[Definition of treatment-refractory obsessive-compulsive disorder based on cognitive behavioral therapy]

Several lines of evidence have shown that cognitive behavioral therapy (CBT) is more effective than pharmacotherapy for people with obsessive-compulsive disorder (OCD). Not only pharmacotherapy-resistant but also CBT-resistant OCD should be defined. After reviewing previous studies, patients with treatment-refractory OCD may be required to show severe symptoms with a score of at least 28 on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) even after therapy, and have at least a 5-year history of OCD. I propose CBT-RESISTANT OCD as a term to describe cases of OCD that do not respond to adequate standard CBT of at least 30 hours. Moreover, CBT-REFRACTORY OCD can only be determined if a person has tried intensive CBT (including exposure and ritual prevention for 4 weeks, followed by eight weekly maintenance session) of at least 40 hours after standard CBT.