title: The role of avoidance in the phenomenology of obsessive-compulsive disorder.
abstract: BACKGROUND
  Pathologic levels of ritualistic avoidance (also known as active avoidance) are common in the clinical presentation of obsessive-compulsive disorder (OCD). Despite its clinical relevance, there has been little examination of active avoidance as a ritualistic compulsion in adults with OCD.
  
  
  OBJECTIVE
  The objective of this study is to determine if adults with OCD who engage in ritualistic avoidance have greater obsessive-compulsive, anxiety, and depressive symptom severity and different comorbidity patterns than adults who do not engage in ritualistic avoidance.
  
  
  METHODS
  Adults with OCD (n = 133) completed an evaluation that included clinician ratings of obsessive-compulsive severity; overall illness severity; and self-reported ratings of anxiety, depression, and obsessive-compulsive severity.
  
  
  RESULTS
  Ritualized avoidance was endorsed by greater than 25% of the sample. Avoidant subjects and, more specifically, contaminant avoidant and reading-writing avoidant subjects presented with elevated levels of obsessive-compulsive symptom severity and greater overall clinical severity than comparison patients who did not engage in each respective avoidance ritual.
  
  
  CONCLUSIONS
  Patients who engage in ritualized avoidance exhibited greater obsessive-compulsive symptom severity than patients who did not. These findings suggest that ritualized avoidance functions as a compulsion for adults with OCD and that avoidance should receive careful consideration in assessment and treatment.
authors.affiliation: Department of Psychology, University of South Florida, Tampa, FL 33620, USA. jfmcguire@mail.usf.edu
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Price
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rasmussen
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Goodman
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D003192:Compulsive Behavior / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009770:Obsessive Behavior / Q000175:diagnosis / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology*; D012720:Severity of Illness Index