Mental Contamination in Obsessive-Compulsive Disorder: Associations With Contamination Symptoms and Treatment Response

The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.     

Development and Open Trial of a Psychosocial Intervention for Young Children With Chronic Tics: The CBIT-JR Study

The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5–8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms.Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen’s d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics.Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.     

Adolescent Disruptive Behavior and Borderline Personality Disorder Symptoms in Young Adult Men

Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal conflict of Oppositional Defiant Disorder (ODD) and the impulsivity of Attention Deficit Hyperactivity Disorder (ADHD) in particular may be indicative of an early developmental path towards BPD. The present study uses longitudinal data from a clinical sample of 177 boys, initially between the ages of 7 and 12, who were followed up annually to age 18, and who were reassessed at age 24 (n = 142). The study examines the prediction from repeated childhood measures of psychopathology measured annually through adolescence to BPD symptoms assessed at age 24, accounting for the effects of covariates including substance use, other personality disorders at age 24 and harsh physical punishment. The prevalence of BPD in this sample was consistent with other population estimates. Attention Deficit Hyperactivity Disorder (ADHD) and ODD were the only child psychiatric disorders to predict BPD symptoms, and the oppositional behavioral dimension of ODD was particularly predictive of BPD. These results indicate possible developmental links between early psychiatric disorders and BPD.     

The Utilization of Exercise to Decrease Depressive Symptoms in Young Adult Women

Depression is a prevalent issue for women on college campuses. Undergraduate women participated in (a) an aerobic exercise class, (b) a weight‐lifting class, or (c) a control group to determine the effect of exercise on depressive symptoms. Participants in the aerobic exercise group exhibited a significant decrease in depressive symptoms. Implications for college counselors are discussed.     

The Sense of Incompleteness as a Motivator of Obsessive-Compulsive Symptoms: An Empirical Analysis of Concepts and Correlates

Contemporary models of obsessive-compulsive disorder emphasize the importance of harm avoidance (HA) and related dysfunctional beliefs as motivators of obsessive-compulsive (OC) symptoms. Recently, there has been a resurgence of interest in Janet’s (1908) concept of incompleteness (INC) as another potentially important motivator. Contemporary investigators define INC as the sense that one’s actions, intentions, or experiences have not been properly achieved. Janet defined INC more broadly to include alexithymia, depersonalization, derealization, and impaired psychological mindedness. We conducted two studies to address four issues: (a) the clinical correlates of INC; (b) whether INC and HA are distinguishable constructs; (c) whether INC predicts OC symptoms after controlling for HA; and (d) the relative merits of broad versus narrow conceptualizations of INC. Study 1 was a meta-analysis of the clinical correlates of narrowly defined INC (16 studies, N = 5,940). INC was correlated with all types of OC symptoms, and was more strongly correlated with OC symptoms than with general distress. Study 2 (N = 534 nonclinical participants) showed that (a) INC and HA were strongly correlated but factor analytically distinguishable; (b) INC statistically predicted all types of OC symptoms even after controlling for HA; and (c) narrow INC was most strongly correlated with OC symptoms whereas broad INC was most strongly correlated with general distress. Although the findings are limited by being correlational in nature, they support the hypothesis that INC, especially in its narrow form, is a motivator of OC symptoms.     

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.     

Symptoms of PTSD Among Adolescents and Young Adult Survivors Six Years after the 2010 Haiti Earthquake

This study investigates the long-term consequences for adolescents and young adults who experienced the January 12, 2010, earthquake that struck Haiti. It aims to evaluate the consequences of the earthquake in adolescents and young adults six years after the disaster. During May and June 2016, in Port-au-Prince, 723 adolescents and young adults (364 girls and young women) aged 14 to 24 were assessed by means the Impact of Event Scale–Revised (IES-R) in addition to social demographic characteristics. In our sample, 35.82% reported clinically significant symptoms of PTSD, with a higher prevalence for girls and young women. They also had consistently higher scores than boys and young men on every subscale. Participants with working parents had consistently higher scores across all the subscales than participants whose parents did not work. This study showed that, more than six years after the earthquake, more than one third of the participants assessed had severe PTSD symptoms. Our results may prove useful for setting up mental health programs and devising tools appropriate for the youth population in Haiti.     

Prenatal Smoke Exposure Predicts Hyperactive/Impulsive but Not Inattentive ADHD Symptoms in Adolescent and Young Adult Girls

We examined the longitudinal associations between prenatal tobacco smoke exposure (PSE) and attention‐deficit hyperactivity disorder (ADHD) symptom domains in adolescence and young adulthood. A sample of girls with ADHD combined presentation (N = 93), ADHD predominantly inattentive presentation (N = 47), and matched comparisons (N = 88) was assessed prospectively. Symptoms of hyperactivity/impulsivity (HI), inattention (IA), and oppositionality (oppositional defiant disorder) were measured via multiple informants 5 (M age = 14 years; retention rate = 92%) and 10 years (M age = 20 years; retention rate = 95%) following childhood ascertainment. PSE was captured via maternal self‐report. We used linear regressions to examine the prediction from PSE to both HI and IA in adolescence and early adulthood after stringent control of relevant confounding variables. PSE significantly predicted HI during adolescence and young adulthood across multiple informants but did not predict IA at either wave. Symptoms of HI may have partial etiological independence from IA symptoms. Copyright © 2015 John Wiley & Sons, Ltd.     

3 Culture and Ego-Ideal in Suicide: An Adult Case

A case is presented in which the patient's self-expectations, arising from his ego ideal, were violated by a conflict with his wife, who came from a different culture and did not share his marital and family values. When she left him he was devastated, not only by the loss of his family, but by the destruction of his ideal vision of himself as a husband and father. A dangerous suicide attempt followed. The psychodynamic formulation of the case and the treatment that followed from it are discussed.     

Time-Varying and Time-Invariant Dimensions in Intolerance of Uncertainty: Specificity in the Prediction of Obsessive-Compulsive Symptoms

Intolerance of uncertainty (IU) is the tendency to respond negatively toward uncertain situations. IU consists of a Prospective factor (desire for predictability) and an Inhibitory factor (uncertainty paralysis) and is central to theoretical approaches to obsessive-compulsive disorder (OCD). However, time-invariant (TI) and time-varying (TV) components of IU and their association with OCD symptoms are not yet understood. The present study examined the association between TI and TV components of IU and OCD symptoms in community adults (N = 1,280) over a 5-month period. Latent variable models were fit to the data to examine the relative impact of TI and TV components of IU on OCD symptoms. As a test of specificity, models examining the association between TI and TV components of IU and depressive symptoms were also examined. The results showed that IU consists of significant TI and TV components, although the TI component accounted for most of the variance (76–84%) and was more strongly associated with OCD and depressive symptoms than the TV component. Furthermore, the TI component of IU was strongly associated with OCD symptoms when controlling for depressive symptoms, and the TI component of IU was strongly associated with depressive symptoms when controlling for OCD symptoms. A consistent pattern was observed for both Prospective and Inhibitory IU factors, with stable TI components demonstrating stronger relations with OCD and depressive symptoms than TV components. These findings have implications for conceptualizing the TI component of IU as a risk for OCD and other emotional disorders.     

An Open Trial Investigation of a Transdiagnostic Group Treatment for Children With Anxiety and Depressive Symptoms

The current study investigates the feasibility and preliminary outcomes associated with a transdiagnostic emotion-focused group protocol for the treatment of anxiety disorders and depressive symptoms in youth. Twenty-two children (ages 7 to 12; M = 9.79) with a principal anxiety disorder and varying levels of comorbid depressive symptoms were enrolled in an open trial of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Bilek, 2009), an intervention adapted from existent unified protocols for the treatment of emotional disorders among adults and adolescents. Results indicate that participants experienced significant improvements in clinician-rated severity of principal anxiety disorder diagnoses (d = 1.38), the sum of all anxiety and depressive disorder severity ratings (d = 1.07), and child-reported anxiety (d = 0.47) and parent-reported depressive symptoms (d = 0.54) at the posttreatment assessment. EDTP had good retention rates and reports of high satisfaction. Thus, preliminary evidence suggests that EDTP is a feasible and potentially efficacious treatment of youth anxiety disorders and co-occurring depressive symptoms. Children experiencing a range of internalizing symptoms may benefit from this more generalized, emotion-focused treatment modality, as it offers flexibility to families and the mental health clinician, while maintaining a concurrent focus on the provision of cognitive-behavioral treatment skills vital to the amelioration of anxiety and depressive disorder symptoms in youth.     

Recent Decreases in Specific Interpretation Biases Predict Decreases in Neuroticism: Evidence From a Longitudinal Study With Young Adult Couples

Engaging in a romantic relationship represents one important life experience in young adulthood that has been shown to catalyze age‐related decrease in neuroticism (Neyer & Lehnart, 2007). The current research builds directly on this finding by investigating one process that underlies the partnership effect. We focused on the relationship‐specific interpretation bias (RIB; Finn, Mitte, & Neyer, 2013), which is the tendency to interpret ambiguous partner and relationship scenarios in a negative way. It was expected that the RIB decreases within relationships in young adulthood and that this decrease in turn predicts long‐term declines in neuroticism. A sample of 245 young adult romantic couples was assessed four times across 9 months. Actor and partner effects of changes in the RIB on changes in neuroticism were analyzed using a dyadic dual change model. Recent time‐to‐time decreases in the RIB predicted one's own (actor effect) decline in neuroticism across 9 months. Similarly, there was a trend for a partner effect. We conclude that changes in biased relationship‐specific interpretations reflect one unique process that contributes to the understanding of romantic relationship effects on personality development.     

Symptoms of Specific and Generalized Social Phobia: An Examination of Discriminant Validity and Structural Relations With Mood and Anxiety Symptoms

Current models divide social phobia into specific (SSP) and generalized (GSP) subtypes and suggest strong overlap between GSP and avoidant personality disorder (APD). Meanwhile, other research suggests reclassifying anxiety and mood disorders as fear and distress disorders. To unify these separate lines of research, this study was designed to test the hypothesis that SSP is more related to fear disorders (e.g., panic and phobias), whereas GSP and APD are more related to distress disorders (e.g., depression and generalized anxiety). Confirmatory factor analysis suggested the best-fitting model had symptoms of GSP, APD, and depression loading on one factor, and symptoms of SSP, panic, and specific phobias loading on a second factor. Key components of this model were (a) the inclusion of GAD symptoms reduced model fit and (b) GSP and APD symptoms significantly predicted SSP symptoms; this is consistent with conceptualizations of individuals with both GSP and SSP reporting performance anxiety.     

The Effect of War Stressors and Life Events on Gulf War Veterans With Chronic Fatigue Syndrome Symptoms

This study examines the association of life stressors and the period when they occur, with the development of chronic fatigue syndrome (CFS) symptoms in Gulf War veterans. Of data collected from Gulf War Health Registry veterans, 113 met CFS criteria and 441were controls. After hierarchical multiple regression, several negative life stressors were associated with CFS group membership: being wounded, experiencing a traumatic war experience, frequent battle experiences, demotion, and unable to work within 2 years of returning from the Gulf. The positive life stressor of buying a house more than 2 years after returning protected against being in the CFS group. The findings are consistent with etiological hypotheses of CFS incorporating a psychosocial component and are useful in developing programs for veterans returning from war.     

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.     

Effects of Group Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in a Youth With Autism Spectrum Disorder

Individuals with Autism Spectrum Disorder (ASD) often present with comorbid Obsessive Compulsive Behaviors (OCBs), but little research exists on effective intervention for OCBs. Using a single-case experimental design, this study highlights the efficacy of a Group Functional Behavior-based Cognitive-Behavior Therapy (Fb-CBT) to reduce OCBs in an 11-year-old youth with ASD. Tailored to the individual needs of this youth, Fb-CBT included traditional CBT components (e.g., psychoeducation, cognitive-behavioral skills training, and exposure and response prevention) coupled with functional behavior assessment and intervention. Time-series parent report data and standardized measures showed clinically significant decreases in OCBs, an increase in psychosocial functioning, and high consumer satisfaction.     

Predictors of Suggestibility and False-Memory Production in Young Adult Women

Recent controversy over memories retrieved in therapy has highlighted the importance of increasing our understanding of individual differences in suggestibility and false-memory production. The purpose of this laboratory study was to assess the ability of several clinically relevant variables (acquiescence, self-esteem, and negative affect) to predict the tendency to yield to suggestive questioning, to alter responses in the face of interpersonal criticism, or to produce false memories (in this study, false recall of implied words). Results indicated that acquiescence significantly predicted suggestibility, as did competence self-esteem scores, but global self-esteem and negative affect scores did not. False-memory production (i.e., false recall of implied words) was associated with higher levels of both acquiescence and negative affect, but the tendency to alter responses after criticism was not significantly predicted by any variable.     

Care Orientation in the Teens as a Predictor of Young Adult Psychosocial Adjustment

The transition from adolescence to young adulthood is a watershed period in development that carries risk for poor psychosocial adjustment. It also carries potential for positive transitions into the caregiving roles and responsibilities of adult life. Research to date has predominantly focused on adolescent predictors of problematic rather than positive transitions; yet predictors of the latter hold equal (if not greater) promise for informing health promoting interventions. The purpose of this study was threefold: (1) to use Latent Profile Analysis (LPA) to define patterns of psychosocial adjustment and maladjustment in young adulthood (21-years of age); (2) to examine the unique role of adolescent prosocial behaviour (e.g., volunteering and civic engagement) in promoting adjustment and reducing maladjustment in young adulthood; and, (3) to examine whether protective developmental relationships are maintained after adjustment for other covariates including socio-economic background factors and personality characteristics. Data were drawn from the Victorian cohort of the International Youth Development Study (IYDS; N = 2407), a representative sample of students in Victoria, Australia. Students were assessed in Grade 9 (Mean age = 15-years) and followed up at age 21-years. LPA identified three psychosocial adjustment classes at age 21 defined as: (1) Adjusted (24.8 %); (2) Normative (63.9 %); and, (3) Maladjusted (11.3 %). Adolescent volunteering, belief in a moral order, family opportunities for prosocial behaviour, and commitment to school were associated with enhanced adjustment and reduced maladjustment in young adulthood. Findings highlight the potential benefit of interventions designed to enhance adolescent prosocial behaviours and care orientation in promoting healthy transitions into young adult life.