The Overlap of Obsessive-Compulsive Disorder and Social Phobia and its Treatment

Abstract

Both obsessive-compulsive disorder (OCD) and social phobia are common in community and clinical settings, and it should be expected that a proportion of patients with one of these conditions will also fulfill either current or lifetime criteria for the other condition. However, comorbid social phobia is more common among patients with a primary diagnosis of OCD than is comorbid OCD in patients with a primary diagnosis of social phobia. This article explores the extent of the association of OCD and social phobia in epidemiological studies, and examines the possible role of underlying depression and other disorders in mediating the appearance of the comorbid condition. Although there have been no published randomized controlled trials in patients with this particular pattern of co-morbidity, it seems sensible to adopt pharmacologic and psychologic treatment approaches which have been found efficacious in both OCD and social phobia. Pharmacologic management therefore centers on first-line treatment with a selective serotonin reuptake inhibitor. Psychologic intervention should draw on the range of cognitive and behavioral approaches required for optimal outcomes in OCD and social phobia, as discrete conditions.

Obsessive-compulsive disorder: Insights from animal models

“…Higher rates of unemployment, marital discord and financial instability occur among adult OCD patients (Kim et al, 2012), while children with OCD display impaired abilities for making and keeping friends (Kim et al, 2012; Piacentini et al, 2003). Social phobia and OCD show varying symptom intensity, are characterized by severe occupational infringement, and respond preferentially to SSRI’s (Baldwin et al, 2008; Lochner et al, 2003; Niederauer et al, 2007). Furthermore, comorbid OCD and social impairment demonstrate greater OC symptom severity and treatment resistance (Alarcon et al, 1993; Khanna et al, 1988), while greater OC severity with poor social functioning predict a poor treatment outcome (Stewart et al, 2010).…”

Of mice and marbles: Novel perspectives on burying behavior as a screening test for psychiatric illness

“…The aims of the present study were (1) to investigate whether the compulsive-like expression of motor behavior by high-stereotypical (H) deer mice can be associated with unique MB behavior, relative to nonstereotypical (N) controls; (2) to assess whether deer mice habituate to burying behavior; and (3) to determine whether such behavior is attenuated by chronic (four-week), high-dose (50 mg/kg/day) oral escitalopram (Baldwin, Brandish, & Meron, 2008).…”

Obsessive-Compulsive Disorders or Not: Differential Diagnosis of Repetitive Behaviors Among Individuals with Intellectual and Developmental Disorders

“…This data also reveals that the risk for ASD drops off rapidly when investigators focused on more distant relatives. These findings also suggest an answer to the clinical observation that many patients with treatment resistant OCD (Jacobs et al, 2009), and OC Personality Disorder (Baldwin et al, 2008) may in fact present with undiagnosed ASD. A downside to this argument is that when OCD and ASD co-occur, it is the ASD that exerts the more profound effects on both treatment response and clinical outcome.…”

“…In addition, among nonhuman primates defeat contributes to submissive postures and increased grooming dominant members of the group. These behaviours also have analogues in social anxiety disorder and OCD (Feinstein et al, 2007;Baldwin et al, 2008). For example, cleaning/grooming may have its origins in conflicts over social dominance that predate our modern pre-occupation with germs.…”

“…Children with ASD on the other hand, may have limited interest in play or social fantasy and prefer instead to line up toys or "play" alone. In a similar vein children who are genetically at risk for OCD are already expressing worries and rituals of at risk children differ from those of "normal children" (Black et al 2008;Baldwin et al 2008). For vulnerable children, magical beliefs, superstitions and rituals do not resolve but morph into patterns that are consistent with sub-clinical or full syndrome OCD.…”