Effects of axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia

The impact of concurrent axis I diagnoses and axis II traits on the efficac y of a 22-session exposure-based treatment program for 43 outpatients with panic disorder and agoraphobia (PDA) and 63 with obsessive-compulsive disor der (OCD) was examined. Trained interviewers used the Structured Clinical I nterview for DSM-III-R (SCID) to assess axis I diagnoses and the SCID-II to identify the number of axis II criteria met for anxious, dramatic, and odd clusters. Among axis I diagnoses, secondary major depressive disorder (MDD ), dysthymia, social phobia, and generalized anxiety disorder (GAD) were pr esent in sufficient numbers to study their effects on treatment outcome. Ou tcomes were assessed on self-rated target fears and functioning and on a be havioral avoidance test at post-treatment and at 6 months follow-up. Only G AD comorbidity predicted dropout, whereas MDD and all three personality clu ster traits predicted post-treatment outcomes. Follow-up analyses showed si gnificant effects of MDD and GAD, but axis II cluster criteria were not pre dictive. Copyright (C) 2007 by W.B. Saunders Company.