Onset of obsessive-compulsive disorder: premorbid conditions and prodromal phase

This article focuses on the clinical onset of obsessive-compulsive disorder (OCD), specifically addressing the age of onset, gradual and acute onset, and whether there are some types of premorbid conditions or a prodromal phase that predispose individuals to the onset of OCD. Clinical and epidemiological studies have come to different conclusions regarding age at onset as well as regarding differences between the sexes. Data gleaned from research to date have demonstrated a relationship between OCD and obsessive-compulsive personality disorder (OCPD), although OCPD does not appear to be the more prevalent personality disorder among patients with OCD. Preliminary research has suggested that Axis I disorders may predispose individuals to OCD onset; however, the significance of this relationship remains to be clarified. Evidence of the association between OCD and subthreshold obsessive-compulsive syndrome suggests that these disorders lie on a continuum of severity, with some cases developing OCD while others do not.     

Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.     

Do traumatic events influence the clinical expression of compulsive hoarding?

Traumatic experiences have been posited as one potential catalyst for the abrupt onset of obsessive-compulsive symptoms including compulsive hoarding. To determine whether traumatic life events (TLEs) might influence the expression of compulsive hoarding in obsessive-compulsive disorder (OCD), interview responses to the Posttraumatic Stress Disorder module of the Structured Clinical Interview for DSM-IV (SCID) were examined in 180 individuals with OCD. Compared to individuals with OCD who did not meet criteria for hoarding, participants classified as hoarders (24% of the sample) were significantly more likely to have reported at least one TLE in their lifetime. Patients who met criteria for hoarding and who had also experienced TLEs had significantly greater hoarding symptom severity than those hoarders not exposed to trauma. This association was found to be robust. That is, the relationship between TLEs and hoarding symptom severity was not better accounted for by age, age of OCD onset, depressive symptoms, general OCD symptomatology, or mood and anxiety comorbidity. Closer examination revealed that the clutter factor of compulsive hoarding (and not difficulty discarding or acquisitioning) was most strongly associated with having experienced a traumatic event.     

The role of life events in the onset of panic disorder

Twenty-five panic disorder patients and fifteen obsessive-compulsive patients are compared with regard to a number of Life Events over the last 12 months prior to onset of the disorder and additionally over the total life course up until onset of the disorder. Panic Disorder patients do not differ from obsessive-compulsive disorder patients in terms of the number of life events, they experience during the last year prior to onset of their disorder. However, over the total life course, Panic Disorder patients do seem to be exposed to more Life Events than obsessive-compulsive disorder patients. The findings are discussed in light of the existing literature.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

The role of glutamate in anxiety and related disorders

Anxiety, stress, and trauma-related disorders are a major public health concern in the United States. Drugs that target the gamma-aminobutyric acid or serotonergic system, such as benzodiazepines and selective serotonin reuptake inhibitors, respectively, are the most widely prescribed treatments for these disorders. However, the role of glutamate in anxiety disorders is becoming more recognized with the belief that drugs that modulate glutamatergic function through either ionotropic or metabotropic glutamate receptors have the potential to improve the current treatment of these severe and disabling illnesses. Animal models of fear and anxiety have provided a method to study the role of glutamate in anxiety. This research has demonstrated that drugs that alter glutamate transmission have potential anxiolytic action for many different paradigms including fear-potentiated startle, punished responding, and the elevated plus maze. Human clinical drug trials have demonstrated the efficacy of glutamatergic drugs for the treatment of obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social phobia. Recent data from magnetic resonance imaging studies provide an additional link between the glutamate system and anxiety. Collectively, the data suggest that future studies on the mechanism of and clinical efficacy of glutamatergic agents in anxiety disorders are appropriately warranted.     

Memory of the traumatic event as a risk factor for the development of PTSD: lessons from the study of traumatic brain injury

Traumatic memories, and the mechanisms by which they operate, continue to occupy a central role in the scientific investigation of risk factors for the development of posttraumatic stress disorder (PTSD). However, empirically based studies are constrained by practical and ethical considerations and are limited to naturalistic models. Consequently, the paradigms most appropriate for the exploration of the relationship between traumatic memories and PTSD have been identified in conditions involving traumatic events where memories may be compromised. Indeed, traumatic brain injury, a condition that is commonly associated with memory impairment, has often been utilized as a naturally occurring model for the study of traumatic memory and its contribution to the development of PTSD. This article presents a critical review of these research efforts and discusses their theoretical and clinical implications.     

Obsessive-compulsive disorder: boundary issues

The boundaries between obsessive-compulsive disorder (OCD) and other neuropsychiatric disorders remain unresolved and may well differ from one disorder to another. Endophenotypes are heritable, quantitative traits hypothesized to more closely represent genetic risk for complex polygenic mental disorders than overt symptoms and behaviors. They may have a role in identifying how closely these disorders are associated with another and with other mental disorders with which they share major comorbidity. This review maps the nosological relationships of OCD to other neuropsychiatric disorders, using OCD as the prototype disorder and endophenotype markers, such as cognitive, imaging, and molecular data as well as results from demographic, comorbidity, family, and treatment studies. Despite high comorbidity rates, emerging evidence suggests substantial endophenotypic differences between OCD and anxiety disorders, depression, schizophrenia, and addictions, though comparative data is lacking and the picture is far from clear. On the other hand, strong relationships between OCD, Tourette syndrome, body dysmorphic disorder, hypochondriasis, grooming disorders, obsessive-compulsive personality disorder, and pediatric autoimmune neuropsychiatric disorders associated with streptococcus are likely. Studies designed to delineate the cause, consequences, and common factors are a challenging but essential goal for future research in this area.     

Hopelessness as a Risk Factor for Post‐traumatic Stress Disorder Symptoms Among Interpersonal Violence Survivors

Post‐traumatic stress disorder often co‐occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post‐traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self‐reported and interviewer‐rated measures of hopelessness gathered at 2 weeks post‐trauma and self‐reported and interviewer‐rated symptoms of post‐traumatic stress disorder gathered at 2 weeks and 3 months post‐trauma were examined. Hierarchical, simultaneous regression analyses that co‐varied trauma type revealed that hopelessness was related to self‐reported symptoms of post‐traumatic stress disorder, both concurrently and prospectively. Follow‐up analyses revealed that relationships between hopelessness and symptoms of post‐traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer‐rated symptoms of post‐traumatic stress disorder.     

急性应激障碍（ASD）研究述评

急性应激障碍是个体在亲历、目击或面临一个对自己或他人具有死亡威胁、严重伤害的创伤事件后的2天至4周内所表现的应激反应。急性应激障碍的症状主要表现为分离、再历、回避和过度警觉。文章回顾了以往的相关研究,从急性应激障碍的测评方法、发生率、与创伤后应激障碍和创伤记忆的关系、心理治疗和干预等方面进行了综述。最后对未来可能的研究方向提出了展望     

Long-Term Guilt and Hostility Underlying Posttraumatic Stress Symptoms in War Combatants and Ex-Prisoners of War

The link between posttraumatic guilt and posttraumatic stress disorder has gained recognition over the past decades and was recently expressed in the modifications made to the diagnostic criteria for the disorder under the DSM-V. Yet, the psychological dynamics underlying this relation are still not fully understood. The present study introduces a model whereby different dynamics between guilt and hostility are related to posttraumatic stress disorder symptoms (PTSS), following different traumatic war experiences. One hundred and forty-four former prisoners of war (ex-POWs) and 143 comparable combatants participated in the study, 30 years after the war, reporting on their PTSS, guilt, and hostility. Moderation analyses revealed a three-way interaction, where high hostility buffered the effect of guilt on PTSS only among ex-POWs. This finding suggests a distinctive dynamic among guilt, hostility, and PTSS following diverse traumatic events. Specifically, it appears that hostility can have a mitigating effect on the negative outcomes of guilt for ex-POWs following trauma, but not for non-POW veterans. The theoretical reasoning and the clinical implications of these findings are discussed.     

Thought-action fusion: a comprehensive analysis using structural equation modeling

Thought-action fusion (TAF), the phenomenon whereby one has difficulty separating cognitions from corresponding behaviors, has implications in a wide variety of disturbances, including eating disorders, obsessive-compulsive disorder, generalized anxiety disorder, and panic disorder. Numerous constructs believed to contribute to the etiology or maintenance of TAF have been identified in the literature, but to date, no study has empirically integrated these findings into a comprehensive model. In this study, we examined simultaneously an array of variables thought to be related to TAF, and subsequently developed a model that elucidates the role of those variables that seem most involved in this phenomenon using a structural equation modeling approach. Results indicated that religiosity, as predicted by ethnic identity, was a significant predictor of TAF. Additionally, the relation between ethnic identity and TAF was partially mediated by an inflated sense of responsibility. Both TAF and obsessive-compulsive symptoms were found to be significant predictors of engagement in neutralization activities. Clinical and theoretical implications are discussed.     

Childhood trauma and psychosis: Review of the evidence and directions for psychological interventions

There is controversy over whether childhood trauma (CT) is a causal risk factor for psychosis. The aim of this study was to provide psychologists with a brief overview of the research into relationship between childhood trauma and psychosis and directions for psychological interventions. It details six of the highest quality studies in the area and tentatively concludes from these that there is evidence for a relationship between CT and psychosis. Hallucinations and delusions have been implicated as important factors in the relationship between CT and psychotic disorder and these are discussed, along with post‐traumatic intrusions and schemas, which have been conceptualised as part of the psychological mechanisms whereby CT confers a risk for psychosis. The development of psychological interventions for people with psychosis who have experienced CT is in its infancy but has been based on evidence‐based cognitive behavioural interventions in psychosis and post‐traumatic stress disorder. A formulation‐based approach is described in this paper, along with a case study.     

The relationship between schizotypal and obsessive-compulsive features in university students

Comorbid schizotypal personality disorder (SPD) is relatively common in patients with obsessive-compulsive disorder. Some have argued, however, that the severity of the primary disorder results in inflated estimates of personality disorder. The present investigation explored the possibility that schizotypal features are also significantly related to obsessive-compulsive features in a nonclinical sample. One-hundred and ninety-two student volunteers completed the Maudsley Obsessional-Compulsive Inventory (MOCI) and the Schizotypal Personality Questionnaire (SPQ), the latter being a self-report inventory designed to tap all nine features of DSM-III-R SPD. Correlations between schizotypal and obsessive-compulsive features were strongest for compulsive checking as opposed to compulsive washing, slowness or doubting. Regression analyses revealed that only the MOCI checking subscale was a significant independent predictor of the total SPQ schizotypal score. Findings indicate that schizotypal features are also found in association with nonclinical levels of obsessive-compulsive features, particularly checking behaviors. The influence of gender on these findings are discussed.     

Associations in the course of personality disorders and Axis I disorders over time

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders.     

Relationship of obsessive-compulsive personality to obsessive-compulsive disorder: a review of the literature

The nature of the relationship between obsessive-compulsive personality and obsessive-compulsive disorder has been the subject of considerable debate. The present article dealt with clinical opinion and reviewed empirical data bearing on this issue. It was concluded that, although the two clinical entities bear a surface similarity in terms of shared behavioral features and defenses, obsessive-compulsive personality is neither a necessary nor sufficient factor in the development of obsessive-compulsive disorder, though the latter appears to be more frequently associated with premorbid obsessive-compulsive personality patterns than with other personality patterns. Suggestions for future research study are made.     

Sociodemographic, clinical and outcome differences among anxiety disorders

The aims of this paper are to analyze differences in sociodemographic and clinical characteristics among the various anxiety disorders treated in a Psychology Clinic, and the results of treatment in each anxiety disorder. Data from 282 patients of University Psychology Clinic at the Complutense University of Madrid, who had at least one diagnosis of anxiety according to DMS-IV-TR criteria, were analyzed. The most frequent anxiety disorders were nonspecific anxiety disorder (19.1%) and social phobia (18.8%). Significant differences were observed according to sex (in all disorders, the percentage of women was significantly higher than that of men, except for obsessive-compulsive disorder). Unspecific anxiety disorder required a smaller number of assessment and treatment sessions, whereas obsessive-compulsive disorder required a greater number of sessions. There were no significant differences between the percentage of patients who completed treatment and dropout rates in specific phobia, general anxiety disorder and obsessive-compulsive disorder. Differences between epidemiological and clinical data are discussed.     

Thought suppression and psychopathology.

Wegner's seminal investigations of effects of thought suppression on later thought frequency have had a significant impact on recent approaches to understanding emotional disorders characterized by the occurrence of persistent, repetitive, unwanted thoughts. Thought suppression has now been implicated as a etiological and/or maintaining factor in depression, generalized anxiety disorder, specific phobia, posttraumatic stress disorder and obsessive-compulsive disorder. These developments are fairly new, and it has not been until recently that studies have investigated the effects of suppressing thoughts that are actually analogous to problematic thoughts characteristic of emotional disorder. This paper provides a review of this body of work, including the findings and their relevance for existing models of specific disorders. Directions for future research are suggested.     

Overview of diagnosis and drug treatments of anxiety disorders

Anxiety disorders are common and often disabling. They fall into five main categories: panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder and posttraumatic stress disorder, each of which have characteristic symptoms and cognitions. All anxiety disorders respond to drugs and psychological treatments. This review will focus on drug treatments. Recent research has emphasized the value of antidepressants especially the selective serotonin reuptake inhibitors, benzodiazepines, and related sedative-like compounds. The common co-existence of depression with all of the anxiety disorders means that the selective serotonin reuptake inhibitors are now generally considered to be the first-line treatments but the benzodiazepines have some utility especially in promoting sleep and working acutely to reduce extreme distress.     

Obsessive Compulsive Symptoms Predict Posttraumatic Growth: A Longitudinal Study

Although posttraumatic growth (PTG) has received growing attention, the relationship between PTG and distress remains unclear. This longitudinal study examines the relationship between posttraumatic obsessive-compulsive (OC) symptoms and PTG. Israeli veterans were followed over 17 years using self-report questionnaires of OC symptoms, posttraumatic stress disorder (PTSD), and PTG. Hierarchical regression analyses demonstrated that OC symptoms predicted PTG, even when initial PTG levels and PTSD symptoms were controlled for in the combatants group. These preliminary findings suggest that OC symptoms may play an important role in facilitating psychological growth. Future research is warranted to explore the mechanisms responsible for this relationship.