Scrupulosity and Obsessive Compulsive Disorder: The Cognitive Perspective in Islamic Sources

A moral/religious subtype of obsessive compulsive disorder has been termed as scrupulosity by mental health professionals. Since ultimate feared consequence in scrupulous individuals is religious or moral in nature, it also presents interesting and difficult issue for religious authorities. This article focuses on various aspects of scrupulosity that have until now been poorly conceptualized in Islamic world and provides a conceptual cognitive framework and analysis of scrupulosity according to Islamic sources.     

Treating Scrupulosity in Religious Individuals Using Cognitive-Behavioral Therapy

Scrupulosity, the obsessional fear of thinking or behaving immorally or against one's religious beliefs, is a form of obsessive-compulsive disorder that has been relatively understudied to date. Treating religious patients with scrupulosity raises a number of unique clinical challenges for many clinicians. For example, how does one distinguish normal beliefs from pathological scrupulosity? How does one adapt exposures to a religious patient whose fears are related to sinning? How far should one go in exposures in such cases? How and when does one include clergy in treatment? We address these issues and report a case example of the successful treatment of an ultra-Orthodox Jewish woman using the treatment principles that we recommend for religious individuals with scrupulosity.     

Obsessive-Compulsive Disorder: Current Views

Obsessive-compulsive disorder has been of central interest to psychoanalysis since Freud's early papers, most particularly in the “Rat Man” case. This early literature spelled out with great clarity the presumed development, psychodynamics, and meaning of obsessional and compulsive symptoms. Unfortunately, since Anna Freud's 1969 review of the subject, virtually nothing has appeared in the psychoanalytic literature that has added to our understanding of the disorder or enhanced the very limited therapeutic influence of psychoanalysis in such cases. Meanwhile, there has been an avalanche of contributions from biological psychiatry and behavioral psychology that have propounded different theories of pathogenesis and have laid claim to significant therapeutic effectiveness. If psychoanalysis is to have credibility in this field, it will have to enlist itself in multidisciplinary research efforts directed toward enriching our knowledge about the psychodynamics and the biological substrate of this illness (more common than once believed) and the efficacy of our efforts to treat it.     

强迫症的元认知研究:进展与趋势

该文分析了强迫症患者在现实监控、知道感、元认知信念和责任控制等方面的研究,发现缺乏对不同类型强迫症元认知差异的研究、被试选取的典型性和代表型有待提高,现实监控障碍的身心原因尚不明确、责任-控制障碍形成的机制研究不足.指出元认知干预的强迫症治疗范式、强迫症与其他精神症元认知障碍的比较、强迫症元认知的认知神经科学探索和强迫性网络使用的元认知机制等是未来研究的趋势.     

Inhibitory control in Obsessive-Compulsive Disorder

The clinical features of Obsessive-Compulsive Disorder (OCD) suggest that a fundamental deficit of inhibitory control is intrinsic to the disorder. In this preliminary study, we sought to examine cognitive disinhibition in OCD by using an established laboratory technique. The stop signal task was administered to a higher functioning, untreated group of individuals with OCD, and to healthy comparison participants. Surprisingly, the OCD participants exhibited more accurate performance, suggesting better inhibitory control on this task. This unexpected finding suggests that higher functioning individuals with OCD are capable of adequate inhibition in certain contexts. It was speculated, however, that emotional stimulation might negatively affect performance and that this might be studied in subsequent research.     

Obsessive-Compulsive Disorder in the Media

Scholars have long been concerned that mass media depictions of those with mental disorders foster stigma. Research is needed extricating how particular disorders are represented and perceived, such as obsessive-compulsive disorder (OCD). This article examines what images of obsessions and compulsions exist in the media, and how persons interpret these. It employs two methods: qualitative in-depth interviews and content analysis. Data indicate the media represents obsessions and compulsions in distinguishable ways that both reinforce and complicate common media stereotypes of those with mental disorders—fostering a stigma hierarchy and having contradictory effects on mental health literacy.     

强迫症的脑功能障碍

近期,对强迫症(OCD)的现象学解释强调了病人在特定情境下错误识别和情绪与动机功能的异常加工。来自神经解剖、神经生理以及近期神经心理和功能成像等的相关研究证据显示：OCD病人眶额皮层（OFC）、前扣带回皮层（ACC）的过度激活可能会导致错误识别功能和对行为结果预期的情绪与动机评价增高;背外侧前额皮层(DLPC)的活动减弱损害了对信息加工的认知整合能力。以上这些皮层信号在控制行为活动程序的尾状核进行整合。OCD病人的强迫性观念和行为可能由这些结构相关的神经网络中一个或多个环节的功能障碍所致     

Obsessive-Compulsive Disorder in Late Life

Although obsessive-compulsive disorder (OCD) has received increasing attention, the study and treatment of OCD in late life has been neglected. The obsessions and compulsions seen with older adults do not appear to differ from the symptoms experienced by other age groups, although developmental issues might influence symptom focus (e.g., memory functioning-related obsessions). Hoarding difficulties might be prevalent in late life, although additional studies are needed. Seniors with OCD can present with comorbid psychiatric disorders, multiple general medical problems, and impaired cognitive functioning, complicating evaluation. There have not been controlled clinical trials of cognitive-behavioral therapy (CBT) for late-life OCD, although initial reports suggest older adults respond to CBT that includes age-related treatment modifications. We illustrate the challenges to assessing and treating older adults with OCD with case examples involving memory-related obsessions and clinical hoarding. The successful strategies used for adapting CBT for the treatment of late-life generalized anxiety disorder might serve as a model for advancing the study and treatment of late-life OCD.     

Inference processes in Obsessive-Compulsive Disorder: Some clinical observations

In this paper we outline a cognitive model of Obsessive-Compulsive Disorder (OCD) which proposes that the core belief of OCD evolves through a series of illogical inferences. These faulty inference processes involve inferring the plausibility of events on the basis of irrelevant associations, dismissing actual evidence on the grounds of going beyond surface reality to a deeper reality, and finally inferring that a completely fictional narrative is a remote probability. A therapy aimed specifically at changing these inference processes is illustrated with case examples of OCD clients who had not benefited from conventional behavior therapy. The inference based approach (IBA) complements existing cognitive-behavioral therapy but suggests that in certain cases, the conventional cognitive therapy view of OCD beliefs as exaggerated fears of remote possibilities may actually reinforce the obsessional belief since even remote events are real. The IBA on the contrary suggests that an important goal in therapy is to highlight this confusion found in OCD between imagination and reality and illuminate for the OCD client how their compulsions, far from reassuring them about a remote possibility, actually take them further away from reality and reinforce their imaginary doubt.     

Attenuated Access to Emotions in Obsessive-Compulsive Disorder

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that OCD is associated with attenuated access to internal states. Here we explored the implications of this model in the realm of emotions. Participants with OCD, anxiety disorders, and nonclinical control participants completed the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), assessing two domains of emotional intelligence: Experiential emotional intelligence (EI), reflecting the ability to perceive and feel emotions accurately, and Strategic EI, reflecting the ability to understand and manage emotions correctly. As only Experiential EI requires accurate perception of one’s emotions for adequate performance, we predicted an interaction between group and EI area. Specifically, we predicted that compared to both anxiety disorders and healthy control participants, OCD participants would show a larger deficit in Experiential area of the MSCEIT relative to the Strategic area. Results were fully in line with this prediction. Moreover, supporting the specificity of the hypothesized deficit to OCD, participants with anxiety disorders did not differ from nonclinical control participants in their performance, and findings were not attributable to anxiety or depression levels. These results replicate and extend previous findings obtained with analogue samples and suggest that OCD is associated with attenuated access to emotional states, which may be partially compensated for by reliance on semantic knowledge of emotion.     

Religious obsessions and compulsions in a non-clinical sample: the Penn Inventory of Scrupulosity (PIOS)

The present investigation reports on the development and psychometric evaluation of the Penn Inventory of Scrupulosity (PIOS), a 19-item self-report scale measuring religious obsessive-compulsive symptoms. Factor analysis yielded a two factor solution with the first subscale measuring fears about having committed sin, and the second measuring fears concerning punishment from God. Using a sample of college students, the PIOS was shown to be internally consistent and possess good convergent and discriminant validity. Highly devout participants evidenced higher scores on both PIOS subscales, but devout Jews evidenced fewer fears of sin and punishment from God compared to devout Protestants or Catholics. The PIOS has utility both as a research and clinical tool.     

Religious Context Matters: Exploring the Relationship Between Religious Context and Underage Alcohol Consumption

Previous research has demonstrated that individual religious beliefs and practices may reduce the likelihood of underage alcohol consumption, but less is known about how the overall religious cultural influence of a religion may influence individual alcohol consumption behaviors. Using multilevel analyses on two waves of the National Study of Youth and Religion merged with county-level variables from the U.S. Census and the Religious Congregations and Membership Study, we find that a county’s higher Catholic population share leads to more frequent underage drunkenness even after controlling for a wide range of individual and county-level variables. Contrary to other studies’ findings discovered at individual level, a greater population share of conservative Protestants is also linked with higher level of underage drunkenness. This study highlights the importance of viewing religious influence on health behaviors as a contextual, cultural force.     

强迫症诊断研究的新变化

临床实践与相关研究表明,强迫症的诊断标准已不能满足复杂的临床工作需要。首先,有关患者的自知力以及主观痛苦程度等诊断指标需要进一步修订。其次,就强迫症的核心症状而产生的争议,研究者提出应重新考虑强迫症、焦虑障碍、强迫谱系障碍和囤积障碍这四个概念之间的从属关系和诊断标准。未来研究应考虑从认知神经科学的视角探索强迫症的核心症状和病理机制,为强迫症的诊断标准提供新的依据。     

The Application of Acceptance and Commitment Therapy to Obsessive-Compulsive Disorder

This paper is part of a case series illustrating the application of different therapies to a case of obsessive-compulsive disorder (OCD). It describes the hypothetical application of Acceptance and Commitment Therapy (ACT). This paper covers the philosophy and basic research on language and cognition that inform ACT. It also provides an ACT-based case conceptualization of this case and examples of therapeutic procedures. The goal of this paper is to familiarize clinicians with the use of ACT for OCD.     

The Doubting Process: A Longitudinal Study of the Precipitants and Consequences of Religious Doubt in Older Adults

Religious doubt arises from a process in which there is a precipitant, the experience of doubt, a coping response, and a health-related outcome. We assess whether social factors precipitate doubt and the coping responses that are invoked to deal with doubt. We evaluate whether these coping responses are, in turn, associated with health. Over time, people who encounter more negative interaction with fellow congregants have more doubts about religion, whereas more spiritual support and greater involvement in prayer groups are associated with less religious doubt. People who encounter more negative interaction are more likely to suppress religious doubts, but people who attend Bible study groups are more likely to seek spiritual growth when faced with doubt. Suppressing religious doubt is associated with less favorable health, whereas seeking spiritual growth has no significant effect.     

Emotional Schemas and Self-Help: Homework Compliance and Obsessive-Compulsive Disorder

Many patients will either refuse to enter treatment or will drop out of treatment where exposure and response prevention (ERP) are employed. Patients may have a number of “good reasons” for noncompliance with ERP. For example, they may view their intrusions as conveying responsibility, reflecting higher threat, as personally relevant, and as requiring perfect and certain solutions. Inducing anxiety, from this perspective, only exacerbates the “problem.” Moreover, patients may employ beliefs about emotion and anxiety that conflict with exposure—such as the belief that anxiety should always be avoided or decreased because it is assumed to rise indefinitely and cause psychological harm. Homework or between-session self-help necessarily involves exposure with increased anxiety and discomfort. In the current case study, both meta-cognitive and meta-emotional conceptualization and strategies were employed in the treatment of a previously treatment-resistant case of OCD, and homework compliance was improved through the use of an emotional schema approach.     

A New Scrupulosity Scale for the Dimensional Obsessive-Compulsive Scale (DOCS): Validation With Clinical and Nonclinical Samples

Scrupulous obsessions are a prominent presentation of obsessive-compulsive disorder (OCD). Previous conceptualizations of scrupulosity have indicated that it belongs to the unacceptable thoughts dimension, which pertains to sexual, violent, and religious obsessive themes. However, research suggests that scrupulous symptoms may differ from other unacceptable thoughts symptoms, necessitating the need for targeted and thorough assessment. We added a Scrupulous or Religious Thoughts subscale (DOCS-SR) to the Dimensional Obsessive-Compulsive Scale (DOCS) and tested its factorial structure, psychometric properties, and clinical correlates in a nonclinical and clinical sample. In the first study, nonclinical participants (N = 203) completed the DOCS-SR, which was subjected to an exploratory factor analysis. Analyses revealed that the DOCS-SR reflected a one-factor solution and possessed acceptable internal consistency, as well as strong convergent validity with clinical correlates of OCD. In the second study, we administered the DOCS, as well as the DOCS-SR to a clinical sample (N = 314). An exploratory factor analysis and confirmatory factor analysis both suggested that the four subscales and additional DOCS-SR represented a five-factor solution. Internal consistency and convergent validity were strong. The DOCS Unacceptable Thoughts subscale and the DOCS-SR shared a moderate correlation but evidenced differences in associations with other correlates. This suggested both convergent and divergent validity. Collectively, our results support the utility of examining the individual components of the unacceptable thoughts dimension of OCD for effective assessment and treatment planning.     

Obsessive-Compulsive Disorder: The Process of Parental Adaptation and Implications for Genetic Counseling

Obsessive-compulsive disorder (OCD) has primarily pediatric onset and well-documented unique impacts on family functioning. Limited research has assessed the understanding that parents of children with OCD have of the etiology of the condition, and there are no data regarding potential applications of genetic counseling for this population. We recruited 13 parents of 13 children diagnosed with OCD from the OCD Registry at British Columbia Children’s Hospital, and conducted qualitative semi-structured telephone interviews to explore participants’ experiences with their child’s OCD, causal attributions of OCD, and perceptions of two genetic counseling vignettes. Interviews were audio-recorded, transcribed, and analyzed using elements of grounded theory qualitative methodology. Analysis revealed key components and contextual elements of the process through which parents adapt to their child’s OCD. This adaptation process involved conceptualizing the meaning of OCD, navigating its impact on family dynamics, and developing effective illness management strategies. Adaptation took place against a backdrop of stigmatization and was shaped by participants’ family history of mental illness and their child’s specific manifestations of OCD. Parents perceived genetic counseling, as described in the vignettes, as being empowering, alleviating guilt and blame, and positively impacting treatment orientation. These data provide insight into the process of parental adaptation to pediatric OCD, and suggest that genetic counseling services for families affected by OCD may help facilitate adaptation to this illness.     

Cognitive Therapy for Obsessive-Compulsive Disorder: a Case Example

Cognitive therapy for OCD is an empirically validated alternative to the more widely used and validated behavioral therapy for OCD. The cognitive approach is based on the premise that belief systems contribute importantly to the development and maintenance of all types of OCD. By identifying and challenging maladaptive thoughts, beliefs, and core beliefs, patients can improve significantly and maintain their gains over time. This approach is demonstrated in detail with the case of Caroline, a 51-year-old woman with contamination obsessions.     

A Specific Developmental Deficit in Obsessive-Compulsive Disorder: The Example of the Wolf Man

In this paper I suggest that the origins of the “contamination/cleaning” form of obsessive compulsive disorder (OCD) include a developmental history characterized by marked overprotectiveness allied with parental failure to respond to core aspects of the child's personal reality. The combined effect of these parental behaviors is likely to impede the establishment of a mature conception of the boundary between inner and outer worlds. The consequence of such a deficiency is the persistence of the magical form of thinking which is essential to the production of OCD. In addition, the individual is left with a disruption of personality development, the main features of which include timidity and falseness. The Wolf Man provides an example of both the characteristic development history in OCD and its consequences. Treatment based on this theoretical background may provide benefit not predicted by current psychoanalytic pessimism.