Standard criteria for relapse are needed in obsessive-compulsive disorder
Open accessAbstract
To assess how different criteria for relapse affect inferences about relapse in obsessive-compulsive disorder (OCD), a post hoc analysis of relapse was conducted using data from a multisite randomized controlled trial comparing clomipramine (CMI), exposure and ritual prevention (EX/RP), and its combination (EX/RP+CMI) in adults with OCD. Different relapse definitions were constructed based on criteria used in prior studies. For each definition, the number of relapsers was computed, and the proportion of relapsers and time to relapse were compared. When applied to this data set, relapse criteria used in prior OCD studies yielded different observed relapse rates (range: 27-63% for CMI; 0-50% for EX/RP; and 7-67% for EX/RP+CMI). Most criteria found that EX/RP responders (with or without CMI) had a significantly lower relapse rate and longer time to relapse after treatment discontinuation than did responders to CMI alone. However, some relapse criteria (e.g., those requiring minimal worsening) found no significant treatment differences in relapse rates or time to relapse, and some generated biases against one treatment or another. Most definitions concurred: in adults with primary OCD, EX/RP treatment (with or without CMI) can produce more durable short-term gains after treatment discontinuation than CMI alone. However, different relapse criteria can lead to very different observed relapse rates and even contradictory inferences about relapse. Standard criteria for relapse are needed in OCD to facilitate comparisons between studies (enabling better treatment guidelines) and to advance research on mechanisms of relapse and relapse prevention.
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The combined criteria account for the possibility that participants with lower baseline scores might more easily worsen when only a percentage definition is used.
“This combined criteria also accounts for the fact that participants with lower scores at randomization might more easily worsen when solely using a percentage definition [44].”
From Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods (2018) · cites this paper as [44]
In “Impact of Different Relapse Criteria on Outcome” (page unavailable), the paper says responders with the lowest posttreatment Week 12 scores could meet a percentage-only relapse threshold after trivial increases. The claim instead specifies scores at randomization, and the paper does not establish that the combined criteria account for this problem. The Discussion (page unavailable) also says it is unclear whether combining severity criteria produces more valid definitions. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSome individuals experience a return of fear following exposure therapy.
“some experience return of fear”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Simpson, Franklin, Cheng, Foa, & Liebowitz, 2005
The Description of the Sample reports that some patients relapsed after exposure and ritual prevention, with relapse defined as a return to pretreatment OCD severity. The paper does not establish that fear specifically returned; it measures OCD symptoms and clinical severity. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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- Authors
- Simpson, H. B., Franklin, M. E., Cheng, J., Foa, E. B., & Liebowitz, M. R.
- Affiliations
- New York State Psychiatric Institute (US)
- University of Pennsylvania (US)
- Corresponding author
- Simpson, Helen Blair
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2005
- Volume
- 21
- Issue
- 1
- Pages
- 1-8
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2160324498
- Cited by
- 50
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 6 · 2017: 1 · 2016: 4 · 2015: 4 · 2014: 3 · 2013: 4
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH045436)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, relapse definition, clomipramine, exposure and response prevention, treatment discontinuation, relapse rate, time to relapse, relapse prevention, treatment durability
- MeSH terms
- Antidepressive Agents, Tricyclic, Clomipramine, Combined Modality Therapy, Humans, Obsessive-Compulsive Disorder, Cognitive Behavioral Therapy, Stereotypic Movement Disorder, Secondary Prevention
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