Symptom Dimensions in Obsessive-Compulsive Disorder: Phenomenology and Treatment Outcomes with Exposure and Ritual PreventionWilliams M.T.a · Mugno B.b · Franklin M.c · Faber S.d
aCenter for Mental Health Disparities, Department of Psychological and Brain Sciences, University of Louisville, Louisville, Ky., bDepartment of Psychology, Bryn Mawr College, and cDepartment of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pa., USA; dBioville GmbH, Leipzig, Germany Psychopathology 2013;46:365-376 (DOI:10.1159/000348582)
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.
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