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.     

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.     

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.     

Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder

The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.     

Functional analytic psychotherapy and the treatment of obsessive compulsive disorder

This paper argues that Functional Analytic Psychotherapy (FAP) can contribute to the treatment of Obsessive Compulsive Disorder (OCD). FAP is a behavior analytically informed approach to talk-therapy, developed by Kohlenberg and Tsai. It uses natural occurrences of clinically relevant behavior in the client-therapist relationship to promote therapeutic change. A selection of vignettes of client-therapist dialogues involving two clients with OCD is discussed. The examples show how natural interactions between therapist and client can be used to bring therapeutic technique closer to the natural occurrences of obsessive-compulsive behavior. Furthermore, the fragments illustrate that FAP can encompass exposure and response prevention. Therefore, the in vivo learning during the session as promoted in FAP can be an asset in the treatment of clients with OCD, and it deserves attention in future treatment research.     

Effects of September 11 on patients with obsessive compulsive disorder

Effects of the September 11, 2001 terrorist attacks in the USA were investigated in 25 patients with obsessive compulsive disorder and 27 normal controls 4-6 months after the attacks. Participants completed a 15-item questionnaire to retrospectively assess changes in mood, cognition, behavior and somatic complaints since September 11, 2001. Overall, both patients with obsessive compulsive disorder and normal controls reported minor changes in mood, behavior and somatic complaints. However, normal controls reported severe to extreme initial impact, slightly more cognitive symptoms (uncertainty about the future, intrusive recollections and greater desire to be with loved ones) and a slightly greater degree of overall impact on emotion and behavior at 1, 2 and 3 months after September 11 than did patients with obsessive compulsive disorder. Results support previous research that has found a relatively minor lasting impact of September 11 on both clinical and normal populations. Differences in cognition and coping mechanisms between normal controls and patients with obsessive compulsive disorder are proposed.     

Screening for obsessive and compulsive symptoms: validation of the Clark-Beck Obsessive-Compulsive Inventory

The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria and current cognitive-behavioral formulations. Revisions were made to the CBOCI on the basis of psychometric and item analyses of an initial pilot study of clinical and nonclinical participants. The construct validity of the revised CBOCI was supported in a subsequent validation study involving OCD, nonobsessional clinical, and nonclinical samples. A principal-factor analysis of the 25 items found 2 highly correlated factors of Obsessions and Compulsions. OCD patients scored significantly higher on the measure than nonobsessional anxious, depressed, and nonclinical samples. The questionnaire had strong convergent validity with other OCD symptom measures but more modest discriminant validity.     

Effects of September 11 on patients with obsessive compulsive disorder

Effects of the September 11, 2001 terrorist attacks in the USA were investigated in 25 patients with obsessive compulsive disorder and 27 normal controls 4–6 months after the attacks. Participants completed a 15‐item questionnaire to retrospectively assess changes in mood, cognition, behavior and somatic complaints since September 11, 2001. Overall, both patients with obsessive compulsive disorder and normal controls reported minor changes in mood, behavior and somatic complaints. However, normal controls reported severe to extreme initial impact, slightly more cognitive symptoms (uncertainty about the future, intrusive recollections and greater desire to be with loved ones) and a slightly greater degree of overall impact on emotion and behavior at 1, 2 and 3 months after September 11 than did patients with obsessive compulsive disorder. Results support previous research that has found a relatively minor lasting impact of September 11 on both clinical and normal populations. Differences in cognition and coping mechanisms between normal controls and patients with obsessive compulsive disorder are proposed.     

Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment

The main aim of this study was to test the hypothesis that neurological soft signs and neuropsychological abnormalities associated with obsessive-compulsive disorder (OCD) predict poor response to behavioural treatment. The design permitted investigation of secondary hypotheses, regarding correlations among these neurological markers and levels of symptomatology, and their stability in relation to changes in levels of symptomatology. Thirty-five participants satisfying DSM-IV diagnostic criteria for OCD were assessed pre- and postbehavioural treatment using a scaled measure of symptom severity, and a battery of tests sensitive to neuropsychological deficits associated with OCD. Eighteen of the participants were also assessed on an inventory of neurological soft signs. Neither neuropsychological test deficits nor neurological soft signs pretreatment predicted response to behavioural treatment. Lower performance on neuropsychological tasks and symptom severity were both significantly correlated with levels of soft signs. Some neurological markers were less severe posttreatment, but these changes were not related to treatment response.     

Relation between the syndromes of bulimia nervosa and obsessive compulsive disorder

Bulimia nervosa (BN) has been conceptualized as similar to obsessive compulsive disorder (OCD). The results of studies investigating the relation between BN and OCD, however, are inconclusive. Our goal was to attempt to clarify the relation between the syndromes of BN and OCD. The Padua Inventory (PI), a measure of OCD, and the Bulimia Test—Revised (BULIT-R), a measure of bulimic behaviors, were administered to 981 women and 722 men. A significant relationship, equal in magnitude for women and men, was found between BN and OCD. Bulimic symptoms also had a stronger relation to obsessions than compulsions. Finally, 6 of 23 women (26%) who met the diagnostic criteria for BN also met the criteria for OCD, while 1 of 1 man who met the criteria for BN also met the criteria for OCD. Implications for similarities between the two disorders as well as future issues in the study of comorbidity are discussed.This report is based on the first author's masters thesis, which was supervised by the second author.     

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.     

Neurological soft signs in obsessive compulsive disorder: standardised assessment and comparison with schizophrenia

While several studies have detected raised levels of neurological soft signs in patients with obsessive compulsive disorder (OCD), the specificity of these abnormalities remains uncertain. This study used a new standardised measure, the Cambridge Neurological Inventory (CNI), to assess soft signs in 51 subjects with OCD. Comparison was made with data on patients with schizophrenia and a non-clinical control group from a previously reported study. Individuals with OCD showed raised levels of soft signs compared with non-clinical controls in many categories of the CNI: Motor Coordination, Sensory Integration, Primitive Reflexes, Extrapyramidal Signs, and Failure of Suppression. Compared with patients with schizophrenia, the OCD group had lower levels of neurological signs in some CNI categories: Hard Signs, Motor Co-ordination, Tardive Dyskinesia, Catatonic Signs, and Extrapyramidal Signs. However, levels of soft signs in the OCD group did not significantly differ from those in the schizophrenia group in other CNI categories: Sensory Integration, Primitive Reflexes and Failure of Suppression. The significance of these patterns of findings is discussed.     

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.     

Testing a conceptual model of patient and family predictors of obsessive compulsive disorder (OCD) symptoms

Path analysis was used to test a model linking family member's attributions, criticism, hostility, emotional overinvolvement (EOI) that focused on intrusiveness, and family accommodation to severity of obsessive compulsive symptoms. This study draws upon previous expressed emotion (EE) research by including separate components of EE assessed in relatives and patients, as well as family accommodation measures to build a model of family influences on OCD symptoms. Measures of patient- and relative-perceived criticism, family accommodation, EOI intrusiveness and OCD symptom severity were collected on a single occasion from 50 patients and 50 relatives whom the patient had daily contact with. Novel self-report scales for the three EE components of criticism, hostility and EOI derived from existing instruments showed good to excellent internal consistency. Confirmatory path analyses were used to demonstrate that the data provided an adequate fit to the hypothesized path model. The patient-rated data suggested that patients who perceived their relatives as either critical or hostile were likely to have more severe OCD symptoms. For relative-rated EE, hostility proved to be a better determinant than criticism in the path model. Implications of this model for interventions and for future research are discussed. The measures employed may prove to be a cost-effective alternative to the labor intensive Camberwell Family Interview.     

No evidence of attentional bias in obsessive compulsive checking on the dot probe paradigm

Attentional biases have been proposed as maintaining and causal factors in anxiety, and it has been suggested that training attentional bias can impact on emotional responding. Given the severity of obsessive compulsive disorder (OCD) and the considerable number of clients who do not respond to traditional therapies, understanding the factors that maintain anxiety in OCD is critical for the development of effective treatments. This study investigated attentional biases in a homogenous group of OCD patients whose primary concern was checking (OCD-Check; n = 18) compared to a Control group individually matched for age, gender and level of education (Control; n = 18) using a dot probe task. No evidence of attentional bias, or of differences in orienting to or disengaging from checking-relevant stimuli, was found in the OCD group compared to the matched Control group. From this data, it would appear that attentional bias may not be a feature of obsessive compulsive checking. The limitations of the present study and future research directions are discussed.     

Family burden of compulsive hoarding: results of an internet survey

Compulsive hoarding, the acquisition of and failure to discard large numbers of possessions, is associated with substantial health risk, impairment in functioning, and economic burden. Despite clear indications that hoarding has a detrimental effect on people living with or near someone with a hoarding problem, no empirical research has examined these harmful effects. The aim of the present study was to examine the burden of hoarding on family members. Six hundred sixty-five family informants who reported having a family member or friend with hoarding behaviors completed an internet-based survey. Living with an individual who hoards during childhood was associated with elevated reports of childhood distress and family strain. Family members reported high levels of patient rejection attitudes, suggesting high levels of family frustration and hostility. Rejecting attitudes were predicted by severity of hoarding symptoms, the individual's perceived lack of insight into the behavior, and having lived in a cluttered environment during childhood. These results suggest that compulsive hoarding adversely impacts not only the hoarding individual, but also those living with them.     

The relationship of the Yale-Brown Obsessive Compulsive Scale (YBOCS) to other measures of obsessive compulsive symptoms in a nonclinical population

The Yale-Brown Obsessive Compulsive Scale (YBOCS; Goodman, Price, Rasmussen, & Mazure, 1989a) is an interview-based rating scale measuring severity of obsessive compulsive disorder (OCD). Because it is independent of the number and type of OCD symptoms and minimizes confounding with other types of symptoms, it has become the "gold standard" for assessing the outcome of behavioral and pharmacological treatments. This study was designed to further validate the YBOCS in relation to self-report measures of obsessive compulsive phenomena in a nonclinical population. Among a group of 45 female college students, the three primary YBOCS measures (obsessions, compulsions, and total score) were internally consistent and correlated moderately to strongly with self-report measures of obsessive compulsive phenomena that have been used in previous research. The compulsive subscale of the YBOCS showed the lowest correlation with self-report measures sharing only 25% of the common variance. This measure is appropriate for use with nonclinical samples and may prove superior to other instruments for detecting the presence and severity of obsessive and compulsive symptoms.