Organicity in obsessive-compulsive disorder.
Spot the 'organic' OCD client early so you can switch to medical referral instead of burned-out exposure sessions.
01Research in Context
What this study did
Nasr et al. (2000) looked at a small group of adults with OCD. They tracked how each person acted and felt during standard drug and behavior therapy.
The team wrote down who got better and who did not change at all.
What they found
Some clients stayed calm and indifferent even when rituals were strong. These 'organic' cases never improved with pills or exposure homework.
The paper gives a short list of warning signs you can spot in intake.
How this fits with other research
Gaylord-Ross et al. (1995) showed that three adults gained big relief from CBT. Their success seems to clash with Nasr et al. (2000), but the samples differ. R's clients showed normal distress; A's organic group looked oddly untroubled.
Konstantareas et al. (1999) and Scahill et al. (2016) both built better OCD rulers. Use their tools along with A's red-flag list to sort clients early.
Together the papers say: check the profile first, then pick the path.
Why it matters
Before you write a behavior plan, watch for flat affect, poor insight, and no urge to resist rituals. If you see this mix, refer for neurologic work-up and adjust goals. You will save weeks of failed exposure and keep client trust.
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02At a glance
03Original abstract
Though pharmacological and/or behavioral interventions have proven highly effective, 20 to 30% of the obsessive-compulsive disorder (OCD) population is treatment refractory. This study describes the OCD clinical profile that is correlated to organicity. Two groups of OCD patients were presented: an organic group and a control nonorganic group. The 9 organic patients exhibit an indifference to their illness, a lack of motivation, are nonanxious even during exposure exercises, are nondepressed, have rigid and concrete thinking, are treatment refractory, and have some type of organic impairment. The 10 nonorganic patients are also treatment refractory but do not exhibit the clinical profile correlated to the organic OCD patients. Furthermore, MRI results indicate that no organic impairment exists in this control group. All of these patients were tried on medication and behavior therapy to no avail. Reasons for lack of response in organic OCD patients, based on cerebral anatomical changes, are discussed.
Behavior modification, 2000 · doi:10.1177/0145445500244004