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5 - Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  10 January 2025

Stephen Hupp
Affiliation:
Southern Illinois University, Edwardsville
David F. Tolin
Affiliation:
Institute of Living
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Summary

Based on a review using the new criteria for empirically supported treatments, this chapter emphasizes exposure with response prevention for obsessive-compulsive disorder, a treatment that has strong research support. Cognitive therapy is also discussed. Credible components of treatment include exposure, behavioral experiments, and cognitive reappraisal. A sidebar also reviews treatments for body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation.

Type
Chapter
Information
Science-Based Therapy
Raising the Bar for Empirically Supported Treatments
, pp. 64 - 80
Publisher: Cambridge University Press
Print publication year: 2025

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References

Useful Resources

Anxiety & Depression Association of America Clinical Practice Guidelines: https://adaa.org/resources-professionals/practice-guidelines-ocd

International Obsessive-Compulsive Disorder Foundation: www.iocdf.org

Mental Health America: www.mentalhealthamerica.net/conditions/ocd

National Institute of Mental Health Fact Sheets: www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

Springer, K. S., & Tolin, D. F. (2020). The big book of exposures: Innovative, creative, and effective CBT-based exposures for treating anxiety-related disorders. New Harbinger.

References

Abramovitch, A., Abramowitz, J. S., & McKay, D. (2021). The OCI-12: A syndromally valid modification of the obsessive-compulsive inventory-revised. Psychiatry Research, 298, 113808.CrossRefGoogle ScholarPubMed
Abramovitch, A., Abramowitz, J. S., Riemann, B.C., & McKay, D. (2020). Severity benchmarks and contemporary clinical norms for the Obsessive-Compulsive Inventory-Revised (OCI-R). Journal of Obsessive-Compulsive and Related Disorders, 27, 100557.CrossRefGoogle Scholar
Abramowitz, J. S. (2018). Presidential address: Are the obsessive-compulsive related disorders related to obsessive compulsive disorder? A critical look at DSM-5’s new category. Behavior Therapy, 49, 111.CrossRefGoogle Scholar
Abramowitz, J. S., Storch, E. A., McKay, D., Taylor, S., & Asmundson, G. J. G. (2009). The obsessive-compulsive spectrum: A critical review. In McKay, D., Abramowitz, J. S., Taylor, S., & Asmundson, G. J. G. (Eds.), Current perspectives on anxiety disorders: Implications for DSM-V and beyond (pp. 329352). Springer.Google Scholar
Abramowitz, J. S., Taylor, S., & McKay, D. (2005). Potentials and limitations of cognitive treatments for obsessive-compulsive disorder. Cognitive Behaviour Therapy, 34, 140147.CrossRefGoogle ScholarPubMed
Abramowitz, J., McKay, D., & Taylor, S. (2005). Special series: Subtypes of obsessive-compulsive disorder. Behavior Therapy, 36, 367369.CrossRefGoogle Scholar
Adam, Y., Meinlschmidt, G., Gloster, A. T., & Lieb, R. (2012). Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Social Psychiatry and Psychiatric Epidemiology, 47, 339349.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.Google Scholar
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). American Psychiatric Association.Google Scholar
Anxiety and Depression Association of America (2015). OCD Clinical Practice Task Force – Clinical practice review for OCD. Anxiety and Depression Association of America. https://adaa.org/resources-professionals/practice-guidelines-ocd.Google Scholar
Bennett-Levy, J., Butler, G., Fennell, M., et al. (Eds.) (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.CrossRefGoogle Scholar
Bronfeld, M., & Bar-Gad, I. (2013). Tic disorders: What happens in the basal ganglia? The Neuroscientist, 19, 101108.CrossRefGoogle ScholarPubMed
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 718. https://doi.org/10.1037/0022-006X.66.1.7.CrossRefGoogle ScholarPubMed
Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. Guilford.Google Scholar
Corr, P. J., & Perkins, A. M. (2006). The role of theory in the psychophysiology of personality: From Ivan Pavlov to Jeffrey Gray. International Journal of Psychophysiology, 62, 367376.CrossRefGoogle Scholar
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 1023.CrossRefGoogle ScholarPubMed
Craske, M. G., Treanor, M., Zbozinek, T. D., & Vervliet, B. (2022). Optimizing exposure therapy and inhibitory retrieval approach and the OptEx Nexus. Behaviour Research and Therapy, 152, 104069.CrossRefGoogle ScholarPubMed
da Silva, R.M.F., Batistuzzo, M.C., Shavitt, R.G., et al. (2019). Transcranial direct current stimulation in obsessive-compulsive disorder: An update in electric field modeling investigations for optimal electrode montage. Expert Review in Neurotherapeutics, 19, 10251035.CrossRefGoogle ScholarPubMed
Deacon, B. J., Farrell, N. R., Kemp, J. J., et al. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27, 772780.CrossRefGoogle ScholarPubMed
Diefenbach, G.J., Tolin, D.F., Meunier, S., & Worhunsky, P. (2008). Emotion regulation and trichotillomania: A comparison of clinical and nonclinical hair pulling. Journal of Behavior Therapy and Experimental Psychiatry, 39, 3241.CrossRefGoogle ScholarPubMed
Elsner, B., Jacobi, T., Kischkel, E., Schulze, D., & Reuter, B. (2022). Mechanisms of exposure and response prevention in obsessive-compulsive disorder: Effects of habituation and expectancy violation on short-term outcome in cognitive-behavioral therapy. BMC Psychiatry, 22, 66.CrossRefGoogle ScholarPubMed
Farhat, L.C., Olfson, E., Nasir, M., et al. (2020). Pharmacological and behavioral treatment of trichotillomania: An updated systematic review and meta-analysis. Depression & Anxiety, 37, 715727.CrossRefGoogle Scholar
Ferrando, C., & Selai, C. (2021). A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 31, 100684.CrossRefGoogle Scholar
Fineberg, N. A., Apergis-Schoute, A. M., Vaghi, M. M., et al. (2021). Mapping compulsivity in the DSM-5 obsessive compulsive related disorders: Cognitive domains, neural circuitry, and treatment. International Journal of Neuropsychopharmacology, 21, 4258.CrossRefGoogle Scholar
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 2025.CrossRefGoogle ScholarPubMed
Foa, E. B., Huppert, J. D., Leiberg, S., et al. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485496.CrossRefGoogle ScholarPubMed
Frank, B., & McKay, D. (2019). Introduction to the special series: Clinical applications of the inhibitory learning model. Cognitive & Behavioral Practice, 26, 127129.CrossRefGoogle Scholar
Franklin, M. A., Sapyta, J., Freeman, J.B., et al. (2011). Cognitive behavior therapy augmentataion of pharmacotherapy in pediatric obsessive-compulsive disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized Controlled trial. JAMA, 306, 12241232.CrossRefGoogle ScholarPubMed
Freeman, J., Sapyta, J., Garcia, A., et al. (2014). Family-based treatment of early childhood obsessive-compulsive disorder: The Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr) – A randomized clinical trial. JAMA Psychiatry, 71, 689698.CrossRefGoogle ScholarPubMed
Freeston, M. H., Ladouceur, R., Thibodeau, N., & Gagnon, F. (1991). Cognitive intrusions in a nonclinical population: I. Response style, subjective experience, and appraisal. Behaviour Research and Therapy, 29, 585597CrossRefGoogle Scholar
Freud, S. (1909). A case of obsessional neurosis. Standard edn, 10.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al. (1989). The Yale–Brown obsessive compulsive scale. II. Validity. Archives of General Psychiatry, 46, 10121016.CrossRefGoogle ScholarPubMed
Grabill, K., Merlo, L., Duke, D., et al. (2008). Assessment of obsessive-compulsive disorder: A review. Journal of Anxiety Disorders, 22, 117.CrossRefGoogle ScholarPubMed
Gratz, K. L., Weiss, N. H., & Tull, M. T. (2015). Examining emotion regulation as an outcome, mechanism, and target of psychological treatments. Current Opinion in Psychology, 3, 8590.CrossRefGoogle Scholar
Gruner, P., & Pittenger, C. (2017). Cognitive inflexibility in obsessive-compulsive disorder. Neuroscience, 345, 243255.CrossRefGoogle ScholarPubMed
Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 2840.CrossRefGoogle ScholarPubMed
Janet, P. (1908). Les obsessions et la psychasthénie. (2nd ed., Adamowicz, M. W., trans.). Alcan.Google Scholar
Julien, D., O’Connor, K., & Aardema, F. (2016). The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. Journal of Affective Disorders, 202, 187196.CrossRefGoogle ScholarPubMed
Keuthen, N. J., Rothbaum, B. O., Falkenstein, M. J., et al. (2011). DBT-enhance habit reversal treatment for trichotillomania: 3- and 6-month follow-up results. Depression & Anxiety, 28, 310313.CrossRefGoogle ScholarPubMed
Kim, S.-K., McKay, D., Taylor, S., et al. (2016). The structure of obsessive-compulsive symptoms and beliefs: A correspondence and biplot analysis. Journal of Anxiety Disorders, 38, 7987.CrossRefGoogle ScholarPubMed
Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Psychiatric Association. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf.Google ScholarPubMed
Kozak, M. J., & Foa, E. B. (1994). Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder. Behaviour Research and Therapy, 32, 343353.CrossRefGoogle ScholarPubMed
Kringlen, E. (1965). Obsessional neurotics: Long-term outcome. British Journal of Psychiatry, 111, 709722.CrossRefGoogle Scholar
Lochner, C., Roos, A., & Stein, D. J. (2017). Excoriation (skin-picking) disorder: A systematic review of treatment options. Neuropsychiatric Disease and Treatment, 13, 18671872.CrossRefGoogle ScholarPubMed
Mahjani, B., Bey, K., Boberg, J., & Burton, C. (2021). Genetics of obsessive-compulsive disorder. Psychological Medicine, 51, 22472259.CrossRefGoogle ScholarPubMed
Mancusi, L., & McKay, D. (2021). Behavioral avoidance tasks for eliciting disgust and anxiety in contamination fear: An examination of a test for a combined disgust and fear reaction. Journal of Anxiety Disorders, 78, 102366.CrossRefGoogle ScholarPubMed
Mansueto, C. S., & Keuler, D. J. (2005). Tic or compulsion? It’s Tourettic OCD. Behavior Modification. 29, 784799.CrossRefGoogle ScholarPubMed
Mason, E. C., & Richardson, R. (2012). Treating disgust in anxiety disorders. Clinical Psychology: Science & Practice, 19, 180194.Google Scholar
Mathes, B. M., Morabito, D. M., & Schmidt, N.B. (2019). Epidemiology and clinical gender differences in OCD. Current Psychiatry Reports, 21, 36.CrossRefGoogle ScholarPubMed
McKay, D. (2017). Presidential address: Embracing the repulsive: The case for disgust as a functionally central emotional state in the theory, practice, and dissemination of cognitive-behavior therapy. Behavior Therapy, 48, 731738.CrossRefGoogle Scholar
McKay, D. (2019). Pharmacological treatment of obsessive-compulsive disorder and related disorders. In Evans, S. & Carpenter, K. (Eds.), APA handbook of psychopharmacology for psychologists (pp. 245–265). Washington, DC: American Psychological Association.Google Scholar
McKay, D., Abramowitz, J., Calamari, J., et al. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24, 283313.CrossRefGoogle ScholarPubMed
McKay, D., Abramowitz, J.S., & Storch, E.A. (2021). Mechanisms of harmful treatments for obsessive-compulsive disorders. Clinical Psychology: Science & Practice, 28, 5259.Google Scholar
McKay, D., Kim, S.-K., Taylor, S., et al. (2014). An examination of obsessive-compulsive symptoms and dimensions using profile analysis via multidimensional scaling (PAMS). Journal of Anxiety Disorders, 28, 352357.CrossRefGoogle ScholarPubMed
McKay, D., Sookman, D., Neziroglu, F., et al. (2015). Efficacy of cognitive-behavior therapy for obsessive-compulsive disorder. Psychiatry Research, 227, 104113.CrossRefGoogle ScholarPubMed
McKay, D., Taylor, S., & Abramowitz, J.S. (2010). Obsessive-compulsive disorder. In McKay, D., Abramowitz, J. S., & Taylor, S. (Eds.), Cognitive-behavioral therapy for refractory cases: Turning failure into success (pp. 89109). Washington, DC: American Psychological Association Press.CrossRefGoogle Scholar
Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4, 273280.CrossRefGoogle ScholarPubMed
O’Connor, K. P., & Robillard, S. (1995). Inference processes in obsessive-compulsive disorder: Some clinical observations. Behaviour Research and Therapy, 33, 887896.CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behaviour Research and Therapy, 39, 9871005.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory – Part 2: Factor analysis and testing of a brief version. Behaviour Research and Therapy, 43, 15271542.CrossRefGoogle Scholar
Ong, C. W., Clyde, J. W., Bluett, E. J., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 817.CrossRefGoogle ScholarPubMed
Pearlman, D. M., Vora, H. S., Marquis, B. G., Najjar, S., & Dudley, L. A. (2015). Anti-basal ganglia antibodies in primary obsessive-compulsive disorder: Systematic review and meta-analysis. British Journal of Psychiatry, 205, 816.CrossRefGoogle Scholar
Pediatric OCD Treatment Study (POTS) Team (2004). Cognitive-behavior therapy, sertraline, and the combination for children and adolescents with obsessive-compulsive disorder: The Pediatric Obsessive Compulsive Treatment Study (POTS) randomized controlled trial. JAMA, 292, 19691976.CrossRefGoogle Scholar
Pertusa, A., Frost, R. O., Fullana, M. A., et al. (2010). Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clinical Psychology Review, 30, 371386.CrossRefGoogle ScholarPubMed
Pittenger, C. (2017). Obsessive-compulsive disorder: Phenomenology, pathophysiology, and treatment. Oxford University Press.CrossRefGoogle Scholar
Rachman, S., & Hodgson, R. J. (1980). Obsessions and compulsions. Prentice-Hall.Google Scholar
Rapp, A. M., Bergman, R. L., Piacentini, J., & McGuire, J. F. (2016). Evidence-based assessment of obsessive-compulsive disorder. Journal of Central Nervous System Disease, 8, 1329CrossRefGoogle ScholarPubMed
Rector, N. A., Richter, M. A., Katz, D., & Leybman, M. (2019). Does the addition of cognitive therapy to exposure and response preventions for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting. British Journal of Clinical Psychology, 58, 118.CrossRefGoogle Scholar
Richard, D. C. S., & Gloster, A. T. (2006). Exposure therapy has a public relations problem: A dearth of litigation amid a wealth of concern. In Richard, D. C. S. & Lauterbach, D. L. (Eds.), Handbook of exposure therapies (pp. 409–425). Academic Press.Google Scholar
Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez., F. (2008). Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clinical Psychology Review, 28, 13101325CrossRefGoogle ScholarPubMed
Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 5363.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 25, 571583.CrossRefGoogle Scholar
Salkovskis, P. M. (2007). Psychological treatment of obsessive-compulsive disorder. Psychiatry, 6, 229233.CrossRefGoogle Scholar
Skapinakis, P., Caldwell, D. M., Hollingworth, W., et al. (2016). Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 3, 730739.CrossRefGoogle ScholarPubMed
Society of Clinical Psychology (n.d.) Obsessive-compulsive disorder. https://div12.org/diagnosis/obsessive-compulsive-disorder/.Google Scholar
Spencer, S. D., Stiede, J. T., Wiese, A. D., et al. (2023). Cognitive-behavioral therapy for obsessive-compulsive disorders. Psychiatric Clinics of North America, 46, 167180.CrossRefGoogle Scholar
Stahnke, B. (2021). A systematic review of misdiagnosis in those with obsessive-compulsive disorder. Journal of Affective Disorders Reports, 6, 100231.CrossRefGoogle Scholar
Stein, D. J., Costa, D. L. C., Lochner, C., et al. (2019). Obsessive-compulsive disorder. Nature Reviews: Disease Primers, 5, 52.Google ScholarPubMed
Storch, E. A., McGuire, J. F., & McKay, D. (2018). The clinician’s guide to cognitive-behavioral therapy for children with obsessive-compulsive disorder. Academic Press.Google Scholar
Tao, Y., Li, H., Li, L., et al. (2022). Comparing the efficacy of pharmacological treatment, alone and in combination, in children and adolescents with obsessive-compulsive disorder: A network meta-analysis. Journal of Psychiatric Research, 148, 95102.CrossRefGoogle ScholarPubMed
Taylor, S., Abramowitz, J. S., & McKay, D. (2007). Cognitive-behavioral models of obsessive-compulsive disorder. In Antony, M. M., Purdon, C., & Summerfeldt, L. J. (Eds.), Psychological theories of obsessive-compulsive disorder: Fundamentals and beyond (pp. 929). American Psychological Association.CrossRefGoogle Scholar
Taylor, S., Abramowitz, J. S., McKay, D., & Garner, L. (2020). Obsessive compulsive and related disorders. In Antony, M. M. & Barlow, D. H. (Eds.), Handbook of assessment and treatment planning for psychological disorders (3rd ed.) (pp. 253294). Guilford.Google Scholar
Taylor, S., McKay, D., Crowe, K. B., et al. (2014). The sense of incompleteness as a motivator of obsessive-compulsive symptoms: An empirical analysis of concepts and correlates. Behavior Therapy, 45, 254262.CrossRefGoogle ScholarPubMed
Tolin, D. F., Frost, R. O., & Steketee, G. (2013). Buried in treasures: Help for compulsive acquisition and hoarding (2nd ed.). Oxford University Press.CrossRefGoogle Scholar
Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22(4), 317338. https://doi.org/10.1111/cpsp.12122.Google Scholar
Tolin, D. F., Melnyk, T., & Marx, B. (2015). Exposure and response prevention for obsessive-compulsive disorder. www.div12.org/wp-content/uploads/2019/10/Treatment-Review-ERP-for-OCD.pdf.Google Scholar
Tolin, D.F., Worhunsky, P., & Maltby, N. (2004). Sympathetic magic in contamination-related OCD. Journal of Behavior Therapy and Experimental Psychiatry, 35, 193205.CrossRefGoogle ScholarPubMed
Wheaton, M. G., & Gallina, E. R. (2019). Using cognitive-behavioral therapy to treat obsessive-compulsive disorder with co-occurring depression. Journal of Cognitive Psychotherapy, 33, 228241.CrossRefGoogle ScholarPubMed
Wilhelm, S., & Steketee, G. (2006). Cognitive therapy for obsessive-compulsive disorder: A guide for professionals. New Harbinger.Google Scholar
Wilhelm, S., Phillips, K., & Steketee, G. (2012). Cognitive-behavioral therapy for body dysmorphic disorder: A treatment manual. Guilford Press.Google Scholar
Williams, M., Domanico, J., Marques, L., Leblanc, N. J., & Turkheimer, E. (2012). Barriers to treatment among African Americans with obsessive-compulsive disorder. Journal of Anxiety Disorders, 26, 555563.CrossRefGoogle ScholarPubMed
Williams, M., Powers, M., Yun, Y. G., & Foa, E. (2010). Minority participation in randomized controlled trials for obsessive-compulsive disorder. Journal of Anxiety Disorders, 24, 171177.Google ScholarPubMed
Woody, S. R., Whittal, M. L., & McLean, P. D. (2011). Mechanisms of symptom reduction in treatment for obsessions. Journal of Consulting and Clinical Psychology, 79, 653664.CrossRefGoogle ScholarPubMed

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