Rachel C. Leonard, Ph.D.1, Bradley C. Riemann, Ph.D.1, and Jonathan S. Abramowitz, Ph.D.2 The DOCS (Abramowitz et al., 2010) was recently developed to assess OCD symptom dimensions, including: a) contamination-related obsessions and cleaning compulsions; b) obsessions regarding doubt about responsibility for making mistakes or causing harm, with checking and reassurance-seeking rituals; c) obsessions regarding need for completeness, symmetry, or exactness with ordering and arranging rituals; and d) obsessional intrusive thoughts regarding unwanted violent, sexual, or religious content with covert mental rituals or neutralizing rituals. To date, ways in which DOCS dimensions predict symptom improvement have not yet been examined. Therefore, the present study examined how DOCS scores at admission to an intensive outpatient or residential treatment program predict discharge Y-BOCS (Goodman et al., 1989). Results indicated that DOCS Responsibility for Harm and Mistakes and Symmetry/Ordering dimensions predicted discharge Y-BOCS scores, while DOCS Contamination and Unacceptable Thoughts dimensions did not. These results suggest that responsibility for harm and mistakes and symmetry/ordering symptoms may be particularly important targets of treatment.

1. Using the Dimensional Obsessive-Compulsive Scale to Predict OCD Symptom Severity
Following Treatment
Rachel C. Leonard, Ph.D.1, Bradley C. Riemann, Ph.D.1, and Jonathan S. Abramowitz, Ph.D.2
1
Rogers Memorial Hospital, Oconomowoc, WI 2
University of North Carolina, Chapel Hill, NC
Abstract Methods Results Conclusions
The DOCS (Abramowitz et al., 2010) was recently developed Participants In order to determine whether data from the IOP and Although all variables decreased from admission to
to assess OCD symptom dimensions, including: a) Participants included 159 individuals (males = 82) in an residential programs could be collapsed, we first examined discharge, only DOCS Responsibility for Harm and
contamination-related obsessions and cleaning compulsions; intensive outpatient program (IOP; n = 35, 22.0%) or interactions between the DOCS subscale scores and Mistakes and DOCS Symmetry/Ordering significantly
b) obsessions regarding doubt about responsibility for making residential treatment program (n = 124, 78.0%) for OCD. treatment program in predicting discharge Y-BOCS-SR predicted OCD severity at discharge. This suggests that
mistakes or causing harm, with checking and reassurance- scores. None of the interaction terms were significant; Responsibility for Harm and Mistakes and
Participants had an average age of 30.88 years (SD =
seeking rituals; c) obsessions regarding need for therefore, data from the two programs were collapsed for all Symmetry/Ordering may be particularly important targets
12.00, range = 18 - 70). The majority of participants were
completeness, symmetry, or exactness with ordering and subsequent analyses. of treatment. It is also possible that therapists providing
Caucasian (89.3%), followed by Hispanic (5.0%), African
arranging rituals; and d) obsessional intrusive thoughts the treatment in this study were more successful in
regarding unwanted violent, sexual, or religious content with
American (1.9%), Asian (1.9%), and American Indian (0.6%) Data regarding admission and discharge scores are
with missing data on 2 participants. All participants had a presented below. targeting contamination symptoms than other
covert mental rituals or neutralizing rituals. To date, ways in
primary diagnosis of OCD, a score of 16 or higher on the presentations or that symptoms within these dimensions
which DOCS dimensions predict symptom improvement have
self-report version of the Y-BOCS (Baer, Brown-Beasley, Measure Admission Discharge Test of were better captured by the Y-BOCS than symptoms from
not yet been examined. Therefore, the present study
Sorce, & Henriques, 1993), and completed the measures of Significance the Contamination and Unacceptable Thoughts
examined how DOCS scores at admission to an intensive
interest at admission and a completed self-report Y-BOCS M (SD) M (SD) t(df), p dimensions.
outpatient or residential treatment program predict discharge
Y-BOCS-SR 26.98 (5.47) 15.75 (7.03) 19.11(158),
Y-BOCS (Goodman et al., 1989). Results indicated that at discharge. Most participants (81.8%) had at least one <.001 Limitations and Future Directions
DOCS Responsibility for Harm and Mistakes and Symmetry/ additional diagnosis. One hundred eleven participants were DOCS 7.39 (6.53) 3.36 (3.83) 10.48(152), This study has several limitations. First, 111 individuals
Ordering dimensions predicted discharge Y-BOCS scores, excluded due to not having completed all measures of Contamination <.001
were not included in the analyses due to having
while DOCS Contamination and Unacceptable Thoughts interest. Of note, participants were not excluded based on DOCS 7.34 (6.18) 3.56 (4.08) 9.29(150), <.001
incomplete data. It is possible that these individuals differ
dimensions did not. These results suggest that responsibility acquired dosage of treatment; therefore, the data presented Responsibility for
Harm and significantly from those included in the study, and
for harm and mistakes and symmetry/ordering symptoms includes individuals who terminated treatment prematurely.
Mistakes therefore the results could have been affected by this.
may be particularly important targets of treatment.
Treatment DOCS 10.21 (5.89) 5.59 (4.86) 10.73(151), Further, although there are advantages to conducting
Introduction Participants admitted between May 19, 2008 and January Unacceptable
Thoughts
<.001 research in more naturalistic settings, this sample was
Due to the heterogeneity in OCD symptom presentations, 11, 2012 and had an average length of stay of 67.29 days complex in terms of comorbidity and severity, and
DOCS Symmetry/ 7.18 (5.52) 3.69 (3.80) 9.29(151), <.001
researchers have attempted to identify meaningful (SD = 32.12, range = 8 – 166 days), with participants in the received a variety of psychiatric medications. Therefore,
Ordering
symptom dimensions or subtypes underlying the disorder. RTC program having an average length of stay of 66.50 future research using more tightly controlled methodology
Identified symptom dimensions differ with respect to days (SD = 31.42) and participants in the IOP program and a larger sample size may be beneficial.
In order to more fully examine these relationships, a
comorbidity profiles, neural mechanisms, and rates of having an average length of stay of 40.05 sessions (SD = regression analysis was conducted with admission DOCS
treatment response (e.g., Mataix-Cols, Rosario-Campos, 19.88). Treatment in both programs primarily consisted of
exposure and response prevention (ERP), with cognitive
subscale scores as the predictor variables and discharge Y- References
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Admission DOCS .172 2.043 .043
thoughts. Although the DOCS has demonstrated of 10 items rated from 0 to 4 for a total score ranging from 0 Radomsky, A., Sookman, D. et al. (2004). A critical
Symmetry/
sensitivity to change over the course of treatment, was in to 40, with higher scores representing greater OCD Ordering evaluation of obsessive-compulsive disorder subtypes:
which DOCS dimensions relate to treatment outcome symptom severity. Baer and colleagues (1993) found that Symptoms versus mechanisms. Clinical Psychology
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study examined how DOCS symptom dimensions at interview version, and that the Y-BOCS-SR has acceptable
admission relate to OCD symptom severity at discharge internal consistency within OCD samples and has
following treatment. We predicted that all four DOCS acceptable test-retest reliability.
subscales would significantly predict OCD symptom
severity at discharge.
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