Abstract
Perfectionism has been identified as a vulnerability factor in the onset and maintenance of several psychological disorders and is particularly prominent in obsessive-compulsive disorder (OCD). Evidence indicates that there is a subgroup of OCD associated with high perfectionism that is characterized by greater frequency of obsessions and compulsions related to symmetry, ordering, repeating, cleaning, and hoarding. Although perfectionism-related OCD can be particularly resistant to treatment, exposure and response prevention (ERP) has been shown to be an efficacious psychological intervention. The case vignette described in this chapter illustrates the implementation of a comprehensive cognitive behavioral assessment, case formulation, and treatment plan for OCD characterized by perfectionism-driven symmetry, ordering, checking, and reassurance seeking. A detailed account of ERP is described, including constructing a multi-themed exposure hierarchy, in-session exposure practices, and expansion of between-session exposure practices to a lifestyle-management approach to challenge his obsessive thoughts across a range of situations and triggers throughout the day. Complicating factors associated with the enduring, pervasive, ego-syntonic nature of these difficulties are presented, along with strategies for building motivation, assessing therapy-interfering behaviors, and challenging obstacles in treatment.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Antony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998). Dimensions of perfectionism across the anxiety disorders. Behaviour Research and Therapy, 36, 1143–1154.
Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004a). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36, 1373–1385. doi:10.1016/S0191-8869(03)00235-6.
Bieling, P. J., Summerfeldt, L. J., Israeli, A. L., & Antony, M. M. (2004b). Perfectionism as an explanatory construct in comorbidity of axis I disorders. Journal of Psychopathology and Behavioral Assessment, 26, 193–201. doi:10.1023/B:JOBA.0000022112.27186.98.
Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2008). Facial attractiveness ratings and perfectionism in body dysmorphic disorder and obsessive-compulsive disorder. Journal of Anxiety Disorders, 22, 540–547. doi:10.1016/j.janxdis.2007.05.004.
Chik, H. M., Whittal, M. L., & O’Neill, M. L. (2008). Perfectionism and treatment outcome in obsessive-compulsive disorder. Cognitive Therapy and Research, 32, 676–688. doi:10.1007/s10608-007-9133-2.
Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford.
Coles, M. E., Frost, R. O., Heimberg, R. G., & Rhéaume, J. (2003). “Not just right experiences”: Perfectionism, obsessive-compulsive features and general psychopathology. Behaviour Research and Therapy, 41, 681–700. doi:10.1016/S0005-7967(02)00044-X.
Coles, M. E., Pinto, A., Mancebo, M. C., Rasmussen, S. A., & Eisen, J. L. (2008). OCD with comorbid OCPD: A subtype of OCD? Journal of Psychiatric Research, 42, 289–296. doi:10.1016/j.jpsychires.2006.12.009.
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31, 203–212. doi:10.1016/j.cpr.2010.04.009.
Egan, S. J., Wade, T. D., Shafran, R., & Antony, M. M. (2014). Cognitive-behavioral treatment of perfectionism. New York: Guilford.
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV Axis II personality disorders (SCID-II). Washington, DC: American Psychiatric.
First, M.B., Williams, J. B. W., Karg, R. S., & Spitzer, R.L. (2015). Structured clinical interview for DSM-5 disorders—Clinician version (SCID-5-CV). Arlington: American Psychiatric.
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496. doi:10.1037/1040-3590.14.4.485.
Franklin, M. E., & Foa, E. B. (2008). Obsessive-compulsive disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 164–215). New York: Guilford.
Freeston, M. H., Ladouceur, R., Gagnon, F., Thibodeau, N., Rhéaume, J., Letarte, H., & Bujold, A. (1997). Cognitive-behavioral treatment of obsessive thoughts: A controlled study. Journal of Consulting and Clinical Psychology, 65, 405–413. doi:10.1037/0022-006X.65.3.405.
Frost, R. O., & Steketee, G. (1997). Perfectionism in obsessive-compulsive disorder patients. Behaviour Research and Therapy, 35, 291–296.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449–468. doi:10.1007/BF01172967.
Frost, R. O., Novara, C., & Rhéaume, J. (2002). Perfectionism in obsessive compulsive disorder. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp. 91–105). Amsterdam: Pergamon/Elsevier Science.
Goodman, W. K., Rasmussen, S. A., Price, L. H., & Storch, E. A. (2006). Yale-Brown obsessive-compulsive scale—second edition (unpublished manuscript).
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470. doi:10.1037/0022-3514.60.3.456.
Jang, K. L., Livesley, W. J., & Vernon, P. A. (1996). Heritability of the big five personality dimensions and their facets: A twin study. Journal of Personality, 64, 577–591. doi:10.1111/j.1467-6494.1996.tb00522.x.
Key, B., Rowa, K., Drvaric, L., Bieling, P., & McCabe, R. (2013 June). Mindfulness-based cognitive therapy for residual anxiety symptoms in obsessive-compulsive disorder. In B. Key (Chair), Mindfulness and anxiety: Innovative applications of mindfulness interventions for anxiety disorders. Symposium conducted at the meeting of the Canadian Psychological Association, Quebec, QC.
Leckman, J. F., Walker, D. E., Goodman, W. K., Pauls, D. L., & Cohen, D. J. (1994). “Just right” perceptions associated with compulsive behavior in Tourette's syndrome. American Journal of Psychiatry, 151, 675–680.
Mancebo, M. C., Eisen, J. L., Grant, J. E., & Rasmussen, S. A. (2005). Obsessive compulsive personality disorder and obsessive compulsive disorder: Clinical characteristics, diagnostic difficulties, and treatment. Annals of Clinical Psychiatry, 17, 197–204. doi:10.1080/10401230500295305.
Mataix-Cols, D., Rauch, S. L., Baer, L., Eisen, J. L., Shera, D. M., Goodman, W. K., et al. (2002). Symptom stability in adult obsessive-compulsive disorder: Data from a naturalistic two-year follow-up study. American Journal of Psychiatry, 159, 263–268. doi:10.1176/appi.ajp.159.2.263.
Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive–compulsive disorder. Behaviour Research and Therapy, 35, 667–681. doi:10.1016/S0005-7967(97)00017-X.
Obsessive Compulsive Cognitions Working Group. (2001). Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006. doi:10.1016/S0005-7967(00)00085-1.
Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory-part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542. doi:10.1016/j.brat.2004.07.010.
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. J. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47, 33–41. doi:10.1016/j.jpsychires.2012.08.020.
Pleva, J., & Wade, T. D. (2007). Guided self-help versus pure self-help for perfectionism: A randomised controlled trial. Behaviour Research and Therapy, 45, 849–861. doi:10.1016/j.brat.2006.08.009.
Rasmussen, S. A., & Eisen, J. L. (1989). Clinical features and phenomenology of obsessive compulsive disorder. Psychiatric Annals, 19, 67–73.
Riley, C., Lee, M., Cooper, Z., Fairburn, C. G., & Shafran, R. (2007). A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: A preliminary study. Behaviour Research and Therapy, 45, 2221–2231. doi:10.1016/j.brat.2006.12.003.
Rufer, M., Grothusen, A., Maß, R., Peter, H., & Hand, I. (2005). Temporal stability of symptom dimensions in adult patients with obsessive-compulsive disorder. Journal of Affective Disorders, 88, 99–102. doi:10.1016/j.jad.2005.06.003.
Samuels, J., Nestadt, G., Bienvenu, O. J., Costa, P. T., Jr., Riddle, M. A., Liang, K., et al. (2000). Personality disorders and normal personality dimensions in obsessive-compulsive disorder. British Journal of Psychiatry, 177, 457–462. doi:10.1192/bjp.177.5.457.
Simpson, H. B., & Zuckoff, A. (2011). Using motivational interviewing to enhance treatment outcome in people with obsessive-compulsive disorder. Cognitive and Behavioral Practice, 18, 28–37. doi:10.1016/j.cbpra.2009.06.009.
Steketee, G. (1999). Overcoming obsessive-compulsive disorder: A behavioral and cognitive protocol for the treatment of OCD. Oakland: New Harbinger.
Summerfeldt, L. J. (2004). Understanding and treating incompleteness in obsessive-compulsive disorder. Journal of Clinical Psychology, 60, 1155–1168. doi:10.1002/jclp.20080.
Summerfeldt, L. J. (2007). Treating incompleteness, ordering, and arranging concerns. In M. M. Antony, C. Purdon, & L. J. Summerfeldt (Eds.), Psychological treatment of obsessive-compulsive disorder: Fundamentals and beyond (pp. 187–207). Washington, DC: American Psychological Association.
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Hood, H., Antony, M. (2016). Treatment of Perfectionism-Related Obsessive-Compulsive Disorder. In: Storch, E., Lewin, A. (eds) Clinical Handbook of Obsessive-Compulsive and Related Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-17139-5_7
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