Does time-intensive ERP attenuate the negative impact of comorbid personality disorders on the outcome of treatment-resistant OCD?

Background and objectives: There is growing interest regarding patients with obsessive-compulsive disorder (OCD) who do not fully respond to cognitive-behavioural therapy (CBT). Limited data are available on the role of Comorbid Personality Disorders (CPDs) in the outcome of treatment-resistant obsessivecompulsive disorder (OCD), despite the fact that CPDs are considered a predictor of a poorer outcome. This study investigated whether a time-intensive scheduling of treatment could be an effective strategy aimed at attenuating the negative influence of CPDs on outcome in a sample of 49 inpatients with a primary diagnosis of treatment-resistant OCD. Method: 38 inpatients completed the five-week individual treatment consisting of daily and prolonged sessions of exposure with response prevention (ERP) delivered for 2 h in the morning and 2 h in the afternoon. 44% of the sample received a full diagnosis of one or more CPDs. Following a pre-post-test design, outcome measures included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Results: Data showed that the treatment was effective and indicated that CPDs were not a significant predictor of treatment failure. Limitations: Future larger studies should evaluate the role of specific clusters of CPDs on the outcome of resistant OCD. Conclusions: These findings suggest that an intensive treatment could be effective for severely ill patients who have not responded to weekly outpatient sessions and could also attenuate the negative impact of CPDs on outcome, evidencing the importance of a tailored therapeutic approach for patients who need a rapid reduction in OCD-related impairment.