Effects of axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia.
The impact of concurrent axis I diagnoses and axis II traits on the efficacy of a 22-session exposure-based treatment program for 43 outpatients with panic disorder and agoraphobia (PDA) and 63 with obsessive-compulsive disorder (OCD) was examined. Trained interviewers used the Structured Clinical Interview for DSM-III-R (SCID) to assess axis I diagnoses and the SCID-II to identify the number of axis II criteria met for anxious, dramatic, and odd clusters. Among axis I diagnoses, secondary major depressive disorder (MDD), dysthymia, social phobia, and generalized anxiety disorder (GAD) were present in sufficient numbers to study their effects on treatment outcome. Outcomes were assessed on self-rated target fears and functioning and on a behavioral avoidance test at post-treatment and at 6 months follow-up. Only GAD comorbidity predicted dropout, whereas MDD and all three personality cluster traits predicted post-treatment outcomes. Follow-up analyses showed significant effects of MDD and GAD, but axis II cluster criteria were not predictive.
Steketee
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School of Social Work, Boston University, MA 02215, USA.
Chambless
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D000293:Adolescent; D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003887:Desensitization, Psychologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors