ABSTRACT
BACKGROUND: Although body dysmorphic disorder (BDD) has many features in common with obsessive-compulsive disorder (OCD) and is frequently comorbid with OCD, few studies have directly compared the 2 disorders. Although BDD and OCD respond to similar medications and cognitive-behavioral therapy (CBT), their response to treatment has never been directly compared. METHOD: We studied 107 consecutive patients with DSM-III-R OCD (N = 96) or BDD (N = 11) treated openly for 6 weeks with intensive CBT, medication, and psychosocial rehabilitation, in a specialized partial hospitalization program for severely ill OCD patients. All patients were assessed, before and after treatment, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). Retrospectively, we compared the clinical characteristics, symptom severity, and response to treatment of BDD patients with those of OCD patients. RESULTS: BDD patients and OCD patients had similar sex ratio, age, treatment duration, prevalence of comorbid major depression, and pretreatment Y-BOCS and GAS scores. BDD patients had significantly higher pretreatment HAM-D and HAM-A scores. The proportions of patients treated with serotonin reuptake inhibitors and antipsychotics did not differ between groups. Both groups improved with treatment, with significant (p < .001) changes in Y-BOCS, HAM-D, HAM-A, and GAS scores. Change in Y-BOCS did not differ between groups, but changes in HAM-D and HAM-A were significantly greater in BDD patients than in OCD patients. CONCLUSION: While BDD may be associated with greater severity of depressive and anxiety symptoms than OCD, this study suggests that BDD may respond to intensive, multimodal treatment.
Subject(s)
Cognitive Behavioral Therapy , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/therapy , Psychotropic Drugs/therapeutic use , Somatoform Disorders/diagnosis , Somatoform Disorders/therapy , Adult , Anxiety Disorders/epidemiology , Anxiety Disorders/therapy , Combined Modality Therapy , Comorbidity , Depressive Disorder/epidemiology , Depressive Disorder/therapy , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Length of Stay , Male , Obsessive-Compulsive Disorder/epidemiology , Patient Education as Topic , Psychiatric Status Rating Scales/statistics & numerical data , Retrospective Studies , Severity of Illness Index , Somatoform Disorders/epidemiology , Treatment OutcomeABSTRACT
Thirty treatment-resistant patients with a primary DSA-IV diagnosis of obsessive-compulsive disorder were assessed at admission to and discharge from a partial hospitalization program to determine whether improvement in symptoms of the disorder was associated with improvements in patients' quality of life. Symptom severity was measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS). Quality of life was measured using Lehman's Quality of Life (QOL) scale, which includes several objective and subjective indexes. YBOCS scores significantly improved with treatment, as did scores on the majority of the QOL subjective indexes and on the objective social, health, and activity indexes. No significant association between changes in YBOCS scores and QOL scores was found.
Subject(s)
Day Care, Medical , Obsessive-Compulsive Disorder/therapy , Outcome Assessment, Health Care , Quality of Life , Adult , Analysis of Variance , Female , Humans , Los Angeles , Male , Middle Aged , Obsessive-Compulsive Disorder/psychology , Statistics, NonparametricABSTRACT
The interaction of imipramine and operant conditioning on weight gain in an anorexia nervosa patient was examined by a single-subject experiment consisting of a baseline and four treatment phases: phase 1--contingency management only; phase 2--contingency management plus imipramine; phase 3--contingency management plus imipramine placebo; phase 4--contingency management only. The results showed that the interaction of drug and behavior therapy had no significant effect on weight gain, but that imipramine may have contributed to a decrease in depression. Observations are made regarding weight changes related to passes and medication refusals.
Subject(s)
Anorexia Nervosa/therapy , Behavior Therapy , Imipramine/therapeutic use , Adult , Anorexia Nervosa/drug therapy , Anorexia Nervosa/psychology , Body Weight/drug effects , Combined Modality Therapy , Conditioning, Operant , Depressive Disorder/psychology , Depressive Disorder/therapy , Double-Blind Method , Female , Hospitalization , Humans , MMPI , PlacebosABSTRACT
Blinking is related to certain cognitive processes. For example, individuals "punctuate" their speech by blinking between phrases and at the end of sentences. Daydreaming is associated with low rates of blinking. Blinking occurs between fixations and may be timed so as not to interfere with significant visual input. Apparently, blinking occurs at transitions between internal events and is inhibited at other times. In the experiment reported here, blinking was measured while the activity of operational memory was manipulated with mental load kept constant. The rate of blinking was significantly reduced when the cognitive operation of internal counting was being performed. It is inferred that the blink rate is low when information in memory is being operated on. To suspend blinking during certain cognitive activities would be adaptive if blinking disrupts them. Since the blackout period of the blink produces a rapid change in visual level, blinking disrupts those cognitive processes utilizing display areas accessible to visual input. Operational memory and the visual imagination may share components with the visual perceptual system. To protect these vulnerable processes from interference, blinking may be inhibited when they are active.
