Five-Year Course of Obsessive-Compulsive Disorder: Predictors of Remission and Relapse [CME]
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Article Abstract Background: Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD. Method: A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as part of the Brown Longitudinal Obsessive Compulsive Study, a prospective, naturalistic study of treatment-seeking adults with primary OCD. OCD symptoms were assessed annually over the 5-year follow-up period using the Longitudinal Interval Follow-Up Evaluation. Results: Thirty-nine percent of participants experienced either a partial (22.1%) or a full (16.9%) remission. Two OCD symptom dimensions impacted remission. Participants with primary obsessions regarding overresponsibility for harm were nearly twice as likely to experience a remission (P < .05), whereas only 2 of 21 participants (9.5%) with primary hoarding achieved remission. Other predictors of increased remission were lower OCD severity (P < .0001) and shorter duration of illness (P < .0001). Fifty-nine percent of participants who remitted subsequently relapsed. Participants with obsessive-compulsive personality disorder were more than twice as likely to relapse (P < .005). Participants were also particularly vulnerable to relapse if they experienced partial remission versus full remission (70% vs 45%; P < .05). Conclusions: The contributions of OCD symptom categories and comorbid obsessive-compulsive personality disorder are critically important to advancing our understanding of the prognosis and ultimately the successful treatment of OCD. Longer duration of illness was also found to be a significant predictor of course, highlighting the critical importance of early detection and treatment of OCD. Furthermore, having full remission as a treatment target is an important consideration for the prevention of relapse in this disorder. J Clin Psychiatry 2013;74(3):233-239 © Copyright 2013 Physicians Postgraduate Press, Inc. Submitted: January 17, 2012; accepted October 4, 2012 (doi:10.4088/JCP.12m07657). Corresponding author: Jane L. Eisen, MD, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906 (jane_eisen@brown.edu).
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Some 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 Eisen et al., 2013
The Results section (page unavailable) reports that 49 of 83 participants with OCD who achieved remission subsequently relapsed, supporting the general idea that symptoms can return. It does not identify the returning symptoms as fear or establish that relapse followed exposure therapy; the Methods section says treatment effects were not comprehensively analyzed. (LLM, conf=0.83)
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Obsessive–compulsive and related disorders
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- Authors
- Eisen, J. L., Sibrava, N. J., Boisseau, C. L., Mancebo, M. C., Stout, R. L., Pinto, A., & Rasmussen, S. A.
- Affiliations
- Brown University (US)
- Corresponding author
- Eisen, Jane L.
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2013-03-15
- Volume
- 74
- Issue
- 03
- Pages
- 233-239
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC3899346
- OpenAlex
- W2157527535
- Cited by
- 248
- References
- 52
- Citations by year
- 2026: 27 · 2025: 25 · 2024: 17 · 2023: 14 · 2022: 21 · 2021: 24 · 2020: 21 · 2019: 23 · 2018: 21 · 2017: 11 · 2016: 15 · 2015: 14 · 2014: 9 · 2013: 6
- FWCI
- 16.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH060218, K23MH080221, K23MH091032)
- 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, long-term clinical course, remission, relapse, obsessive-compulsive personality disorder, hoarding, symptom subtypes, disease duration, disease severity, prognosis, treatment-seeking patients, early detection and treatment, relapse prevention, DSM-IV
- MeSH terms
- Adult, Behavioral Symptoms, Compulsive Behavior, Compulsive Personality Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obsessive-Compulsive Disorder, Prognosis, Psychiatric Status Rating Scales, Remission Induction, Risk Factors, Time Factors, Comorbidity, Outcome Assessment, Health Care, Diagnostic and Statistical Manual of Mental Disorders, Secondary Prevention
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