Measuring Change in OCD: Sensitivity of the Obsessive-Compulsive Inventory-Revised

This study examined the sensitivity to change and specificity of response of the Obsessive-Compulsive Inventory-Revised (OCI-R), an 18-item self-report measure of obsessive-compulsive disorder (OCD) severity. Seventy-seven OCD patients received cognitive-behavioral therapy incorporating exposure and response prevention (ERP). Change from pre- to posttest on the OCI-R was compared to changes as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other measures of OCD and related symptoms. Results suggest the OCI-R is sensitive to treatment effects and that pre- to posttest change on this instrument reflects improvement in OCD and related symptoms of depression, anxiety, and global functioning. The OCI-R was not sensitive to improvement in patients’ insight into the senselessness of their OCD symptoms. The OCI-R appears suitable for use in clinical settings and naturalistic outcome studies where time and resources do not permit administration of lengthy symptom interviews.     

Unwanted memories of assault: what intrusion characteristics are associated with PTSD?

Intrusive memories are common in the immediate aftermath of traumatic events, but neither their presence or frequency are good predictors of the persistence of posttraumatic stress disorder (PTSD). Two studies of assault survivors, a cross-sectional study (N=81) and a 6-month prospective longitudinal study (N=73), explored whether characteristics of the intrusive memories improve the prediction. Intrusion characteristics were assessed with an Intrusion Interview and an Intrusion Provocation Task. The distress caused by the intrusions, their "here and now" quality, and their lack of a context predicted PTSD severity. The presence of intrusive memories only explained 9% of the variance of PTSD severity at 6 months after assault. Among survivors with intrusions, intrusion frequency only explained 8% of the variance of PTSD symptom severity at 6 months. Nowness, distress and lack of context explained an additional 43% of the variance. These intrusion characteristics also predicted PTSD severity at 6 months over and above what could be predicted from PTSD diagnostic status at initial assessment. Further predictors of PTSD severity were rumination about the intrusive memories, and the ease and persistence with which intrusive memories could be triggered by photographs depicting assaults. The results have implications for the early identification of trauma survivors at risk of chronic PTSD.     

The structural relationships among generalized anxiety, obsessions-compulsions, and depression at the syndrome and sub-syndrome level

This study explored anxiety's relationship to depression by assessing a group of 592 undergraduate psychology students at Washington State University. Multiple measures of generalized anxiety (GA), obsessions–compulsions (O–C), and depression were used to conduct several confirmatory factor analyses (CFAs). A three-factor model of GA, O–C, and depression was found superior in fit to a one-factor “negative-affect” model, a two-factor model of anxiety and depression, and a second-order three-factor model. Further CFAs divided GA, O–C, and depression into six independent symptom category factors utilizing instrument subscales (e.g., worry, somatic anxiety, obsessions, compulsions, cognitive depression, and somatic depression). The fit for this model was superior to three alternative measurement models. The correlations among the six symptom category constructs revealed differential patterns among the cognitive and somatic symptoms.     

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.     

Neurocognitive impairment does not predict treatment outcome in obsessive-compulsive disorder

There is conflicting evidence pertaining to whether or not neurocognitive task performance at baseline predicts treatment response in obsessive-compulsive disorder (OCD). In the present study, we administered a set of executive neurocognitive tests with a putative sensitivity for treatment outcome to a sample of 138 OCD patients. Additionally, subjective neurocognitive dysfunction was determined via a questionnaire. All patients participated in a cognitive-behavioural treatment program (CBT). Results showed that responders (n = 73) did not differ from non-responders (n = 65) on any of the parameters except for decreased performance on the delayed alternation test (p < .1, effect size: .61). A subsidiary analysis revealed that slowing on the Trail-Making Test A and an enhanced rate of perserveration errors on the Wisconsin Card Sorting Test predicted poor outcome for the treatment of compulsions. It is concluded that neurocognitive impairment does not represent a reliable early warning sign for non-response to CBT.     

Development of the body image concern inventory

Development of the Body Image Concern Inventory (BICI), a measure designed to assess dysmorphic concern, is described. A panel of expert raters supported the construct validity of the measure, and four college student samples (Ns=184, 200, 56, 40) supported the internal consistency of the BICI. In addition, in studies 1 and 3, concurrent validity was established through comparison of the BICI to extant self-report and interview measures of dysmorphic symptomatology. Convergent validity patterns were assessed through comparison with measures of obsessive-compulsive and eating disorder symptomatology in studies 2 and 4. Finally, the results of study 4 supported that the BICI discriminated individuals with a diagnosis of Body Dysmorphic Disorder or bulimia (disorders that frequently involve high levels of dysmorphic concern) from those with subclinical symptoms. Results suggest that the BICI is a reliable, valid, and user-friendly tool for assessing dysmorphic concern, with utility in both research and clinical settings.     

Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder

The current study investigated aspects of post-traumatic stress disorder and attention deficit/ hyperactivity disorder (ADHD) among hoarders. Compared to a sample of 36 controls, hoarders (n=26) reported a significantly greater number of different types of trauma, more frequent traumatic experiences, more symptoms of inattention, hyperactivity, and greater comfort derived from possessions. These findings are consistent with previous reports of extensive comorbidity associated with hoarding behaviors, and may reflect the potential usefulness of assessing PTSD and ADHD symptoms at the outset of hoarding treatments, as well as considering alternative pharmacological interventions.     

Treatment of panic disorder: live therapy vs. self-help via the Internet

A randomized trial was conducted comparing 10 individual weekly sessions of cognitive behaviour therapy for panic disorder (PD) with or without agoraphobia with a 10-module self-help program on the Internet. After confirming the PD diagnosis with an in-person structured clinical interview (SCID) 49 participants were randomized. Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail can be equally effective as traditional individual cognitive behaviour therapy. Composite within-group effect sizes were high in both groups, while the between-group effect size was small (Cohen's d=16). One-year follow-up confirmed the results, with a within-group effect size of Cohen's d=0.80 for the Internet group and d=0.93 for the live group. The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs.     

Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV

The “Not Otherwise Specified” (NOS) category within DSM-IV is designed for disorders of clinical severity that are not specified within broad diagnostic classes. “NOS” diagnoses are intended to be residual categories and they tend to be neglected by researchers. This can be inappropriate. The problems associated with certain NOS diagnoses are well illustrated by “Eating Disorder NOS” (sometimes termed EDNOS), which is the most common category of eating disorder encountered in routine clinical practice yet it has barely been studied. Indeed, there has been no research on its treatment. Interim and longer-term conceptual and practical solutions to the anomalous status of eating disorder NOS are proposed including the creation of a new diagnosis termed “mixed eating disorder”. Several of these solutions are of relevance to NOS categories in general. All the solutions should fulfil criteria for clinical utility.