Associations between miscellaneous symptoms and symptom dimensions in adults with obsessive-compulsive disorder

Abstract

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with a heterogeneous array of obsessions and compulsions. Although factor analytic studies have identified symptom dimensions comprising the clinical presentation of OCD, many frequently reported miscellaneous symptoms are not considered in factor analytic studies because they do not fit conceptually within a particular symptom category, despite being functionally related. In the present study, we examined the associations between miscellaneous symptoms and OCD symptom dimensions in a sample of 111 adults with OCD. Overall, most miscellaneous symptoms were associated with one or more symptom dimensions in previously identified four- (14 of the 22 symptoms) and five-factor models (12 of the 22 symptoms). In both models, Contamination/Cleaning was the only dimension not related to any miscellaneous symptom. The present results provide information about which miscellaneous symptoms may be related to particular symptom dimensions, which will assist in clinical evaluations and help planning behavioral psychotherapy (e.g., hierarchy development).     

Belief and Survival

Our ability to survive in a world beset by looming global perils depends ultimately on our collective will to harness our intellects and change our behaviors. In order to respond appropriately, people must first believe that serious problems exist, that there are potential solutions, and that they have a role to play in finding and implementing them. Without such beliefs, individual change is unlikely. In order to promote belief change, it is important to understand how beliefs are learned, what their functions are, and why they are so often resistant to change. These issues are discussed in this article, along with the role that social dilemmas play in inhibiting individually prosocial behavior.     

Symmetry, ordering and arranging compulsive behaviour

Compulsive ordering and arranging, and a preoccupation with symmetry are features of obsessive-compulsive disorder (OCD) that have not been examined experimentally. Three connected studies were conducted to examine this phenomenon: a self-report measure of this behaviour was developed and validated, participants were asked to engage in tasks designed to assess preferences for order, and to assess the interference of disorderly surroundings in the completion of a stressful activity. The self-report measure has sound psychometric properties and validity. Participants with a strong preference for order were made more anxious by having to complete a difficult task in a disorganized environment. Participants without this preference did not show this effect. The results are discussed in terms of the phenomenology of compulsive ordering and arranging, and its relationships with both OCD and normal human behaviour. It is suggested that compulsive ordering and a drive for symmetry are extreme manifestations of the common preference for order and symmetry.     

Two Facets of Belief

Abstract

I begin by contrasting two facets of belief: that belief is a response to a sufficiency of evidence and that belief plays a role in one’s representation of reality. I claim that these conceptions of belief are in tension because whilst the latter – Representationalism – requires Logical Coherence of belief the former – Thresholdism – conflicts with Logical Coherence. Thus we need to choose between conceptions. Many have argued that the Preface Paradox supports Thresholdism. In contrast I argue that Representationalism has a more plausible response to the paradox.     

Family Impact of Tourette's Syndrome

Tourette's syndrome (TS) is a neuropsychological disorder characterized by vocal and motor tics. TS is also associated with several behavior disorders such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, conduct disorder, and Obsessive-Compulsive Disorder. We examined the impact of Tourette's syndrome with and without comorbid psychiatric disorders on the family. TS complicated by comorbid disorders had a greater impact on the family than uncomplicated TS. Tourette's symptom severity was significantly correlated with the level of impact on the family and with the number of comorbid disorders. TS is a disorder with effects that extend beyond motor and vocal tics.     

Belief, faith, and acceptance

Belief is a central focus of inquiry in the philosophy of religion and indeed in the field of religion itself. No one conception of belief is central in all these cases, and sometimes the term ‘belief’ is used where ‘faith’ or ‘acceptance’ would better express what is intended. This paper sketches the major concepts in the philosophy of religion that are expressed by these three terms. In doing so, it distinguishes propositional belief (belief that) from both objectual belief (believing something to have a property) and, more importantly, belief in (a trusting attitude that is illustrated by at least many paradigm cases of belief in God). Faith is shown to have a similar complexity, and even propositional faith divides into importantly different categories. Acceptance differs from both belief and faith in that at least one kind of acceptance is behavioral in a way neither of the other two elements is. Acceptance of a proposition, it is argued, does not entail believing it, nor does believing entail acceptance in any distinctive sense of the latter term. In characterizing these three notions (and related ones), the paper provides some basic materials important both for understanding a person’s religious position and for appraising its rationality. The nature of religious faith and some of the conditions for its rationality, including some deriving from elements of an ethics of belief, are explored in some detail.     

When hoarding is a symptom of OCD: A case series and implications for DSM-V

Hoarding, the excessive collection and failure to discard objects of apparently little value, can represent a serious psychiatric problem and pose a threat to public health. Hoarding has traditionally been considered a symptom (or symptom dimension) of Obsessive-Compulsive Disorder (OCD), but its nosological status has recently been debated. Mounting evidence suggests that, once other primary causes are ruled out, hoarding may be a discrete diagnostic entity, recently named Hoarding Disorder. However, hoarding can sometimes be a genuine OCD symptom. This can be confusing and clinicians may sometimes struggle making the differential diagnosis. To illustrate this, we describe 10 OCD patients with severe hoarding behavior that is better conceptualized as a symptom of OCD. We focus on the motivations for hoarding and the overlapping of hoarding with other obsessive-compulsive symptom dimensions. We estimate that this clinical presentation is relatively rare and accounts for a minority of severe hoarding cases. We discuss the unique characteristics of hoarding as a symptom of OCD and the implications for DSM-V.     

Gricean Belief Change

One of the standard principles of rationality guiding traditional accounts of belief change is the principle of minimal change: a reasoner's belief corpus should be modified in a minimal fashion when assimilating new information. This rationality principle has stood belief change in good stead. However, it does not deal properly with all belief change scenarios. We introduce a novel account of belief change motivated by one of Grice's maxims of conversational implicature: the reasoner's belief corpus is modified in a minimal fashion to assimilate exactly the new information. In this form of belief change, when the reasoner revises by new information p ∨ q their belief corpus is modified so that p∨q is believed but stronger propositions like p∧q are not, no matter what beliefs are in the reasoner's initial corpus. We term this conservative belief change since the revised belief corpus is a conservative extension of the original belief corpus given the new information.     

Feared identity and obsessive-compulsive disorder

We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits.     

On Revising Fuzzy Belief Bases

We look at the problem of revising fuzzy belief bases, i.e., belief base revision in which both formulas in the base as well as revision-input formulas can come attached with varying degrees. Working within a very general framework for fuzzy logic which is able to capture certain types of uncertainty calculi as well as truth-functional fuzzy logics, we show how the idea of rational change from “crisp” base revision, as embodied by the idea of partial meet (base) revision, can be faithfully extended to revising fuzzy belief bases. We present and axiomatise an operation of partial meet fuzzy base revision and illustrate how the operation works in several important special instances of the framework. We also axiomatise the related operation of partial meet fuzzy base contraction.This paper is an extended version of a paper presented at the Nineteenth Conference on Uncertainty in Arti.cial Intelligence (UAI’03).     

Perfectionism in depression, obsessive-compulsive disorder and eating disorders

High levels of perfectionism have been observed in major depression, anxiety disorders and eating disorders. Though few studies have compared levels of perfectionism across these disorders, there is reason to believe that different dimensions of perfectionism may be involved in eating disorders than in depression or anxiety [Bardone-Cone, A. M. et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 84-405]. The present study compared patients with major depression, obsessive-compulsive disorder, and eating disorders on dimensions of perfectionism. Concern over Mistakes was elevated in each of the patient groups while Pure Personal Standards was only elevated in the eating disorder sample. Doubts about Actions was elevated in both patients with obsessive-compulsive disorder and eating disorders, but not in depressed patients. Analyses of covariance indicated that Concern over Mistakes accounted for most of the variance in the relationship of perfectionism to these forms of psychopathology.     

信念与结果对道德、法律责任判断的影响

在"执行者"和"旁观者"两个情境中,通过操纵当事人的信念和事件结果,考察了被试的道德与法律责任判断。结果显示:进行道德责任判断时,被试对当事人的信念信息更敏感;进行法律责任判断时,则对事件结果的信息更敏感。"执行者"情境中的道德和法律责任评分均高于"旁观者"情境中的责任评分。这说明道德、法律责任判断的内部机制有所不同,并且当事人的不同角色导致第三方对其的责任判断出现差异。     

Development and Evaluation of the Belief Acceptance Scale

The Belief Acceptance Scale (BAS) is a nine question scale that was developed to evaluate how open and accepting an individual is to other people’s beliefs across interdependent life domains. The purposes of this article are to demonstrate the internal consistency of the BAS and examine the instrument’s substructure and to correlate the BAS with validated measures of religiosity and demographic data gathered from a web-based Survey of Spiritual Experiences. The BAS focuses on cultural beliefs instead of religious motivations and was designed to be administered to religious and non-religious individuals. Three domains of belief acceptance were tested: the internal or subjective openness to other beliefs (Psychological Domain), willingness to participate in other ideologies and rituals (Reciprocal Domain), and the willingness to date or marry outside one’s belief system or cultural background (Social Domain). Responses from 350 individuals were correlated and analysed to estimate the scale’s internal consistency and subscale structure. Analyses support the validity of the BAS scores in that they demonstrate expected correlations with demographic data and standardised measures of religiosity. The results show that the BAS is an internally consistent scale with a coherent substructure that adequately measures openness to other beliefs, ideologies and belief systems.     

Community treatment of severe, refractory obsessive-compulsive disorder

Despite the existence of effective psychological and pharmacological interventions for obsessive-compulsive disorder (OCD), there are a large proportion of individuals for whom intervention is not effective. The study reports on the results of a community treatment service for individuals with treatment-refractory OCD who have not benefitted from previous cognitive behavioural or pharmacological treatment by community mental health services. A total of 205 individuals accepted for treatment by a specialist community OCD treatment service in London were provided with a combination of behavioural, cognitive, and pharmacological treatment within a specialist OCD service, with 158 completing treatment. Treatment was associated with significant reduction in clinician-rated and self-reported OCD symptoms after 12 weeks, with further reductions in OCD symptoms over a subsequent 12-week period. A significant reduction in symptoms of depression was also observed after 12 and 24 weeks. Approximately 40% of individuals treated experienced clinically significant improvement in their symptoms, with approximately 10% deemed to have recovered by the end of treatment. Our results add to previous research into refractory OCD, and provide support for the existence of specialist community treatment services which may provide assistance to individuals who have not responded to previous treatment.     

A Model for Structural Changes of Belief

The paper suggests a way of modeling belief changes within the tradition of formal belief revision theories. The present model extends the scope of traditional proposals, such as AGM, so as to take care of “structural belief changes” – a type of radical shifts that is best illustrated with, but not limited to, instances of scientific discovery; we obtain AGM expansions and contractions as limiting cases. The representation strategy relies on a non-standard use of a semantic machinery. More precisely, the model seeks to correlate knowledge states with interpretations of a given formal language L, in such a way that the epistemic state of an agent at a given time gives rise to a picture of how things could be, if there weren’t anything else to know. Interpretations of L proceed along supervaluational ideas; hence, the model as a whole can be seen as a particular application of supervaluational semantics to epistemic matters. Presented by Hannes Leitgeb     

Memory and metamemory in obsessive-compulsive disorder

Studies on the link between checking and memory problems have produced equivocal results regarding a general memory deficit in patients with obsessive-compulsive disorder and subclinical checkers. However, there is clear and consistent evidence that patients with obsessive-compulsive disorder (OCD) show lack of confidence in their memory performance. The purpose of the present study was to investigate memory and metamemory performance (feeling-of-knowing judgments) for neutral and threat-related material in three groups: OCD patients (OCs), subclinical checkers (SCs), and normal controls (NCs). Participants studied a list of neutral and threat word pairs. After an initial cued-recall test, they provided feeling-of-knowing (FOK) judgments for unrecalled word pairs, followed by a recognition test. The results showed that OCs but not SCs were impaired in both recall and recognition compared to NCs. OCs were also less confident about their future memory performance than the other two groups, as reflected in their lower FOK ratings. Moreover, FOK judgments of the OCs were not reliable predictors of their recognition performance. Finally, neither OCs nor SCs showed any evidence of memory bias for threat-relevant information. The results support the idea of a general memory and a metamemory deficit in OCs.     

Dysfunctional belief-based obsessive-compulsive disorder subgroups

An attempt was made to identify obsessive-compulsive disorder (OCD) subgroups based on differences in OCD related beliefs. OCD patients (N=367) were assessed with the Obsessional-Beliefs Questionnaire prior to treatment. Individuals' scores on measures of inflated personal responsibility and the tendency to overestimate threat, perfectionism and intolerance of uncertainty, and over-importance and over-control of thoughts were subjected to cluster analysis. Support for both a simple and complex subgroup model was found (2-subgroup and 5-subgroup taxonomies). A low-beliefs subgroup was identified in both taxonomies. The low-beliefs subgroups reported scores on belief measures equivalent to scores reported for non-OCD comparison groups in earlier studies. Additional analyses were conducted to determine relations between belief-based and symptom subgroups. Significant relationships were found (e.g., Symmetry symptom subgroup membership was associated with membership in the Perfectionism/Certainty beliefs subgroup), although the shared variance was modest. Implications for understanding OCD heterogeneity and for cognitive theory are discussed.