Center for Mental Health Disparities, Department of Psychological and Brain Sciences, University of Louisville, Louisville, Ky., USA.
Psychopathology. 2013;46(6):365-76. doi: 10.1159/000348582. Epub 2013 Apr 20.
Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. Currently, the cognitive-behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP); however, clinical impression and some empirical data suggest that certain OCD symptoms are more responsive to treatment than others.
Prior work identifying symptom dimensions within OCD is discussed, including epidemiological findings, factor analytic studies, and biological findings. Symptom dimensions most reliably identified include contamination/cleaning, doubt about harm/checking, symmetry/ordering, and unacceptable thoughts/mental rituals. The phenomenology of each of these subtypes is described and research literature is summarized, emphasizing the differential effects of EX/RP and its variants on each of these primary symptom dimensions.
To date it appears that EX/RP is an effective treatment for the various OCD dimensions, although not all dimensions have been adequately studied (i.e. symmetry and ordering).
Modifications to treatment may be warranted for some types of symptoms. Clinical implications and directions for future research are discussed.
强迫症（OCD）是一种症状表现多样的严重疾病。目前，最具实证支持的认知行为治疗是暴露和仪式预防（EX/RP）；然而，临床印象和一些实证数据表明，某些 OCD 症状对治疗的反应优于其他症状。
讨论了在 OCD 中确定症状维度的先前工作，包括流行病学发现、因素分析研究和生物学发现。最可靠地确定的症状维度包括污染/清洁、对伤害/检查的怀疑、对称/有序和不可接受的想法/心理仪式。描述了每种亚型的现象学，并总结了研究文献，强调了 EX/RP 及其变体对这些主要症状维度的不同影响。
迄今为止，EX/RP 似乎是治疗各种 OCD 维度的有效方法，尽管并非所有维度都得到了充分研究（即对称和有序）。
可能需要对某些类型的症状进行治疗修改。讨论了临床意义和未来研究方向。
