Inferential confusion,obsessive beliefs and obsessive–compulsive symptoms: a multidimensional investigation of cognitive domains

Generally, research into the relationship between cognitive domains and obsessive–compulsive symptoms involves the use of scales that are highly intercorrelated with each other. The current study investigates the relationship between cognitive constructs and obsessive–compulsive symptoms using the item set of the Obsessive Beliefs Questionnaire and the Inferential Confusion Questionnaire. In order to create constructs that would not be excessively correlated with each other, factor scores were used to investigate the relationship between cognitive domains and obsessive–compulsive symptoms. Factor analysis followed by oblique rotation resulted in four moderately correlated cognitive constructs (importance/control of thoughts, inferential confusion/threat estimation, perfectionism/certainty and responsibility for preventing harm). With the exception of responsibility for preventing harm, the cognitive constructs under investigation were quite strongly related to obsessive–compulsive symptoms. In particular, hierarchical regression revealed the construct inferential confusion/threat estimation to be a global and strong predictor of obsessive–compulsive symptoms, followed by the constructs of perfectionism/certainty and the construct importance/control. Responsibility for preventing harm acted to be a negative predictor of obsessive–compulsive symptoms. It is concluded that the construct of inferential confusion acts as a more powerful predictor of obsessive–compulsive symptoms than any specific obsessive belief Copyright © 2008 John Wiley & Sons, Ltd.     

Genetic meta‐analysis of obsessive–compulsive disorder and self‐report compulsive symptoms

We investigated whether obsessive–compulsive (OC) symptoms from a population‐based sample could be analyzed to detect genetic variants influencing obsessive–compulsive disorder (OCD). We performed a genome‐wide association studies (GWAS) on the obsession (rumination and impulsions) and compulsion (checking, washing, and ordering/precision) subscales of an abbreviated version of the Padua Inventory (N = 8,267 with genome‐wide genotyping and phenotyping). The compulsion subscale showed a substantial and significant positive genetic correlation with an OCD case–control GWAS (r _G = 0.61, p = .017) previously published by the Psychiatric Genomics Consortium (PGC‐OCD). The obsession subscale and the total Padua score showed no significant genetic correlations (r _G = ?0.02 and r _G = 0.42, respectively). A meta‐analysis of the compulsive symptoms GWAS with the PGC‐OCD revealed no genome‐wide significant Single‐Nucleotide Polymorphisms (SNPs combined N = 17,992, indicating that the power is still low for individual SNP effects). A gene‐based association analysis, however, yielded two novel genes (WDR7 and ADCK1). The top 250 genes in the gene‐based test also showed a significant increase in enrichment for psychiatric and brain‐expressed genes. S‐Predixcan testing showed that for genes expressed in hippocampus, amygdala, and caudate nucleus significance increased in the meta‐analysis with compulsive symptoms compared to the original PGC‐OCD GWAS. Thus, the inclusion of dimensional symptom data in genome‐wide association on clinical case–control GWAS of OCD may be useful to find genes for OCD if the data are based on quantitative indices of compulsive behavior. SNP‐level power increases were limited, but aggregate, gene‐level analyses showed increased enrichment for brain‐expressed genes related to psychiatric disorders, and increased association with gene expression in brain tissues with known emotional, reward processing, memory, and fear‐formation functions.     

Obsessive–compulsive disorder beliefs,metacognitive beliefs and obsessional symptoms: relations between parent beliefs and child symptoms

Investigations of obsessive–compulsive disorder (OCD) have increasingly emphasized the role of cognition in symptom development and maintenance. In the present study, relationships between parent and adolescent child OCD symptoms and OCD cognition measures were explored to elucidate how OCD related beliefs and OCD symptoms might develop. One hundred and twenty‐six non‐clinical parent–adolescent pairs completed measures of OCD symptoms, OCD related beliefs and metacognitive beliefs (cognitive self‐consciousness [CSC], the tendency to focus attention on thought processes). A significant indirect relationship was found between parent OCD symptoms and adolescent OCD symptoms through specific adolescent OCD related beliefs. Contrary to expectations, parent and adolescent CSC were not correlated. Although findings were limited by the correlational and cross‐sectional design, implications of the observed associations for theory and treatment are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Thought‐action fusion and inflated responsibility beliefs in obsessive‐compulsive disorder

In obsessive‐compulsive disorder (OCD), inflated responsibility (IR) beliefs and thought‐action fusion (TAF) are two cognitive schema argued to contribute to obsessions and compulsions. We investigated whether IR and TAF are OCD‐specific or whether they occur in other anxiety disorders. Adults diagnosed with OCD (n = 20) or other anxiety disorders (n = 21), and non‐clinical controls (n = 22) completed measures of OCD symptomatology and severity, TAF, appraisals and interpretations of responsibility, and depression. IR was more prominent in those with OCD as compared with those with other anxiety disorders, with correlational analyses confirming that a high sense of personal responsibility was associated with high levels of obsessionality even after controlling for depression. No group differences, however, emerged between the clinical groups on measures of TAF, both groups showing elevated TAF compared with controls. Indeed, TAF and obsessional symptoms were correlated only in the presence of negative affect. These results suggest that although IR may be higher in those with OCD compared with other anxiety disorders, TAF is not specific to OCD. Results are discussed in the context of cognitive appraisal models of OCD.     

Metacognitive beliefs and strategies predict worry,obsessive–compulsive symptoms and coping styles: A preliminary prospective study on an Italian non‐clinical sample

Eighty undergraduate students completed the Italian versions of the Metacognition Questionnaire and Thought Control Questionnaire along with well‐established measures of worry, obsessive–compulsive symptoms and coping styles on two occasions four months apart. A series of hierarchical regression analyses revealed that, after controlling the initial level of both worry and obsessionality, negative beliefs about worry focused on uncontrollability and danger appeared consistently associated with worry and obsessive symptoms at a four‐month distance. In addition, positive beliefs about worry predicted maladaptive coping styles whereas cognitive self‐consciousness and thought strategies aimed at distraction appeared to foster or facilitate adaptive coping styles. Results, implications and limitations are discussed according to Well's metacognitive model of emotional disorders. Copyright © 2007 John Wiley & Sons, Ltd.     

Obsessive compulsive symptoms in Gilles de la Tourette syndrome and obsessive compulsive disorder

The distribution of obsessive compulsive symptoms was compared in 16 individuals with primary obsessive compulsive disorder (OCD) and 16 individuals with Gilles de la Tourette syndrome (GTS) and associated obsessive compulsive behaviors (OCB). The two groups showed significant differences in the distribution of OC symptomatology. Furthermore, those OCD probands who shared a similar symptom profile with GTS individuals all had a positive family history of OCD. All of the other OCD probands were isolated cases. Implications of this finding on the etiology and pathogenesis of the two disorders are discussed. Am. J. Med. Genet. 74:432–438, 1997. © 1997 Wiley-Liss, Inc.     

The relationship between resilience and levels of anxiety,depression, and obsessive–compulsive symptoms in adolescents

Objective: Mental health problems affect approximately 20% of adolescents. Traditionally, the principal focus has been on vulnerability and risk factors and less on protective factors. The study, therefore, explores the relation between frequent psychiatric symptoms and resilience factors among older adolescents. Method: The Resilience Scale for Adolescents (READ) was completed by 307 Norwegian high school students (M = 16.4 years) along with the Depression Anxiety Stress Scales, and the Obsessive–Compulsive Inventory‐Revised. Results: Higher resilience scores predicted lower scores on levels of depression, anxiety, stress and obsessive–compulsive symptoms after controlling for age and gender. Conclusion: This study provides further evidence that it may be fruitful for clinicians and researchers to attend to resilience factors in relation to psychological symptoms among older adolescents. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Resilience is significantly related to psychological symptoms in older adolescents after controlling for age and gender. ? Resilience factors are differently expressed by female and male youths, but overall resilience is equally distributed among the sexes. ? Assessment of resilience factors may provide appropriate targets for interventions among youths.     

Sex differences in the genetic architecture of obsessive–compulsive disorder

Obsessive–compulsive disorder (OCD) is a highly heritable complex phenotype that demonstrates sex differences in age of onset and clinical presentation, suggesting a possible sex difference in underlying genetic architecture. We present the first genome‐wide characterization of the sex‐specific genetic architecture of OCD, utilizing the largest set of OCD cases and controls available from the Psychiatric Genomics Consortium. We assessed evidence for several mechanisms that may contribute to sex differences including a sex‐dependent liability threshold, the presence of individual sex‐specific risk variants on the autosomes and the X chromosome, and sex‐specific pleiotropic effects. Furthermore, we tested the hypothesis that genetic heterogeneity between the sexes may obscure associations in a sex‐combined genome‐wide association study. We observed a strong genetic correlation between male and female OCD and no evidence for a sex‐dependent liability threshold model, suggesting that sex‐combined analysis does not suffer from widespread loss of power because of genetic heterogeneity between the sexes. While we did not detect any significant sex‐specific genome‐wide single nucleotide polymorphisms (SNP) associations, we did identify two significant gene‐based associations in females: GRID2 and GRP135, which showed no association in males. We observed that the SNPs with sexually differentiated effects showed an enrichment of regulatory variants influencing expression of genes in brain and immune tissues. These findings suggest that future studies with larger sample sizes hold great promise for the identification of sex‐specific genetic risk factors for OCD.     

Dose meta‐cognition or responsibility predict obsessive–compulsive symptoms: a test of the metacognitive model

Cognitive models of Obsessive–Compulsive disorder (OCD) have emphasized inflated responsibility (Salkovskis, 1985), thought–action fusion (Rachman, 1993), and metacognitive beliefs (Wells, 1997; Wells & Matthews, 1994), as factors contributing to disorder. The metacognitive model views responsibility as a by‐product of metacognitions that make little additional contribution to OCD, and gives rise to the following hypotheses: (1) responsibility and meta‐cognitive beliefs are positively correlated with obsessive–compulsive symptoms, (2) the relationship between responsibility and obsessive–compulsive symptoms is statistically dependent on meta‐cognition, (3) meta‐cognitions positively correlate with obsessive–compulsive symptoms independently of responsibility. The results supported each of these hypotheses and exploratory analyses were conducted to find the best unique set of predictors among a range of metacognitive dimensions. Metacognitive beliefs concerning need to control thoughts, thought–action fusion, and negative beliefs about cognitive competence emerged as reliable predictors. An additional contribution was made by thought–event fusion in one equation. The results provide support for the meta‐cognitive model. Copyright © 2004 John Wiley & Sons, Ltd.     

Self‐compassion and emotion regulation difficulties in obsessive–compulsive disorder

Lack of self‐compassion and deficits in emotion regulation are associated with various psychopathological symptoms and may play a role in the development and maintenance of obsessive–compulsive disorder (OCD). However, further empirical research is still needed to better understand these constructs in the context of this disorder. The present study investigated the relation between self‐compassion, emotion regulation difficulties, obsessive beliefs, and obsessive–compulsive symptom severity in 90 patients with OCD using self‐report questionnaires. Symptom severity and obsessive beliefs were negatively correlated to self‐compassion and positively associated with emotion regulation difficulties. Additionally, self‐compassion showed a negative relation to emotion regulation difficulties. Emotion regulation difficulties—but not self‐compassion—predicted symptom severity when controlling for obsessive beliefs and depression in a hierarchical regression analysis. Further analyses showed that emotion regulation deficits mediated the relationship between self‐compassion and OCD symptom severity. Our results provide preliminary evidence that targeting self‐compassion and putting more emphasis on emotion regulation deficits might be promising treatment approaches for patients with OCD. Future studies could investigate which specific interventions that directly address these variables improve treatment outcome.     

Parenting style and obsessive‐compulsive symptoms and personality traits in a student sample

There is widespread acceptance of the idea that aspects of parenting such as overprotectiveness and perfectionism contribute to the pathogenesis of obsessive‐compulsive disorder (OCD). Less resolved is whether the important dimensions of parenting are overprotectiveness, lack of acceptance, authoritarian style, discouragement of risk‐taking, and/or induction of guilt. It is also unclear whether different parenting characteristics are associated with the development of symptoms of OCD, compared to the traits of obsessive‐compulsive personality disorder (OCPD). OCD symptoms and OC personality traits were measured in a non‐clinical, student sample and correlated with students' report of parents' acceptance, disciplinary firmness, and psychological control (a construct which included psychological manipulation and guilt‐induction). Following the literature on both clinical and subclinical OCD and OCPD, we predicted that all three scales would correlate with OCD symptoms and OCPD traits. Stepwise regression analysis revealed that psychological control was the unique predictor, controlling for depressive symptoms. Unexpectedly, a controlling parenting style was not selectively associated with classical OC symptoms or OC personality traits. Rather, psychological control was associated with a broad‐spectrum of anxiety and depressive symptoms which cut across diagnostic boundaries. Findings are generally compatible with a single underlying vulnerability to both OCD and OCPD, as well as generalized/social anxiety and depressive symptoms, which can be shaped by cultural and familial factors to a specific clinical presentation. Copyright © 2002 John Wiley & Sons, Ltd.     

Obsessive and compulsive symptoms in a general population sample of female twins

Obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) exhibit a familial pattern of transmission. The different components of these conditions and the extent to which these components are inherited have not been studied well. A sample of 1,054 female twins, including both members of 527 pairs, from the Virginia Twin Registry returned questionnaires that included 20 items from the Padua Inventory of obsessive-compulsiveness. Their responses were used to estimate the heritability of the different factors of OCS in this population. Principal components analysis suggested two meaningful factors corresponding roughly to obsessions and compulsions. The best-fit model suggested heritabilities of 33 and 26%, respectively. The correlation between additive genetic effects on compulsiveness and obsessiveness was found to be +0.53. Self-report symptoms of obsessions and compulsions in women from the general population are moderately heritable and due, in part, to the same genetic risk factors. An understanding of the etiology of these symptoms is relevant to the study of OCD. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:791-796, 2000.     

Compulsive behaviours and levels of belief in obsessive–compulsive disorder: a case‐series analysis of their interrelationships

This study examined interrelationships of changes in compulsive behaviours and two levels of belief over treatment of obsessive–compulsive disorder (OCD). Levels were individual‐specific obsessive beliefs (termed here manifest beliefs) and OCD‐relevant general beliefs. If OCD‐relevant general beliefs are functionally linked to manifest beliefs and compulsive behaviours, changes in compulsive behaviours and both belief types should occur mostly in tandem, even if only one or two of these three elements are explicitly targeted. Baselines consisting of time performing compulsive behaviours, strength of manifest belief and strength of OCD‐relevant general beliefs were monitored daily by six participants over three phases in an A/B/B + C design. (A = no treatment, B = exposure/response prevention and C = cognitive therapy targeting only OCD‐relevant general beliefs.) Changes in compulsive behaviours, manifest beliefs and OCD‐relevant general beliefs moved primarily in tandem over treatment phases, suggesting functional links between these elements. Copyright © 2006 John Wiley & Sons, Ltd.     

DIRT—danger ideation reduction therapy for obsessive–compulsive washers: a comprehensive guide to treatment

Danger ideation reduction therapy (DIRT) for obsessive compulsive disorder (OCD) is a new intervention focusing on providing corrective information, and is the subject of a new comprehensive guide to treatment for compulsive washing. The components of DIRT are well presented in this manual‐based treatment and the documentation includes dialogues, filmed interviews with workers in dangerous occupations, and fact sheets to persuade the client to exchange beliefs about danger for beliefs about safety. The book is well organized and user friendly. Clinical trials have shown DIRT to be an effective treatment. Although DIRT as a stand alone therapy seems to offer some advantages over conventional CBT, it may function currently more as an adjunct to help cognitive restructuring. DIRT certainly encourages us to rethink some assumptions about the use of corrective information in treating OCD. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Danger ideation therapy is principally a cognitive approach. ? Corrective information may help in the treatment of OCD for washing. ? The application of DIRT in other types of OCD and symbolic contamination remains uncertain.