Treating incompleteness in obsessive-compulsive disorder: A meta-analytic review

Incompleteness (INC) is a prevalent, impairing subtype of obsessive-compulsive disorder (OCD) in which rituals are performed to counteract "not just right" sensations. Although individuals with INC may be most in need of treatment, conventional OCD interventions emphasize harm avoidance (HA) over INC, contributing to the pervasive assumption that INC is treatment resistant. However, this assumption has not been adequately tested. This paper presents the first meta-analytic investigation of the efficacy of OCD treatments for INC. Thirteen eligible treatments representing 11 papers and 530 participants were identified through Psyclnfo and MEDLINE. There was no evidence of publication bias or outliers, and heterogeneity of effect sizes across studies was low-to moderate. Both uncontrolled (g = 0.57; n = 13 treatments) and controlled (g = 0.44; n = 4 treatments) meta analyses estimated INC to improve significantly but modestly over treatment. An exploratory meta-analysis synthesizing three studies that measured both HA and INC found that INC and HA improvement did not significantly differ (g = 0.04). Moderator analyses revealed that tailoring treatments to INC and using the Obsessive-Compulsive Core Dimensions Questionnaire to measure INC were associated with significantly greater INC improvement. Results suggest that current treatments, unless explicitly tailored to INC, insufficiently target INC symptoms, and highlight the importance of increasing clinicians' awareness of INC.