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Treatment of Common Co-morbid Disorders

Co-morbidities are the norm rather than the exception in people with OCD. Table 3.3 lists treatment guidance for the most common of these.

Clinical Pearls for Obsessive Compulsive Disorder

  • • SRI therapy is the first-line pharmacotherapy treatment for children and adults with OCD. In many cases it will be necessary to titrate to doses higher than used in the treatment of depression, in order to achieve clinical response.
  • • Cognitive behavioral therapy, especially exposure and response prevention (ERP) is the first-line psychotherapy intervention for OCD.
  • • Since treatment response is often only partial, attending to quality of life and long-term functioning is critical.

TABLE 3.3 How to Treat Common Co-morbid Disorders

Co-morbid Disorder

Treatment Challenge

Major Depressive Disorder

Responds to some antidepressants which have no proven efficacy in OCD; CBT skills have demonstrated efficacy for depression

Bipolar Disorder

Treatment of OCD with high dose SRIs may precipitate manic episodes; may need mood stabilizer in place before starting SRI

Obsessive Compulsive Personality Disorder

No proven response of OCPD symptoms to SRIs and therefore may confuse understanding of treatment response. ERP focusing on perfectionism, for example, may be beneficial

Body Dysmorphic Disorder

Less robust response to SRIs and higher rates of suicide attempts. CBT/ERP helpful for Body Dysmorphic Disorder

Substance Use Disorders

Certain drugs of abuse may alleviate OCD symptoms; limited benefit from SRIs for Substance Use Disorders. Exposure therapies have questionable efficacy for Substance Use Disorders

  • • Misdiagnosis is common. OCD is highly co-morbid with major depression, other anxiety disorders, Tic Disorders, hoarding, and Obsessive Compulsive Personality Disorder (OCPD).
  • • More than one obsession or compulsion is common. Use materials like the Y-BOCS symptom checklist and scoring sheet to help in determining the nature and extent of obsessions and compulsions present.

Key References

  • • Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials. Int J Neuropsychopharmacol. 2013 Apr;16(3):557-74.
  • • Fineberg NA, Gale TM. Evidence-based pharmacotherapy of obsessive compulsive disorder. Int J Neuropsychopharmacol. 2005 Mar;8(1):107-29.
  • • World Health Organization. bod_obsessivecompulsive.pdf
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