Obsessive beliefs and their relation to obsessive–compulsive symptoms

Relationships between obsessive–compulsive symptoms and beliefs identified as relevant to obsessive–compulsive disorder (OCD) are investigated among university students and a small clinical sample. One hundred and fifty‐four participants completed measures of OCD‐related beliefs, OCD symptoms, and anxiety and depression symptoms. Results showed that belief domains were strongly interrelated and were not sufficiently separate to use individually in further analysis. The summed obsessive beliefs score was significantly correlated with all measured obsessional symptom subtypes, after controlling for anxiety and depression. Possible explanations and clinical implications of the results are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Not just thinking,but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions

Cognitive fusion (CF) involves the tendency to “buy in” to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive–compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional cognitive–behavioural constructs (i.e., obsessive beliefs such as inflated responsibility), predict OCD symptoms. Fifty‐two treatment‐seeking adults with OCD completed self‐report measures of CF, obsessive beliefs, OCD symptoms, and general distress. Domains of CF were differentially associated with the responsibility for harm, symmetry, and unacceptable thoughts of OCD dimensions; yet after accounting for obsessive beliefs, only the negative evaluation domain of CF significantly predicted symmetry OCD symptoms. Obsessive beliefs significantly predicted all OCD dimensions except for contamination. These findings provide additional support for existing cognitive–behavioural models of OCD across symptom dimensions, with the exception of contamination symptoms, and suggest that the believability of thoughts and feelings about negative evaluation adds to the explanation of symmetry symptoms. Conceptual and treatment implications, study limitations, and future directions are discussed.     

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.     

Are the dysfunctional beliefs that predict worry different from those that predict obsessions?

Chronic worry present in Generalized Anxiety Disorder (GAD) and obsessions characteristic of the Obsessive–Compulsive Disorder (OCD) are cognitive phenomena that share some features, but they also differ on others. Based on current cognitive approaches, dysfunctional meta‐cognitive beliefs underlie the development and/or maintenance of both GAD and OCD. However, to date, there has been little empirical evidence about the differences between the beliefs that predict the occurrence of obsessions and those that predict worry. This study focuses on the search for these differences and examines to what extent worry and obsessions are associated with a similar or different pattern of dysfunctional cognitive contents. One hundred and seventy‐five community subjects completed measures of worry and obsessional intrusive thoughts, as well as questionnaires assessing obsession‐related and worry‐related meta‐cognitive beliefs. Results showed that beliefs about uncontrollability and danger, as well as cognitive self‐consciousness, play a central role in predicting worry, whereas the beliefs concerning the importance of thoughts and Thought–Action Fusion probability are relevant in accounting for the frequency of obsessive intrusive thoughts. Copyright © 2007 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.     

Interpersonal mediators linking acculturation stressors to subsequent internalizing symptoms and self‐esteem in latino adolescents

The specific aim of this study was to examine pathways leading to internalizing symptoms and self‐esteem in Latino adolescents. Adolescent feelings of interpersonal humiliation, family conflict and commitment, and friendships with peers were investigated as potential mediators linking acculturation stress to subsequent adolescent self‐esteem and internalizing symptoms. Path analyses on data from a sample of 288 Latino adolescents (average age 15 years; 66% foreign‐born) showed that acculturation conflicts and perceived discrimination were risk factors for both internalizing problems at baseline and parent–adolescent conflict 6 months later. Baseline internalizing problems, and Time 2 variables (humiliation, parent–adolescent conflict, negative peer relationships, and changes in familism) mediated the effects of acculturation stress on Time 3 (T3) internalizing symptoms and self‐esteem. Latino cultural involvement was a key cultural asset, impacting T3 internalizing symptoms and self‐esteem by decreasing feelings of humiliation and by promoting familism. Familism was also a critical cultural asset associated with lower parent–adolescent conflict and higher self‐esteem. Study limitations and implications for practice with Latino families were discussed. © 2009 Wiley Periodicals, Inc.     

Specific relationships between core beliefs and personality disorder symptoms in a non‐clinical sample

The current study examined the relationship of clinically relevant core beliefs measured by the Young Schema Questionnaire‐Short Form (YSQ‐SF) to personality disorder (PD) symptoms in a large non‐clinical sample (N = 804). Results indicated that the 15 YSQ‐SF scales added sizeable explained variance (4% to 13%) to self‐reported symptoms of 12 PDs, above variance explained by gender and symptoms of other PDs. In addition, several specific core beliefs related uniquely to individual PDs after controlling for the other core beliefs. Given that core beliefs related to personality disorder symptoms in a non‐clinical sample of people at the typical onset age of PDs, it is possible that such beliefs might be important to understanding the development of PDs. Copyright © 2007 John Wiley & Sons, Ltd.     

Sensitivity to change of the Obsessive Beliefs Questionnaire

The Obsessive–Compulsive Beliefs Questionnaire‐87 (OBQ‐87) has been constructed by leading obsessive–compulsive disorder (OCD) experts to assess dysfunctional beliefs typical for OCD patients. The OBQ‐87 has recently been revised (Obsessive–Compulsive Beliefs Questionnaire‐44 [OBQ‐44]) to improve its psychometric properties. The current investigation entailed two goals: (1) to assess the sensitivity of both Obsessive Beliefs Questionnaire (OBQ) versions to treatment change and other OCD measures; and (2) to assess relations between symptom subtypes, OBQ beliefs and changes in beliefs as a consequence of treatment. One hundred and four patients have completed the OBQ before and after 12 sessions of behaviour therapy. Results suggest that (1) both OBQ versions exhibit an identical medium effect size; (2) overlap between clinical and non‐clinical populations limit the use of the OBQ as a primary measure of treatment change; and (3) the symptom dimension obsessions + checking was related to initial OBQ scores, but no symptom dimensions were related to OBQ pre‐treatment to post‐treatment changes. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Both versions of the OBQ demonstrate similar sensitivity to treatment change; however the clinical utility of this measure is doubtful.

     

Obsessional beliefs,compulsive behaviours and symptom severity: their evolution and interrelation over stages of treatment

The current study reports a case series examining (1) the variation in strength of obsessional doubt and belief in consequences of the doubt; and (2) the interaction between these cognitive components and symptom measures of duration and severity of obsessive–compulsive disorder (OCD), over 24 weeks of cognitive behaviour therapy. Eight participants diagnosed with OCD, four with contamination‐related rituals and four with checking behaviours, were selected on the basis of the Yale–Brown obsessive–compulsive scale (Y‐BOCS) and Padua ratings. All participants completed daily diaries measuring strength of principal obsessional doubt (0–100), strength of belief in consequences of the doubt (0–100) and the duration of the compulsive rituals throughout the 24 weeks of therapy. Severity of symptomatology was measured pre‐ and post‐treatment using the Y‐BOCS. Change in all measures was analysed over time following the procedure outlined by Storchheim and O'Mahoney (2006). Results showed that decrease in belief in secondary consequences is always accompanied by a decrease in strength of obsessions, but the converse does not hold. Furthermore, change in OCD symptomatology may precede cognitive changes. Copyright © 2008 John Wiley & Sons, Ltd.     

Anxiety disorders and control related beliefs: the exemplar of Obsessive-Compulsive Disorder (OCD)

Beliefs about control have been postulated to be important to anxiety and mood disorders. In particular, the phenomenology of Obsessive-Compulsive Disorder (OCD) suggests that it may be an exemplar of an anxiety disorder where control issues related to the self (behavior and thoughts) and world (the external environment) are particularly important. However, only beliefs concerning the need to control thoughts have been incorporated into contemporary theories of OCD. This article summarizes the theoretical and empirical research relevant to control-related beliefs in OCD. It is suggested that discrepancies between an individual's desired level of control and their perceived level of control could contribute to OCD symptoms, and exacerbate the tendency for individuals with OCD to engage in magical ideation and superstitious rituals. Overall, this review demonstrates how consideration of control cognitions could enhance our understanding of OCD and further improve its treatment.     

Spanish version of the Inferential Confusion Questionnaire‐Expanded Version: Further support for the role of inferential confusion in obsessive–compulsive symptoms

The purposes of this research were (1) to analyse the psychometric properties of the Inferential Confusion Questionnaire‐Expanded Version (ICQ‐EV) in a Spanish population; (2) to explore the role of inferential confusion in obsessive–compulsive disorder (OCD); and (3) to compare the inferential confusion construct in nonclinical and clinical samples. A sample of 342 nonclinical participants and 66 patients with OCD completed the ICQ‐EV Spanish adaptation as well as a set of questionnaires. Results confirmed a good fit of the ICQ‐EV Spanish version to the original unifactorial structure and excellent internal consistency and test–retest reliability. Moreover, results confirmed that the ICQ‐EV predicts Obsessing, Checking, Washing, and Hoarding symptoms, independently of the contribution of dysfunctional beliefs. In addition, OCD patients scored significantly higher on the ICQ‐EV than nonclinical participants. The Spanish version of the ICQ‐EV is a reliable instrument to assess inferential confusion, and further support is provided for the relevance of the inferential confusion construct in OCD.     

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.     

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.     

Decreased response monitoring in individuals with symptoms of trichotillomania

Trichotillomania (TTM) was long classified as an impulse‐control disorder; however, the many characteristics it shares with obsessive‐compulsive disorder (OCD) led to its recategorization in the DSM‐V. The present study aimed to assess and inform the taxonomic placement of TTM through an examination of its neural correlates. While research has consistently associated OCD with enhanced response monitoring, the present study investigated whether a similar neural process is associated with TTM. Undergraduates reporting TTM symptoms and controls performed a modified version of the flanker task, and their event‐related potentials were examined for between‐group differences in error‐related negativity (ERN). Results confirm that individuals who have symptoms of hair pulling have significantly smaller ERNs than the control group. Smaller ERNs reflect decreased levels of response monitoring and support the idea that TTM is distinct from OCD.     

Metacognitive beliefs in obsessive-compulsive patients: A comparison with healthy and schizophrenia participants

Introduction. Distorted metacognitive beliefs are increasingly considered in theoretical models of obsessive-compulsive disorder (OCD). However, so far no consensus has emerged regarding the specific metacognitive profile of OCD.

Methods. Participants with OCD (n=55), schizophrenia (n=39), and nonclinical controls (n=49) were assessed with the Metacognitions Questionnaire (MCQ-30).

Results. Except for positive beliefs about worry, both patient samples exceeded nonclinical controls on all MCQ subscales. The MCQ “need to control thoughts” and “negative beliefs about uncontrollability and danger” subscales showed strong correlations with obsessions, and scores in the former scale were elevated in hallucinators. In contrast to several prior studies, “cognitive confidence” was related neither to core OCD nor to schizophrenia symptomatology.

Conclusions. Notwithstanding large pathogenetic differences between OCD and schizophrenia, findings suggest that obsessions and hallucinations may share a common metacognitive pathway. Need to control thoughts and dysfunctional beliefs about the malleability of worries may represent critical prerequisites for the two phenomena to emerge.     

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.     

The relationship between body dysmorphic disorder symptoms and self‐construals

Background: Cognitive models of body dysmorphic disorder (BDD) suggest that beliefs and evaluations related to self‐concept are central to the maintenance of the disorder, but such beliefs have received little empirical attention. This study examined the relative importance of contingent self‐worth and self‐ambivalence to BDD symptoms in comparison to their importance to obsessive–compulsive disorder and social phobia symptoms. Method: The sample comprised 194 non‐clinical participants (female, N = 148; males, N = 46) with a mean age of 24.70 years (standard deviation = 9.34). Participants were asked to complete a battery of self‐report questionnaires. Results: While significant relationships were found between the self‐beliefs and symptoms of all three disorders, some specificity was found in the relationships. Conclusions: Self‐worth based upon appearance was most important in BDD, while contingent self‐worth based on the approval of others was important in social phobia. Self‐ambivalence was associated with each disorder. Implications and limitations are discussed.     

The familial association of tourette's disorder and ADHD: The impact of OCD symptoms

Tourette's disorder (TD) frequently co‐occurs with attention‐deficit/hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). While the relationship between TD and OCD suggests that they share etiological factors, the exact relationship between TD and ADHD is less clear. The goal of the current analyses was to understand better the familial relationship between DSM‐IV ADHD and TD. Direct interview diagnostic data from a case–control study of 692 relatives of 75 comorbid TD and ADHD (TD + ADHD), 74 TD without ADHD (TD Only), 41 ADHD without TD (ADHD Only), and 49 control probands were analyzed. Hierarchical loglinear modeling was used to explore association patterns between TD, ADHD, and OCD or sub‐clinical OCD (OCD/OCDsub) diagnoses among the 190 affected probands and their 538 relatives. The presence of OCD or OCDsub diagnosis in a proband was associated with a significantly increased risk of comorbid TD + ADHD in his/her relatives. The finding of an association between TD, ADHD and a proband OCD/OCDsub diagnosis was unexpected. The current results suggest that TD, ADHD, and OCD symptoms have overlapping neurobiology when occurring in families of TD and/or ADHD probands. © 2011 Wiley‐Liss, Inc.     

An exploratory genetic analysis: Associations between parent depression symptoms,child temperament,and the serotonin transporter gene polymorphism (5HTTLPR)

Child temperament has been shown to be biologically based and heritable; however, genetic association studies of temperament have been fairly inconclusive, and the role that parental depressive symptoms play is largely unexplored in this context. The relationship between parent depressive symptoms and the child temperament dimensions of fear and activity level (AL ) were examined in 100 sibling pairs 2.5–5.5 years of age and their mothers. Parent reports of child temperament and parent self‐reports of depressive symptoms were obtained from families, as well as DNA samples from each child during their lab visit. Associations between the serotonin transporter gene (SLC6A4 ) polymorphism 5‐HTTLPR /rs25531 and the phenotypic variables were also explored. Parent depressive symptoms were significantly related to higher child AL , but minimally associated with fear outcomes. More powerful regression analyses revealed that parent depressive symptoms, child gender, and child age predicted child AL , but only child gender and age predicted child fear. In our exploratory candidate gene analyses, the low‐expressing genotypes of the 5‐HTTLPR /rs25531 polymorphism predicted child fearfulness, but not child AL . Our phenotypic findings indicate that a child with at least one parent with depressive symptoms is more likely to have higher AL , and results of the initial genetic analyses show that the 5‐HTTLPR /rs25531 polymorphism is associated with child fearfulness. Future research employing larger samples, observational assessments, and related child behavioral maladjustment measures will further clarify these findings.     

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.