Obsessive–Compulsive Personality Traits in Youth with Obsessive–Compulsive Disorder

While interest in the relationship between obsessive–compulsive disorder (OCD) and obsessive compulsive personality disorder has increased, there are currently no studies that have examined the presence of obsessive compulsive personality traits (OCPTs) in youth. The current study sought to determine the latent factors and psychometric properties of a modified version of the Childhood Retrospective Perfectionism Questionnaire (CHIRP) and examine the correlates of specific OCPTs (e.g., rigidity, perfectionism) in youth with OCD. Participants included 96 treatment-seeking youth diagnosed with primary OCD (and a parent). Parents and youth completed measures of OCPTs, OCD severity, depression, and disability. A confirmatory factor analysis of the modified CHIRP resulted in a two-factor model: perfectionism and preoccupation with details. The CHIRP and its subscales demonstrated acceptable internal consistency and preliminary evidence for convergent and divergent validity. Obsessive compulsive traits in youth were also found to be associated with the checking, symmetry and contamination symptom dimensions.     

The Characterization of Beliefs in Obsessive–Compulsive Disorder

Beliefs are associated with most obsessions and compulsions in obsessive–compulsive disorder (OCD). The characteristics of these beliefs can vary considerably, which has led to some of them being regarded as overvalued ideas or delusions and has contributed to confusion regarding the conceptualization and classification of OCD. This article proposes that beliefs arising in the context of OCD be assessed along the following, well-defined characteristics: conviction, fixity, fluctuation, resistance (to beliefs), insight pertaining to an awareness of the inaccuracy of one’s belief, and insight referring to the ability to attribute the belief to an illness. This approach to the assessment of OCD-related beliefs may allow a clearer distinction between non-delusional beliefs, overvalued ideas, and delusions. Although the characteristics of non-delusional beliefs may vary, especially on the dimension of awareness of the inaccuracy of belief, these beliefs can generally be distinguished from overvalued ideas and delusions in terms of lower levels of conviction and fixity and greater fluctuation, resistance and ability to attribute the belief to OCD. The development of an assessment tool using these well-defined characteristics will test the proposed model, which may lead to a more objective evaluation of OCD-related beliefs. This is likely to have implications for diagnostic conceptualization and subtyping of OCD.     

ASD Traits Among Youth with Obsessive–Compulsive Disorder

Research has shown high rates of comorbid psychiatric disorders among samples of youth with obsessive–compulsive disorder (OCD) (Farrell et al., Psychiatry Res 199(2):115–123, 2012; Lewin et al., Psychiatry Res 178(2):317–322, 2010; POTS Team, J Am Med Assoc 292(16):1969–1976, 2004). Autism and autistic traits co-occur at high rates within clinical samples of youth with OCD (Ivarsson and Melin in J Anxiety Disord 22(6):969–978, 2008; Stewart et al. in Child Psychiatry Hum Dev 1–9, 2016). This study extends the literature by examining the relationship between ASD traits, family accommodation, and functional impairment in a sample of youth with OCD across a wide age range (n?=?80; aged 7–17 years). Results indicated that autistic traits, as measured by the social responsiveness scale (SRS), were elevated in 32.5% of youth (based on a T-score of 66T and above) relative to typically developing youth, as well as youth with non-autism-related psychiatric disorders (Constantino and Gruber in Social responsiveness scale, Western Psychogical Services, Torrance, 2012). Furthermore, 27.5% of youth scored within a moderate range (66T–75T) and 5% of youth scored within a severe range (76T or higher) on the SRS, typical of children with ASD (Constantino and Gruber in Social responsiveness scale, Western Psychogical Services, Torrance, 2012). Additionally, ASD traits were associated with greater functional impairment above OCD severity. Furthermore, family accommodation mediated the relationship between ASD traits and functional impairment. Implications of these findings are discussed in the context of clinical assessment and direction for further research.     

Trends in Autism Spectrum Disorder Diagnoses: 1994–2007

We analyzed predictors of parent-reported initial diagnosis (autistic disorder [AD], pervasive developmental disorder-not otherwise specified [PDD-NOS], pervasive developmental disorder [‘PDD’] and autism spectrum disorder [‘ASD’], and Asperger syndrome [AS]), among 6,176 individuals with autism spectrum disorders diagnosed from 1994 through 2007. Overall, distribution of diagnoses was influenced by a secular time trend factor; other significant factors included ethnicity, white race, geographic location, urbanicity, and initial evaluator. Since 2001, most initial diagnoses of AD and AS have remained steady while ‘PDD’ and PDD-NOS have decreased. ‘ASD’ diagnoses have increased, especially among school-based teams; AS diagnoses also increased uniquely among these evaluators. Findings from this study suggest that current diagnostic guidelines may not be meeting all community evaluator needs.

Optimizing Deep Brain Stimulation Parameters in Obsessive–Compulsive Disorder

ObjectivesDeep brain stimulation (DBS) is an innovative and effective treatment for patients with therapy-refractory obsessive–compulsive disorder (OCD). DBS offers unique opportunities for personalized care, but no guidelines on how to choose effective and safe stimulation parameters in patients with OCD are available. Our group gained relevant practical knowledge on DBS optimization by treating more than 80 OCD patients since 2005, the world’s largest cohort. The article’s objective is to share this experience.Materials and MethodsWe provide guiding principles for optimizing DBS stimulation parameters in OCD and discuss the neurobiological and clinical basis.ResultsAdjustments in stimulation parameters are performed in a fixed order. First, electrode contact activation is determined by the position of the electrodes on postoperative imaging. Second, voltage and pulse width are increased stepwise, enlarging both the chance of symptom reduction and of inducing side effects. Clinical evaluation of adjustments in stimulation parameters needs to take into account: 1) the particular temporal sequence in which the various OCD symptoms and DBS side-effects change; 2) the lack of robust response predictors; 3) the limited sensitivity of the Yale-Brown Obsessive–Compulsive Scale to assess DBS-induced changes in OCD symptoms; and 4) a patient’s fitness for additional cognitive-behavioral therapy (CBT).ConclusionsDecision-making in stimulation parameter optimization needs to be sensitive to the particular time-courses on which various symptoms and side effects change.     

The Relationships Between Obsessive–Compulsive Symptom Dimensions and Cognitions in Obsessive–Compulsive Disorder

Several studies have linked obsessive–compulsive symptoms to specific obsessive–compulsive cognitions, however methodologies have varied, and no study has determined obsessive–compulsive symptoms using the most widely used clinician rating scale, the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS). Considering that almost all studies that used factor analysis to ascertain OCD symptom dimensions were based on the Y-BOCS and that self-report instruments assessing obsessive–compulsive symptoms correlate poorly with the Y-BOCS, there is a need to use the Y-BOCS to examine the relationship between obsessive–compulsive cognitions and obsessive–compulsive symptom dimensions. This study examined the relationship between five Y-BOCS-derived obsessive–compulsive symptom dimensions and the three obsessive–compulsive cognitive domains identified by the obsessive-beliefs questionnaire (OBQ). The symmetry/ordering symptom dimension was associated with increased perfectionism/intolerance of uncertainty, the unacceptable/taboo thoughts symptom dimension was associated with increased importance/control of thoughts and the doubt/checking symptom dimension was associated with increased responsibility/threat estimation. There was no statistical evidence of an association between any OBQ belief sub-scale and the hoarding symptom dimension nor the contamination/cleaning symptom dimension. The findings encourage symptom-based approaches to cognitive-behavioural therapy for some OCD symptoms and call for further research on cognitions associated with contamination/cleaning symptoms and hoarding.     

Comorbid Personality Disorders in Obsessive–Compulsive Disorder and Its Symptom Dimensions

The current paper was aimed at: (1) investigating the comorbidity between obsessive–compulsive disorder (OCD) and personality disorders (PDs) using an OCD sample and clinician-administered structured interviews; (2) exploring the associations of different cluster comorbid PDs with the specific symptom dimensions of OCD; (3) analyzing the variables which could play a significant role in the probability of having at least one comorbid PD, controlling for confounding variables. The SCID-II and Y-BOCS, together with a series of self-report measures of OCD, depression and anxiety symptoms were administered to a clinical sample of 159 patients with a primary diagnosis of OCD. 20.8 % of the participants suffered from at least one comorbid PD; the most common was obsessive–compulsive PD (9.4 %), followed by narcissistic PD (6.3 %). In OCD patients with comorbid cluster C PDs, the percentage of responsibility for harm, injury, or bad luck symptoms was significantly greater than other OCD symptom dimensions (p < .005). Logistic regression found some evidence supporting the association between severity of OCD symptoms and comorbid PDs. PDs are prevalent among Italian people with OCD and should be routinely assessed, as comorbidity may affect help-seeking behaviour and response to treatment.     

Clinical Correlates of Comorbid Obsessive–Compulsive Disorder and Depression in Youth

A burgeoning body of literature addresses the comorbidity of depression and OCD in adults. The purpose of this study was to extend this area of research to children and adolescents by examining the clinical correlates associated with co-occurring depressive disorders in a clinical sample of youth with OCD. Participants included children and adolescents seeking treatment at a university-based research clinic. One group was comprised of 28 children (ages 10–17 years) who met diagnostic criteria for OCD but had no comorbid depressive disorders, whereas the second group consisted of 28 children matched for age and gender who met diagnostic criteria for OCD and co-occurring depressive disorder. The two groups were compared on measures of broad-band psychopathology, internalizing problems, social difficulties, and family characteristics. As anticipated, findings revealed comorbid depression and OCD was associated with more severe internalizing problems, more extensive obsessive–compulsive symptomatology, and more social problems. Youth with comorbid depression and OCD also had higher family conflict and lower family organization compared to those with OCD and no depression. These results may have implications for the treatment of youth with comorbid OCD and depression.     

Autism Spectrum Disorder as Early Neurodevelopmental Disorder: Evidence from the Brain Imaging Abnormalities in 2–3 Years Old Toddlers

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that occurs within the first 3 years of life, which is marked by social skills and communication deficits along with stereotyped repetitive behavior. Although great efforts have been made to clarify the underlying neuroanatomical abnormalities and brain-behavior relationships in adolescents and adults with ASD, literature is still limited in information about the neurobiology of ASD in the early age of life. Brain images of 50 toddlers with ASD and 28 age, gender, and developmental quotient matched toddlers with developmental delay (DD) (control group) between ages 2 and 3 years were captured using combined magnetic resonance-based structural imaging and diffusion tensor imaging (DTI). Structural magnetic resonance imaging was applied to assess overall gray matter (GM) and white matter (WM) volumes, and regional alterations were assessed by voxel-based morphometry. DTI was used to investigate the white matter tract integrity. Compared with DD, significant increases were observed in ASD, primarily in global GM and WM volumes and in right superior temporal gyrus regional GM and WM volumes. Higher fractional anisotropy value was also observed in the corpus callosum, posterior cingulate cortex, and limbic lobes of ASD. The converging findings of structural and white matter abnormalities in ASD suggest that alterations in neural-anatomy of different brain regions may be involved in behavioral and cognitive deficits associated with ASD, especially in an early age of 2–3 years old toddlers.     

Prospective Relationship Between Obsessive–Compulsive and Depressive Symptoms During Multimodal Treatment in Pediatric Obsessive–Compulsive Disorder

The present study examined the prospective relationship between obsessive–compulsive and depressive symptoms during a multimodal treatment study involving youth with obsessive–compulsive disorder (OCD). Participants included fifty-six youth, aged 7–17 years (M = 12.16 years) who were enrolled in a two-site randomized controlled pharmacological and cognitive behavioral therapy treatment trial. Obsessive–compulsive severity was measured using the Children’s Yale-Brown Obsessive–Compulsive Scale, and depressive symptoms were rated using the Children’s Depression Rating Scale-Revised. Multi-level modeling analyses indicated that, on average over the course of treatment, variable and less severe obsessive–compulsive symptoms significantly predicted a decrease in depressive symptoms. Additionally, week-to-week fluctuations in OCD severity did not significantly predict weekly changes in depressive symptom severity. Level of baseline depressive symptom severity did not moderate these relationships. Findings suggest that when treating youth with OCD with co-occurring depression, therapists should begin by treating obsessive–compulsive symptoms, as when these are targeted effectively, depressive symptoms diminish as well.     

Bipolar II Disorder and Borderline Personality Disorder - co-morbidity or spectrum?

We assess the number of patients who we have on the Database of a Community Mental Health Team in the UK who have Bipolar Disorder and Borderline Personality Disorder. We report how many of these have been seen as having both disorders. Hence we discuss the issue as to whether Borderline Personality disorder is to be placed within the bipolar spectrum. We note the difficulties regarding the use of phenomenology alone to decide this problem, and we note the similarities in genetics, neuroimaging observations and neurobiological mechanisms among the following conditions; Bipolar Disorder, Unipolar Depression, Post-traumatic Stress Disorder, and Borderline Personality Disorder. Ethiologies such as Trauma, Abuse, Childhood adversity and exposure to War appear to influence all these conditions via epigenetic mechanisms. Hence we argue that for a spectrum to be proposed, conditions in the spectrum need to be underpinned by similar or common Neuroimaging and neurobiological mechanisms.On this basis, it may be reasonable to include Borderline Personality Disorder within a broadly described bipolar spectrum. New details of the common Neurobiological mechanisms continue to emerge.     

Psychometric Validation of the Internet Disorder Scale–Short Form in an Italian Adult Sample

International Journal of Mental Health and Addiction - Research examining online addictions has conceptualized generalized internet addiction as an “umbrella” term comprising the...     

Motor Skills in Children Aged 7–10 Years, Diagnosed with Autism Spectrum Disorder

This study used the Movement Assessment Battery for Children (M-ABC2) to assess motor skills in children aged 7-10?years with autism (n?=?18) in comparison to two groups of age-matched typically developing children; a receptive vocabulary matched group (n?=?19) and a nonverbal IQ matched group (n?=?22). The results supported previous work, as indicated by a significant general motor impairment in the group with autism. However, sub-analysis of the M-ABC2 revealed that there were only 2 out of 8 subcomponent skills which showed universal significant specific deficits for the autism group; i.e. catching a ball and static balance. These results suggest that motor skill deficits associated with autism may not be pervasive but more apparent in activities demanding complex, interceptive actions or core balance ability.     

Reduced Prefrontal Hemodynamic Response in Pediatric Obsessive–Compulsive Disorder as Measured by Near-Infrared Spectroscopy

Recent developments in near-infrared spectroscopy (NIRS) have enabled non-invasive clarification of brain functions in psychiatric disorders. Functional neuroimaging studies of patients with obsessive–compulsive disorder (OCD) have suggested that the frontal cortex and subcortical structures may play a role in the pathophysiology of the disorder. Twelve treatment-naïve children with OCD and 12 age- and sex-matched healthy control subjects participated in the present study after giving consent. The relative concentrations of oxyhemoglobin (oxy-Hb) were measured with prefrontal probes every 0.1 s during the Stroop color-word task, using 24-channel NIRS machines. During the Stroop color-word task, the oxy-Hb changes in the OCD group were significantly smaller than those in the control group in the prefrontal cortex, especially in the frontopolar cortex. The present study suggests that children with OCD have reduced prefrontal hemodynamic response as measured by NIRS.