Elsevier

Behavior Therapy

Volume 36, Issue 4, Autumn 2005, Pages 393-400
Behavior Therapy

Original research
Subtypes of obsessive-compulsive disorder: Implications for specialized cognitive behavior therapy

https://doi.org/10.1016/S0005-7894(05)80121-2Get rights and content

Abstract

Although obsessive-compulsive disorder (OCD) is a heterogeneous condition, OCD subtypes have received limited attention in trials of cognitive behavior therapy (CBT). Because many patients with OCD do not respond optimally to CBT, it is important for clinicians to consider whether variability in treatment response is related to symptom presentation. Treatment modifications for patients without overt compulsions or with hoarding symptoms show promise. In this article we discuss the available research addressing the treatment of OCD subtypes, review the clinical characteristics and treatment recommendations for prominent OCD subtypes, raise the prospect of using dysfunctional beliefs as a potentially helpful conceptual approach to subtyping OCD and matching treatment to subtypes, and consider future directions in the treatment of OCD subtypes.

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      As OCD symptoms are heterogeneous, many studies have tried to differentiate between various symptom dimensions using a taxonomy approach. Studies using this approach have found approximately 3–5 dimensions (e.g.; Bloch, Landeros-Weisenberger, Rosario, Pittenger, & Leckman, 2008; Mataix-Cols, Rosario-Campos, & Leckman, 2005), including 1) contamination/washing, characterized by fears of getting contaminated or contaminating others and washing rituals to prevent this assumed danger (Sookman, Abramowitz, Calamari, Wilhelm, & McKay, 2005); 2) harming/checking, which comprises fears of endangering oneself or others and checking rituals to prevent harm (Sookman et al., 2005); 3) hoarding, which refers to a pathological degree of collecting things (Samuels et al., 2007); 4) symmetry/ordering which is characterized by compulsions to ensure that objects in the environment are in a “correct” order (Radomsky & Rachman, 2004); 5) and obsessions, in which one harbors certain obsessions but does not show overt compulsive behaviors (Sookman et al., 2005). As Leckman et al. (2010) pointed out, it is useful to consider symptom dimensions when making treatment choices, since they appear to have an impact on treatment outcome.

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