Associations between miscellaneous symptoms and symptom dimensions in adults with obsessive-compulsive disorder
ABSTRACT Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with a heterogeneous array of obsessions and compulsions. Although factor analytic studies have identified symptom dimensions comprising the clinical presentation of OCD, many frequently reported miscellaneous symptoms are not considered in factor analytic studies because they do not fit conceptually within a particular symptom category, despite being functionally related. In the present study, we examined the associations between miscellaneous symptoms and OCD symptom dimensions in a sample of 111 adults with OCD. Overall, most miscellaneous symptoms were associated with one or more symptom dimensions in previously identified four- (14 of the 22 symptoms) and five-factor models (12 of the 22 symptoms). In both models, Contamination/Cleaning was the only dimension not related to any miscellaneous symptom. The present results provide information about which miscellaneous symptoms may be related to particular symptom dimensions, which will assist in clinical evaluations and help planning behavioral psychotherapy (e.g., hierarchy development).
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ABSTRACT: Background: Since the publication of the DSM-IV in 1994, research on obsessive–compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered “time-consuming” for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a “general medical condition”; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to “poor insight,” and adding “tic-related OCD”); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.Depression and Anxiety 06/2010; 27(6):507 - 527. DOI:10.1002/da.20669 · 4.29 Impact Factor
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ABSTRACT: The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was recently revised to address several clinical and conceptual issues. The resultant measure, named the Yale-Brown Obsessive-Compulsive Scale-Second Edition, consists of two primary scales: the Severity Scale and the Symptom Checklist. Although the Severity Scale has been the subject of a comprehensive psychometric analysis, no data have been reported on the psychometric properties of the Y-BOCS-II Symptom Checklist (Y-BOCS-II-SC). Accordingly, in the present study, clinician ratings on the Y-BOCS-II-SC for 130 patients with obsessive-compulsive disorder (OCD) were examined on a number of validity and reliability indices. Partially consistent with past factor analytic studies of the Y-BOCS Symptom Checklist, the Y-BOCS-II-SC yielded four factors representing symmetry/ordering, contamination/washing, hoarding, and sexual/religious/aggression dimensions; checking rituals cross-loaded with other dimensions. Generally, the Y-BOCS-II-SC dimensions were internally consistent and rated stably across raters and over a short interval. The Y-BOCS-II-SC symptom dimensions showed good convergence with self-reported obsessive-compulsive symptoms, and were at best moderately associated with divergent measures (e.g., OCD symptom severity, depressive symptoms, and symptoms of anxiety). Overall, the Y-BOCS-II-SC shows good psychometric properties; we highlight several domains in which the Y-BOCS-II-SC may have clinical and research utility, as well as several areas for future study.Journal of anxiety disorders 08/2010; 24(6):650-6. DOI:10.1016/j.janxdis.2010.04.010 · 2.68 Impact Factor
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ABSTRACT: In recent years, much progress has been made in pharmacotherapy for pediatric obsessive-compulsive disorder (OCD) and chronic tic disorders (CTDs). What were previously considered relatively intractable conditions now have an array of efficacious medicinal (and psychosocial) interventions available at clinicians' disposal, including selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha-2 agonists. The purpose of this review is to discuss the evidence base for pharmacotherapy with pediatric OCD and CTDs with regard to efficacy, tolerability, and safety, and to put this evidence in the context of clinical management in integrated behavioral healthcare. While there is no single panacea for these disorders, there are a variety of medications that provide considerable relief for children with these disabling conditions.06/2011; 3:125-42. DOI:10.4137/JCNSD.S6616