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Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

Pinto, Anthony ; Liebowitz, Michael R. ; Foa, Edna B. ; Simpson, H. Blair

Behaviour Research and Therapy, August 2011, Vol.49(8), pp.453-458 [Peer Reviewed Journal]

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  • Title:
    Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder
  • Author/Creator: Pinto, Anthony ; Liebowitz, Michael R. ; Foa, Edna B. ; Simpson, H. Blair
  • Language: English
  • Subjects: Obsessive Compulsive Disorder ; Obsessive Compulsive Personality Disorder ; Perfectionism ; Exposure and Ritual Prevention ; Exposure and Response Prevention ; Treatment Outcome
  • Is Part Of: Behaviour Research and Therapy, August 2011, Vol.49(8), pp.453-458
  • Description: Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome. Highlights► This is the first study to test OCPD as a predictor of EX/RP outcome for OCD. ► Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome. ► Perfectionism is the OCPD criterion most strongly associated with poor EX/RP outcome. ► Incorporating treatments that target OCPD traits into EX/RP may improve OCD outcome.
  • Identifier: ISSN: 0005-7967 ; DOI: 10.1016/j.brat.2011.04.004