Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.     

Diagnostic efficiency of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder

This study examined the diagnostic efficiency of the DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). Two hundred and eleven consecutive adult patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. Conditional probabilities-sensitivity, specificity, positive predictive power (PPP), and negative predictive power (NPP)-were calculated for each of the eight criteria for OCPD, using the 'best-estimate' OCPD diagnosis as the standard. The diagnostic efficiencies of the OCPD criteria were variable, with three criteria failing to have predictive value (PPP<0.50). The best inclusion criterion (highest PPP) was 'Perfectionism,' which was also the overall most predictive criterion. The findings suggest ordering of the DSM-IV criteria for OCPD based on performance and call into question the utility of some criteria.     

The presence of magical thinking in obsessive compulsive disorder

Two research groups have raised the possibility that magical ideation may be a fundamental feature of obsessive-compulsive disorder. It has been proposed to underlie thought action fusion and superstitious beliefs. In this study, the Magical Ideation scale, the Lucky Behaviours and Lucky Beliefs scales, the Thought Action Fusion-Revised scale, the Padua Inventory, and the Obsessive Compulsive Inventory-Short Version were completed by 60 obsessive compulsive patients at a hospital clinic. Of all the measures, the Magical Ideation (MI) scale was found to be the most strongly related to obsessive compulsive symptoms. Large and significant relationships between MI scores and the measures of OCD were obtained even when alternative constructs (Lucky Behaviours, Lucky Beliefs, Thought Action Fusion-Revised scales) were held constant. No other variable remained significantly related to the Obsessive Compulsive Inventory-Short Version when magical ideation scores were held constant. The findings suggest that a general magical thinking tendency may underpin previous observed links between superstitiousness, thought action fusion and OCD severity.     

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.     

Hoarding in obsessive compulsive disorder: results from a case-control study

Hoarding occurs relatively frequently in obsessive-compulsive disorder (OCD), and there is evidence that patients with hoarding symptoms have more severe OCD and are less responsive to treatment. In the present study, we investigated hoarding symptoms in 126 subjects with OCD. Nearly 30% of the subjects had hoarding symptoms; hoarding was twice as prevalent in males than females. Compared to the 90 non-hoarding subjects, the 36 hoarding individuals had an earlier age at onset of, and more severe, obsessive-compulsive symptoms. Hoarders had greater prevalences of symmetry obsessions, counting compulsions, and ordering compulsions. Hoarders also had greater prevalences of social phobia, personality disorders, and pathological grooming behaviors (skin picking, nail biting, and trichotillomania). Hoarding and tics were more frequent in first-degree relatives of hoarding than non-hoarding probands. The findings suggest that the treatment of OCD patients with hoarding symptoms may be complicated by more severe OCD and the presence of co-occurring disorders. Hoarding appears to be transmitted in some OCD families and may differentiate a clinical subgroup of OCD.     

Discriminative performance of the domestic hen in a visual acuity task

The performance of 6 domestic hens on a visual acuity task was studied using a spatial discrete-trial conditional discrimination procedure. Gray stimuli and vertical square-wave gratings, ranging in spatial frequency from 1 to 10 cycles per millimeter, were presented in a descending and ascending series of probes. On each trial, either a grating or gray stimulus was presented. Only one spatial frequency of grating was presented during each session. Between probe sessions, training continued at the coarsest grating value. Stimulus discriminability, measured as values of log d, changed with changes in grating spatial frequency for both probe series. Fitted lines described the linear portion of the psychometric functions. Thresholds estimated from the lines generally ranged from four to six cycles per degree, with slightly greater estimates from data from the descending probe series. There were no systematic changes in response bias as a function of grating spatial frequency.     

Reduced visual acuity is mirrored in low vision imagery

Research has examined the nature of visual imagery in normally sighted and blind subjects, but not in those with low vision. Findings with normally sighted subjects suggest that imagery involves primary visual areas of the brain. Since the plasticity of visual cortex appears to be limited in adulthood, we might expect imagery of those with adult-onset low vision to be relatively unaffected by these losses. But if visual imagery is based on recent and current experience, we would expect images of those with low vision to share some properties of impaired visual perception. We examined key parameters of mental images reported by normally sighted subjects, compared to those with early- and late-onset low vision, and with a group of subjects with restricted visual fields using an imagery questionnaire. We found evidence that those with reduced visual acuity report the imagery distances of objects to be closer than those with normal acuity and also depict objects in imagery with lower resolution than those with normal visual acuity. We also found that all low vision groups, like the normally sighted, image objects at a substantially greater distance than when asked to place them at a distance that ‘just fits’ their imagery field (overflow distance). All low vision groups, like the normally sighted, showed evidence of a limited visual field for imagery, but our group with restricted visual fields did not differ from the other groups in this respect. We conclude that imagery of those with low vision is similar to that of those with normal vision in being dependent on the size of objects or features being imaged, but that it also reflects their reduced visual acuity. We found no evidence for a dependence on imagery of age of onset or number of years of vision impairment.     

The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder

The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, externalizing behavior problems, number of comorbid psychiatric disorders, and a lower perception of control were associated with lower pre-treatment expectations. Parent expectation was associated with parental OCD symptoms, child depressive symptoms and child-reported impairment. Therapist expectations inversely correlated with child depressive symptoms, externalizing problems, and child-rated impairment. Pre-treatment OCD severity and prior treatment history were not linked to expectancy. Finally, higher treatment expectations were linked to better treatment response, lower attrition, better homework compliance, and reduced impairment.     

Family and psychosocial predictors of obsessive compulsive disorder in a community sample of young adolescents

A two-stage epidemiologic study conducted between 1986 and 1988 in the southeastern United States investigated family and psychosocial predictors of obsessive compulsive disorder (OCD) and subclinical OCD in young adolescents. In the first stage, a life-event schedule and a family adaptability and cohesion scale were administered to a community sample of 3,283 adolescents. In stage two, the Schedule for Affective Disorders and Schizophrenia in School Age Children and the Children's Global Assessment Scale were administered to 488 mother-child pairs. In multivariable models family cohesion was the only significant correlate of OCD (odds ratio=0.95, 95% confidence interval 0.91–0.98). Gender, race, age, socioeconomic status, guardian status, adaptability, undesirable life events and desirable life events were not found to be significant predictors of OCD in models adjusting for cohesion. Note of the above variables were significantly associated with subclinical OCD. However, separate analyses of the 41 individual life events indicated seven specific events were significantly associated with OCD or subclinical OCD. These findings are at odds with the theory that overinvolvement of family members is a risk factor for OCD, though an association with overly rigid family structure cannot be eliminated based on these data. Further exploration of family characteristics is warranted.     

Individual differences in visual acuity and face matching ability

The visual acuity of the eyes varies outside the range of normal vision, requiring corrective lenses, but also within the normal range. This study investigated whether both types of variation relate to individual differences in face-identity matching, considering this applied task requires perception of detail. Across two experiments, face-matching accuracy correlated with variation in acuity when this fell outside the normal range of vision and was uncorrected with glasses or contact lenses. In contrast, variation in visual acuity within the normal range did not affect face-matching accuracy, whereas matching accuracy at a given level of acuity could vary substantially. These results indicate that visual acuity is only a problem for occupations performing face-identity matching when below-normal acuity is not diagnosed or adequately corrected. In turn, these findings suggest that variation in acuity within the normal range is not a contributing factor to individual differences in face matching accuracy.     

Simultaneous visual discrimination in Asian elephants

Two experiments explored the behavior of 20 Asian elephants (Elephas aximus) in simultaneous visual discrimination tasks. In Experiment 1, 7 Burmese logging elephants acquired a white+/black- discrimination, reaching criterion in a mean of 2.6 sessions and 117 discrete trials, whereas 4 elephants acquired a black+/white- discrimination in 5.3 sessions and 293 trials. One elephant failed to reach criterion in the white+/black- task in 9 sessions and 549 trials, and 2 elephants failed to reach criterion in the black+/white- task in 9 sessions and 452 trials. In Experiment 2, 3 elephants learned a large/small transposition problem, reaching criterion within a mean of 1.7 sessions and 58 trials. Four elephants failed to reach criterion in 4.8 sessions and 193 trials. Data from both the black/white and large/small discriminations showed a surprising age effect, suggesting that elephants beyond the age of 20 to 30 years either may be unable to acquire these visual discriminations or may require an inordinate number of trials to do so. Overall, our results cannot be readily reconciled with the widespread view that elephants possess exceptional intelligence.     

The effect of increased response requirements on discriminative performance of the domestic hen in a visual acuity task.

Six domestic hens were trained in a spatial discrimination task. A controlled reinforcement procedure insured that the ratio of scheduled and obtained reinforcement remained equal. Gray stimuli and gratings ranging in spatial frequency from 1 to 10 cycles per millimeter were presented in seven descending series of probes. The response requirement to the sample key was varied from fixed ratio 1 to fixed ratio 40 in seven experimental conditions. An increase in response requirements from fixed ratio 1 to fixed ratio 5 and fixed ratio 10 resulted in significantly higher accuracy at discriminable grating values. Further increases in response requirements did not consistently improve performance. Generally, response biases increased and occasionally became extreme for probes at finer gratings with increased response requirements.     

Testing for effects of racial attitudes and visual contrast on the speed of a driver’s response to a pedestrian

Although ethnic minorities are overrepresented in pedestrian-vehicle collisions, previous driving studies did not examine racial attitudes in such collisions. Our objective was to determine whether the speed of a driver’s response to a pedestrian was affected by the driver’s racial attitudes and the contrast between the pedestrian’s skin colour and background. Participants viewed simulated driving scenes of a pedestrian on a road and pressed a button as soon as they saw an obstacle. Visual information, but not racial attitudes, affected the time it took observers to respond to pedestrian and non-pedestrian stimuli in driving scenes. Results indicated that contrast affected response time even when the stimulus was subliminal. We believe this is the first demonstration of contrast effects with subliminal stimuli in a driving context. Results have implications for traffic safety and for methodology used to study racial attitudes.     

Attention deficit hyperactivity disorder among inmates in Bergen Prison

The aim of this study was to investigate whether clinical findings are consistent with research indicating a high prevalence of attention deficit hyperactivity disorder (ADHD) among prison inmates. Forty‐three male inmates who were referred for ADHD assessment at the health service in Bergen prison participated. Although most of them reported symptoms in accordance with ADHD both in childhood and adulthood, only 35% of the referred inmates fulfilled the criteria for ADHD when a comprehensive assessment was conducted. The results emphasize the importance of a comprehensive assessment when diagnosing ADHD among prison inmates.     

Low-level visual attention and its relation to joint attention in autism spectrum disorder

Visual attention is integral to social interaction and is a critical building block for development in other domains (e.g., language). Furthermore, atypical attention (especially joint attention) is one of the earliest markers of autism spectrum disorder (ASD). The current study assesses low-level visual attention and its relation to social attentional processing in youth with ASD and typically developing (TD) youth, aged 7 to 18 years. The findings indicate difficulty overriding incorrect attentional cues in ASD, particularly with non-social (arrow) cues relative to social (face) cues. The findings also show reduced competition in ASD from cues that remain on-screen. Furthermore, social attention, autism severity, and age were all predictors of competing cue processing. The results suggest that individuals with ASD may be biased towards speeded rather than accurate responding, and further, that reduced engagement with visual information may impede responses to visual attentional cues. Once attention is engaged, individuals with ASD appear to interpret directional cues as meaningful. These findings from a controlled, experimental paradigm were mirrored in results from an ecologically valid measure of social attention. Attentional difficulties may be exacerbated during the complex and dynamic experience of actual social interaction. Implications for intervention are discussed.     

You detect while I search: examining visual search efficiency in a joint search task

Numerous factors impact attentional allocation, with behaviour being strongly influenced by the interaction between individual intent and our visual environment. Traditionally, visual search efficiency has been studied under solo search conditions. Here, we propose a novel joint search paradigm where one individual controls the visual input available to another individual via a gaze contingent window (e.g., Participant 1 controls the window with their eye movements and Participant 2 – in an adjoining room – sees only stimuli that Participant 1 is fixating and responds to the target accordingly). Pairs of participants completed three blocks of a detection task that required them to: (1) search and detect the target individually, (2) search the display while their partner performed the detection task, or (3) detect while their partner searched. Search was most accurate when the person detecting was doing so for the second time while the person controlling the visual input was doing so for the first time, even when compared to participants with advanced solo or joint task experience (Experiments 2 and 3). Through surrendering control of one’s search strategy, we posit that there is a benefit of a reduced working memory load for the detector resulting in more accurate search. This paradigm creates a counterintuitive speed/accuracy trade-off which combines the heightened ability that comes from task experience (discrimination task) with the slower performance times associated with a novel task (the initial search) to create a potentially more efficient method of visual search.     

Sound improves diminished visual temporal sensitivity in schizophrenia

Visual temporal processing and multisensory integration (MSI) of sound and vision were examined in individuals with schizophrenia using a visual temporal order judgment (TOJ) task. Compared to a non-psychiatric control group, persons with schizophrenia were less sensitive judging the temporal order of two successively presented visual stimuli. However, their sensitivity to visual temporal order improved as in the control group when two accessory sounds were added (temporal ventriloquism). These findings indicate that individuals with schizophrenia have diminished sensitivity to visual temporal order, but no deficits in the integration of low-level auditory and visual information.     

Differences in multiple‐target visual search performance between non‐professional and professional searchers due to decision‐making criteria

Professional visual searches, such as those conducted by airport security personnel, often demand highly accurate performance. As many factors can hinder accuracy, it is critical to understand the potential influences. Here, we examined how explicit decision‐making criteria might affect multiple‐target search performance. Non‐professional searchers (college undergraduates) and professional searchers (airport security officers) classified trials as ‘safe’ or ‘dangerous’, in one of two conditions. Those in the ‘one = dangerous’ condition classified trials as dangerous if they found one or two targets, and those in the ‘one = safe’ condition only classified trials as dangerous if they found two targets. The data suggest an important role of context that may be mediated by experience; non‐professional searchers were more likely to miss a second target in the one = dangerous condition (i.e., when finding a second found target did not change the classification), whereas professional searchers were more likely to miss a second in the one = safe condition.