Symposia
Transdiagnostic
Natasha H. Bailen, M.A., Ph.D.
Boston University Center for Anxiety and Related Disorders
Brookline, Massachusetts
Anthony J. Rosellini, PhD
Research Assistant Professor
Center for Anxiety and Related Disorders at Boston University
Boston, Massachusetts
Christina Galiano, MA
Doctoral Student in Clinical Psychology
Center for Anxiety and Related Disorders at Boston University
Boston, Massachusetts
Timothy A. Brown, PsyD
Director of Research
Center for Anxiety and Related Disorders at Boston University
Boston, Massachusetts
At least a third of patients with obsessive compulsive disorder (OCD) have a concurrent diagnosis of major depressive disorder (MDD), with comorbid presentations demonstrating increased symptom severity and attenuated effects of psychotherapy. Thus, it is important to identify factors that contribute to poor outcomes in comorbid presentations. Two such factors could be poor tolerance and rejection of one's own negative emotional experiences, two transdiagnostic features of OCD and depressive disorders that have been shown to relate to negative outcomes in community and clinical samples.
We examined this question in a sample of 1138 individuals who presented to an outpatient clinic for psychiatric evaluation and treatment. All participants were administered the ADIS-5 to evaluate for DSM-5 disorders and were administered self-report measures of distress tolerance and non-acceptance of emotion. Of the original 1138 participants, 172 individuals were diagnosed with MDD or persistent depressive disorder (PDD) and no OCD; 130 with OCD and no mood disorder; and 34 with OCD and comorbid MDD/PDD.
Based on previous research, we hypothesized that among the broader clinical sample, distress aversion and non-acceptance of emotion would contribute unique variance to the prediction of obsessive-compulsive and depressive symptom severity. This hypothesis was supported (all ps < .001). We also hypothesized that individuals diagnosed with comorbid OCD and mood disorders would have higher symptom severity (both OCD and depressive) than those with either diagnosis alone. This was partially supported, with compulsive behaviors, but not obsessions or total OCD severity, higher in the comorbid group than the OCD group (p < .01), and with no difference in depressive severity between the depressed group and the comorbid group. Finally, we hypothesized that those in the comorbid group would have higher levels of distress aversion and non-acceptance of emotion than those with either diagnosis alone. Non-acceptance was higher (p < .001) and distress aversion marginally higher (p = .07) in the comorbid group than in the OCD group; no differences were found between the mood disorder and comorbid groups.
These findings confirm that distress aversion and emotional non-acceptance are related to the phenomenology and severity of OCD and depression. Based on the differences found between comorbid OCD-depression and OCD alone, these two factors should be explored further in relation to the poor outcomes associated with OCD with comorbid depression.