Sensitive domains of self-concept in obsessive-compulsive disorder (OCD): further evidence for a multidimensional model of OCD

Aspects of self-concept have been implicated in recent empirical and theoretical investigations of obsessive-compulsive disorder (OCD). This article extends previous theory and research by investigating the proposal that specific self-structures may be linked with OCD [e.g., Doron, G., & Kyrios, M. (2005). Obsessive-compulsive disorder: a review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, 25, 415-432]. In particular, it was hypothesized that individuals who value the domains of morality, job and scholastic competence, and social acceptability, but who feel incompetent in these domains (i.e., "sensitive" domains of self), would hold a greater level of OC-related beliefs and display more OC-symptoms. The study was performed in 198 non-clinical participants, using a multidimensional measure of self-concept. As predicted, it was found that sensitivity in the four domains was related to higher levels of OC-related beliefs. Sensitivity in the domains of morality, job competence and social acceptability also related to higher levels of OC-symptoms. Further, these findings were generally maintained when controlling for global self-worth. Based on these results, it is argued that sensitivity of self-concept may be associated with OC cognitions and phenomena. Implications for theory and treatment are discussed.     

Exploring the role of obsessive-compulsive relevant self-worth contingencies in obsessive-compulsive disorder patients

This article examines whether self-worth contingencies in the personal domains of cleanliness, morality, hoarding, certainty, accuracy, religion and respect for others have specific associations with obsessive symptoms and cognitions in individuals with obsessive-compulsive disorder (OCD). Fifty-seven patients with a primary diagnosis of OCD completed the Obsessional Concerns and Self Questionnaire (OCSQ), designed to assess the extent to which respondents consider OCD content domains relevant to their self-worth, along with a battery of other instruments. Results indicate that the OCSQ is more associated with OCD than with non-OCD anxiety symptoms, and that it is also associated with comorbid depressive symptoms in OCD patients. Moreover, the OCSQ-Order and Cleanliness and Hoarding dimensions are associated with their symptom counterparts (i.e., contamination, checking, order, hoarding and neutralizing). OCSQ domains were highly associated with dysfunctional beliefs about obsessions. However, only the OCSQ scores, but not the dysfunctional beliefs, predicted OCD symptoms. These results support cognitive conceptualizations implicating self-concept in OCD development, and they suggest the need to further analyze the influence of self-worth in OCD development and maintenance.     

Beliefs in Obsessive-Compulsive Disorder

Several types of beliefs have been hypothesized to be associated with obsessive-compulsive disorder (OCD), including responsibility for harm, need to control thoughts, overestimates of threat, intolerance of uncertainty, and beliefs about the consequences of anxiety and capacity to cope. The present study compared 62 subjects with OCD, 45 with other anxiety disorders (AD) and 34 controls, using 3 measures of OCD-related beliefs. OCD subjects scored higher than AD and control samples on 2 general belief measures. A closer analysis of specific belief domains indicated that OCD subjects scored higher than AD and control subjects on all 6 specific belief domains (responsibility, control, estimation of threat, tolerance of uncertainty, beliefs about the consequences of anxiety, and the capacity to cope). Four of the 6 domains showed reasonable convergent and discriminant validity with measures of OCD symptoms compared to other psychopathology; anxiety and coping beliefs were the exceptions. In regression analyses, cognitive measures contributed significant explanatory power beyond mood state and worry with uncertainty predicting severity of OCD symptoms above all other belief domains. Further research on OCD-relevant belief domains in etiology, maintenance and treatment is warranted.     

In search of specificity: “Not just right experiences” and obsessive–compulsive symptoms in non-clinical and clinical Italian individuals

The cognitive model of OCD proposes that certain beliefs may contribute to the development and maintenance of this disorder. To date, however, it is not yet clear which beliefs are more relevant for explaining OCD symptomatology; moreover, their causal status is yet to be clearly established. In the effort to identify other constructs and processes related to OCD, the phenomenon labeled “not just right experiences” (NJREs) has received increasing attention. In this study, measures of NJREs (the NJRE-Q-R), OCD symptoms, general distress (i.e., anxiety, and depression), and perfectionism were administered to a large sample of college students and a small sample of OCD and non-OCD patients. The clinical sample also completed a measure of OC beliefs. Results showed that NJREs could be reliably measured through a self-report format in non-clinical and clinical Italian individuals. A specific association between NJREs severity and OCD symptoms was found in the non-clinical sample, after controlling for anxiety, depression, and perfectionism. The NJRE-Q-R Severity scale clearly discriminated OCD patients from patients with other anxiety disorders or depression. Lastly, the NJREs measure differentiated the clinical groups when OC beliefs were controlled, whereas OC beliefs did not discriminate among the groups after NJREs severity was controlled. The concept of NJREs may contribute to improve current psychological and biological model of OCD.     

Incremental specificity of disgust sensitivity in the prediction of obsessive-compulsive disorder symptoms: Cross-sectional and prospective approaches

The present study examines the association between disgust sensitivity (DS) and obsessive-compulsive disorder (OCD) symptoms in two non-clinical samples. Findings from Study 1 (n = 270) revealed a significant association between DS and OCD symptoms even after controlling for negative affect and anxiety sensitivity. Subsequent analysis also revealed a specific association between DS and the washing subtype of OCD symptoms when controlling for other OCD symptom dimensions. DS did not significantly predict residual change in total symptoms of OCD over a 12-week period (n = 300) when controlling for risk factors for anxiety disorder symptoms in general (e.g., negative affect, anxiety sensitivity) and OCD specifically (e.g., obsessive beliefs) in Study 2. However, exploratory analyses suggest that DS may be predictive of residual change in some OCD symptom subtypes but not others. Implications of these findings for future research on the role of disgust in OCD are discussed.     

An explorative study on metacognition in obsessive-compulsive disorder and panic disorder

ObjectiveTo test the hypothesis that dysfunctional metacognitions might be a general vulnerability factor for anxiety disorder, metacognitive beliefs among patients with obsessive-compulsive disorder (OCD), patients with panic disorder (PD), and healthy subjects (HS) were studied. Correlations between metacognitive beliefs, OCD, and PD symptoms were also investigated.MethodsPatients with OCD (n = 114), patients with PD (n = 119), and HS (n = 101) were assessed with the Metacognition Questionnaire (MCQ).ResultsPatients with OCD and those with PD scored significantly higher than HS on the MCQ in 2 dimensions: negative beliefs about worry concerning uncontrollability and danger as well as beliefs about the need to control thoughts dimensions. No difference in MCQ scores was observed between the OCD and PD groups. The former 2 MCQ dimensions were positively correlated with the degree of indecisiveness in patients with OCD, whereas the MCQ negative beliefs about worry positively correlated with the average intensity of anticipatory anxiety in patients with PD.ConclusionsThe presence of dysfunctional metacognitions in both patients with OCD and those with PD suggests that such beliefs can represent not only generic vulnerability factors for anxiety disorders but also elements that contribute to maintaining the disorder, as evidenced by their associations with aspects of OCD and PD symptoms.     

Contingency-competence-control-related beliefs and symptoms of anxiety and depression in a young adolescent sample

The present study examined the connection between contingency-competence-control–related beliefs, on the one hand, and anxiety and depression, on the other hand, in a large sample of young adolescents aged 10 to 14 years (N = 214). Participants completed measures of perceived contingency, competence, and control, as well as a questionnaire assessing symptoms of common anxiety disorders and major depressive disorder. Results showed that contingency-competence-control–related beliefs were intercorrelated and that these beliefs, in turn, were significantly associated with symptoms of anxiety and depression. Structural equation modeling provided support for a model in which perceived contingency and perceived competence predicted perceived control and in which perceived competence (anxiety and depression) and perceived control (depression only), in turn, predicted symptoms of psychopathology. A prospective test of this model indicated that none of the contingency-competence-control–related beliefs was able to predict symptoms of anxiety and depression at 4-weeks follow-up. However, data also demonstrated that perceived competence significantly contributed to the subjective experience of anxiety and depression on both occasions.     

Disgust sensitivity and obsessive-compulsive symptoms in a non-clinical sample

Disgust sensitivity has been posited to play a role in the etiology and/or maintenance of obsessive-compulsive disorder (OCD); however, results of studies in this area have been mixed. We examined the relationship between specific domains of disgust sensitivity and specific OCD symptom patterns. One thousand and five undergraduate volunteers completed an internet battery of questionnaires including measures of OCD symptoms, depression, anxiety, and disgust sensitivity. Results indicated that even when controlling for depression and anxiety, several OCD symptom groups (checking, ordering, and washing) were associated with disgust sensitivity. Analysis of residuals, in which we controlled for every other OCD and disgust sensitivity domain for each paired comparison, indicated that the clearest relationship was between washing symptoms of OCD and disgust sensitivity toward hygiene-related stimuli. Examination of these items, however, raises questions about whether commonly accepted measures of disgust sensitivity might confound disgust with other forms of aversion. We discuss possible strategies for clarifying the degree to which fear and disgust are involved in OCD symptoms.     

Scrupulosity in patients with obsessive-compulsive disorder: relationship to clinical and cognitive phenomena

Scrupulosity is often encountered among individuals with obsessive-compulsive disorder (OCD), yet relatively few studies have examined this particular symptom presentation. Using a large sample of OCD patients, the present investigation examined (a) the relationship between religiosity and scrupulosity, (b) the association between scrupulosity and the severity of OCD, anxiety, and depressive symptoms, and (c) the connection between scrupulosity and cognitive domains related to OCD. Scrupulosity was correlated with obsessional symptoms and several cognitive domains of OCD, including beliefs about the importance of, and need to control intrusive thoughts, an inflated sense of responsibility, and moral thought-action fusion. These results are examined in terms of cognitive behavioral conceptualizations of OCD and the treatment implications of these findings are discussed.     

The relationship between adverse childhood experience and obsessive-compulsive symptoms and beliefs: The role of anxiety, depression, and experiential avoidance

Current cognitive-behavioral models of the etiology of obsessive-compulsive disorder (OCD) suggest that maladaptive appraisal of otherwise normal intrusive thoughts have their origins in early learning experiences. The present study investigated the relationship between adverse childhood experience and OCD symptoms and related dysfunctional beliefs in a general population using a structural equation modeling approach. The role of experiential avoidance and anxiety and depression were also explored in the model. Results indicated that adverse childhood experience was strongly associated with OCD symptoms and beliefs, but after controlling for anxiety and depression the relationship with OCD symptoms became non-significant and only a weak relationship with OCD beliefs remained. Experiential avoidance was significantly associated with OCD symptoms and beliefs and remained significant after controlling for anxiety and depression. Implications of these results in the context of a complete model of the development of OCD are discussed.     

Intolerance of uncertainty, hypochondriacal concerns, obsessive-compulsive symptoms, and worry

Intolerance of uncertainty (IU) has been found to be involved in several anxiety disorders, including generalized anxiety disorder and obsessive-compulsive disorder (OCD). Few studies have examined the role of IU in health anxiety (HA)/hypochondriacal concerns (HC). We conducted two studies exploring the associations between IU and HA/HC. The first study included undergraduates (n = 114) and indicated an association between IU and several HA/HC indices. When controlling for neuroticism, worry about illness was the single index of HA/HC that remained associated with IU. In the second study among bereaved adults (n = 126), IU was associated with one index of HA/HC but not when neuroticism and anxiety sensitivity were controlled. In both studies, IU was found to be more strongly associated with OCD symptoms and worry than with HA/HC.     

Imagery special issue: intrusive images and memories of earlier adverse events in patients with obsessive compulsive disorder

Mental imagery is increasingly considered to be an important feature in anxiety disorders. The aim of this study was to investigate the prevalence and characteristics of mental images in obsessive compulsive disorder (OCD) and their possible association with earlier adverse events. A consecutive sample of 37 patients with OCD admitted to a specialist unit was interviewed using a semi-structured interview. Thirty (81%) patients with OCD reported mental images. Most images were either memories of earlier adverse events (n=10 or 34%) or were associated with them (n=13 or 45%). Patients with mental images had more obsessive compulsive symptoms, responsibility beliefs and anxiety than those without. Previous research has shown that patients with OCD and comorbid posttraumatic stress disorder might not benefit as much from standard behavioural treatment as those without. Consequently, additional therapeutic interventions such as imaginal reliving and restructuring of meaning or imagery modification of traumatic memories might be helpful in OCD patients with mental images that are linked to earlier adverse events.     

Distress tolerance in OCD and anxiety disorders,and its relationship with anxiety sensitivity and intolerance of uncertainty

There is a growing interest in the role of distress tolerance (i.e., the capacity to withstand negative emotions) in the onset and maintenance of anxiety. However, both empirical and theoretical knowledge regarding the role of distress tolerance in the anxiety disorders is relatively under examined. Accumulating evidence supports the relationship between difficulties tolerating distress and anxiety in nonclinical populations; however, very few studies have investigated distress tolerance in participants with diagnosed anxiety disorders. Individuals with social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with and without agoraphobia (PD/A) and obsessive-compulsive disorder (OCD) completed measures of distress tolerance (DT), conceptually related measures (i.e., anxiety sensitivity (AS), intolerance of uncertainty (IU)), and anxiety symptom severity. Results showed that DT was negatively associated with AS and IU. DT was correlated with GAD, SAD and OCD symptoms, but not PD/A symptoms, in individuals with those respective anxiety disorders. DT was no longer a significant predictor of OCD or anxiety disorder symptom severity when AS and IU were also taken into account. There were no between group differences on DT across OCD and the anxiety disorder groups. Implications for the role of distress tolerance in anxiety pathology are discussed.     

Psychometric properties and construct validity of the Obsessive-Compulsive Inventory--Revised: Replication and extension with a clinical sample

The present study examined the psychometric properties and construct validity of the Obsessive-Compulsive Inventory--Revised (OCI-R) with the aim of replicating and extending previous findings, and addressing limitations of previous investigations. Individuals with OCD (n = 167) and other anxiety disorders (n = 155) completed the OCI-R, measures of OCD and related symptom severity, and measures of cognitive variables associated with OCD symptoms. Results indicate that the OCI-R is a psychometrically sound and valid measure of OCD and its various symptom presentations. Confirmatory factor analysis confirmed a six-factor solution. The instrument also evidenced good convergent validity, and performed well in discriminating OCD from other anxiety disorders. Theoretically consistent patterns of associations between OCI-R symptom-based subscales and OCD-related cognitive variables were found, and five of the six OCI-R subscales corresponded closely to identified OCD symptom dimensions. The OCI-R is recommended as an empirically validated instrument that can be used in a range of clinical and research settings for research on OCD.     

Psychometric properties of the Dutch version of the Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A) in non-clinical adolescents and adolescents with obsessive-compulsive disorder

Although the meta-cognitive model (Wells, 1997, 2000) for obsessive-compulsive disorder (OCD) has clearly influenced research and treatment of OCD, little research has been performed in youth samples. In the present study the psychometric properties of the Dutch Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A; Cartwright-Hatton et al., 2004) were examined in a clinical sample of adolescents with OCD (N = 40, 12-18 years) and a non-clinical sample (N = 317; 12-18 years). Results provided support for the 5-factor structure, and showed fair to good internal consistency and generally good retest reliability. Overall, adolescents with OCD reported more meta-cognitive beliefs than non-clinical adolescents. Several subscales were associated with self-reported obsessive-compulsive symptoms, anxiety and depression, but not with clinician-rated OCD severity. In conclusion, results suggest that the Dutch MCQ-A is a reliable and valid questionnaire to examine meta-cognitive beliefs in adolescents.     

Comorbidity of anxiety disorders with anorexia and bulimia nervosa

OBJECTIVE: A large and well-characterized sample of individuals with anorexia nervosa and bulimia nervosa from the Price Foundation collaborative genetics study was used to determine the frequency of anxiety disorders and to understand how anxiety disorders are related to state of eating disorder illness and age at onset. METHOD: Ninety-seven individuals with anorexia nervosa, 282 with bulimia nervosa, and 293 with anorexia nervosa and bulimia were given the Structured Clinical Interview for DSM-IV Axis I Disorders and standardized measures of anxiety, perfectionism, and obsessionality. Their ratings on these measures were compared with those of a nonclinical group of women in the community. RESULTS: The rates of most anxiety disorders were similar in all three subtypes of eating disorders. About two-thirds of the individuals with eating disorders had one or more lifetime anxiety disorder; the most common were obsessive-compulsive disorder (OCD) (N=277 [41%]) and social phobia (N=134 [20%]). A majority of the participants reported the onset of OCD, social phobia, specific phobia, and generalized anxiety disorder in childhood, before they developed an eating disorder. People with a history of an eating disorder who were not currently ill and never had a lifetime anxiety disorder diagnosis still tended to be anxious, perfectionistic, and harm avoidant. The presence of either an anxiety disorder or an eating disorder tended to exacerbate these symptoms. CONCLUSIONS: The prevalence of anxiety disorders in general and OCD in particular was much higher in people with anorexia nervosa and bulimia nervosa than in a nonclinical group of women in the community. Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa.     

Technology supported mindfulness for obsessive compulsive disorder: The role of obsessive beliefs

The current study examined the association of OCD symptoms and OCD belief domains, for individuals engaged in Technology Supported Mindfulness training (TSM) using an EEG-based biofeedback device (called “Muse”) that permits individuals to engage in home based mindfulness meditation practices. In this randomized controlled study, treatment-seeking participants with a principal DSM-5 diagnosis of OCD (N = 71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the “Muse” device, or 2) wait list control. At weeks 1, 4, and 8, participants completed self-report measures of OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale) and OCD beliefs (OBQ; OCCWG, 2005). Latent Difference Score (LDS) models indicated that there was no significant longitudinal relationship between OBQ “Responsibility/Threat” (OBQ R/T) scores and OCD symptoms. The analysis of OBQ “Perfectionism/Certainty” (OBQ P/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ P/C and vice versa. The analysis of OBQ “Importance/Control of Thoughts” (OBQ I/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ I/C and vice versa. The analysis of OBQ domains and EEG derived attentional changes demonstrated a significant association between OBQ P/C and Alpha band frequencies. These results clarify the association of OBQ belief domains, OCD symptom change and EEG derived indicators of attention during TSM.     

Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder

BACKGROUND: There is growing recognition that the anxiety disorders are disabling disorders associated with substantial morbidity and impaired quality of life (QOL). Nevertheless, there have been few studies comparing QOL across these conditions. SAMPLING AND METHODS: 337 outpatients with obsessive-compulsive disorder (OCD; n = 220), panic disorder (PD; n = 53), or social anxiety disorder (SAD; n = 64) were compared using a number of assessment scales to compare objective and subjective impairment in QOL. The association of QOL with symptom severity and comorbid depression was also assessed. RESULTS: The extent of impairment due to OCD, PD or SAD appears to be similar across the QOL scales. However, various domains are differentially affected in each of the disorders; OCD patients had more impairment in family life and activities of daily living; SAD patients had more impairment in social life and leisure activities, and PD patients were less able to avoid the use of nonprescribed drugs. QOL was lower in patients with increased symptom severity as well as in those with comorbid depression. CONCLUSIONS: While the extent of impairment appears similar across a number of different anxiety disorders, characteristic symptoms of each disorder may be associated with differential impairment of various domains of function, and may require specifically tailored interventions.     

Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity

The goals of this study were to examine relationships among symptom categories in obsessive-compulsive disorder (OCD), to establish OCD symptom dimensions by factor- and cluster-analytic analyses, and to explore associations between OCD symptom dimensions and comorbid neuropsychiatric conditions. A total of 317 OCD participants underwent a systematic diagnostic interview using the Structured Clinical Interview for DSM-IV. OCD symptoms assessed by the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (N=169) and by the Thoughts and Behaviors Inventory (N=275) were subjected to factor and cluster analyses. An identical four-factor solution emerged in two different data sets from overlapping samples, in agreement with most smaller factor-analytic studies employing the YBOCS checklist alone. The cluster analysis confirmed the four-factor solution and provided additional information on the similarity among OCD symptom categories at five different levels. OCD symptom dimensions showed specific relationships to comorbid psychiatric disorders: Factor I (aggressive, sexual, religious and somatic obsessions, and checking compulsions) was broadly associated with comorbid anxiety disorders and depression; Factor II (obsessions of symmetry, and repeating, counting and ordering/arranging compulsions) with bipolar disorders and panic disorder/agoraphobia; and Factor III (contamination obsessions and cleaning compulsions) with eating disorders. Factors I and II were associated with early onset OCD. This study encourages the use of cluster analyses as a supplementary method to factor analyses to establish psychiatric symptom dimensions. The frequent co-occurrence of OCD with other psychiatric disorders and the relatively specific association patterns between OCD symptom dimensions and comorbid disorders support the importance of OCD subtyping for treatment, genetic, and other research studies of this heterogeneous disorder.     

Treatment seeking by individuals with obsessive-compulsive disorder from the british psychiatric morbidity survey of 2000

OBJECTIVE: For several reasons, many individuals with obsessive-compulsive disorder (OCD) do not seek treatment. However, data on treatment seeking from community samples are scant. This study analyzed service use by adults with OCD living in private households in Great Britain. METHODS: Data from the British Survey of Psychiatric Morbidity of 2000, in which 8,580 individuals were surveyed, were analyzed. Service use was compared for those with OCD, with other neuroses, with different subtypes of OCD (only obsessions, only compulsions, or both), and with OCD and comorbid neuroses. RESULTS: Persons with OCD (N=114) were more likely than persons with other neuroses (N=1,395) to be receiving treatment (40% compared with 23%, p<.001). However, those with OCD alone (N=38) were much less likely than those with OCD and a comorbid disorder to be in treatment (14% compared with 56%, p<.001). In the previous year, 9.4% of persons with OCD had seen a psychiatrist and 4.6% had seen a psychologist. Five percent were receiving cognitive-behavioral therapy, 2% were taking selective serotonin reuptake inhibitors, and 10% were taking tricyclics. CONCLUSIONS: Most persons with OCD were not in contact with a mental health professional, and apparently very few were receiving appropriate treatments. Very few persons with noncomorbid OCD were receiving treatment. Individuals with OCD who are in treatment may not be disclosing their obsessions and compulsions and may be discussing other emotional symptoms, leading to inappropriate treatment strategies. Public awareness of OCD symptoms should be raised, and primary care professionals should inquire about them with all patients who have depressive or anxiety disorders.