The characteristics of unacceptable/taboo thoughts in obsessive–compulsive disorder

Background

In the quest to unravel the heterogeneity of obsessive–compulsive disorder (OCD), an increasing number of factor analytic studies are recognising unacceptable/taboo thoughts as one of the symptom dimensions of OCD.

Aims

This study aims to examine the characteristics associated with unacceptable/taboo thoughts.

Methods

Using the Yale–Brown Obsessive–Compulsive Scale Symptom Checklist (YBOCS-SC) with 154 individuals with OCD, obsessive–compulsive symptoms were subjected to principal components analysis. The characteristics associated with the resulting symptom dimensions were then assessed using logistic and linear regression techniques.

Results

Unacceptable/taboo thoughts comprised of sexual, religious and impulsive aggressive obsessions, and mental rituals. Higher scores on an unacceptable/taboo thoughts symptom dimension were predicted by higher Y-BOCS obsession subscores, Y-BOCS time preoccupied by obsessions scores, Y-BOCS distress due to obsessions scores, importance of control of thought ratings, male gender, and having had treatment prior to entering into the study. Unacceptable/taboo thoughts were also predicted by greater levels of hostility, and a past history of non-alcohol substance dependence.

Conclusions

An unacceptable/taboo thought symptom dimension of OCD is supported by a unique set of associated characteristics that should be considered in the assessment and treatment of individuals with these symptoms.     

Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians

Background and objectives

The cognitive-behavioural perspective on obsessions recognizes that certain cultural experiences such as adherence to religious beliefs about the importance of maintaining strict mental control might increase the propensity for obsessional symptoms via the adoption of faulty appraisals and beliefs about the unacceptability and control of unwanted intrusive thoughts. Few studies have directly investigated this proposition, especially in a non-Western Muslim sample.

Method

In the present study high religious, low religious and religious school Canadian Christian and Turkish Muslim students were compared on measures of OCD symptoms, obsessive beliefs, guilt, religiosity, and negative affect.

Results

Analysis revealed that religiosity had a specific relationship with obsessional but not anxious or depressive symptoms in both samples, although the highly religious Muslim students reported more compulsive symptoms than highly religious Christians. In both samples the relationship between religiosity and obsessionality was mediated by importance/control of thoughts and responsibility/threat beliefs as well as generalized guilt.

Limitations

The sample composition was limited to non-clinical undergraduates and only two major religions were considered without recognition of denominational differences.

Conclusions

These findings indicate that the tendency for highly religious Christians and Muslims to experience greater obsessionality is related to their heightened sense of personal guilt and beliefs that they are responsible for controlling unwanted, threatening intrusive thoughts.     

The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions

Background and objectives

Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are dangerous, is a cognitive vulnerability factor for certain anxiety symptoms such as panic and posttraumatic stress symptoms. Very little research, however, has examined the relationship between AS and obsessive-compulsive (OC) symptoms, which was the objective of the current research.

Methods

We administered dimensional measures of AS and OC symptoms to a large sample of undergraduate students (N = 636). We also included measures of general distress and cognitive distortions related to OCD (i.e., obsessive beliefs) as control variables.

Results

Regression analyses indicated that AS was predictive of OC symptoms even after controlling for general distress and obsessive beliefs. In addition, the three domains of AS (physical, social, and cognitive concerns) were differentially associated with the four dimensions of OC symptoms (contamination, responsibility for harm, symmetry, and unacceptable thoughts).

Limitations

Our findings are based on a non-clinical student sample and their generalization to OCD requires replication with a sample of OCD patients.

Conclusions

These results provide preliminary evidence that AS plays a role in OC symptoms. Implications for clinical practice and for future research are discussed.     

Clinically significant hoarding in obsessive-compulsive disorder: results from an Indian study

Background

Hoarding is frequently conceptualized as a symptom of obsessive-compulsive disorder (OCD), but recent evidence indicates that, in most cases, hoarding may be better conceptualized as a distinct disorder that can coexist with OCD. Most of the research on hoarding is from the Western countries. This study aimed to provide data on the prevalence and correlates of clinically significant hoarding in a large sample of patients with OCD from the Indian subcontinent.

Methods

We examined 200 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically significant hoarding using the Saving Inventory–Revised, followed by a clinical interview.

Results

Twenty patients (10%) had clinically significant hoarding. In all cases, hoarding did not appear to be related or secondary to other OCD symptoms. None of the cases consulted for their hoarding problems. Compared with nonhoarders, hoarders hailed exclusively from an urban background and had a significantly higher frequency of certain obsessions and compulsions, bipolar disorder, generalized anxiety disorder, cluster C personality disorders, and a higher number of lifetime suicidal attempts. They also had a more severe OCD along with poorer global functioning and somewhat poorer insight into obsessive-compulsive symptoms.

Conclusions

The results suggest that clinically significant hoarding is relatively prevalent in Indian patients with OCD and that it appears to be largely unrelated to the OCD phenotype. However, the presence of comorbid hoarding is associated with more severe OCD, high comorbidity, more suicidal attempts, and a lower level of functioning. The results contribute to the current nosologic debate around hoarding disorder and provide a unique transcultural perspective.     

Neuroinflammation in the fetus exposed to maternal obsessive–compulsive disorder during pregnancy: A comparative study on cord blood tumor necrosis factor-alpha levels

Objective

The relationship between maternal psychiatric disorders and fetal neurodevelopment is unclear. Obsessive–compulsive disorder (OCD) is relatively frequent during pregnancy. The study aimed to investigate whether maternal OCD during pregnancy affects fetal circulating tumor necrosis factor-alpha (TNF-α) levels, an important pro-inflammatory cytokine, by comparing cord blood TNF-α levels in newborn infants of women with and without OCD.

Methods

The study sample included 7 women with OCD and 30 healthy women. OCD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of TNF-α level was obtained from the umbilical cord during delivery.

Results

Cord blood TNF-α levels in newborn infants exposed to maternal OCD were significantly higher compared to non-exposed infants. Maternal anxiety symptom level was found to positively correlate with cord blood TNF-α levels in newborn infants of women with OCD.

Conclusion

The study results imply that maternal OCD during pregnancy may lead to neuroinflammation in the developing fetal brain through higher levels of circulating TNF-α.     

Moral rigidity in obsessive-compulsive disorder: Do abnormalities in inhibitory control,cognitive flexibility and disgust play a role?

Background and objectives

Abnormalities in cognitive control and disgust responding are well-documented in obsessive-compulsive disorder (OCD), and also interfere with flexible, outcome-driven utilitarian moral reasoning. The current study examined whether individuals with OCD differ from healthy and anxious individuals in their use of utilitarian moral reasoning, and whether abnormalities in inhibitory control, cognitive flexibility and disgust contribute to moral rigidity.

Methods

Individuals with OCD (n = 23), non-OCD anxiety (n = 21) and healthy participants (n = 24) gave forced-choice responses to three types of moral dilemmas: benign, impersonal, personal. Scores on measures of cognitive flexibility, inhibitory control and trait disgust were also examined.

Results

Individuals with OCD gave fewer utilitarian responses to impersonal moral dilemmas compared to healthy, but not anxious, individuals. Poorer cognitive flexibility was associated with fewer utilitarian responses to impersonal dilemmas in the OCD group. Furthermore, greater trait disgust was associated with increased utilitarian responding to personal dilemmas in the OCD group, but decreased utilitarian responding to impersonal dilemmas in the anxious group.

Limitations

Although we did not find an association between inhibitory control and moral reasoning, smaller associations may be evident in a larger sample.

Conclusion

These data indicate that individuals with OCD use more rigid moral reasoning in response to impersonal moral dilemmas compared to healthy individuals, and that this may be associated with reduced cognitive flexibility. Furthermore, these data suggest that trait disgust may exert opposing effects on moral reasoning in individuals with OCD compared to those with other forms of anxiety.     

Cognitive endophenotypes in OCD: A study of unaffected siblings of probands with familial OCD

Background

Impairments in executive functions and non-verbal memory are considered potential endophenotype markers of obsessive–compulsive disorder (OCD). For the neuropsychological deficits to be considered endophenotypes, they should be demonstrable in unaffected family members.

Aim

To compare the neuropsychological performance in unaffected siblings of probands with familial OCD with that of individually matched healthy controls.

Methods

Twenty-five unaffected siblings of OCD probands with familial OCD, and 25 individually matched healthy controls were assessed with tests of attention, executive function, memory and intelligence.

Results

Unaffected siblings showed significant deficits in tests of decision making and behavioural reversal i.e., the Iowa Gambling Task (IGT) and the Delayed Alternation Test (DAT) respectively, but performed adequately in other tests.

Conclusions

Our study suggests that the deficits in decision making and behavioural reversal could be potential endophenotypes in OCD. These deficits are consistent with the proposed neurobiological model of OCD involving the orbitofrontal cortex. Future studies could couple cognitive and imaging strategies to identify neurocognitive endophenotypes in homogenous samples of OCD.     

Evidence for specific cognitive deficits in visual information processing in patients with OCD compared to patients with unipolar depression

Objective

Neuropsychological studies comparing cognitive performance in patients suffering from Obsessive-Compulsive Disorder (OCD) or Major Depressive Disorder (MDD) revealed deficits in the domains of verbal fluency and viso-motor speed/set shifting in both groups. Spatial working memory deficits, however, have been identified as specific markers of OCD. As yet, it has not been substantiated whether deficits in visual organization and complex visual memory are also specific to OCD and are not shared by MDD.

Method

Test performance in seven cognitive domains was assessed in 40 OCD patients, 20 MDD patients, and 40 healthy controls. Patient groups were matched according to severity of depressive symptoms.

Results

Deficits shared by both patient groups, as compared to controls, were found in delayed spatial recall and verbal fluency while verbal memory was normal in both patient groups. Only patients with OCD, but not MDD patients were impaired in the domains visual memory, viso-motor speed/set shifting, visual organization, and problem solving. In addition, OCD patients differed significantly from MDD subjects in visual organization and problem solving. Visual organization scores correlated significantly with severity of current compulsions in the OCD group (r = −.324).

Conclusions

OCD patients demonstrate difficulties in visual organization and mental manipulation of complex visual material, which are not accounted for by depressive symptoms and which constitute a specific cognitive deficit of the disorder.     

Further evidence for biased semantic networks in obsessive–compulsive disorder (OCD): When knives are no longer associated with buttering bread but only with stabbing people

Background and objectives

Semantic network models suggest that individuals with obsessive–compulsive disorder (OCD) process words with multiple meanings (e.g., “knife”) more likely in an OC-related (i.e., “weapon”) than in a neutral way (i.e., “cutlery”). Initial evidence was found in an online study. The aim of the current study was to investigate semantic networks in a clinical OCD sample and particularly to identify whether changes in semantic networks following the add-on intervention association splitting (AS) exceeded changes expected through cognitive behavioral therapy (CBT) alone.

Methods

An association task was presented to 36 healthy controls and 70 OCD patients over a period of eight weeks with OCD patients receiving CBT and an add-on intervention (randomized allocation to either AS or a computerized cognitive training). Participants were asked to generate up to five associations to standardized (OC-relevant, negative, neutral) and individual cue words. Associations were rated with regard to OC-relevance and valence.

Results

Analyses revealed that OCD participants produced a) significantly more OC-relevant associations and b) more negative associations than controls for cue words. In the OCD sample, the OC-relevance and valence of associations changed after therapy for personal cue words. This effect was associated with AS at statistical trend level.

Limitations

No clinical control group was recruited; no inter-rater reliability was assessed for the association task.

Conclusions

Further evidence for biased associative networks in OCD was found. Associations of individually chosen cue words proved to be modifiable by therapy.     

Latent class analysis of obsessive–compulsive symptoms in a clinical sample

Objective

Obsessive–compulsive disorder (OCD) is probably a heterogeneous condition. To date, research investigating the symptom structure of OCD has generally focused on variable-classification approaches, primarily factor analysis. Our aim was to use the latent class analysis, an advanced individual-classification method, in order to define homogeneous sub-groups based on the Yale–Brown Obsessive–Compulsive Scale Check List (Y-BOCS CL) assessments within 193 outpatients with OCD.

Method

Latent class analysis of 13 obsessive–compulsive symptom-clusters measured by the Yale–Brown Obsessive–Compulsive Scale Check List was performed. Associations of demographic and clinical features with latent class membership were tested by using logistic regression models. Differences in severity of obsessive–compulsive symptoms, obsessive beliefs, and depressive symptomotology between latent classes were evaluated with the chi-square likelihood test.

Results

Latent class analysis models of best fit yielded 3 latent classes: “autogenous obsessions”, “reactive obsessive–compulsive”, and “reactive obsessions”. Outpatients in reactive obsessive–compulsive group reported significantly higher scores on the Y-BOCS global, obsessions, and compulsions scales than outpatients in other two sub-groups. Participants in reactive obsessive–compulsive group were predominantly female, single, and had a history of family psychopathology; whereas autogenous and reactive obsessions groups were predominantly male. There were no differences in severity of depression and obsessive belief domains.

Conclusions

The results provide support for the validity of autogenous/reactive distinction for OCD. These three classes may have important implications for research and clinical purposes.     

Metacognitions and emotional schemas: a new cognitive perspective for the distinction between unipolar and bipolar depression

Introduction

Clinicians need to make the differential diagnosis of unipolar and bipolar depression to guide their treatment choices. Looking at the differences observed in the metacognitions, and the emotional schemas, might help with this differentiation, and might provide information about the distinct psychotherapeutical targets.

Methods

Three groups of subjects (166 unipolar depressed, 140 bipolar depressed, and 151 healthy controls) were asked to fill out the Metacognitions Questionnaire–30 (MCQ-30), and the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the volunteers according to the criteria of DSM-IV-TR with a structured clinical interview (MINI), and rated the moods of the subjects with the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on the MCQ-30, and the LESS.

Results

The bipolar and unipolar depressed patients' scores on the MCQ-30 were significantly different from the healthy controls, but not from each other. On the LESS dimensions of guilt, duration, blame, validation, and acceptance of feelings, all three groups significantly differed from each other. There were no statistically different results on the LESS dimensions of comprehensibility, consensus, and expression. The mood disordered groups scored significantly different than the healthy controls on the LESS dimensions of simplistic view of emotions, numbness, rationality, rumination, higher values, and control.

Conclusions

These results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar depression. These results are also compatible to a great extent with the emotional schema theory of depression.     

The impacts of elevated autism spectrum disorder traits on clinical and psychosocial features and long-term treatment outcome in adult patients with obsessive-compulsive disorder

Background

While a close relation between obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) has been pointed out, there are few studies that have investigated whether highly elevated ASD traits may have significant impacts on clinical and psychosocial features as well as long-term treatment outcome in adult OCD patients.

Methods

We assessed ASD traits using the Autism Spectrum Quotient (AQ) in 81 Japanese patients with OCD. The relation between degree of ASD traits and clinical and psychosocial variables and the 48-week treatment outcomes was analyzed in the subjects.

Results

A substantial proportion of the subjects showed higher ASD traits (35%) with more severe depressive or pervasive anxiety status, and social impairments and lower QOL compared to other OCD individuals. However, elevated ASD traits may exert rather smaller impact on the OCD phenomenology along with on the long-term treatment outcome than expected.

Conclusions

Elevated ASD traits may further emphasize the general psychopathological and socio-dysfunctional features rather than clinical aspects associated with OCD. Co-existing depressive or anxious symptom severity may further exacerbate the core-deficits related to ASD pathology. Thus the assessment of ASD traits should be important for understanding the clinical and psychosocial features and treatment responses in OCD patients.     

Underlying mechanisms of verbal memory deficits in obsessive-compulsive disorder and major depression--the role of cognitive self-consciousness

Background and Objectives

Previous studies have demonstrated that some individuals suffering from obsessive-compulsive disorder (OCD) are impaired in verbal memory performance. This study was designed to investigate the role of cognitive self-consciousness (CSC) as a putative underlying mechanism of these cognitive deficits.

Methods

Verbal memory performance of 36 participants with OCD, 36 individuals with major depression disorder (MDD) and 36 healthy controls was assessed with the California Verbal Learning Test under three different experimental conditions: (1) single-task condition, (2) while simultaneously focusing on their thoughts (CSC condition), (3) while simultaneously focusing on external stimuli (dual-task condition).

Results

Memory performance in the CSC condition and in the dual-task condition was reduced compared to single-task condition but no interaction effect was found.

Limitations

It remains unclear whether CSC and other concepts with an inward self-referential focus of attention (e.g. rumination) differ in the way they influence cognitive performance.

Conclusions

These results confirm the deteriorating influence of heightened CSC on verbal memory encoding but suggest that the effect is not specific to OCD.     

Disgust mediates the relation between attentional shifting and contamination aversion

Background and objectives

Aversion of contaminants is important for several psychiatric disorders, particularly contamination-based obsessive-compulsive disorder (OCD). Recent theoretical models have proposed that the ability to control one's attention, especially when processing affectively laden information, is important in the etiology of pathological anxiety. The present study tested the relations between attentional control, affective arousal, and behavioral approach toward contaminants (contamination aversion).

Methods

Thirty-three non-selected (undergraduate university students) participants completed a measure of trait attentional control and three behavioral approach tasks, which measured emotional reactivity and approach toward contaminants.

Results

Preliminary analyses showed that poorer attentional control and greater affective arousal predicted less behavioral approach toward contaminants. Modeling of direct and indirect relations showed that poor attentional shifting ability and greater subjective disgust were related to less behavioral approach. Moreover, disgust fully mediated the relation between attentional shifting and behavioral approach.

Limitations

The present study used a convenience sample, which is not representative of the general population or individuals with OCD; therefore, research using clinical samples is necessary before making clinical interpretations. Moreover, the present study utilized subjective measures of attentional control and affective arousal. The use of objective measures of attention and affective arousal would provide a more valid test of the role of attentional control in contamination aversion.

Conclusions

These findings suggest that attentional shifting abilities may serve as a vulnerability to affective arousal/regulation and behavioral avoidance of contaminants, but the latter relation only operated indirectly via disgust. These findings have clear implications for the etiology of contamination-related OCD.     

Complex regional pain syndrome,alexithymia, and psychological distress

Objective

This study aims to elucidate the relationships between alexithymia, psychological distress, and pain in persons with complex regional pain syndrome (CRPS).

Methods

Participants were 60 Israeli adults ages 19–65. This is a cross sectional study with a comparison group. Alexithymia, psychological distress, and pain were assessed in 30 individuals with CRPS in comparison to 30 gender- and age-matched persons with lower back pain (LBP). Assessments included the Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale, and two subscales of the McGill Pain Questionnaire.

Results

Persons with CRPS had significantly higher ratings of psychological distress and of alexithymia when compared to LBP controls. Pain severity was significantly associated with higher levels of alexithymia and psychological distress among persons with CRPS, but not among controls. Alexithymia and pain severity correlations were significantly different between the two groups. In persons with CRPS, the relationships between alexithymia and pain severity and between difficulty identifying feelings and pain were not confounded by psychological distress.

Conclusions

To our knowledge, this is the first cross sectional study providing empirical evidence on the relationship between alexithymia and CRPS. From the perspective of conceptualizing alexithymia as an outcome of CRPS, findings highlight the importance of early CRPS diagnosis and support the provision of care that addresses pain-related psychological distress and alexithymia among CRPS patients. Also, findings underscore the need to generate alternative, non-physical avenues, such as learning to identify feelings for processing pain, in order to reduce pain among persons with CRPS.     

Risk factors for delaying treatment seeking in obsessive-compulsive disorder

Background

Despite the multiple alternatives of treatment, it is well known that patients with obsessive-compulsive disorder (OCD) delay seeking treatment. In this study, the aim was to determine the risk factors for delaying treatment seeking in OCD patients.

Methods

The sample consisted of 132 OCD who completed the Yale-Brown Obsessive-Compulsive Scale, Yale-Brown Obsessive-Compulsive Scale Symptom Checklist, and Beck Depression Inventory.

Results

In univariate analyses with risk evaluation, income level, being single or divorced, having a history of psychiatric treatment, poor insight for the symptoms, and obsessions of hoarding were the variables that were found to be significant. In the regression model, history of psychiatric treatment and duration of OCD were the 2 variables that remained statistically significant.

Conclusion

This was the first study wherein the sample included patients who were recruited from a nonpsychiatric department: the dermatology clinic. Application to dermatology has not been determined as a risk factor for delaying treatment seeking in OCD patients.     

Aptitude–Treatment interaction effects in psychooncological interventions

Objective

To examine aptitude–treatment interaction (ATI) effects in cancer patients receiving psychooncological interventions (POIs).

Method

N= 36 cancer patients were treated with POI. Hierarchical linear regression was used to test two interaction effects between patient baseline characteristics (aptitudes) and process analyses of therapy sessions (treatment) on change in mental health during POI.

Results

Patients with high emotional distress did best when their therapy reduced arousal, and patients with lower emotional distress benefited most if therapists emphasized arousal induction. The interaction between the coping style of the patient (internalizing vs. externalizing) and the focus of the treatment (emotion vs. behavior) did not predict POI outcomes.

Conclusions

The ATI effect of patient's distress and therapist's arousal induction/reduction may help therapists to make differential treatment decisions in POI. Tailoring treatments to cancer patients based on their personal characteristics may enhance the effectiveness of POI.     

Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics

Objective

The principal aims of this study were to examine the prevalence rate, clinical characteristics, and related factors of postpartum obsessive-compulsive disorder (OCD).

Method

The subjects were a nonclinical sample of 400 postpartum women. They were interviewed from the 2nd up to the 26th week after birth. The Mini International Neuropsychiatric Interview was used for diagnosis of OCD, the Yale-Brown Obsessive-Compulsive Symptom Checklist was used to determine the types of obsessions and compulsions, and the Structured Clinical Interview for DSM-IV Axis I Disorders was used to diagnose comorbid depressive episode.

Results

Thirty-six (9%) of the sample met the diagnostic criteria for OCD according to the Mini International Neuropsychiatric Interview, and 9 (2.3%) reported postpartum onset OCD. Obsessive-compulsive disorder was more frequent in mothers with personal history of previous psychiatric disorder, somatic disease, or obstetric complication in pregnancy/birth, and who were multiparous. The most common obsessions were aggressive, contamination and miscellaneous, and compulsion for washing/cleaning and checking, and 38.9% have a comorbid depressive episode.

Conclusion

Women have increased risk of OCD or obsessive-compulsive symptoms in the postpartum period. For this reason, all women, particularly women with previous psychiatric history, somatic disease, or with complications in pregnancy or at the birth should be carefully screened for OCD in the postpartum period.     

Altered EEG lagged coherence during rest in obsessive–compulsive disorder

Objective

Functional magnetic resonance imaging (fMRI) studies found alterations of functional connectivity in obsessive compulsive disorder (OCD). However, there is little knowledge about region of interest (ROI) based electroencephalogram (EEG) connectivity, i.e. lagged non-linear and linear coherence in OCD. Goal of this study was to compare these EEG measures during rest and at different vigilance stages between patients and healthy controls (HC).

Methods

A 15 min resting-state EEG was recorded in 30 unmedicated patients and 30 matched HC. Intracortical lagged non-linear coherence of the main EEG-frequency bands within a set of frontal ROIs and within the default mode network (DMN) were computed and compared using intracortical exact low resolution electromagnetic tomography (eLORETA) software.

Results

Lagged non-linear but not linear coherence was significantly decreased for patients in comparison to HC for the beta 2 frequency between frontal brain areas but not within the DMN. When analysing separate EEG-vigilance stages, only high vigilance stages yielded decreased frontal phase synchronisation at beta and theta frequencies.

Conclusions

The results underline an altered neuronal communication within frontal brain areas during rest in OCD.

Significance

These findings encourage further research on connectivity measures as possible biomarkers for physiological homogeneous subgroups.