A Norwegian version of the Obsessive‐Compulsive Inventory–Revised: Psychometric properties

Solem, S., Hjemdal, O., Vogel, P.A. & Stiles, T.C. (2010). A Norwegian version of the Obsessive‐Compulsive Inventory–Revised: Psychometric properties. Scandinavian Journal of Psychology 51, 509–516. The aims of this study were to test the psychometric properties of the Norwegian version of the Obsessive‐Compulsive Inventory–Revised (OCI‐R). The study included a student/community control sample (N = 1167) and a clinical sample (N = 72) with a diagnosis of obsessive‐compulsive disorder (OCD). The results indicated a good fit for the six‐factor structure of the OCI‐R. The mean scores and standard deviations were similar to that of studies from other countries as was the internal consistency. The OCI‐R scores were significantly higher in the OCD sample compared to the control sample. All the subscales, except hoarding, were significant predictors of obsessive‐compulsive severity, and the OCI‐R subscales seemed to be in agreement with the different subtypes of OCD according to DSM‐IV. The OCI‐R showed meaningful correlations with measures related to obsessive compulsive symptoms. As expected, it showed the strongest correlation with the Yale‐Brown Obsessive Compulsive Scale, followed by measures of worry, anxiety, and depression. In summary, the Norwegian OCI‐R showed adequate psychometric properties suggesting it could be a suitable measure of obsessive‐compulsive symptoms.     

A multilevel longitudinal study of adolescent Internet addiction: The role of obsessive–compulsive symptoms and classroom openness to experience

Internet addiction (IA) in adolescence was longitudinally examined in relation to individual obsessive–compulsive symptoms and the personality trait of openness to experience (OTE) at the classroom level. The study consists of a two-point measure of a normative sample comprising 648 Greek adolescents (retention = 363, age 16–18 years, wave 1: age = 15.75 years, SD = 0.57, males = 46.2%, females = 53.8%). IA was assessed with the IA Test (Young, K. S. [1998]. Caught in the net: How to recognize the signs of internet addiction—And a winning strategy for recovery. New York, NY: Wiley), obsessive–compulsive symptoms with the Symptom check list 90 revised (Derogatis, L. R., & Savitz, K. L. [1999]. The SCL-90-R, brief symptom inventory, and matching clinical rating scales. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 679–724). Mahwah, NJ: Lawrence Erlbaum Associates Publishers) and OTE with the FFFK (Asendorpf, J. D., & van Aken, M. A. G. [2003]. Validity of big five personality judgments in childhood: A 9 year longitudinal study. European Journal of Personality, 17, 1–17). A three-level hierarchical linear model investigated individual- and classroom-level effects on IA score and its changes over time. The findings revealed that IA at the initial level was associated with the obsessive–compulsive symptoms of the individual and negatively related to classroom-level OTE. However, adolescents high on obsessive–compulsive symptoms in high on OTE classrooms presented higher IA scores over time.     

Recollections of parent–child relationships,attachment insecurity,and obsessive–compulsive beliefs

To adequately understand Obsessive Compulsive Disorder (OCD), it is important to understand the developmental origins of obsessive beliefs and corresponding compulsive acts. Prior work has shown that having cold, neglectful parents in childhood and/or insecure attachment styles are both linked to emotional disturbances. In this study, we explored the potential contributions of early parent–child relationships to attachment styles and the severity of obsessive–compulsive beliefs in adulthood. A sample of 397 college students completed online, self-report measures of retrospective parent–child relationships, adult attachment styles, and ongoing obsessive–compulsive symptoms. Analyses revealed that attachment anxiety partially mediated the association between parent–child relationships and obsessive beliefs; attachment avoidance failed to operate as a mediating mechanism. Our findings provide support for interpersonal approaches to obsessive–compulsive symptoms and disorder, with implications for the continuity of relationship dysfunction from childhood into adulthood.     

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.     

Hierarchical Structure of Dysfunctional Beliefs in Obsessive‐Compulsive Disorder

The Obsessive Beliefs Questionnaire was developed as a comprehensive measure of dysfunctional beliefs, which cognitive models consider to be etiologically related to obsessive‐compulsive disorder. Obsessive Beliefs Questionnaire subscales tend to be highly correlated, which raises the question of whether obsessive‐compulsive‐related beliefs are hierarchically structured, consisting of lower‐order factors loading on 1 or more higher‐order factors. To investigate the nature and relative importance of these factors, a hierarchical factor analysis was conducted (n = 202 obsessive‐compulsive disorder patients), using a Schmid‐Leiman transformation. Results indicated a higher‐order (general factor) and 3 lower‐order factors: (i) responsibility and overestimation of threat, (ii) perfectionism and intolerance of uncertainty and (iii) importance and control of thoughts. The high‐order factor accounted for more variance in Obsessive Beliefs Questionnaire scores (22%) than did the lower‐order factors (6–7%), thereby underscoring the importance of the higher‐order factor. Despite the importance of the higher‐order factor, the lower‐order factors significantly predicted unique variance in measures of obsessive‐compulsive symptoms, including severity ratings of compulsions. These finding suggest that cognitive models of obsessive‐compulsive disorder should take into consideration the hierarchic structure of obsessive‐compulsive‐related beliefs.     

Elucidating the Relation of Hoarding to Obsessive Compulsive Disorder and Impulse Control Disorders

Hoarding has historically been conceptualized as a symptom of Obsessive Compulsive Disorder (OCD); however, data demonstrate important differences between hoarding and OC symptoms (for discussion, see Grisham et al. Anxiety Disorders, 19, 767‑779. 2005). Hoarding has also been observed in disorders besides OCD, including specific Impulse Control Disorders (ICDs; e.g., kleptomania, trichotillomania, pathological gambling, compulsive buying). Therefore, the current study tested the hypothesis that hoarding would be as strongly related to symptoms of ICDs as it is to OCD and that these relationships would be medium to strong in magnitude. Results from an undergraduate sample showed hoarding behaviors were strongly related to symptoms of OCD, moderately related to symptoms of compulsive buying, and more modestly related to symptoms of pathological gambling, trichotillomania, and kleptomania. Finally, findings suggest indecisiveness may be a particularly important underlying feature in hoarding behaviors. These results support the consideration of hoarding outside the confines of OCD.

Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder

In spite of a growth in cognitive conceptualizations of obsessive‐compulsive symptoms, relatively little has been done to extend such concepts to childhood. This study investigated the relationship between responsibility attitudes and obsessive‐compulsive symptoms in normal children. A measure of responsibility attitudes in children was constructed on the basis of Salkovskis' Responsibility Attitudes Scale. This measure (Responsibility Attitudes Scale for Children) was administered together with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory to a sample of two hundred and two 10–14‐year‐old schoolchildren in Iceland. The responsibility measure correlated moderately and similarly with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory. In a hierarchical regression analysis predicting Leyton Obsessive Inventory Child Version scores, age and gender were entered in the equation first, followed by Children's Depression Inventory scores and, finally, Responsibility Attitudes Scale for Children scores. It was shown that Responsibility Attitudes Scale for Children scores added significantly to the prediction of Leyton Obsessive Inventory Child Version over and above the other variables. It is concluded that the study of the role of responsibility attitudes in children's obsessive‐compulsive symptoms is at least promising.     

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.     

Behavior analysis and the primary prevention of occupational injuries

Contemporary cognitive models of obsessive‐compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive‐compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive‐compulsive symptoms. To investigate this issue, data from 248 obsessive‐compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2‐ and 3‐way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive‐compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.     

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.     

Compulsive perseveration: empirical criticism on the mood-as-input model

It has been proposed that the "Mood as Input" model provides an explanation of the perseverative nature of Obsessive Compulsive (OC) behaviour (MacDonald, B. C., & Davey, G. C. L. (2005). A mood-as-input account of perseverative checking: The relationship between stop rules, mood and confidence in having checked successfully. Behaviour Research and Therapy, 43, 69-91). The model implies that task perseveration occurs when individuals (a) experience a bad mood and (b) ask themselves "did I do as much as I can?" In two earlier experiments with healthy participants (MacDonald, B. C., & Davey, G. C. L. (2005). A mood-as-input account of perseverative checking: The relationship between stop rules, mood and confidence in having checked successfully. Behaviour Research and Therapy, 43, 69-91) it was found that when the allegedly critical conditions were met (negative mood and "did I as much as I can?" stop rule) perseveration occurred on a complex text-correction task. This finding was held to support a "mood as input" explanation of compulsive perseveration. It is important to note, however, that perseveration in clinical samples occurs for very simple "tasks" (e.g. closing a door or washing ones hands) and perseveration does not increase efficacy of performance. In the present study we compared the effects of the original task to effects of text correction tasks that were simpler and more OCD-like. The original effects were replicated: the combination of negative mood and the "did I do as much as I can" stop rule provoked perseveration. Meanwhile, "perseveration" was highly functional: the more "perseveration" the more text-errors were detected. Secondly, to the degree that tasks became simpler and more OCD-like, less checking occurred and the effects of the "did I do as much as I can?" stop rule on detection of errors became smaller. The findings raise questions about the validity of the paradigm as a model of OC perseveration.     

Validation of a French version of the Obsessive–Compulsive Inventory-Revised in a non-clinical sample

Foa et al. (2002) presented a new instrument, the Obsessive–Compulsive Inventory-Revised (OCI-R), designed to evaluate the severity of obsessive–compulsive symptoms in both clinical and non-clinical individuals. The present study investigates the psychometric properties of a French version of this scale. The OCI-R French version was completed by 583 undergraduate students. The results revealed satisfactory internal consistency as measured by Cronbach's alpha coefficients (ranging from 0.63 to 0.86). In addition, the six-factor structure found by Foa et al. (2002) was confirmed in our sample by a confirmatory factor analysis. In brief, the French version of the OCI-R seems satisfactory for measuring Obsessive–Compulsive Disorders (OCD) symptoms in non-clinical samples. Future research is, however, needed to confirm these data in a sample of OCD patients.     

Perseverative and compulsive-like staring causes uncertainty about perception

Earlier studies have found that perseverative checking provokes memory distrust for checked stimuli, suggesting that compulsive checking is a counter-productive strategy to increase memory confidence. Obsessive Compulsive (OC) uncertainty also occurs for functions other than memory, like perception. Uncertainty about perception in OC patients gives rise to prolonged attending to the issues that patients feel uncertain about. In an experiment with 40 healthy volunteers, it was tested whether OC-like, perseverative (visual) attending induces OC-like experiences of dissociation and perceptual uncertainty. Participants had to look at an object (a gas stove or a light bulb) during a pre-test and a post-test. In between these tests, participants in the experimental condition were asked to stare at an object that was the same as the to-be-looked-at object during the pre/post-tests. Participants in the control condition stared at an object that was different from the object they looked at during pre/post-test. Both in the experimental and control conditions, dissociation was observed; the effects were equally strong. Critically, with regards to OC-like perceptual uncertainty, the effects were significantly stronger in the experimental condition. The findings indicate that OC-like perseveration induces distrust, not only about memory, but also about perception. To explain the results, we suggest that perseveration interferes with spreading of activation and that cognitive uncertainty (and possibly derealisation) is the experiential end-product of perseveration. It is suggested that all forms of OC perseveration share such interference and that all undermine confidence in cognitive operations.     

Dimensionality of the Obsessive Beliefs Questionnaire (OBQ)

The Obsessive Beliefs Questionnaire (OBQ) is a self-report measure in development by the Obsessive Compulsive Cognitions Working Group (OCCWG), who studies cognitive aspects of obsessive–compulsive disorder (OCD). The aim of this paper was to evaluate the dimensionality of the OBQ in students (n = 995). Two models were tested in a confirmatory framework, corresponding to the OCCWG's (a) original six subscales (87 items), and (b) more recent three subscales (44 items). Both models fit the present data poorly; thus, an exploratory analysis was undertaken. Results revealed one large factor that is relevant, but not unique, to OCD, and three factors that are conceptually consistent with the OCCWG's recent three: (a) distorted beliefs about one's own thoughts, (b) perfectionism, and (c) inflated responsibility. Convergent and divergent validity analyses of the present OBQ factors generally supported the preceding interpretations. Readers are referred to the work of the OCCWG for revisions to the OBQ.     

Pointing and the interference effect in obsessive‐compulsive disorder (OCD)

The interference effect in obsessive‐compulsive disorder (OCD) was investigated in order to analyze cognitive aspects of motor stereotypy in OCD‐related compulsions. So far, the domain of cognitive control in compulsive behavior has been under‐investigated. Twelve participants (OCD patients and healthy controls) completed a newly created computer‐based pointing task as well as standard clinical and psychological background measures. Findings showed that the patients displayed a larger visual interference effect compared to the controls and pointing paths were longer in time as well as distance when a distractor stimulus was present. It is concluded that, for compensation, patients would need to generate excessive amounts of attentional resources not available to overcome motor rigidity on the one side and visual distraction on the other side.     

The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample

The aims of the study were to estimate the prevalence rate of compulsive hoarding, and to determine the association between compulsive hoarding and compulsive buying in a nationally representative sample of the German population (N = 2307). Compulsive hoarding was assessed with the German version of the Saving Inventory-Revised (SI-R; Frost, R.O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: saving inventory-revised. Behaviour Research and Therapy, 42, 1163-1182.). The point prevalence of compulsive hoarding was estimated to be 4.6%. Individuals with compulsive hoarding did not differ significantly from those without compulsive hoarding regarding age, gender, and other sociodemographic characteristics. Significant correlations were found between the compulsive hoarding and the compulsive buying measures. Participants with compulsive hoarding reported a higher propensity to compulsive buying than respondents without hoarding. About two thirds of participants classified as having compulsive hoarding were also defined as suffering from compulsive buying. In summary, these results suggest that compulsive hoarding may be relatively prevalent in Germany and they confirm the close association between compulsive hoarding and compulsive buying through the investigation of a large scale representative sample.     

强迫症患者抑制困难与促进效应的实验研究

强迫症的发病是抑制困难还是促进效应, 或者是两者共同起作用的缘故, 是当前强迫症研究中急需解决的问题。因此, 本研究采用国际上较为新颖的抑制与促进范式, 探讨强迫症患者的抑制困难与促进效应, 并且进一步探寻了作为焦虑障碍一种的强迫症是否与其他焦虑障碍共同存在抑制与促进效应。结果发现: (1) 强迫症患者存在抑制困难与促进效应, 但是同正常个体组相比, 促进效应较为微弱, 而抑制困难作用则更为凸显; (2) 抑制困难是强迫症患者的特有的机制, 而不是与焦虑障碍患者的“共享物”。     

Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder

This study evaluated an inference‐based approach (IBA) to the treatment of obsessive‐compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. “Maybe the door is open”, “My hands could be dirty”) as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty‐four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y‐BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.     

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.     

Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30–40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.