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.     

A feminist psychotherapeutic approach to working with women who eat compulsively1

Feminist psychoanalytic theorists argue that eating problems demonstrate ways in which conscious and unconscious gendered feelings about women are split off and projected on to their bodies. As such, they are complex ways in which women attempt to negotiate and express their identities within their paradoxical social position in contemporary western society. They are not just consumers but also objects of consumption. This paper explores material from a feminist psychodynamic therapy group for women with a variety of eating problems, focusing on how interweaving both discursive and unconscious approaches to understanding the gendered function of weight can facilitate change. Feminist psychodynamic therapists work with the concept that the body is an interface between conscious and unconscious mind within both an internal and a social world. This framework enables the client to understand the connections between socially constructed frameworks of femininity, emotions and bodily sensations, rather than to act on them through some form of bodily abuse. This approach is based on my adaptation of Susie Orbach's (1978) ‘Fat is a Feminist Issue’ therapeutic model for working with compulsive eaters. While arguing that a feminist psychoanalytic framework is crucial in this type of work, I suggest that it is essential to combine this with cognitive and behavioural therapeutic interventions in order to provide a pedagogic structure in which food, eating and body size come to be seen as meaningful.     

Manipulation of responsibility in non-clinical subjects: does expectation of failure exacerbate obsessive-compulsive behaviors?

An exaggerated sense of responsibility is currently considered as the ground for the obsessive-compulsive disorder. Obsessive-like behaviors, such as hesitations and checks, may be induced in non-clinical subjects by increasing perceived responsibility (i.e., perceived personal influence on negative outcomes). In line with Salkovskis' proposal [The cognitive approach to anxiety: threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions, in: P.M. Salkovskis (Ed.), Frontiers of Cognitive Therapy, Guilford, New York], we tested the hypothesis that reduced coping abilities (i.e., an exaggerated expectation of failure) are another effectual factor contributing to obsessive-like behaviors. We examined 47 normal volunteers in a visuo-spatial memory task, and manipulated their perceived personal influence and expectation of failure by giving differential instructions and feedback about their performance. Increase of perceived personal influence induced slowness, hesitations and checks without enhancing performance. Expectation of failure exacerbated obsessive-like behaviors, again without affecting performance. These results confirm the role of responsibility in obsessive-like behavior and indicate that reduced coping abilities may contribute to worsen dysfunctional strategies.     

Fear of contamination

Compulsive cleaning is an attempt to remove feelings of contamination that threaten one's physical health, mental health or ability to function socially. The fear of becoming contaminated can be complex, powerful, persistent and easily spread. Contamination is defined, the main types of contaminants set out and the characteristics of the fear are described. The distinction between normal and abnormal feelings of contamination is considered, and abnormal beliefs about contamination are analysed. Attention is drawn to the fact that contamination can occur without any physical contact, and the concept of mental pollution is used to elucidate this process. The causes and consequences of contamination fears are described, and some connections between fear and disgust are considered. The concept of cognitive co-morbidity is applied to an analysis of associations between the fear of contamination and obsessions, social fears and phobias. It is suggested that applying cognitive analyses and tactics may improve our ability to treat these powerful and tenacious fears.     

Cognitive behavioral therapy for compulsive buying disorder

To our knowledge, no psychotherapy treatment studies for compulsive buying have been published. The authors conducted a pilot trial comparing the efficacy of a group cognitive behavioral intervention designed for the treatment of compulsive buying to a waiting list control. Twenty-eight subjects were assigned to receive active treatment and 11 to the waiting list control group. The results at the end of treatment showed significant advantages for cognitive behavioral therapy (CBT) over the waiting list in reductions in the number of compulsive buying episodes and time spent buying, as well as scores on the Yale–Brown Obsessive Compulsive Scale—Shopping Version and the Compulsive Buying Scale. Improvement was well-maintained at 6-month follow-up. The pilot data suggests that a cognitive behavioral intervention can be quite effective in the treatment of compulsive buying disorder. This model requires further testing.     

Traiter ses données proprement : vers un meilleur usage du data cleaning

Data cleaning has long been shown to be an essential step in data analysis but its application is not systematic and varies between researchers. The aim of the present article is to study the effect of the different elements of data cleaning and to give recommendations. The steps considered are normality, outliers and missing values. Firstly, we advise a close examination of the data and its normality with a view to transformation. Secondly, we look at outliers and their treatment (trimming and winsorizing). Lastly, we turn our attention to missing values and how to deal with them depending on their randomness. We also cover the importance of visualizing data before analysis. Finally, we illustrate the effect of these data cleaning practices on a real data set. We show that data cleaning can lead to a significant result becoming non-significant and therefore demonstrate the importance of these steps before starting data analysis.     

Sleep disturbances in treatment‐seeking OCD‐patients: Changes after concentrated exposure treatment

Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD‐treatment. Thirty‐six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow‐up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre‐treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD‐symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow‐up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre‐treatment had better outcome on OCD‐symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.     

A Flaw in the Fabric

There appears to be a broad impression that an explicitly psychoanalytic framework of obsessive–compulsive disorder (OCD) is outdated and obsolete. However, interpersonal dynamics and experiences within the family during childhood and their intrapersonal sequelae in particular, may have substantial bearing on the early stages of the development of OCD. The author presents a set of observations about obsessional thoughts based on case material from research projects, psychometric assessments and psychotherapy with these patients. Freud’s contributions to understanding the internal world of the patient are discussed, suggesting a need to extend beyond the crucible of emerging affects and their regulation and into the wider stage in which the most profound struggle exists around relating to the other. We place the individual’s experience of others at the centre of our theories of the aetiology of OCD. We need to expand our understanding of OCD, particularly in how we locate the individual’s internal struggles within the context of the social environment in, and perhaps out of, which they have emerged.     

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.     

Deteriorating memory confidence, responsibility perceptions and repeated checking: comparisons in OCD and control samples

Repeated checking has been repeatedly associated with memory distrust. We sought to extend previous research using a computer-based checking task by incorporating a group of 15 individuals with OCD, and examining the effect of increased perceived responsibility. Participants were asked to repeatedly check a virtual stovetop, with half the participants also placed under a condition of high-perceived responsibility. Our observations replicated previous research showing that the act of repeatedly checking leads to reductions in memory vividness, detail and confidence, without accompanying reductions in memory accuracy. Furthermore, while a sense of increased personal responsibility had little effect on a student control sample, it led to a significant further deterioration in memory confidence in individuals with OCD. These results suggest that in people with OCD, normal reductions in memory confidence over repeated trials are exacerbated and intensified by inflated responsibility perceptions.