A SIGNIFICANT EFFECT OF INVOLVEMENT BEHAVIORS ON LONG-TERM TREATMENT OUTCOMES IN JAPANESE PATIENTS WITH OBSESSIVE COMPULSIVE DISORDER (OCD)
Authors: Yokozumi *Erisa , Mukai Keiichiro , Ogino Shun , Hosoi Yukihiko , Sakurai Masahiko , Matsunaga Hisato 
Published: February 2025

Abstract

Background
Patients with obsessive-compulsive disorder (OCD) frequently exhibit involvement behaviors (IBs) in which they accommodate their caregivers to their OCD symptoms by 1) asking them for reassurance, 2) forcing them to participate in their rituals, or 3) forcing them to assist in avoidance according to the patients' rules or demands. Such behaviors correspond to those of their caregivers, and are referred to as family accommodation (FA).

Aims and Objectives
Family accommodation or the emotional burden on the caregivers of OCD patients has been explored extensively in Western countries. However, few studies have examined the clinically related and predictive factors of involving behaviors along with the impact of IBs on the long-term treatment outcomes in OCD patients. Therefore, we performed multifactorial comparisons between Japanese OCD patients with and without IBs in a larger sample to examine 1) the clinical, phenomenological, and psychopathological features related to IBs, 2) predictive factors for the presence of IBs, and 3) the impact of IBs on 1-year treatment outcomes.

Methods
We performed multifactorial comparisons between 256 OCD patients with and without IBs in order to examine the differential characteristics of OCD between the groups. A multiple logistic regression analysis was also performed to identify the related and predictive factors of IBs. Additionally, we prospectively assessed the long-term treatment outcomes of OCD patients with IBs compared to those without IBs. After the initial assessments, each subject was treated with a standardized combination of selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine (FLV) or paroxetine (PXT) and cognitive-behavioral therapy (CBT) according to the treatment guidelines by the APA.

Results
A total of 108 out of the 256 OCD patients examined (42%) were determined to exhibit IBs. OCD patients with IBs were differentially characterized by demographic and phenomenological characteristics (e.g. female predominance and poorer insight), and more severe psychopathological features (e.g. lower GAFS, higher anxiety, or a depressive status). The predictive factors of IBs such as being female, having a higher compulsive score, and lower GAFS were identified by logistic analyses and structural equation modeling. The OCD subjects with IBs also showed poorer 1-year treatment outcomes compared to those without IBs

Discussion and Conclusion
The presence of IBs was associated with the severe clinical features, and poorer 1-year treatment outcome of OCD. It was also identified as a poorer outcome predictor in our 10-year follow-up study of OCD. [1] These findings may suggest the clinical significance of early identification of IBs in OCD patients, and also support the necessity and possible effectiveness of the family intervention focusing on IBs in the treatment of OCD.

References
[1]Nakajima A, Matsuura N, Mukai K et al. Ten-year follow-up study of Japanese patients with obsessive-compulsive disorder Psychiatry Clin Neurosci 72:502-512, 2018.