Factors such as a patient’s age, gender, income, beliefs, and concerns can influence which treatments they choose for obsessive compulsive disorder (OCD) and may help inform the planning of more successful treatment, suggests new research published in Psychiatric Services.

Few prior studies have examined the role such factors play in the treatment of OCD. After revealing identifiable treatment preferences among OCD patients in their previous work, the researchers set out to identify factors behind these preferences.

The study, published October 17, comes from a team of scientists from Columbia University, the New York State Psychiatric Institute, and the Harlem Hospital Center. Led by Sapana Patel Ph.D. and Helen Blair Simpson, M.D., Ph.D., a 2005 NARSAD Young Investigator Grantee and 2010 NARSAD Independent Investigator Grantee, the team also included Lisa B. Dixon, M.D., M.P.H., a 1991 NARSAD Young Investigator Grantee, and 1999 NARSAD Independent Investigator Grantee.

Gender, income, age, and beliefs can affect which treatments patients with #OCD prefer—new research explores how. Tweet >

Patients with #OCD often prefer psychotherapy to meds—new research explores the factors behind this preference.     Tweet >

Using online surveys, the researchers collected responses from over 200 patients with at least moderate OCD symptoms. The patients reported which established treatments they preferred and why—including medications often prescribed for OCD as well as other anxiety disorders and depression known as SSRIs (selective serotonin reuptake inhibitors) and a cognitive-behavioral therapy known as exposure and response prevention (EX/RP). Patients also rated the acceptability of new treatments under development and testing, including an invasive procedure called Deep Brain Stimulation (DBS) and a behavioral intervention known as Acceptance and Commitment Therapy.

Of two distinct patient “profiles” which emerged from the analysis, only one—patients with a history of OCD diagnosis and treatment, higher income, and private insurance—preferred medication (SSRIs) over cognitive-behavioral therapy, EX/RP. Overall, adults with OCD were more likely to prefer EX/RP to SSRIs as a first-line treatment.

Participants who were already on medications for OCD preferred adding EX/RP over adding antipsychotic medications, commonly used to improve response to treatment. Similarly, among newer treatments, behavioral interventions such as Acceptance and Commitment Therapy and Kundalini yoga were viewed as more acceptable by adult patients than procedures such as DBS.  

In  the case of OCD, nationwide data demonstrates that office-based physicians more commonly treat the disorder with medications than with behavioral interventions. Considering this, the researchers recommended taking action to increase access to EX/RP. They also called for increasing awareness and reducing stigma related to OCD among the general public, pointing to past public health campaigns for stigmatized illnesses such as HIV as a model for fostering productive attitudes about OCD.

TAKEAWAY: While a variety of both novel and established treatment options are available for OCD, patients may not view all of these treatments as viable options, tending to prefer behavioral interventions over medications. Using online surveys, researchers determined that a patient’s preference for or acceptance of a particular treatment may be predicted in part by factors such as age, gender, income, and beliefs.