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Revision of the Padua Inventory of obsessive compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions

Authors:
G. Leonard Burns at Washington State University
G. Leonard Burns
S G Keortge
S G Keortge
S G Keortge
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G M Formea
G M Formea
G M Formea
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L G Sternberger
L G Sternberger
L G Sternberger
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Abstract

The Padua Inventory (PI), a self-report measure of obsessive and compulsive symptoms, is increasingly used in obsessive compulsive disorder (OCD) research. Freeston, Ladouceur, Rheaume, Letarte, Gagnon and Thibodeau (1994) [Behaviour Research and Therapy, 32, 29-36], however, recently showed that the PI measures worry in addition to obsessions. In an attempt to solve this measurement problem, this study used a content distinction between obsessions and worry to revise the PI. The revision was constructed to measure five content dimensions relevant to OCD i.e. (1) obsessional thoughts about harm to oneself or others; (2) obsessional impulses to harm oneself or others; (3) contamination obsessions and washing compulsions; (4) checking compulsions; and (5) dressing/grooming compulsions. A total of 5010 individuals participated in the study, 2970 individuals completing the PI and the Penn State Worry Questionnaire (PSWQ) and an additional 2040 individuals completing only the PI. The results provided support for the reliability and validity of the revision. In addition, the revision of the PI was more independent of worry, as measured by the PSWQ, than the original PI. Support was thus found for the validity of the content distinction between obsessions and worry. The importance of this content distinction is also discussed for the evaluation of other hypothesized distinctions between obsessions and worry.
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Padua Inventory – Washington State University Revision
Reference for the revision:
Burns, G.L. (1995). Padua Inventory-Washington State University Revision.
Pullman, WA: Author. (Available from G. Leonard Burns, Department of
Psychology, Washington State University, Pullman, WA 99164-4820)
Subscales:
1. Contamination obsessions and washing compulsions subscale:
Items: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10
2. Dressing/grooming compulsions subscale:
Items: 11, 12, 13
3. Checking compulsions subscale:
Items: 14, 15, 16, 17, 18, 19, 20, 21, 22, 23
4. Obsessional thoughts of harm to self/others subscale:
Items: 24, 25, 26, 27, 28, 29, 30
5. Obsessional impulses to harm self/others subscale:
Items: 31, 32, 33, 34, 35, 36, 37, 38, 39
Reference for the psychometric properties of the revision:
Burns, G.L., Keortge, S., Formea, G., & Sternberger, L.G. (1996). Revision of the Padua
Inventory of obsessive compulsive disorder symptoms: Distinctions between
worry, obsessions, and compulsions. Behavior Research and Therapy, 34, 163-
173.
The following statements refer to thoughts and behaviors which may occur to everyone in everyday life. For each statement,
Choose the reply which best seems to fit you and the degree of disturbance which such thoughts or behaviors may create.
1 I feel my hands are dirty when I touch money. Not at All A little Quite
A Lot
2 I think even slight contact with bodily secretions (perspiration, saliva
urine, etc.) may contaminate my clothes or somehow harm me.
Not at All A little Quite A
Lot
3 I find it difficult to touch an object when I know it has been touched
by strangers or by certain people.
Not at All A little Quite a
Lot
4 I find it difficult to touch garbage or dirty things. Not at All A little Quite a
Lot
5 I avoid using public toilets because I am afraid of disease and
contamination.
Not at All A little Quite a
Lot
6 I avoid using public telephones because I am afraid of contagion and
disease.
Not at All A little Quite a
Lot
7 I wash my hands more often and longer than necessary. Not at All A little Quite a
Lot
8 I sometimes have to wash or clean myself simply because I think I
may be dirty or “contaminated”.
Not at All A little Quite a
Lot
9 If I touch something I think is “contaminated”, I immediately have to
wash or clean myself.
Not at All A little Quite a
Lot
10 If an animal touches me, I feel dirty and immediately have to wash
myself or change my clothing.
Not at All A little Quite a
Lot
11 I feel obliged to follow a particular order in dressing, undressing, and
washing myself.
Not at All A little Quite a
Lot
12 Before going to sleep, I have to do certain things in a certain order. Not at All A little Quite a
Lot
13 Before going to bed, I have to hang up or fold my clothes in a special
way.
Not at All A little Quite a
Lot
14 I have to do things several times before I think they are properly
done.
Not at All A little Quite a
Lot
15 I tend to keep on checking things more often than necessary. Not at All A little Quite a
Lot
16 I check and recheck gas and water taps and light switches after
turning them off.
Not at All A little Quite a
Lot
17 I return home to check doors, windows, drawers, etc., to make sure
they are properly shut.
Not at All A little Quite a
Lot
18 I keep on checking forms, documents, checks, etc., in detail to make
sure I have filled them in correctly.
Not at All A little Quite a
Lot
19 I keep on going back to see that matches, cigarettes, etc, are properly
extinguished.
Not at All A little Quite a
Lot
20 When I handle money, I count and recount it several times. Not at All A little Quite a
Lot
21 I check letters carefully many times before posting them. Not at All A little Quite a
Lot
22 Sometimes I am not sure I have done things which in fact I knew I Not at All A little Quite a
have done. Lot
23 When I read, I have the impression I have missed something
important and must go back and reread the passage at least two or
three times.
Not at All A little Quite a
Lot
24 I imagine catastrophic consequences as a result of absent-
mindedness or minor errors which I make.
Not at All A little Quite a
Lot
25 I think or worry at length about having hurt someone without
knowing it.
Not at All A little Quite a
Lot
26 When I hear about a disaster, I think it is somehow my fault. Not at All A little Quite a
Lot
27 I sometimes worry at length for no reason that I have hurt myself or
have some disease.
Not at All A little Quite a
Lot
28 I get upset and worried at the sight of knives, daggers, and other
pointed objects.
Not at All A little Quite a
Lot
29 When I hear about a suicide or a crime, I am upset for a long time
and find it difficult to stop thinking about it.
Not at All A little Quite a
Lot
30 I invent useless worries about germs and disease. Not at All A little Quite a
Lot
31 When I look down from a bridge or a very high window, I feel an
impulse to throw myself into space.
Not at All A little Quite a
Lot
32 When I see a train approaching, I sometimes think I could throw
myself under its wheels.
Not at All A little Quite a
Lot
33 At certain moments, I am tempted to tear off my clothes in public. Not at All A little Quite a
Lot
34 While driving, I sometimes feel an impulse to drive the car into
someone or something.
Not at All A little Quite A
Lot
35 Seeing weapons excites me and makes me think violent thoughts. Not at All A little Quite a
Lot
36 I sometimes feel the need to break or damage things for no reason. Not at All A little Quite a
Lot
37 I sometimes have an impulse to steal other people’s belongings, even
if they are of no use to me.
Not at All A little Quite a
Lot
38 I am sometimes almost irresistibly tempted to steal something from
the supermarket.
Not at All A little Quite a
Lot
39 I sometimes have an impulse to hurt defenseless children or animals. Not at All A little Quite a
Lot
... Neither Einstein and Menzies (2004) Inventory (PI; Sanavio, 1988) as a measure of OCD symptoms. The PI shares a considerable variance with worry (Wells & Papageorgiou, 1998;Bums, Keortge, Formea & Sternberger, 1996), and the Importance of Thoughts subscale of the PI, that demonstrates the greatest overlap with worry (Bums et al., 1996), demonstrated the strongest association with magical thinking. Magical thinking may therefore be involved to some extent with worry (Einstein & Menzies, 2004). ...
... A possible explanation for the unexpected findings was the use of the PI-R (Bums et al., 1996) as a single measure of OCD symptoms. OCD is argued to be a multidimensional and heterogeneous disorder (Calamari et al., 2004), and measures of OCD that are based upon specific symptom clusters, may omit other key symptoms. ...
... Previous studies (Einstein & Menzies, 2000,2004 use the original PI (Sanavio, 1988) and this measure is demonstrated to overlap considerably with worry Magical thinking in OCD 89 (Bums et al., 1996). Total scores on the original PI are heavily weighted towards scores on the 'Importance of Controlling Mental Activities' subscale, and this subscale is the most problematic in the overlap between symptoms of OCD and worry (Bums et al., 1996). ...
The association of magical thinking and obsessive-compulsive disorder : an experimantal investigation of neutralising behaviour
Thesis
  • Jan 2004
p>Magical thinking is suggested to be a core component in Obsessive Compulsive Disorder (OCD) that underpins the cognitive bias of Thought-Action Fusion (TAF). The literature review considers evidence that TAF is involved in the development and maintenance of OCD, and that TAF-likelihood and magical thinking are associated. It is suggested that magical thinking OCD are also associated, and a review of the evidence for the centrality of magical thinking in OCD is presented. The limitations of previous research are discussed, highlighting the need for experimental investigation, and controlling for the effect of anxiety and depression. It is hypothesised that magical thinking may also be demonstrated in the neutralising behaviours in response to intrusive thoughts in OCD. The experimental paper investigates whether the use of neutralising behaviours in response to a TAF-induction experiment is linked to magical thinking. In a sample of 50 undergraduate students, 74.0% of participants demonstrated at least one form of neutralising behaviour. Individuals that used neutralising strategies demonstrated significantly greater levels of magical thinking, however, there was no difference in the level of OCD symptoms. Magical thinking was significantly associated with OCD symptoms, however it is suggested that the overlap between magical thinking and worry might account for this association. Unexpectedly, no significant association was found between TAF-likelihood and OCD, although, a significant relationship was demonstrated between TAF-moral and OCD symptoms. The effects of the TAF-induction paradigm are discussed, and it is suggested that the paradigm may not be an appropriate model for OCD.</p
... Items are scored on a 5-point Likert-type scale ranging from 0 (not at all) to 4 (very much). The Padua Inventory demonstrated adequate internal consistency [15]. Validated versions of the Padua Inventory were available in English [15], French [38], German [89], Spanish [57], and Turkish [101]. ...
... The Padua Inventory demonstrated adequate internal consistency [15]. Validated versions of the Padua Inventory were available in English [15], French [38], German [89], Spanish [57], and Turkish [101]. The questionnaire was translated in the other languages with the same methodology as described above. ...
Resilience of people with chronic medical conditions during the COVID-19 pandemic: a 1-year longitudinal prospective survey
Article
Full-text available
Backgrounds Individuals with chronic medical conditions are considered highly exposed to COVID-19 pandemic stress, but emerging evidence is demonstrating that resilience is common even among them. We aimed at identifying sustained resilient outcomes and their predictors in chronically ill people during the first year of the pandemic. Methods This international 4-wave 1-year longitudinal online survey included items on socio-demographic characteristics, economic and living situation, lifestyle and habits, pandemic-related issues, and history of mental disorders. Adherence to and approval of imposed restrictions, trust in governments and in scientific community during the pandemic were also investigated. The following tools were administered: the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, the PTSD Checklist DSM-5, the Oslo Social Support Scale, the Padua Inventory, and the Portrait Values Questionnaire. Results One thousand fifty-two individuals reporting a chronic condition out of 8011 total participants from 13 countries were included in the study, and 965 had data available for the final model. The estimated probability of being “sustained-resilient” was 34%. Older male individuals, participants employed before and during the pandemic or with perceived social support were more likely to belong to the sustained-resilience group. Loneliness, a previous mental disorder, high hedonism, fear of COVID-19 contamination, concern for the health of loved ones, and non-approving pandemic restrictions were predictors of not-resilient outcomes in our sample. Conclusions We found similarities and differences from established predictors of resilience and identified some new ones specific to pandemics. Further investigation is warranted and could inform the design of resilience-building interventions in people with chronic diseases.
... Revision of the Padua Inventory (PI) (8-items) [4]. The complete PI inventory is composed of 39 items rated on a 5-point Likert scale from 0 ("not at all") to 4 ("very much") and measures symptoms of obsessions and compulsions. ...
... Coping behaviours during the COVID-19 pandemic (7-items). Items were created using a Likert scale of frequency ["never" (0) to "very frequently" (4)]. The items included the following: i) preventive measures, such as disinfecting packages, consuming over-the-counter medicines/vitamins to avoid contracting an illness, and panic shopping (i.e., buying several products at once for fear of shortage), ii) avoidance behaviours (e.g., avoiding social contact outside the household, such as meeting friends, going out, etc.) and iii) worrying about oneself or people one care about contracting an illness or believing themselves or those they care about to be more vulnerable to the virus in comparison to other people. ...
Coping with COVID- 19 pandemic stressors: Comparisons between non-players and players, and levels of Game Transfer Phenomena
Article
  • Sep 2022
During the COVID-19 pandemic, video game playing increased exponentially. The question if playing could offer benefits to cope with the pandemic stressors emerged. This study compares how non-players and players who may or may not re-experience (e.g., seeing, hearing) game content after playing [i.e., Game Transfer Phenomena (GTP)] cope with the pandemic stressors, emotion regulation and resilience. It also examines the impact of GTP on the perception of self and the world. A total of 567 completed a survey (59.6% male, MeanAge = 28.55). The measures include emotional regulation (ERC), resilience to stress (BRCS) and fear of contamination (PI). No differences between players and non-players on ERC, BRCS and PI were found. Players with moderate GTP levels were more likely to report contamination fears and show preventive COVID coping behaviours. The positive impact of GTP was associated with high resilience and cognitive reappraisal as an emotion regulation strategy. The results suggest that attention should be paid to players who experience GTP more frequently and with a negative impact. Maladaptive coping styles can exacerbate distress from GTP and situational stressors. Identifying methods of protecting vulnerable individuals from these psychological burdens can guide interventions and mitigate consequences in similar situations.
... However, progesterone was measured from saliva samples via immunoassays, which is a method that has recently been criticized for having relatively modest validity when measuring changes in progesterone levels during the menstrual cycle (Arslan et al., 2022). To address this potential limitation, Stern and Shiramizu (2022) tested whether 257 women's scores on the pathogen disgust subscale of the Three Domain Disgust Scale and scores on the contamination subscale of the Revised Padua Obsessive-Compulsive Inventory (Burns et al., 1996) increased on days of the menstrual cycle where progesterone was high when liquid chromatography-mass spectrometry was used to measure progesterone level from saliva. Using this method, Stern and Shiramizu (2022) found no evidence that pathogen disgust tracked changes in progesterone and also found no evidence for increased pathogen disgust during the luteal phase of the menstrual cycle. ...
Is Pathogen Disgust Increased on Days of the Menstrual Cycle when Progesterone is High? Evidence from a Between-Subjects Study Using Estimated Progesterone Levels
Article
Full-text available
  • Dec 2022
Objective The Compensatory Prophylaxis Hypothesis proposes that women will show increased pathogen disgust at points in the menstrual cycle when progesterone is high, compensating for the immunosuppressive effects of progesterone. However, evidence for the Compensatory Prophylaxis Hypothesis from studies that used longitudinal designs to investigate whether pathogen disgust tracks changes in progesterone is mixed. It was recently proposed that longitudinal designs may be poorly suited to testing the Compensatory Prophylaxis Hypothesis because carry-over effects when women are tested repeatedly in within-subject designs might obscure the effects of progesterone and pathogen disgust. Consequently, we used a between-subjects design to test for a positive relationship between scores on the pathogen disgust subscale of the Three Domain Disgust Scale and progesterone levels imputed from menstrual cycle data using actuarial tables. Methods We employed a between-subject design on N = 1346 women using the Three Domains of Disgust Scale (TDDS). Results We found no evidence for a positive effect of progesterone on pathogen disgust, suggesting that null results for the hypothesized relationship between progesterone and pathogen disgust are not limited to studies using designs that may be subject to carry-over effects caused by repeated testing. Conclusion Our results add to a growing body of research that does not support the Compensatory Prophylaxis Hypothesis.
... However, progesterone was measured from saliva samples via immunoassays, which is a method that has recently been criticized for having relatively modest validity when measuring changes in progesterone levels during the menstrual cycle (Arslan et al., 2022). To address this potential limitation, Stern and Shiramizu (2022) tested whether 257 women's scores on the pathogen disgust subscale of the Three Domain Disgust Scale and scores on the contamination subscale of the Revised Padua Obsessive-Compulsive Inventory (Burns et al., 1996) increased on days of the menstrual cycle where progesterone was high when liquid chromatography-mass spectrometry was used to measure progesterone level from saliva. ...
Is pathogen disgust increased on days of the menstrual cycle when progesterone is high? Evidence from a between-subjects study using estimated progesterone levels
Preprint
Full-text available
  • Sep 2022
Objective: The Compensatory Prophylaxis Hypothesis proposes that women will show increased pathogen disgust at points in the menstrual cycle when progesterone is high, compensating for the immunosuppressive effects of progesterone. However, evidence for the Compensatory Prophylaxis Hypothesis from studies that used longitudinal designs to investigate whether pathogen disgust tracks changes in progesterone is mixed. It was recently proposed that longitudinal designs may be poorly suited to testing the Compensatory Prophylaxis Hypothesis because carry-over effects when women are tested repeatedly in within-subject designs might obscure the effects of progesterone and pathogen disgust. Consequently, we used a between-subjects design to test for a positive relationship between scores on the pathogen disgust subscale of the Three Domain Disgust Scale and progesterone levels imputed from menstrual cycle data using actuarial tables. Methods: We employed a between-subject design on N = 1346 healthy women using the Three Domains of Disgust Scale (TDDS). Results: We found no evidence for a positive effect of progesterone on pathogen disgust, suggesting that null results for the hypothesized relationship between progesterone and pathogen disgust are not limited to studies using designs that may be subject to carry-over effects caused by repeated testing. Conclusions: Our results add to a growing body of research that does not support the Compensatory Prophylaxis Hypothesis.
... This subscale was shown to have good internal consistency with Cronbach's alpha (=.85) and testÀretest reliability (=.72). 49 A score of 14 is considered the threshold for high contamination fear. 18, . ...
Fear of Contamination Among Older Adults in the Post-COVID-19 Era
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This study assesses older adults’ fear of contamination in the post-coronavirus disease 2019 (COVID-19) era, examining the factors associated with this fear and investigating its effects on their well-being and use of primary healthcare, considering the moderating effects of activities of daily living (ADL) and multimorbidity in these two relationships. A cross-sectional study was conducted in primary healthcare centers in three regions in Saudi Arabia with a convenience sample of 444 older adults diagnosed with chronic diseases. The results indicated that 77.9% of older adults had high contamination fear, predicted by their age, education level, gender, ADL, and previous COVID-19 infection experience. Subjective well-being and the number of primary healthcare visits in the post-COVID-19 era were negatively affected by contamination fear and both ADL and multimorbidity moderated these relationships. In conclusion, the study confirmed the need to focus on older adults’ contamination fear to mitigate its negative effects on well-being and critical primary healthcare visits.
Examination of a bifactor model of the Obsessive-Compulsive Inventory- Revised
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  • Dec 2022
The current study evaluated a bifactor model for the Obsessive-Compulsive Inventory Revised (OCI-R) in two samples, with (n=188) and without (n=408) obsessive-compulsive disorder(OCD). Since the OCI-R has been traditionally conceptualized as a correlated six-factor instrument, our goal was to evaluate the fit of a bifactor model against three competing models (one general factor,six correlated factors and a hierarchical model). Results revealed that the bifactor model presented the best fit and that all OCI-R items were influenced by a general factor and by one of the six dimensions. Model-based reliability estimated via Omega hierarchical for the total score suggested that OCI-R items are multidimensional, with the general obsessive-compulsive (OC) factor accounting for little more than half of the variability in the items of the total score, with the remaining variability accounted for by the specific OC domains and other sources of variance. Measurement invariance of the bifactor model was also supported among those with and without OCD. Implications for better understanding the structure and further use of the OCI-R are discussed.
Facing Uncertainty: A Comparison of Hierarchical and Variable Exposure Interventions for Contamination Fear
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  • Dec 2022
Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N = 73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d = .78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.
Obsesif Kompulsif Bozukluk Tanılı Ergenlerin ve Annelerin Obsesif İnançları ve Çıkarımsal Karmaşaları Arasındaki İlişki
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  • Jul 2022
Amaç: Obsesif kompulsif bozukluk(OKB) tanılı ergenlerin ve annelerinin obsesif inançları ve çıkarımsal karmaşaları arasındaki ilişkiyi saptayarak OKB’deki bilişsel değerlendirmeleri araştırmaktır. Gereç ve Yöntem: Çalışmaya 25 OKB hastası (20 erkek ve 5 kız) ile bu hastaların anneleri dahil edildi. Hastalara Okul Çağı Çocukları İçin Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Şekli (K-SADS-PL) ve Yale-Brown Obsesyon-Kompulsiyon Ölçeği (Y-BOKÖ) uygulandıktan sonra OKB tanısı alan hastalara ve onların annelerine Obsesif İnançlar Ölçeği-44 (OİÖ-44), Çıkarımsal Karmaşa Ölçeği (ÇKÖ), Padua Envanteri (PE) uygulanmıştır. Hastaların ve annelerinin obsesif inançları, çıkarımsal karmaşaları ile obsesif kompulsif belirti puanlarının korelasyonu incelenmiştir. Bulgular: Ergenler ile annelerin, obsesif inançları ve çıkarımsal karmaşa ölçeği arasında yapılan korelasyon analizlerine göre sadece ergenlerin obsesif inançlardan mükemmeliyetçilik/kesinlik puanları ile annelerin abartılmış sorumluluk/tehlike puanları arasında istatistiksel olarak negatif yönde anlamlı korelasyon bulundu(r = -0.42, p = 0.039). Sonuç: Bu çalışma OKB tanılı ergenlerdeki obsesif inançlar ve çıkarımsal karmaşa ile ilgili hipotezlerini kısmen destekler. Klinik tedaviler ailelerdeki olası patolojik bilişsel faktörler göz önüne alınarak düzenlenmesi tedavi başarısını artırabilir.
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In March 2020, individuals shielding from coronavirus reported high rates of distress. This study investigated whether fear of contamination (FoC) and use of government-recommended behaviours (GRB; e.g., handwashing and wearing masks) were associated with psychological distress during February 2021. An online cross-sectional questionnaire assessed psychological distress in three groups (shielding self, shielding other/s, and control), and those shielding others also completed an adapted measure of health anxiety (α = 0.94). The sample (N = 723) was predominantly female (84%) with a mean age of 41.72 (SD = 15.15). Those shielding (self) demonstrated significantly higher rates of health anxiety and FoC in comparison to other groups (p < 0.001). The use of GRB was significantly lower in controls (p < 0.001), with no significant difference between the two shielding groups (p = 0.753). Rates of anxiety were higher when compared to March 2020 findings, except for controls. Hierarchical regressions indicated FoC and GRB accounted for 24% of variance in generalised anxiety (p < 0.001) and 28% in health anxiety, however, the latter was a non-significant predictor in final models. Those shielding themselves and others during the pandemic have experienced sustained levels of distress; special consideration must be given to those indirectly affected. Psychological interventions should account for realistic FoC and the impact of government-recommended health behaviours, as these factors are associated with distress in vulnerable groups and may extend beyond the pandemic. Future research should focus on longitudinal designs to monitor and better understand the clinical needs of those shielding, and those shielding others post-pandemic.