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The Overlap of Obsessive-Compulsive Disorder and Social Phobia and its Treatment

Published online by Cambridge University Press:  07 November 2014

David S. Baldwin ,
Emma K. Brandish  and
Daniel Meron
David S. Baldwin
Affiliation:
Dr. Baldwin is reader in psychiatry in the Clinical Neuroscience Division at the, University of SouthhamptonSchool of Medicine in the United Kingdom, and honorary consultant psychiatrist at Royal South Hants Hospital, Hampshire Partnership Trust, in Southhampton, UK
Emma K. Brandish
Affiliation:
Ms. Brandish is a research assistant in the Clinical Neuroscience Division at the, University of SouthhamptonSchool of Medicine
Daniel Meron
Affiliation:
Dr. Meron is honorary lecturer in psychiatry in the Clinical Neuroscience Division at the University of Southhampton School of Medicine and consultant psychiatrist at Avon and Wiltshire Partnership Trust, in Salisbury, UK
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Abstract

Both obsessive-compulsive disorder (OCD) and social phobia are common in community and clinical settings, and it should be expected that a proportion of patients with one of these conditions will also fulfill either current or lifetime criteria for the other condition. However, comorbid social phobia is more common among patients with a primary diagnosis of OCD than is comorbid OCD in patients with a primary diagnosis of social phobia. This article explores the extent of the association of OCD and social phobia in epidemiological studies, and examines the possible role of underlying depression and other disorders in mediating the appearance of the comorbid condition. Although there have been no published randomized controlled trials in patients with this particular pattern of co-morbidity, it seems sensible to adopt pharmacologic and psychologic treatment approaches which have been found efficacious in both OCD and social phobia. Pharmacologic management therefore centers on first-line treatment with a selective serotonin reuptake inhibitor. Psychologic intervention should draw on the range of cognitive and behavioral approaches required for optimal outcomes in OCD and social phobia, as discrete conditions.

Type
Research Article
Information
CNS Spectrums , Volume 13 , Issue S14 , 2008 , pp. 47 - 53
Copyright
Copyright © Cambridge University Press 2008

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References

1.Wittchen, H-U, Jacobi, F. Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005;15(4):357–376.CrossRefGoogle ScholarPubMed
2.Degonda, M, Wyss, M, Angst, J. The Zurich Study. XVIII. Obsessive-compulsive disorders and syndromes in the general population. Eur Arch Psychiatry Clin Neurosci. 1993;243(1):16–22.CrossRefGoogle ScholarPubMed
3.Angst, J, Gamma, A, Endrass, J, et al.Obsessive-compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes. Eur Arch Psychiatry Clin Neurosci. 2005;255(1):65–71.CrossRefGoogle ScholarPubMed
4.Grabe, HJ, Meyer, C, Hapke, U, et al.Lifetime-comorbidity of obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in Northern Germany. Eur Arch Psychiatry Clin Neurosci. 2001;251(3):130–135.CrossRefGoogle ScholarPubMed
5.Di Nardo, PA, Barlow, DH. Syndrome and symptom co-occurrence in the anxiety disorders. In: Maser, JD, Cloninger, CR, eds. Comorbidity of Mood and Anxiety Disorders. Washington DC: American Psychiatric Press; 1990:205–230.Google Scholar
6.Rasmussen, SA, Eisen, JL. The epidemiology and differential diagnosis of obsessive compulsive disorder. J Clin Psychiatry. 1992;53(Suppl):4–10.Google ScholarPubMed
7.Eisen, JL, Goodman, WK, Keller, MB, et al.Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. J Clin Psychiatry. 1999;60(5):346–351.CrossRefGoogle ScholarPubMed
8.Diniz, JB, Rosario-Campos, MC, Shavitt, RG, et al.Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder. J Clin Psychiatry. 2004;65(1):22–27.CrossRefGoogle ScholarPubMed
9.Crino, RD, Andrews, G. Obsessive-Compulsive Disorder and Axis 1 Comorbidity. J Anxiety Disord. 1996;10(1):37–46.CrossRefGoogle Scholar
10.Robins, LN, Wing, J, Wittchen, HUet al.The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988;45(12):1069–1077.CrossRefGoogle ScholarPubMed
11.Andrews, G, Stewart, G, Morris-Yates, A, Holt, P, Henderson, S. Evidence for a general neurotic syndrome. Br J Psychiatry. 1990;157:6–12.CrossRefGoogle ScholarPubMed
12.Schneier, FR, Johnson, J, Hornig, CD, Liebowitz, MR, Weissman, MM. Social phobia. Comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry. 1992;49(4):282–288.CrossRefGoogle Scholar
13.Turner, SM, Beidel, DC, Borden, JW, Stanley, MA, Jacob, RG. Social phobia: Axis I and II correlates. J Abnorm Psychol. 1991;100(1):102–106.CrossRefGoogle ScholarPubMed
14.Di Nardo, PA, Barlow, DH. Anxiety Disorders Interview Schedule - Revised (ADIS-R). Albany: Graywind; 1988.Google Scholar
15.Sanderson, WC, DiNardo, PA, Rapee, RM, Barlow, DH. Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder. J Abnorm Psychol. 1990;99(3):308–312.CrossRefGoogle ScholarPubMed
16.Brown, TA, Barlow, DH. Comorbidity among anxiety disorders: implications for treatment and DSM-IV. J Consult Clin Psychol. 1992;60(6):835–844.CrossRefGoogle ScholarPubMed
17.Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110(4):585–599.CrossRefGoogle Scholar
18.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for Axis I disorders - clinician version (SCID/I). 2nd ed. Washington: American Psychiatric Association; 1997.Google Scholar
19.Zimmerman, M, Mattia, JI. The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Compr Psychiatry. 2001;42(3):175–189.CrossRefGoogle ScholarPubMed
20.Zimmerman, M, Chelminski, I. Screening for anxiety disorders in depressed patients. J Psychiatr Res. 2006;40(3):267–272.CrossRefGoogle ScholarPubMed
21.Tukel, R, Polat, A, Ozdemir, O, Aksut, D, Turksoy, N. Comorbid conditions in obsessive-compulsive disorder. Compr Psychiatry. 2002;43(3):204–209.CrossRefGoogle ScholarPubMed
22.Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–55.CrossRefGoogle ScholarPubMed
23.Hong, JP, Samuels, J, Bienvenu, OJ, III et al.Clinical correlates of recurrent major depression in obsessive-compulsive disorder. Depress Anxiety. 2004;20(2):86–91.CrossRefGoogle ScholarPubMed
24.Mannuzza, S, Fyer, AJ, Klein, DF, Endicott, J. Schedule for Affective Disorders and Schizophrenia--Lifetime Version modified for the study of anxiety disorders (SADS-LA): rationale and conceptual development. J Psychiatr Res. 1986;20(4):317–325.CrossRefGoogle Scholar
25.Perugi, G, Akiskal, HS, Ramacciotti, Set al.Depressive comorbidity of panic, social phobic, and obsessive-compulsive disorders re-examined: is there a bipolar II connection? J Psychiatr Res. 1999;33(1):53–61.CrossRefGoogle Scholar
26.Di Nardo, PA, Brown, TA, Barlow, DH. Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). San Antonio: Psychological Corporation; 1994.Google Scholar
27.Richter, MA, Summerfeldt, LJ, Antony, MM, Swinson, RP. Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depress Anxiety. 2003;18(3):118–127.CrossRefGoogle ScholarPubMed
28.Phillips, KA, Stout, RL. Associations in the longitudinal course of body dysmorphic disorder with major depression, obsessive-compulsive disorder, and social phobia. J Psychiatr Res. 2006;40(4):360–369.CrossRefGoogle ScholarPubMed
29.Gunstad, J, Phillips, KA. Axis I comorbidity in body dysmorphic disorder. Compr Psychiatry. 2003;44(4):270–276.CrossRefGoogle ScholarPubMed
30.Coles, ME, Phillips, KA, Menard, W, et al.Body dysmorphic disorder and social phobia: cross-sectional and prospective data. Depress Anxiety. 2006;23(1):26–33.CrossRefGoogle ScholarPubMed
31.Cosoff, SJ, Hafner, RJ. The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder and bipolar disorder. Aust N Z J Psychiatry. 1998;32(1):67–72.CrossRefGoogle ScholarPubMed
32.Yaryura-Tobias, JA, Grunes, MS, Todaro, J, McKay, D, Neziroglu, FA, Stockman, R. Nosological insertion of axis I disorders in the etiology of obsessive-compulsive disorder. J Anxiety Disord. 2000;14(1):19–30.CrossRefGoogle ScholarPubMed
33.Tukel, R, Polat, A, Genc, A, Bozkurt, O, Atli, H. Gender-related differences among Turkish patients with obsessive-compulsive disorder. Compr Psychiatry. 2004;45(5):362–366.CrossRefGoogle ScholarPubMed
34.Cath, DC, Ran, N, Smit, JH, van Balkom, AJ, Comijs, HC. Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: a preliminary case-controlled study. Psychopathology. 2008;41(2):101–110.CrossRefGoogle ScholarPubMed
35.O’Brien, KM, Vincent, NK. Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev. 2003;23(1):57–74.CrossRefGoogle ScholarPubMed
36.Godart, NT, Perdereau, F, Jeammet, P, Flament, MF. Comorbidite et chronologie dapparition des troubles anxieux dans les troubles du comportement alimentaire. Annales Medico-Psychologiques-Revue Psychiatrique. 2003;161(7):498–503.CrossRefGoogle Scholar
37.Schneier, FR, Martinez, D, bi-Dargham, A, et al.Striatal dopamine D(2) receptor availability in OCD with and without comorbid social anxiety disorder: preliminary findings. Depress Anxiety. 2008;25(1):1–7.CrossRefGoogle ScholarPubMed
38.Seigel, A. Treatment of obsessive compulsive disorder and comorbid social phobia. Brief treatment and Crisis Intervention. 2003;3(1):55–81.CrossRefGoogle Scholar
39.Fineberg, NA, Gale, TM. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Int J Neuropsychopharmacol. 2005;8(1):107–129.CrossRefGoogle ScholarPubMed
40.Blanco, C, Raza, MS, Schneier, FR, Liebowitz, MR. The evidence-based pharmacological treatment of social anxiety disorder. Int J Neuropsychopharmacol. 2003;6(4):427–442.CrossRefGoogle ScholarPubMed
41.Baldwin, DS, Anderson, IM, Nutt, DJ, et al.Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005;19(6):567–596.CrossRefGoogle ScholarPubMed
42.Allgulander, C, Mangano, R, Zhang, J, et al.Efficacy of Venlafaxine ER in patients with social anxiety disorder: a double-blind, placebo-controlled, parallel-group comparison with paroxetine. Hum Psychopharmacol. 2004;19(6):387–396.CrossRefGoogle Scholar
43.Liebowitz, MR, Mangano, RM, Bradwejn, J, Asnis, G. A randomized controlled trial of venlafaxine extended release in generalized social anxiety disorder. J Clin Psychiatry. 2005;66(2):238–247.CrossRefGoogle ScholarPubMed
44.Denys, D, van der, WN, van Megen, HJ, Westenberg, HG. A double blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder. J Clin Psychopharmacol. 2003;23(6):568–575.CrossRefGoogle ScholarPubMed
45.Bruce, SE, Yonkers, KA, Otto, MW, et al.Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162(6):1179–1187.CrossRefGoogle ScholarPubMed
46.Overbeek, T, Schruers, K, Vermetten, E, Griez, E. Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. J Clin Psychiatry. 2002;63(12):1106–1112.CrossRefGoogle ScholarPubMed
47.Shetti, CN, Reddy, YC, Kandavel, T, et al.Clinical predictors of drug nonresponse in obsessive-compulsive disorder. J Clin Psychiatry. 2005;66(12):1517–1523.CrossRefGoogle ScholarPubMed
48.Skapinakis, P, Papatheodorou, T, Mavreas, V. Antipsychotic augmentation of serotonergic antidepressants in treatment-resistant obsessive-compulsive disorder: a meta-analysis of the randomized controlled trials. Eur Neuropsychopharmacol. 2007;17:79–93.CrossRefGoogle ScholarPubMed
49.Brawman-Mintzer, O, Knapp, RG, Nietert, PJ. Adjunctive risperidone in generalized anxiety disorder: a double-blind, placebo-controlled study. J Clin Psychiatry. 2005;66(10):1321–1325.CrossRefGoogle ScholarPubMed
50.Pollack, MH, Simon, NM, Zalta, AK, et al.Olanzapine augmentation of fluoxetine for refractory generalized anxiety disorder: a placebo controlled study. Biol Psychiatry. 2006;59(3):211–215.CrossRefGoogle ScholarPubMed
51.Barnett, SD, Kramer, ML, Casat, CD, Connor, KM, Davidson, JR. Efficacy of olanzapine in social anxiety disorder: a pilot study. J Psychopharmacol. 2002;16(4):365–368.CrossRefGoogle ScholarPubMed
52.Foa, EB, Liebowitz, MR, Kozak, MJ, et al.Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 2005;162:151–161.CrossRefGoogle ScholarPubMed
53.Cottraux, J, Mollard, E, Bouvard, M, Marks, I. Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: one year follow-up. Psychiatr Res. 1993;49:63–75.CrossRefGoogle ScholarPubMed
54.Blomhoff, S, Haug, TT, Hellstrom, Ket al.Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. Br J Psychiatry. 2001;179:23–30.CrossRefGoogle ScholarPubMed
55.Clark, DM, Ehlers, A, McManus, F, et al.Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. J Consult Clin Psychol. 2003;71(6):1058–1067.CrossRefGoogle ScholarPubMed
56.Davidson, JR, Foa, EB, Huppert, JD, et al.Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Arch Gen Psychiatry. 2004;61(10):1005–1013.CrossRefGoogle ScholarPubMed
57.Steketee, G, Chambless, DL, Tran, GQ. Effects of axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia. Compr Psychiatry. 2001;42(1):76–86.CrossRefGoogle ScholarPubMed