Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.     

Interpersonal Functioning in Obsessive–Compulsive Personality Disorder

The core symptoms of obsessive–compulsive personality disorder (OCPD) often lead to interpersonal difficulties. However, little research has explored interpersonal functioning in OCPD. This study examined interpersonal problems, interpersonal sensitivities, empathy, and systemizing, the drive to analyze and derive underlying rules for systems, in a sample of 25 OCPD individuals, 25 individuals with comorbid OCPD and obsessive–compulsive disorder (OCD), and 25 healthy controls. We found that OCPD individuals reported hostile-dominant interpersonal problems and sensitivities with warm-dominant behavior by others, whereas OCPD+OCD individuals reported submissive interpersonal problems and sensitivities with warm-submissive behavior by others. Individuals with OCPD, with and without OCD, reported less empathic perspective taking relative to healthy controls. Finally, we found that OCPD males reported a higher drive to analyze and derive rules for systems than OCPD females. Overall, results suggest that there are interpersonal deficits associated with OCPD and the clinical implications of these deficits are discussed.     

Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30–40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.     

Visual Motor Behavior Rehearsal. The Basic Technique

The past decade has witnessed a significant shift toward a more cognitive emphasis in our understanding and treatment of obsessive‐compulsive disorders (OCD). This article discusses the shortcomings in more standard behavioral treatment of OCD, which despite its demonstrated efficacy, led to the recent cognitive‐behavioral approaches to the disorder. Current cognitive behavior therapy for OCD is described and a short critical review of the comparative treatment outcome literature on cognitive behavior therapy vs exposure and response prevention is provided. The article concludes that although the clinical utility of a more cognitive approach to OCD has not been consistently demonstrated, it would be premature to abandon cognitive formulations until some key research questions have been addressed.     

Pointing and the interference effect in obsessive‐compulsive disorder (OCD)

The interference effect in obsessive‐compulsive disorder (OCD) was investigated in order to analyze cognitive aspects of motor stereotypy in OCD‐related compulsions. So far, the domain of cognitive control in compulsive behavior has been under‐investigated. Twelve participants (OCD patients and healthy controls) completed a newly created computer‐based pointing task as well as standard clinical and psychological background measures. Findings showed that the patients displayed a larger visual interference effect compared to the controls and pointing paths were longer in time as well as distance when a distractor stimulus was present. It is concluded that, for compensation, patients would need to generate excessive amounts of attentional resources not available to overcome motor rigidity on the one side and visual distraction on the other side.     

Of mice and marbles: Novel perspectives on burying behavior as a screening test for psychiatric illness

Burying forms part of the normal behavioral routine of rodents, although its expression is species-specific. However, it has been suggested that aberrant burying behavior, of which marble-burying (MB) is an example, may represent neophobic and/or compulsive-like behavior. In the present investigation, we assessed MB in an established animal model of obsessive–compulsive disorder (OCD)—namely, spontaneous stereotypy in the deer mouse—to establish whether high (H) stereotypy is associated with neophobia and/or another compulsive endophenotype, i.e. MB, as compared to nonstereotypical (N) controls. A three-trial, one-zone MB test was performed over three consecutive evenings both before and after chronic treatment with high-dose (50 mg/kg/day) oral escitalopram. Neophobia was measured via the number of marbles buried during the first pre- and posttreatment MB trials, and compulsive-like behavior via the number of marbles buried over all pre- and posttreatment MB trials. The data from the present study support earlier findings that burying is a normal behavioral routine (inherent burying behavior, IBB) that is expressed by all deer mice, irrespective of stereotypical cohort, and is not associated with either neophobia or compulsiveness. Indeed, chronic escitalopram treatment, which is similarly effective in treating clinical anxiety and OCD, as well as in attenuating H behavior, failed to influence IBB. Although 11 % of the animals presented with a unique burying endophenotype (high burying behavior), escitalopram also failed to attenuate said behavior, necessitating further investigation as to its relevance. In conclusion, MB cannot be regarded as a measure of anxiety-like or compulsive behavior in the deer mouse model of OCD.     

Addressing Barriers to Change in the Treatment of Childhood Obsessive Compulsive Disorder

Although considerable evidence supports the use of cognitive behavior therapy (CBT) for the treatment of childhood obsessive compulsive disorder, large numbers of youth fail to respond and clinical remission is often elusive. Poor family functioning frequently is implicated as an obstacle for youth undergoing CBT, with features such as symptom accommodation, family conflict, and blame known to attenuate outcomes. These features are common in child and adolescent obsessive compulsive disorder (OCD) and they may pose particular challenges for exposure-based treatments. Nonetheless, interventions that focus specifically on family functioning have, to date, been limited. This paper reviews the literature on family features associated with childhood OCD and discusses their links to treatment outcome. It then describes the development of a brief family intervention tailored to address the needs of highly distressed families of youth with OCD in the service of improving individual child CBT outcomes. Preliminary pilot data are presented and clinical implications are discussed.     

Effects of DRL and DRL combined with response cost on perseverative verbal behavior of an adult with mental retardation and obsessive compulsive disorder

Although there has been increased interest in the identification and diagnosis of obsessive compulsive disorder (OCD) in people who have developmental disabilities, clinical research has been reported infrequently. The present single‐case study evaluated the effects from systematic behavioral intervention with a 26‐year‐old man who had moderate mental retardation, OCD, and exhibited perseverative verbalizations. Verbalizations were reduced when the man gained access to preferred activities contingent upon a low response frequency (DRL: differential reinforcement of low‐rate responding). The behavior was reduced further when a DRL contingency was implemented in the form of a response cost procedure. The implications of these findings for the treatment of OCD in people with developmental disabilities are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Assessing the Role of the Self‐Concept on the Destructive Impact of Obsessive–Compulsive Disorder in Managers

Managers can have personal afflictions that may interfere with their role as managers in an organization. One of these maladies is obsessive‐compulsive disorder (OCD), a condition frequently identified with excessive patterns of seemingly unnecessary behavior. OCD compels individuals to seek “perfection” in the accomplishment of primarily routine tasks. This overt routine of behaviors distracts individuals from accomplishing their goals and those they manage. This paper examines the role of self‐concept as being central in identifying and understanding the characteristics of the behavioral disorder OCD and how to modify the self‐concept to prevent disruption in the workplace. In addition, the paper explores how to measure OCD and the impact of maladies on peers, subordinates, and superiors in the organization. I've learned . . . that we should be glad God doesn't give us everything we pray for. —My father     

Moving beyond an exclusive focus on harm avoidance in obsessive compulsive disorder: considering the role of incompleteness

Cognitive-behavioral conceptualizations of obsessive compulsive disorder (OCD) have predominantly viewed compulsions as being motivated by harm avoidance. However, sensations of things being incomplete or not "just right" may also underlie compulsions in OCD. Preliminary research suggests that distinguishing between harm avoidance and incompleteness in OCD may have practical utility, but the research on this topic is very limited to date. The current study further addressed the role of incompleteness in OCD. A confirmatory factor analysis provided evidence for harm avoidance and incompleteness as separate constructs in a student sample. Supporting the benefits of considering incompleteness in addition to harm avoidance, self-reported levels of both constructs were significantly correlated with all domains of OCD symptoms and perfectionism assessed. Further, some evidence for unique relationships was found (e.g., incompleteness with ordering and personally prescribed perfectionism; harm avoidance with obsessing). The role of incompleteness in OCD warrants greater attention.     

Inferential confusion in obsessive-compulsive disorder: the inferential confusion questionnaire

The current article represents the further validation of the construct of inferential confusion amongst clinical samples. Inferential confusion is proposed to be a meta-cognitive confusion particularly relevant to obsessive compulsive disorder (OCD) that leads a person to confuse an imagined possibility with an actual probability. As such, it conceptualizes OCD as a form of belief disorder similar to a delusion or overvalued idea that is a product of distorted reasoning processes. In contrast, other cognitive models of OCD emphasize a phobic model of development in OCD, and thus consider the exaggerated interpretation of intrusions as an essential element in OCD. The present study administered a revised version of the Inferential Confusion Questionnaire, and the Obsessive Belief Questionnaire (OBQ), to a total of 183 participants in three clinical groups and a non-clinical control group. Results suggest that OCD, at least in part, follows a non-phobic model of development with inferential confusion significantly related to obsessive-compulsive symptoms independently of cognitive domains as measured by the OBQ, and mood states. Further, scores on inferential confusion were particularly high in those with OCD and delusional disorder as compared to anxious and non-clinical controls.     

Combining Pharmacotherapy with cognitive-behavioral interventions for obsessive-compulsive disorder

This paper reviews the evidence-based literature concerning the efficacy and effectiveness of cognitive behavior therapy (CBT), drug treatment and their combination for obsessive compulsive disorder (OCD). After a brief outline of the seminal studies, the state of the art is presented with reference to the consensual recommendations proposed in the last 10 years. Management of OCD rests on potent selective serotonin reuptake inhibitors and CBT, used separately, sequentially, or concurrently. A hierarchical model for clinical decision-making is reported. With greater severity of OCD, it is recommended to add medications. However, the response rate is still too low in many patients, and some patients remain refractory to any kind of treatment. This stresses the importance of joint efforts of psychological and biological teams to develop new treatments.     

Combining Pharmacotherapy with Cognitive‐Behavioral Interventions for Obsessive‐Compulsive Disorder

This paper reviews the evidence‐based literature concerning the efficacy and effectiveness of cognitive behavior therapy (CBT), drug treatment and their combination for obsessive‐compulsive disorder (OCD). After a brief outline of the seminal studies, the state of the art is presented with reference to the consensual recommendations proposed in the last 10 years. Management of OCD rests on potent selective serotonin re‐uptake inhibitors and CBT, used separately, sequentially, or concurrently. A hierarchical model for clinical decision‐making is reported. With greater severity of OCD, it is recommended to add medications. However, the response rate is still too low in many patients, and some patients remain refractory to any kind of treatment. This stresses the importance of joint efforts of psychological and biological teams to develop new treatments.     

Systemic blockade of D2-like dopamine receptors facilitates extinction of conditioned fear in mice

Extinction of conditioned fear in animals is the explicit model of behavior therapy for human anxiety disorders, including panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Based on previous data indicating that fear extinction in rats is blocked by quinpirole, an agonist of dopamine D2 receptors, we hypothesized that blockade of D2 receptors might facilitate extinction in mice, while agonists should block extinction, as they do in rats. One day after fear conditioning mice with three pairings of a white noise conditional stimulus (CS) with moderate footshock, we injected the D2 antagonist, sulpiride, the D2 agonist, quinpirole, or vehicle, just before repeated CS presentations to generate extinction. We assayed fear by measuring behavioral freezing during extinction presentations and then drug-free during CS presentations 1 d later. We found that sulpiride injections before extinction training facilitated extinction memory 24 h later, while quinpirole partially blocked extinction memory compared with vehicle-injected controls. Notably, sulpiride treatment yielded significant extinction after spaced CS presentations, which yield no extinction at all in vehicle-treated mice. These findings suggest that dopamine D2-mediated signaling contributes physiological inhibition of extinction, and that D2 antagonists may be useful adjuncts to behavior therapy of human anxiety disorders.     

Successful and Unsuccessful Treatment of Obsessive-Compulsive Disorder in Older Adults

Obsessive compulsive disorder (OCD) is a condition that was once thought to rarely occur in older adults. Subsequently, treatment of OCD in the elderly has received very limited attention. However, recent epidemiological studies have highlighted the prevalence of this disorder in late life and, thus, focus has turned to comprehensive treatment for this population. This article describes two older adults who received intensive, cognitive behavioral treatment in an inpatient setting. Treatment modifications incorporating age-specific concerns are discussed, as are potential factors influencing treatment success versus symptom relapse.     

Separating hoarding from OCD

There is confusion about the status of excessive hoarding. In particular, there is an unresolved question about whether or not it is a manifestation of obsessive-compulsive disorder (OCD). There are some definite similarities between ‘compulsive’ hoarding and OCD, but they are outweighed by the differences between them. It is proposed that the matter can be clarified by separating hoarding from OCD, and that this would advance clinical work and research.     

Relationships between anger, symptoms, and cognitive factors in OCD checkers

The purpose of this study was to examine whether individuals diagnosed with obsessive-compulsive disorder (OCD) with primary checking compulsions report higher levels of trait anger and anger expression compared with a student control group, and whether trait anger and anger expression are correlated with specific beliefs and interpretations that are common among individuals who compulsively check. A group of individuals with OCD reporting significant checking compulsions (n=33) and a group of undergraduate students (n=143) completed a questionnaire package that included measures of trait anger and anger expression, as well as measures of obsessive-compulsive symptoms and beliefs. The compulsive checking group reported greater trait anger, though not greater anger expression, than the student control group. Furthermore, beliefs concerning perfectionism and intolerance of uncertainty were positively correlated with anger expression and trait anger among compulsive checkers but not among the student control group. The implications of these findings are discussed in terms of cognitive-behavioural treatments for and models of compulsive checking in OCD.     

Illusion of control and behavioral control attempts in obsessive-compulsive disorder

The present research used the illusion-of-control paradigm to examine the relationships among obsessive-compulsive disorder (OCD) symptoms, behavioral control attempts, and illusory sense of control. Participants were presented with a preprogrammed sequence of aversive and neutral visual stimuli and were encouraged to attempt to control the sequence with keyboard presses. Participants rated their perceived level of control 3 times during the task. In addition, the authors used the repetitiveness of keyboard presses as a measure of rigid, compulsive-like behavior. In Study 1, this procedure was administered to a sample of 55 students who also completed measures of OCD and depression. In Study 2, the task was administered to 22 participants with OCD and 22 matched participants without OCD. In line with predictions, OCD symptoms were correlated with higher illusory sense of control and with more repetitive behavioral control attempts. The authors discuss the central role of control in OCD and specifically the relationships between need for control and compulsive rituals, which may be conceptualized as means for achieving an illusory sense of control over stressful life events.     

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.     

Clinical Feedback About Empirically Supported Treatments for Obsessive‐Compulsive Disorder

Previous evidence for the treatment of obsessive‐compulsive disorder (OCD) has been derived principally from randomized controlled trials. As such, evidence about the treatment of OCD has unilaterally flowed from researchers to clinicians. Despite often having decades of experience treating OCD, clinicians’ feedback on their clinical observations in using these treatments has not been solicited. The current study contacted clinicians for their clinical observations on empirically supported treatments for OCD to identify commonly used cognitive-behavioral techniques and their limitations in their practices. One hundred eighty-one psychotherapists completed an online survey. The average participant practiced psychotherapy for 15 years, worked in private practice, held a doctorate, and treated an average of 25 clients with OCD in their lifetime. In regard to the most common techniques, behavioral strategies involving exposure to a feared outcome and prevention of a compulsive ritual were the most frequent group of interventions, followed by techniques that attempted to identify and challenge irrational thoughts. However, the majority of participants also reported incorporating mindfulness or acceptance-based methods. Based on therapists’ reports, the most common barriers to the efficacy of cognitive-behavioral interventions included limited premorbid functioning, chaotic lifestyles, controlling and critical families, OCD symptom severity, OCD symptom chronicity, and comorbidities. This study provides insight into common practices and limitations in clinical practice to inform future clinically relevant treatment research.