Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.     

Perfectionism and Obsessive-Compulsive Symptoms

This study was designed to determine whether perfectionism, as assessed by the revised almost perfect scale (APS-R; R. B. Slaney, M. Mobley, J. Trippi, J. S. Ashby, & D. G. Johnson, 1996), was a significant predictor of obsessive-compulsive (OC) symptoms in a non-clinical sample of 308 university students. Perfectionistic discrepancy emerged as a general predictor of obsessive thought difficulties and compulsive checking behavior. Excessive concerns about making mistakes also emerged as a significant specific predictor of obsessive cognitive but not behavioral symptoms after other dimensions of perfectionism were controlled. An interaction effect indicated that students with high discrepancy but low standards were more likely to experience OC-related washing symptoms than other students. The general effects of perfectionism on OC symptoms, the specific effects of certain perfectionism dimensions over others, and other perfectionism research results, implicate APS-R discrepancy as a core dimension of maladaptive perfectionism and APS-R high standards as either benign or protective in the associations with OC symptoms.     

Hoarding behaviors in a large college sample

Hoarding behaviors occur in many clinical syndromes but are most commonly linked to obsessive compulsive disorder. Surprisingly little empirical work has examined the nature of hoarding behaviors despite their association with significant distress and impairment. The current study examined hoarding in 563 unselected college students. Using principal components analysis, we identified four domains of hoarding behaviors as measured by the 26-item Saving Inventory-Revised: Difficulty Discarding, Acquisition Problems, Clutter, and Interference/Distress. All four domains and total hoarding behaviors were strongly related to hoarding beliefs and to obsessive compulsive (OC) symptoms. Hoarding behaviors were most strongly correlated with subscales of an OC disorder (OCD) measure assessing hoarding and obsessions and least strongly correlated with the washing subscale. Hoarding behaviors also showed significant, but more modest, correlations with social anxiety, depressive symptoms, and worry. However, worry was not found to contribute unique variance to the prediction of hoarding behaviors. Of greatest note, hoarding behaviors showed a surprisingly strong relationship with anxiety sensitivity, similar in magnitude to the relationship between hoarding and OCD symptoms. Results are interpreted and lines of future research are proposed, with particular emphasis on further elucidating the relationship between hoarding behaviors and anxiety sensitivity.     

Self-Esteem, Negative Emotionality, and Depression as a Common Temperamental Core: A Study of Mid-Adolescent Twin Girls

ABSTRACT We tested the structure and magnitude of genetic and environmental influences on the overlap among self-esteem, negative emotionality, and major depression symptoms in adolescent girls ( N =706) from the Minnesota Twin Family Study. Genetic and environmental influences on all three operated via a general, heritable factor. Genetic influences explained the majority of overlap among the three constructs, as well as most of the variance in self-esteem and negative emotionality. Genetic influences on depression were more modest and largely due to genetic factors specific to depression. These findings support the theory that self-esteem, depression, and neuroticism represent aspects of a common temperamental core. The interrelations among the three constructs in mid-adolescence is consistent with their interrelations in adulthood.     

Obsessional Beliefs and Symptoms of Obsessive–Compulsive Disorder in a Clinical Sample

The aim of the present study was to investigate the relationships among a broad range of obsessive–compulsive disorder (OCD) symptoms and obsessional beliefs in a clinical sample of OCD patients. Ninety-nine treatment-seeking adult OCD patients completed the Obsessive Beliefs Questionnaire and the Obsessive–Compulsive Inventory-Revised. Hierarchical regression analyses, controlling for comorbid symptoms, suggested that washing was predicted by responsibility/threat estimation beliefs. Checking/doubting was not predicted by any obsessional beliefs. Hoarding was predicted by perfectionism/certainty beliefs. Neutralizing was predicted by responsibility/threat estimation beliefs. Obsessing was predicted by importance/control of thoughts and perfectionism/certainty beliefs. Ordering was predicted by perfectionism/certainty beliefs. A principal components analysis of OCD symptom dimensions and accompanying beliefs yielded two components, accounting for 53% of the variance: one, which was labeled “Fear/Threat,” consisted of importance/control of thoughts, obsessing, responsibility/threat estimation, and washing. The second, which was labeled “Incompleteness/Not Just Right,” consisted of neutralizing, perfectionism/certainty, checking/doubting, and hoarding.     

Factor Structure and Validation of the Obsessive Compulsive Inventory-Revised (OCI-R) in a Greek Non-Clinical Sample

This study assessed and validated a Greek version of the Obsessive-Compulsive Inventory-Revised (OCI-R) in a large community sample. A total of 1379 Greek adults, including university students and individuals from the community, participated. Overall, the Greek OCI-R supported the six-factor solution, namely checking, ordering, obsessing, hoarding, washing and neutralizing, which was suggested by the original scale development and was later confirmed in other cultural settings. OCI-R was found to have very good to excellent psychometric properties as demonstrated by the application of traditional and alternative validating methods. Further, a five-factor structure that excluded the hoarding scale provided a slightly better conceptual fit of the data. In light of new recommendations, the Greek version of OCI-R provides compelling evidence of its efficacy to clearly differentiate between high- and low self-reports of OCD symptoms. We discuss that scores from the Greek community sample were commensurate with those observed in clinical samples.     

Biopsychosocial etiology of obsessions and compulsions: an integrated behavioral-genetic and cognitive-behavioral analysis

Accumulating evidence suggests that particular kinds of dysfunctional beliefs contribute to obsessive-compulsive (OC) symptoms. Three domains of beliefs have been identified: (a) perfectionism and intolerance of uncertainty, (b) overimportance of thoughts and the need to control thoughts, and (c) inflated responsibility and overestimation of threat. These beliefs and OC symptoms are both heritable. Although it is widely acknowledged that OC symptoms probably have a complex biopsychosocial etiology, to our knowledge there has been no previous attempt to integrate dysfunctional beliefs and genetic factors into a unified, empirically supported model. The present study was an initial step in that direction. A community sample of monozygotic and dizygotic twins (N = 307 pairs) completed measures of dysfunctional beliefs and OC symptoms. Structural equation modeling was used to compare 3 models: (a) the belief causation model, in which genetic and environmental factors influence beliefs and OC symptoms, and beliefs also influence symptoms; (b) the symptom causation model, which is the same as (a) except that symptoms cause beliefs; and (c) the belief coeffect model, in which beliefs and OC symptoms are the product of common genetic and environmental factors, and beliefs have no causal influence on symptoms. The belief causation model was the best fitting model. Beliefs accounted for a mean of 18% of phenotypic variance in OC symptoms. Genetic and environmental factors, respectively, accounted for an additional 36% and 47% of phenotypic variance. The results suggest that further biopsychosocial investigations may be fruitful for unraveling the etiology of obsessions and compulsions.     

The Relative Contribution of a Typological versus a Dimensional Approach for Understanding Obsessive-Compulsive Symptoms in Adolescents

In order to better understand the heterogeneous nature of Obsessive-Compulsive (OC) symptoms, a typological or a dimensional approach can be used to structure the variety of symptoms into a set of core components. However, there is still no consensus on which approach is the most robust to predict several OC-related criterion measures, especially in adolescents. From this perspective, the current study empirically identified OC classes (i.e., types), and explored whether types or dimensions are the strongest predictors of adolescent OC-related criterion variables. To identify OC classes, we conducted latent class analysis on the Youth Obsessive-Compulsive Symptoms Scale (YOCSS; De Caluwé and De Clercq 2014) that was completed by 682 community and referred adolescents (71.4 % girls, 12–18 years old, mean age = 15.67, SD = 1.53), and we also computed OC dimension scores as outlined in De Caluwé and De Clercq (2014). We subsequently used hierarchical regression analysis to examine the incremental validity of the OC classes beyond the OC domains, and vice versa, in predicting several OC-related criterion variables that were completed by the adolescents or their mothers (N = 325). The results indicated that the two identified OC classes only differed quantitatively but not qualitatively, hence reflecting severity classes, and also showed that OC domains have significant effects beyond the effects of the OC classes, whereas the reverse did not hold. The dimensional approach appears to have the strongest predictive value for OC symptomatology in adolescents, leading to clinical implications for conceptualization and assessment of obsessive and compulsive problems in younger age groups.     

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.     

Measurement of compulsive hoarding: saving inventory-revised

Four studies examined a new measure of compulsive hoarding (Saving Inventory-Revised; SI-R). Factor analysis using 139 hoarding participants identified 3 factors: difficulty discarding, excessive clutter, and excessive acquisition. Additional studies were conducted with hoarding participants, OCD participants without hoarding, community controls and an elderly sample exhibiting a range of hoarding behavior. Internal consistencies and test-retest reliabilities were good. The SI-R distinguished hoarding participants from all other non-hoarding comparison groups. The SI-R showed strong correlations with other indices and methods of measuring hoarding (beliefs, activity dysfunction from clutter, observer ratings of clutter in the home) and relatively weaker correlations with non-hoarding measures (positive and negative affect and OCD symptoms). The SI-R appears to be an appropriate instrument for assessing symptoms of compulsive hoarding in clinical and non-clinical samples.     

The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study

Cognitive models of obsessive-compulsive disorder (OCD) posit that specific kinds of dysfunctional beliefs (e.g., pertaining to responsibility and the significance of intrusive thoughts) underlie the development of this disorder. The present study was designed to prospectively evaluate whether dysfunctional beliefs thought to underlie OCD act as a specific vulnerability factor in the pathogenesis of obsessive-compulsive symptomatology. Eighty-five individuals were prospectively followed over a period of time thought to be associated with an increased onset of OCD symptoms -- childbirth and the postpartum. The majority of these new mothers and fathers experienced intrusive infant-related thoughts and performed neutralizing behaviors similar to, but less severe than, those observed in OCD. Scores on a measure of dysfunctional beliefs thought to underlie OCD predicted the development of obsessive-compulsive symptoms after controlling for pre-existing OCD symptoms, anxiety, and depression. Dysfunctional beliefs also predicted the severity of checking, washing, and obsessional OCD symptom dimensions, but not neutralizing, ordering, or hoarding symptom dimensions. These data provide evidence for specific dysfunctional beliefs as risk factors in the development of some types of OCD symptoms.     

Personality traits and anxiety symptoms: the multilevel trait predictor model

Investigation of relations between personality traits and mental disorders can inform key issues in psychopathology research. However, it has been hindered by extensive correlations among the traits. Building on studies of affect-psychopathology relations (e.g., the tripartite model), an organizational framework is proposed to solve this problem with respect to anxiety pathology. To test the resulting model, associations between four traits (negative emotionality, positive emotionality, anxiety sensitivity, and negative evaluation sensitivity) and four anxiety symptoms (chronic worry, obsessive-compulsive symptoms, panic, and social anxiety) were examined in an undergraduate sample (N=907). Confirmatory factor analyses supported operationalizations of the constructs in this study. Examination of the trait-symptom links using hierarchical multiple regression analyses supported most of the predicted relations. Specifically, negative emotionality emerged as a general predictor that was significantly related to all four symptom dimensions. In contrast, anxiety sensitivity was specific to panic and worry, whereas negative evaluation sensitivity was specific to social anxiety and worry. Finally, positive emotionality was uniquely related to social anxiety. The model accounted for a substantial amount of variance in the symptoms and almost all of the covariation among them.     

The association between temperament and depressive symptoms in adolescence: Brooding and reflection as potential mediators

This study examined whether rumination subtypes (brooding and reflection) mediated prospective associations between temperament (negative emotionality and positive emotionality) and depressive symptoms in a community sample of 423 adolescents. Effortful control and sex were examined as potential moderators of the mediated pathway. Youth self-reported negative emotionality (NE), positive emotionality (PE), and effortful control (EC) at age 12; brooding and reflection subtypes of rumination at age 14; and depressive symptoms at ages 12, 14, and 15. Hierarchical linear regression analyses indicated that, controlling for initial levels of depressive symptoms, high NE, but not low PE, predicted increases in depressive symptoms from age 12 to age 15. Brooding, but not reflection, mediated the association between NE and depressive symptoms. Neither sex nor EC moderated either indirect pathway in the mediated model. The results confirm and extend previous findings on the association between affective and cognitive vulnerability factors in predicting depressive symptoms in adolescence.     

The association between temperament and depressive symptoms in adolescence: brooding and reflection as potential mediators

This study examined whether rumination subtypes (brooding and reflection) mediated prospective associations between temperament (negative emotionality and positive emotionality) and depressive symptoms in a community sample of 423 adolescents. Effortful control and sex were examined as potential moderators of the mediated pathway. Youth self-reported negative emotionality (NE), positive emotionality (PE), and effortful control (EC) at age 12; brooding and reflection subtypes of rumination at age 14; and depressive symptoms at ages 12, 14, and 15. Hierarchical linear regression analyses indicated that, controlling for initial levels of depressive symptoms, high NE, but not low PE, predicted increases in depressive symptoms from age 12 to age 15. Brooding, but not reflection, mediated the association between NE and depressive symptoms. Neither sex nor EC moderated either indirect pathway in the mediated model. The results confirm and extend previous findings on the association between affective and cognitive vulnerability factors in predicting depressive symptoms in adolescence.     

Associations between miscellaneous symptoms and symptom dimensions: an examination of pediatric obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) in children and adults is a heterogeneous disorder associated with significant psychosocial impairment. Although factor analytic studies have identified symptom dimensions, these analyses do not capture the varied miscellaneous symptoms that fail to load on a specific dimension despite being functionally related. The present study sought to extend the findings of previous research in adults to a sample of youth with OCD (n=131). Logistic regression analyses were used to examine the predictive value of each of the four symptom factors (contamination symptoms, obsessions and checking, symmetry and ordering, and hoarding) to the miscellaneous OCD symptoms. The vast majority of miscellaneous symptoms (17 of the 18 symptoms) were associated with one or more symptoms factors (i.e., contamination symptoms, obsessions and checking, symmetry, and ordering). Hoarding was not related to any miscellaneous symptom. In addition to improving our understanding about the clinical presentation of pediatric OCD, findings also have important assessment (e.g., understanding which miscellaneous symptoms relate to certain dimensions) and treatment implications (e.g., hierarchy development).     

Does emotionality predict stress? Findings from the normative aging study

Investigated whether emotionality, assessed in 1975, predicted the reporting of both objective stress (life events) and subjective stress (hassles) 10 years later, and how emotionality affected the relation between both objective and subjective stress and mental health. The sample consisted of 1,159 older men, participants in the Normative Aging Study. Path analysis revealed that the reporting of stress was confounded with personality: Individuals higher in emotionality reported both more life events and more hassles. Furthermore, individuals higher in emotionality exhibited slightly higher levels of symptoms under stress than did individuals lower in emotionality. Nonetheless, both stress measures contributed independent variance to the prediction of psychological symptoms, even controlling for prior levels of emotionality. Implications for the assessment of stress are discussed.     

Hoarding and its relation to obsessive-compulsive disorder

Although hoarding is observed in some patients with obsessive-compulsive disorder (OCD), it has not been shown to share a specific relation with OCD. Across two studies, we found that (a) whereas the classic OCD symptoms of checking, rituals, and contamination intercorrelated consistently strongly with one another, hoarding related only moderately to both these OCD symptoms and to depression; (b) OCD patients were distinguished from both other patients and non-patients by classic OCD symptoms, but not by hoarding; and (c) whereas OCD symptoms showed consistent relations with Negative Affect, hoarding largely was uncorrelated with this dimension. These results do not support a specific OCD-hoarding relation but rather call into question the trend of considering it a specific symptom of OCD.     

Stability and change in temperament during adolescence

This study assessed genetic and environmental contributions to temperament during adolescence within the Nonshared Environment and Adolescent Development project (NEAD; D. Reiss, J. M. Neiderhiser, E. M. Hetherington, & R. Plomin, 2000). NEAD is a national study that includes twins and other sibling types who vary in regard to genetic relatedness. Seven hundred twenty sibling pairs (aged 12.1-13.5 years) participated at Time 1, and 395 sibling pairs (aged 14.7-16.2 years) participated again at Time 2. At both Times, mothers and fathers rated their children's temperament (emotionality, activity, sociability, and shyness). At Times 1 and 2, genetic and nonshared environmental factors accounted for variance in temperament, whereas shared environmental contributions were negligible. However, at Time 1, genetic contributions were inflated, and shared environmental contributions were masked if sibling contrast effects were not taken into account. At Time 2, sibling interaction effects had little impact on estimates of genetic and environmental contributions to temperament. Last, temperament stability was primarily explained by genetic factors, whereas both genetic and nonshared environmental factors accounted for change.     

Emotional regulation,attachment to possessions and hoarding symptoms

This study aimed to test which particular facets of emotion regulation (ER) are most linked to symptoms of hoarding disorder, and whether beliefs about emotional attachment to possessions (EA) mediate this relationship. A non‐clinical sample of 150 participants (108 females) completed questionnaires of emotional tolerance (distress tolerance, anxiety sensitivity, negative urgency – impulsivity when experiencing negative emotions), depressed mood, hoarding, and beliefs about emotional attachment to possessions. While all emotional tolerance measures related to hoarding, when considered together and controlling for depression and age, anxiety sensitivity and urgency were the significant predictors. Anxiety sensitivity was fully mediated, and urgency partially mediated, via beliefs regarding emotional attachment to possessions. These findings provide further support for (1) the importance of anxiety sensitivity and negative urgency for hoarding symptoms, and (2) the view that individuals with HD symptoms may rely on items for emotion regulation, leading to stronger beliefs that items are integral to emotional wellbeing.