hoarding behaviors (Cromer et al, 2007a) to traumatic events. Finally, higher scores on obsession, depression and anxiety measures, and greater rates of suicidality, comorbid mood, anxiety, somatoform and impulse control disorders, indicate that post-traumatic OCD may be particularly severe -although the extent to which it is resistant (Gershuny et al, 2008) or more responsive to treatment (Shavitt et al, 2010) is still unclear.…”

“…It remains unclear whether trauma and other life events may worsen (Gershuny, Baer, Jenike, Minichiello, & Wilhelm, 2002;Gershuny et al, 2008) or even improve treatment response for OCD (Bogetto, Venturello, Albert, Maina, & Ravizza, 1999;Lo, 1967;Shavitt et al, 2010), in part due to the methodological inconsistencies, including differences in research designs and the composition of study samples (regular vs. treatment resistant OCD patients). A comprehensive assessment of additional factors such as the severity of stressors, the influence of comorbid diagnoses, as well as past treatment history will be required before the clinical implications of our current findings may be apparent (Fontenelle, Cocchi, Harrison, Miguel, & Torres, 2011).…”

The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD

“…In addition, this study found that individuals with comorbid OCD and PTSD reported higher incidences of lifetime major depressive disorder, dysthymic disorder, panic disorder with agoraphobia, and social anxiety disorder than individuals with OCD and no lifetime PTSD diagnosis. The other known study that compared the clinical characteristics of OCD with and without comorbid PTSD in an outpatient sample also showed significantly higher OCD symptom severity for the comorbid group when severity was measured using the six OCD symptom dimensions as reference points rather than one principal symptom type (Shavitt et al, 2010). Thus, preliminary evidence suggests that individuals with comorbid OCD and PTSD have more severe symptoms of OCD and related psychopathology than those without a lifetime history of PTSD.…”