St. Catherine University SOPHIA Master of Social Work Clinical Research Papers School of Social Work 5-2016 Anorexia Nervosa and Obsessive-Compulsive Tendencies: A systematic Review of the Literature Janice Loscheider St. Catherine University, [email protected] Follow this and additional works at: https://sophia.stkate.edu/msw_papers Part of the Social Work Commons Recommended Citation Loscheider, Janice. (2016). Anorexia Nervosa and Obsessive-Compulsive Tendencies: A systematic Review of the Literature. Retrieved from Sophia, the St. Catherine University repository website: https://sophia.stkate.edu/msw_papers/629 This Clinical research paper is brought to you for free and open access by the School of Social Work at SOPHIA. It has been accepted for inclusion in Master of Social Work Clinical Research Papers by an authorized administrator of SOPHIA. For more information, please contact [email protected]. Running Head: ANOREXIA NERVOSA AND OCD 1 Anorexia Nervosa and Obsessive-Compulsive Tendencies: A systematic Review of the Literature Janice M. Loscheider M.S.W Clinical Research Paper Presented to the Faculty of the School of Social Work St. Catherine University and the University of St. Thomas St. Paul, Minnesota In partial fulfillment of the requirements for the degree of Master of Social Work Committee Members Lance Peterson, Ph.D., (Chair) Jane Hurley Johncox, MSW, LICSW, LCSW Rebecca Neeck, LICSW The Clinical Research Project is a graduation requirement for MSW students at St. Catherine University/University of St. Thomas School of Social Work in St. Paul, Minnesota and is conducted within a nine-month time frame to demonstrate facility with basic social research methods. Students must independently conceptualize a research problem, formulate a research design that is approved by a research committee and the university Institutional Review Board, implement the project, and publically present the findings of the study. This project is neither a Master’s thesis nor a dissertation. Running Head: ANOREXIA AND OCD 2 Abstract Successful treatment methods for adult sufferers of anorexia nervosa (AN) have still not been supported by research. Recently, many authors have suggested that research into shared traits involving obsessive-compulsive tendencies might contribute to improved theory based on etiology of the illness. The purpose of this systematic literature review is to bring the multitude of studies focusing on the shared underlying traits and the apparent overlap of disorders like obsessive-compulsive disorder, obsessive-compulsive personality disorder, and AN together in a way that truly speaks to improved treatment methods. First, findings include a potential predisposition, or common cause relationship between personality factors like perfectionism, high harm avoidance, high persistence, low novelty-seeking, and low cooperativeness to both OCPD and AN especially among individuals with the restricting subtype. In this case, a new treatment method called radically open-dialectical behavior therapy, which speaks to the common underlying factors of both OCPD and anorexia nervosa, may improve treatment. Secondly, findings show the co-occurrence rates of OCD and AN to be far ranging at 10%-60%, while still showing more co-occurrence than could be explained by chance. Family studies also support a common cause model due to the fact that obsessive-compulsive disorders are more likely to occur in relatives of eating disorder probands. In this case, when true obsessionality and compulsivity is suspected, a new treatment method using a modified obsessive-compulsive spectrum disorder model will inform treatment. Running Head: ANOREXIA AND OCD 3 Table of Contents Introduction......................................................................................................................................5 Literature Review.............................................................................................................................7 Conceptual Framework..................................................................................................................16 Methodology..................................................................................................................................18 Data Abstraction and Analysis...........................................................................................20 Findings..........................................................................................................................................22 Obsessive Compulsive Tendencies....................................................................................22 OCD.......................................................................................................................22 Obsessive-Compulsive Behaviors.........................................................................22 OCPD.....................................................................................................................23 Temperament and Personality Traits.................................................................................24 Perfectionism.........................................................................................................24 The Temperament and Character Inventory..........................................................26 Discussion......................................................................................................................................30 Treatment Implications and Summary...............................................................................30 Transdiagnostic Theory......................................................................................................21 Radically Open-Dialectical Behavior Therapy..................................................................32 A Modified Obsessive-Compulsive Spectrum Disorder Model........................................36 Limitations.........................................................................................................................38 Implications for Future Research.......................................................................................39 References......................................................................................................................................41 Running Head: ANOREXIA AND OCD 4 Acknowledgements I would like to give a special thank-you to my chair, Dr. Lance Peterson for his patience and for being so committed to his students. Right from the very beginning, His flexibility and positive attitude gave me the confidence to do the project that I really wanted to do, even if I couldn’t quite imagine how it was going to come together at that point. Throughout this process, he shared his own inspiring combination of expertise and thoughtful advice and encouragement. I would also like to thank Jane Hurley Johncox for being so inspirational and supportive, for taking time out of her busy schedule to help me, and for believing in me. I would also like to thank Rebecca Neeck for sharing her valuable time to be on my committee and for sharing her opinions and her encouragement. Finally, my family, especially my daughter Vanessa deserves my deepest gratitude. I have so appreciated your ongoing patience, support and understanding as my schedule has often made me less available than I would have liked to be. I am so blessed to have so many who have encouraged me on my academic journey. Running Head: ANOREXIA AND OCD 5 Anorexia Nervosa and Obsessive-Compulsive Disorder: A systematic Review of the Literature The National Association of Anorexia Nervosa and Related Disorders (n.d.) estimates that at least 30 million Americans suffer from eating disorders. However, it is hard to track the prevalence of eating disorders. They are both under-reported and under-treated. In one study funded by the National Institute of Mental Health (2011) it was found that approximately three percent of U.S. adolescents are affected by an eating disorder but the majority do not receive treatment for their eating related condition (Swanson, 2011). Eating disorders are a serious mental illness with the highest mortality rate of any mental illness (“ANAD,” n.d.; Smink, Hoeken, & Hoek, 2012). Increased mortality rates exist across eating disorder diagnosis, even those once thought to be less severe. Death is most commonly due to medical complications associated with the disorder or from suicide (American Psychiatric Association, 2013). Crow et al. (2009) found mortality rates for anorexia nervosa (AN) to be 4.0%; in addition they found rates for bulimia nervosa (BN) and other specified feeding or eating disorder (OSFED) to be at 3.9% and 5.2% respectively. The DSM-5 reports the crude mortality rate for anorexia nervosa to be approximately 5% per decade (American Psychiatric Association, 2013). Most frequently, treatment like cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT) are used to treat eating disorders across individual diagnoses. Unfortunately many still fail to recover (Wilson, Grilo, & Vitousek, 2007). Anorexia nervosa (AN) is arguably one of the most difficult eating disorders to research with any efficacy due to small research samples, the wide variety of often unempirical treatment methods used in studies, and the large drop-out rates among research subjects (Agras et al., 2004; Steinhausen, 2002; Wilson et. al., 2007). In spite of these challenges, Stienhausen (2002) compiled results from Running Head: