Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder

Body dysmorphic disorder (BDD) continues to challenge professionals due to symptom severity, co-morbidity, suicidal ideation, and overvalued ideation. Despite the disorder's severity, little research exists. Clinical observation suggests a noteworthy history of abuse; therefore the present study investigated the reported rate of physical, sexual, and emotional abuse in BDD patients. OCD patients were chosen as a comparison group because BDD is considered to be an obsessive-compulsive spectrum disorder. A group survey design was used (N = 50 for each group). Results show significantly higher levels of emotional and sexual abuse in the BDD sample versus the OCD sample. No significant differences were found in physical abuse. Abuse may be a contributing factor in BDD, but not in OCD.     

The Yale-Brown Obsessive-Compulsive Scale: Confirmatory Factor Analytic Findings

The psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have recently been heavily examined. Specifically, a number of researchers have been interested in determining the factor structure of this scale to find whether it best forms a one, two, or three factor model. The present study continued this examination by considering different scaling models using confirmatory factor analysis with a sample of individuals diagnosed with Obsessive-Compulsive Disorder (OCD). One hundred and forty-six individuals diagnosed with OCD participated and were administered the Y-BOCS and scales measuring depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). It was found that the Y-BOCS forms two different two-factor models. One model consisted of an obsessions and compulsions factor; the other composed of disturbance and symptom severity factors. It was likewise found that depression and anxiety were related to both factors in one model (disturbance and symptom severity). The finding that depression was related to obsessions and anxiety to compulsions was found, as in a previous factor analysis of the Y-BOCS. These findings suggest that OCD may be best characterized as a multidimensional syndrome that may not be adequately examined by a single unitary factor as described in the Y-BOCS.     

The Overvalued Ideas Scale: development, reliability and validity in obsessive-compulsive disorder.

The presence of overvalued ideas in obsessive-compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome [Kozak, M. J. & Foa, E. B. (1994). Obsessions, overvalued ideas and delusions in obsessive-compulsive disorder. Behaviour Research and Therapy, 32, 343-353]. To date, no measures have been developed which quantitatively assess levels of overvalued ideas in obsessive-compulsives. The present studies examined the psychometric properties of a scale developed to measure this form of psychopathology, the Overvalued Ideas Scale (OVIS). In study 1, 102 patients diagnosed with OCD were administered a battery of instruments including the OVIS at baseline and two weeks later, prior to initiating treatment. Results indicate that the OVIS has adequate internal consistency reliability (coefficient alpha = 0.88 at baseline), test-retest reliability (r = 0.86) and interrater reliability (r = 0.88). Moderate to high levels of convergent validity was found with measures of obsessive-compulsive symptoms, a single item assessment of overvalued ideas and psychotic symptoms. Medium levels of discriminant validity with measures of anxiety and depression was obtained in this study. Individuals determined to have high OVI showed greater stability of this pathology than those with lower OVI, suggesting that overvalued ideas are stable for extreme scorers. In study 2 a total of 40 patients participated who were diagnosed with OCD. The same battery of instruments was administered as in study 1, as well as the Beck Depression Inventory and Beck Anxiety Inventories. Results were similar to that obtained in study 1, including a relative lack of discriminant validity with self-report measures of depression and anxiety. It is suggested that further research with the OVIS may show predictive value in treatment outcome studies of OCD.     

Predictive validity of the overvalued ideas scale: outcome in obsessive-compulsive and body dysmorphic disorders

Overvalued ideas have been theoretically implicated in treatment failure for obsessive-compulsive disorder (OCD). Until recently, there have not been valid assessments for determining severity of overvalued ideas. One recent scale, the Overvalued Ideas Scale (OVIS; Neziroglu, McKay, Yaryura-Tobias, Stevens & Todaro, 1999, Behaviour Research and Therapy, 37, 881-902) has been found to validly measure overvalued ideas. However, its predictive utility has not been determined. Two studies were conducted to examine the extent to which the OVIS predicts treatment response. Study 1 examined the response to behavioral therapy in a group of participants diagnosed with OCD. Residual gain scores showed a significant correlation between treatment outcome for compulsions and pretreatment OVIS scores (28.1% variance accounted). Pretreatment OVIS scores were not significantly correlated with residual gains in obsessions (1.7% variance accounted). The predictive utility of the OVIS was superior to a single item assessment of overvalued ideas available on the Yale-Brown Obsessive Scale in predicting outcome for compulsions. For this item, the variance accounted for compulsions was 6.3% and for obsessions was 3.9%. Study 2 examined the response to behavioral therapy in a group of participants diagnosed with body dysmorphic disorder (BDD), a condition ostensibly linked to OCD and presumed to present with higher levels of overvalued ideas. Residual gains scores showed a significant relationship between obsessions and OVIS (accounting for 34.8% of the variance), but not for compulsions (10.2% variance accounted). As in Study 1, the predictive utility of the OVIS was superior to the single item assessment (with 0.2% variance accounted for compulsions, 2.4% variance accounted for obsessions). Taken together, the studies reported here show that this OVIS is predictive of treatment outcome, and the predictive value depends on which symptoms are used to assess outcome. Further, the scale is more effective in predicting outcome than a widely used single item assessment.