H.J.G.M. van Megen

Inference-Based Approach versus Cognitive Behavioral Therapy in the Treatment of Obsessive-Compulsive Disorder with Poor Insight: A 24-Session Randomized Controlled Trial

Objective: Obsessive-compulsive disorder (OCD) with poor insight has severe consequences for patients; nonetheless, no randomized controlled trial has ever been performed to evaluate the effectiveness of any treatment specifically for poor-insight OCD. A new psychotherapy for OCD, the inference-based approach (IBA), targets insight in OCD by strengthening normal sensory-driven reality testing. The goal of the present study is to compare the effectiveness of this new treatment to the effectiveness of cognitive behavior therapy (CBT) for patients with OCD with poor insight. Method: A randomized controlled trial was conducted, in which 90 patients with OCD with poor insight received either 24 CBT sessions or 24 IBA sessions. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS). Secondary outcome measures were level of insight, anxiety and depressive symptoms, and quality of life. Mixed-effects models were used to determine the treatment effect. Results: In both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than the patients treated with CBT [estimated marginal mean = -7.77, t(219.45) = -2.4, p = 0.017]. Conclusion: Patients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight.

The relationship between adverse childhood experiences and symptom severity, chronicity, and comorbidity in patients with obsessive-compulsive disorder.

BACKGROUND Studies on the relationship between adverse childhood experiences (ACEs) and obsessive-compulsive disorder (OCD) symptom severity are scarce. Available studies leave a considerable degree of uncertainty. The present study examines the relationship between ACEs and symptom severity, chronicity, and comorbidity in a sample of patients with OCD. METHOD Baseline data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, in which 382 referred patients with DSM-IV-diagnosed OCD participated, were analyzed. ACEs (physical abuse, sexual abuse, witnessing interparental violence, maternal dysfunction, paternal dysfunction, and early separation from a parent) were measured using a structured interview. Data were collected between September 2005 and November 2009. RESULTS None of the ACEs were related to OCD symptom severity or chronicity, nor was there a dose-response relationship between ACEs and OCD severity or chronicity, but results of linear regression analysis revealed that ACEs were related to comorbidity in patients with OCD (P < .001), in particular to comorbid affective disorders (P < .01), substance use disorders (P < .01), and eating disorders (P < .01), but not to comorbid anxiety disorders. CONCLUSIONS Results of the study suggest that unlike in other psychiatric disorders, ACEs play no significant role in symptom severity and chronicity of OCD. This study was the first to reveal evidence for a relationship between ACEs and comorbidity in patients with OCD. Conclusions about trauma-relatedness of OCD based on studies finding higher trauma rates or severity among patients with OCD than among healthy controls, should be critically reconsidered, since presence of comorbidity might account for these differences.

P03-30 Do ADHD and autism symptoms predict specific OC symptom dimensions or OC symptom severity in OCD?

Backgrond Autism spectrum disorder (ASD) symptoms and attention deficit/ hyperactivity disorder (ADHD) symptoms are frequently comorbid with obsessive-compulsive disorder (OCD). However, limited research exists with respect to the relations between these symptoms, and their impact on OC symptom severity. Method 109 outpatients with primary OCD and 87 healthy controls were administered OCD, ADHD, and ASD questionnaires. Univariate analyses, correlations, and stepwise regression analyses were conducted. Results OCD, ADHD, and autism symptoms were highly correlated, with OCD patients showing elevated ADHD as well as autism scores when compared with healthy controls. OCD patients with comorbid ADHD presented with higher autism symptoms and OCD symptoms, yet similar OCD severity scores as OCD without ADHD patients. The attention switching and lack of social skills subscales of the Autism Questionnaire (AQ) were particularly correlated with ADHD and OCD symptoms in the patient group. The AQ subscale attention switching proved to be the most significant predictor of OCD severity and symptoms (with the exception of hoarding). Contrary to expectations, the AQ subscale attention to detail did not predict OCD symptoms, nor did any of the AQ subscale scores predict hoarding symptoms. Conclusions OCD patients present with elevated scores of ADHD and ASD symptoms, and these symptoms (particularly attention switching) are important in predicting OC symptoms and severity. It is suggested that problems in attention may be related to the uncertainty about ones own memory as demonstrated by OCD patients, as well as a common factor underlying comorbid ADHD and ASD symptoms.

Influence of Religion on Obsessive–Compulsive Disorder: Comparisons Between Dutch Nonreligious, Roman Catholic, and Protestant Patients. Psychology of Religion and Spirituality.

Previous studies have suggested that specific features of religion such as religious denomination and level of religiosity might influence the severity of obsessive–compulsive disorder (OCD) and the occurrence of obsessive–compulsive (OC) cognitions, whereas others could not confirm these findings. The purpose of this study was to elucidate the relation between religion, OCD, and the occurrence of OC cognitions in a Dutch sample of OCD patients. Data were drawn from the baseline assessment of the Netherlands Obsessive Compulsive Disorder Association (NOCDA; Schuurmans et al., 2012) study, which is an ongoing, multicenter, 6-year, longitudinal naturalistic cohort study examining the course of OCD. Participants were 377 outpatients, age 18 years and over, with a lifetime diagnosis of OCD. Neither being religious nor religiosity critically influenced the severity of OCD or the occurrence of OC cognitions. Roman Catholic patients scored significantly higher on anxiety and depression than nonreligious patients, and Roman Catholic patients endorsed significantly more OC cognitions than nonreligious and Protestant patients. These ratings of OC cognitions were not mediated by religious denomination or level of religiosity, but by severity of anxiety and depression, as well as age. The relationship between religious denomination, level of religiosity, and clinical aspects of OCD, which have been described before in the literature, may be spurious and mediated by comorbid psychiatric symptoms, such as anxiety and depression.