and Response Prevention
Rachel A. Davis, MD
Emily Hemendinger, LCSW, MPH
Stephanie Lehto, PsyD
INTRODUCTION TO OCD /
"OCD has a lifetime prevalence of 2.3%[i] and has a bimodal age of onset with early onset in childhood to adolescence and later onset in the mid-twenties[ii]. OCD has a strong genetic basis with monozygotic concordance of 68%[iii]. People with OCD experience intrusive, ego-dystonic thoughts, often the most violent, vulgar, or embarassing things they can imagine. They attempt to counter, undo, or prevent these thoughts with mental and/or physical rituals that are excessive or unrealistic. It takes sufferers an average of eleven years from the time they meet diagnostic criteria for OCD to receive an accurate diagnosis[ii]. This is, in part, because most sufferers have good insight[ii] into the reality that their thoughts and behaviors are bizarre, horrendous, and excessive[ii] – and they are not likely to volunteer these thoughts and behaviors. In OCD, comorbidity is the norm rather than the exception, with individuals often having other disorders such as mood disorders, Tourette Syndrome, ADHD, eating disorders, or substance use disorders[ii]. These disorders are often recognized before OCD is diagnosed. OCD sufferers experience reduced quality of life, with impairment in multiple domains. In particular, social relationships tend to be more affected in OCD sufferers than in other mental or physical illnesses[iv]. People with OCD who are not taking medication are four times more likely than the general population to be unemployed[v]. The most effective treatment for OCD is a combination of serotonergic medications and exposure and response prevention (EX/RP) therapy. OCD is a chronic condition for most individuals[ii]. Even with optimal treatment (clomipramine plus EX/RP), only 65% of patients respond* to treatment, and only 35% obtain remission**[vi]. About 10% of people with OCD remain severely impaired despite adequate, standard of care treatment[vii]."
* Response is defined as 35% or greater reduction in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)[viii] score.
**Remission is defined as scoring in the subclinical range (less than or equal to 7) on the Y-BOCS.
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[ii] Pinto A, Mancebo MC, Eisen JL, et al. The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. J Clin Psychiatry 2006; 67(5): 703-711.
[iii] Nestadt G, Grados M, Samuels JF. Genetics of OCD. Psychiatr Clin North Am 2010; 33(1): 141-158.
[iv] Subramaniam M, Soh P, Vaingankar JA, Picco L, Chong SA. Quality of life in obsessive-compulsive disorder: impact of the disorder and treatment. CNS Drugs 2013; 27: 367-383.
[v] Koran LM, Thienemann ML, Davenport R. Quality of life for patients with obsessive-compulsive disorder. American Journal of Psychiatry 1996; 153: 783-788.
[vi] Simpson HB, Huppert JD, Petkova E, Foa EB, Liebowitz MR. Response versus remission in obsessive-compulsive disorder. J Clin Psychiatry 2006; 67(2): 269-276.
[vii] Kohl S, Schonherr DM, Luigjes J, Denys D, Mueller UJ, Lenartz D, Visser-Vandewalle V, Kuhn J. Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review. BMC Psychiatry 2014; 14: 214.
[viii] Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale, I: development, use, and reliability. Arch Gen Psychiatry 1989; 46:1006-1011.