| Research Abstract |
To investigate the heterogeneity of Obsessive-Compulsive Disorder (OCD), some possible indicators were examined from phenomenological, psychopathological or biological point of view. For instance, OCD subjects with poorer level of insight exhibit more severe psychopathological features such as personality pathology and poorer treatment response compared to those with good or fair insight. In addition, OCD subjects with both washing and checking compulsions were significantly more likely than pure washers or checkers to have poor insight, severe psychopathological features such as perfectionism, and poor responses to both pharmacological and behavioral treatments. These findings support the possibility of that OCD may be heterogeneous, and some distinct subtypes may exist. In addition, the typical treatment strategy for OCD should be modified for each subtype. Indeed, our prospective study revealed that poor level of insight especially that with comorbid cluster A personality disorders
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may be an important indicator of poor treatment outcome.
Taken together, we proposed additional treatment strategies for OCD patients who exhibit poorer responses to the standardized combination treatment of pharmacotherapy such as SSRIs and cognitive behavioral treatment (CBT). As for pharmacotherapy, augmentation of antidepressants especially inhibitors of norepinephrine reuptake appear to be effective for patients with severe depressive status equivalent to a diagnosis of major depression. In addition, augmentation of antipsychotic drugs may also be useful especially for patients with poor insight into their OCD symptoms. As for CBT, the significance of cognitive restructuring should be emphasized especially in patients with persistent belief about the rationality of their OCD symptoms.
Thus there may be subtypes of OCD and the treatment strategies for typical OCD patients should be modified for patients with clinical or psychopathological features indicative of treatment-resistant OCD. Further studies focusing on biological abnormalities such as neuroimaging should be needed to verify the possible subtypes of OCD. Less
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