Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder

In this study we examined the convergence between obsessive-compulsive personality disorder (OCPD) criteria and obsessive-compulsive disorder (OCD). Baseline assessments of 629 participants of the Collaborative Longitudinal Personality Disorders Study were used to examine the associations between OCPD criteria and diagnoses of OCD. Three of the eight OCPD criteria--hoarding, perfectionism, and preoccupation with details--were significantly more frequent in subjects with OCD (n = 89) than in subjects without OCD (n = 540). Logistic regressions were used to predict the probability of each OCPD criterion as a function of Axis I diagnoses (OCD, additional anxiety disorders, and major depressive disorder). Associations between OCD and these three OCPD criteria remained significant in the logistic regressions, showing unique associations with OCD and odds ratios ranging from 2.71 to 2.99. In addition, other anxiety disorders and major depressive disorder showed few associations with specific OCPD criteria. This study suggests variability in the strength of the relationships between specific OCPD criteria and OCD. The findings also support a unique relationship between OCPD symptoms and OCD, compared to other anxiety disorders or major depression. Future efforts to explore the link between Axis I and Axis II disorders may be enriched by conducting analyses at the symptom level.     

Is thought-action fusion specific to obsessive-compulsive disorder?: a mediating role of negative affect

Thought-action fusion (TAF) is a cognitive bias presumed to underlie the development of obsessional problems (i.e. obsessive-compulsive disorder; OCD). Previous studies have found that TAF is related to not only OCD, but also to other anxiety disorders. In the present study we compared levels of TAF in OCD patients and in patients with other anxiety disorders, depression, and healthy controls to examine whether TAF is characteristic of individuals with emotional distress in general, as opposed to anxiety disorders per se. We also examined whether negative affect (i.e. anxiety and depression) mediates the relationship between OCD and TAF. Results indicated that OCD patients were characterized by higher scores on likelihood-self and likelihood-other TAF, but that this difference was predominately due to differences in negative affect. These findings support a model in which negative affect mediates the relationship between OCD and TAF.     

The hoarding dimension of OCD: psychological comorbidity and the five-factor personality model

Although hoarding has been associated with several psychological disorders, it is most frequently linked to obsessive-compulsive disorder (OCD). The present study assessed hoarding obsessions and compulsions in 204 individuals with OCD, and evaluated how hoarding was related to obsessive-compulsive symptom severity, psychological comorbidity, and personality as measured by the five-factor model. Results indicated that hoarding in OCD is a dimensional variable that is positively associated with dysphoria, total number of lifetime Axis I disorders, and lifetime histories of bipolar I, PTSD, and body dysmorphic disorder. Hoarding was negatively correlated with the NEO-Personality Inventory-Revised (NEO-PI-R) factor of Conscientiousness and positively associated with the NEO-PI-R factor of Neuroticism. When all personality and psychopathology variables were entered into a regression equation, dysphoria, bipolar II disorder, Conscientiousness, age, and Extraversion emerged as significant predictors of hoarding severity. Recommendations are made for clinicians and for future research.     

Does obsessive-compulsive personality disorder belong within the obsessive-compulsive spectrum?

It has been proposed that certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders share overlapping clinical features, genetic contributions, and treatment response and fall within an "obsessive-compulsive" spectrum. Obsessive-compulsive personality disorder (OCPD) resembles obsessive-compulsive disorder (OCD) and other spectrum disorders in terms of phenomenology, comorbidity, neurocognition, and treatment response. This article critically examines the nosological profile of OCPD with special reference to OCD and related disorders. By viewing OCPD as a candidate member of the obsessive-compulsive spectrum, we gain a fresh approach to understanding its neurobiology, etiology, and potential treatments.     

Social phobia: Axis I and II correlates

The presence of Axis I and Axis II disorders in 71 social phobic patients was examined. Generalized anxiety disorder was the most common secondary Axis I disorder, followed by simple phobia. Avoidant personality disorder and obsessive-compulsive personality disorder were the most common Axis II diagnoses, and 88% of the sample exhibited features of these 2 personality styles. Subjects with additional Axis I diagnoses were more anxious and depressed than those with no additional Axis I disorder. Social phobics with additional Axis II disorders were more depressed but not more anxious than those with no Axis II diagnosis. Furthermore, those with an additional Axis I disorder had higher scores on measures of neuroticism, interpersonal sensitivity, and agoraphobia. The prevalence and impact of additional Axis I and II disorders on the etiology, maintenance, and treatment outcome for persons with social phobia are discussed.     

Time-Varying and Time-Invariant Dimensions in Intolerance of Uncertainty: Specificity in the Prediction of Obsessive-Compulsive Symptoms

Intolerance of uncertainty (IU) is the tendency to respond negatively toward uncertain situations. IU consists of a Prospective factor (desire for predictability) and an Inhibitory factor (uncertainty paralysis) and is central to theoretical approaches to obsessive-compulsive disorder (OCD). However, time-invariant (TI) and time-varying (TV) components of IU and their association with OCD symptoms are not yet understood. The present study examined the association between TI and TV components of IU and OCD symptoms in community adults (N = 1,280) over a 5-month period. Latent variable models were fit to the data to examine the relative impact of TI and TV components of IU on OCD symptoms. As a test of specificity, models examining the association between TI and TV components of IU and depressive symptoms were also examined. The results showed that IU consists of significant TI and TV components, although the TI component accounted for most of the variance (76–84%) and was more strongly associated with OCD and depressive symptoms than the TV component. Furthermore, the TI component of IU was strongly associated with OCD symptoms when controlling for depressive symptoms, and the TI component of IU was strongly associated with depressive symptoms when controlling for OCD symptoms. A consistent pattern was observed for both Prospective and Inhibitory IU factors, with stable TI components demonstrating stronger relations with OCD and depressive symptoms than TV components. These findings have implications for conceptualizing the TI component of IU as a risk for OCD and other emotional disorders.     

Onset of obsessive-compulsive disorder: premorbid conditions and prodromal phase

This article focuses on the clinical onset of obsessive-compulsive disorder (OCD), specifically addressing the age of onset, gradual and acute onset, and whether there are some types of premorbid conditions or a prodromal phase that predispose individuals to the onset of OCD. Clinical and epidemiological studies have come to different conclusions regarding age at onset as well as regarding differences between the sexes. Data gleaned from research to date have demonstrated a relationship between OCD and obsessive-compulsive personality disorder (OCPD), although OCPD does not appear to be the more prevalent personality disorder among patients with OCD. Preliminary research has suggested that Axis I disorders may predispose individuals to OCD onset; however, the significance of this relationship remains to be clarified. Evidence of the association between OCD and subthreshold obsessive-compulsive syndrome suggests that these disorders lie on a continuum of severity, with some cases developing OCD while others do not.     

The status of hoarding as a symptom of obsessive-compulsive disorder

Hoarding is considered by many to be a symptom of obsessive-compulsive disorder (OCD). Yet although it is observed in people with OCD, hoarding symptoms also appear in a number of other psychological and psychiatric conditions. The present studies were conducted using samples of OCD patients, patients with other anxiety disorders, and a non-clinical sample to further elucidate the relationship between hoarding and OCD. Across two investigations, we found that (a) whereas OCD patients had higher scores than the other groups on non-hoarding symptoms, this was not the case for hoarding symptoms; (b) hoarding tended to correlate more weakly with other OCD symptoms (e.g., washing, checking) than these other symptoms intercorrelated; (c) items measuring hoarding had the weakest factor loadings when a measure of OCD symptoms was submitted to factor analysis; (d) hoarding symptoms were not correlated with global OCD or anxiety severity, whereas other OCD symptoms were; and (e) hoarding did not show consistent relationships with OCD-related cognitive variables. These results do not support a specific relationship between hoarding and OCD; and they call into question hoarding's status as a specific symptom of OCD. Results are also discussed in terms of the importance of functional assessment of hoarding and OCD symptoms.     

Are "obsessive" beliefs specific to OCD?: a comparison across anxiety disorders

Cognitive models of obsessive-compulsive disorder (OCD) assign a central role to maladaptive beliefs about threat, uncertainty, importance and control of thoughts, responsibility, and perfection. Previous research has demonstrated that such beliefs relate to specific OCD symptoms in a theoretically meaningful way. The aim of the present study was to determine whether these beliefs are endorsed more strongly by OCD patients than by those with other anxiety disorders. Eighty-nine adult OCD patients, 72 anxious control (AC) patients, and 33 nonclinical control (NCC) participants completed a measure of obsessive beliefs as well as measures of depression and trait anxiety. Compared to NCCs and ACs, OCD patients more strongly endorsed beliefs related to threat estimation, tolerance of uncertainty, importance and control of thoughts, and perfectionism, but not inflated responsibility. Using revised, condensed subscales, OCD patients differed from ACs on beliefs about perfectionism and certainty and about importance and control of thoughts, but not on beliefs about threat estimation and inflated responsibility. When controlling for depression and trait anxiety, the OCD and AC group did not differ on most belief domains, except for a belief that it is possible and necessary to control one's thoughts. Results are discussed in light of evolving cognitive-behavioral theories that highlight appraisals of thought control and the use and effectiveness of varying thought control strategies.     

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.     

Obsessive-compulsive disorder: boundary issues

The boundaries between obsessive-compulsive disorder (OCD) and other neuropsychiatric disorders remain unresolved and may well differ from one disorder to another. Endophenotypes are heritable, quantitative traits hypothesized to more closely represent genetic risk for complex polygenic mental disorders than overt symptoms and behaviors. They may have a role in identifying how closely these disorders are associated with another and with other mental disorders with which they share major comorbidity. This review maps the nosological relationships of OCD to other neuropsychiatric disorders, using OCD as the prototype disorder and endophenotype markers, such as cognitive, imaging, and molecular data as well as results from demographic, comorbidity, family, and treatment studies. Despite high comorbidity rates, emerging evidence suggests substantial endophenotypic differences between OCD and anxiety disorders, depression, schizophrenia, and addictions, though comparative data is lacking and the picture is far from clear. On the other hand, strong relationships between OCD, Tourette syndrome, body dysmorphic disorder, hypochondriasis, grooming disorders, obsessive-compulsive personality disorder, and pediatric autoimmune neuropsychiatric disorders associated with streptococcus are likely. Studies designed to delineate the cause, consequences, and common factors are a challenging but essential goal for future research in this area.     

Content difference between normal and abnormal obsessions

Although it has long been thought that experiencing an obsession is a psychiatric symptom, more recent literature, has seen the normalisation of obsessions and other presumably clinical phenomena. That is, not only people suffering from psychiatric disorders experience obsessions but non-clinical individuals also do so. Furthermore, it has been argued that such normal obsessions are very similar to abnormal ones, in terms of content. However, in the present study, evidence was obtained indicating that normal and abnormal obsessions do differ in content. A sample of 133 healthy undergraduates was given a list of 70 obsessions, with some originating from obsessive-compulsive disorder (OCD) patients, and others stemming from healthy volunteers. Participants were asked to indicate whether they had ever experienced these obsessions. Participants endorsed significantly more normal than abnormal obsessions, suggesting that the two kinds of obsessions do differ from each other. In addition, the experience of clinical obsessions was more strongly associated with scores on a measure of OCD symptoms, than was the experience of normal obsessions.     

Emotional risk factors and postconcussional disorder

Emotional risk factors were examined in 129 litigant and nonlitigant patients diagnosed with Postconcussional Disorder (PCD) following Mild Traumatic Brain Injury (MTBI). According to Millon Clinical Multiaxial Inventory (MCMI) criteria, four subgroups emerged: (a) 14.7% met criteria for an Axis I disorder, (b) 24.8% for an Axis II disorder, (c) 24.0% for bout Axis I and II disorders, and (d) 36.4% fell below threshold for psychopathology. Thus, 63.5% endorsed emotional pathology. Of the four groups, those with both Axis I and II psychopathology presented the greatest number of emotional complaints in a clinical interview and manifested the lowest neurocognitive test scores. Motor skills, verbal abilities, memory functioning, and IQ were primarily affected. With the exception of post-morbid emotional complaints, no significant differences were identified between litigants and nonlitigants. Our analysis suggests that the combination of both Axis I and II psychopathology is associated with greater impairment following MTBI.     

Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study

OBJECTIVE: To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample.MethodA cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS: The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n = 236), with 8.9% (n = 72) presenting Tourette syndrome, 17.3% (n = 141) chronic motor tic disorder, and 2.8% (n = 23) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD + TD group. Compared to OCD patients without comorbid TD, those with TD (OCD + TD group, n = 236) were more likely to be males (49.2% vs. 38.5%, p < .005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the "aggressive," "sexual/religious," and "hoarding" symptom dimensions were more severe in the OCD + TD group.ConclusionTic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.     

Do patients with OCD and pathological gambling have similar dysfunctional cognitions?

The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models.     

Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.     

The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder

This is the first study that explores whether early maladaptive schemas are related to treatment outcome for patients with obsessive-compulsive disorder (OCD). The sample consisted of 88 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory and Young Schema Questionnaire – Short Form were administered before and after treatment. Regression analyses using post-treatment Y-BOCS as the dependent variable indicated that higher scores on the abandonment schema at pre-treatment were related to poor outcome and explained 7% of the variance in symptoms at post-treatment. Higher scores on the self-sacrifice schema at pre-treatment were related to good outcome and explained 6% of the variance in obsessive-compulsive symptoms at post-treatment. During treatment, only changes in the failure schema were significantly related to good outcome and explained 18% of the variance in symptoms at post-treatment.     

Disgust vulnerability and symptoms of contamination-based OCD: descriptive tests of incremental specificity

The present investigation examines the incremental association between disgust propensity and sensitivity and contamination-based obsessive-compulsive disorder (OCD) symptoms. Structural equation modeling in Study 1 indicated that general disgust was related to contamination fear even when controlling for negative affect in a nonclinical sample. Evidence was also found for a model in which the effect of negative affect on contamination fear is mediated by general disgust. Study 1 also showed that both disgust sensitivity and disgust propensity uniquely predicted contamination fear when controlling for negative affect. Growth curve analyses in Study 2 indicated that higher baseline contamination fear is associated with less reduction in contamination fear over a 6-week period as disgust sensitivity increases even when controlling for negative affect. Lastly, disgust propensity was associated with concurrent levels of excessive washing symptoms among patients with OCD in Study 3 when controlling for depression. Implications of these findings from nonclinical, analogue, and clinical samples for future research on the specificity of disgust-related vulnerabilities in the etiology of contamination concerns in OCD are discussed.     

Obsessive-compulsive spectrum disorders: cross-national and ethnic issues

Epidemiological and clinical data from a variety of cultural and geographic settings on obsessive-compulsive disorder (OCD), and many of the obsessive-compulsive spectrum disorders, suggest that this is a group of disorders with a good degree of transcultural homogeneity. However, the content and themes that predominate in patients with these disorders, and the course of illness, can be shaped by cultural, ethnic, and religious experiences. Across cultures, OCD is commonly comorbid with mood, anxiety, and impulse-control disorders. However, little is known about the mechanisms by which culture and ethnicity may affect the expression of OCD and related disorders. Cross-national comparative studies exploring culturally influenced differences in clinical course, treatment outcome, including ethnogenetic differences in drug response, and prognosis are needed.     

Thought-action fusion and anxiety disorders symptoms in normal adolescents.

The present study examined thought-action fusion (TAF) in a large sample of normal adolescents (n=427). Participants completed the Thought-Action Fusion Questionnaire for Adolescents (TAFQ-A) and scales measuring trait anxiety, symptoms of obsessive-compulsive disorder, other anxiety disorders, and depression. Results showed that the TAFQ-A is a reliable instrument assessing two dimensions of TAF, viz. Morality (i.e., the belief that unacceptable thoughts are morally equivalent to overt actions) and Likelihood (i.e., the belief that thinking of an unacceptable or disturbing situation will increase the probability that that situation actually occurs). Furthermore, TAF was not only associated with symptoms of OCD, but also with symptoms of other anxiety disorders and depression. However, when controlling for levels of trait anxiety, most connections between TAF and anxiety disorders symptoms disappeared. Symptoms of OCD and generalised anxiety remained significantly related to TAF. Altogether, the data are supportive of the notion that TAF is involved in a broad range of anxiety disorders and in particular OCD.