The Overvalued Ideas Scale: development, reliability and validity in obsessive-compulsive disorder

ArticleinBehaviour Research and Therapy 37(9):881-902 · September 1999with 1,267 Reads
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Abstract
The presence of overvalued ideas in obsessive–compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome [Kozak, M. J. & Foa, E. B. (1994). Obsessions, overvalued ideas and delusions in obsessive–compulsive disorder. Behaviour Research and Therapy, 32, 343–353]. To date, no measures have been developed which quantitatively assess levels of overvalued ideas in obsessive–compulsives. The present studies examined the psychometric properties of a scale developed to measure this form of psychopathology, the Overvalued Ideas Scale (OVIS). In study 1, 102 patients diagnosed with OCD were administered a battery of instruments including the OVIS at baseline and two weeks later, prior to initiating treatment. Results indicate that the OVIS has adequate internal consistency reliability (coefficient α=0.88 at baseline), test–retest reliability (r=0.86) and interrater reliability (r=0.88). Moderate to high levels of convergent validity was found with measures of obsessive–compulsive symptoms, a single item assessment of overvalued ideas and psychotic symptoms. Medium levels of discriminant validity with measures of anxiety and depression was obtained in this study. Individuals determined to have high OVI showed greater stability of this pathology than those with lower OVI, suggesting that overvalued ideas are stable for extreme scorers. In study 2 a total of 40 patients participated who were diagnosed with OCD. The same battery of instruments was administered as in study 1, as well as the Beck Depression Inventory and Beck Anxiety Inventories. Results were similar to that obtained in study 1, including a relative lack of discriminant validity with self-report measures of depression and anxiety. It is suggested that further research with the OVIS may show predictive value in treatment outcome studies of OCD.

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  • Chapter
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  • Chapter
    For individuals with obsessive-compulsive disorder (OCD), insight is generally characterized as the degree to which one recognizes the irrational and excessive nature of the OCD symptomology. It is also considered to be multifaceted, including components that consider the fixity, conviction, and stability of the beliefs, among other constructs, and these properties are reflected in the numerous assessment devices used to examine insight. Given the broader impact of family functioning on OCD phenomenology and treatment response, it is important to consider the familial contributors to insight. Reliable reports from the individual may be challenging to obtain, and attenuated motivation and resistance against symptoms will likely be observed, stunting progress in therapy. Given the impactful nature of insight, more nuanced and standardized investigations are pertinent to help clinicians and researchers better understand its mechanism of influence.
  • Chapter
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  • Article
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  • Article
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    Abstract Objective: Delusions are fixed wrong beliefs based on false inference and resistant to change. Most prominent feature of delusions is patients have no insight about their delusional belief. Psychiatry benefits from the scales that evaluate the presence of delusion, the strength of delusion and insight. Out of many scales The Brown Assessment of Beliefs Scale (BABS) is one of the most common scales that used in psychiatry. The aim of our study is to test reliability and validity of BABS’ Turkish version in Turkish population. Method: BABS is translated from English to Turkish by two clinicians and administered to 30 patients with obsessive compulsive disorder (OCD), and 29 patients with schizophrenia. In order to evaluate inter-rater reliability, BABS was administered by two different clinicians. In order to evaluate test- retest reliability, BABS was applied to 57 patients one week later. To examine BABS Turkish discriminant validity, we used Beck Cognitive Insight Scale, Schedule for Assesing the Three Components of Insight Scale and insight item of Yale-Brown Obsessive Compulsive Scale . In order to test construct validity, factor analysis was done. Results: Interrater reliability (Kappa =0.54-0.83) and test–retest reliability (r=0.80-0.96, p<0.001) for the total score and individual item scores was excellent with a high degree of internal consistency (Cronbach alfa=0.90). BABS has strong corelation with Beck Cognitive Insight Scale (r=-0.84, p<0.001), Schedule for Assesing the Three Components of Insight Scale (r=-0.85, p<0.001) and insight item of Yale-Brown Obsessive Compulsive Scale (r=0.67, p<0.001). Conclusion: The data attained from the study of reliability and validity of the scale shows that The Brown Assesment of Beliefs Scale supports reliability and validity in Turkish population.
  • Article
    Full-text available
    The present study evaluated the efficacy of adding a virtual reality (VR) component to the treatment of compulsive hoarding (CH), following inference-based therapy (IBT). Participants were randomly assigned to either an experimental or a control condition. Seven participants received the experimental and seven received the control condition. Five sessions of 1 h were administered weekly. A significant difference indicated that the level of clutter in the bedroom tended to diminish more in the experimental group as compared to the control group F(2,24) = 2.28, p = 0.10. In addition, the results demonstrated that both groups were immersed and present in the environment. The results on posttreatment measures of CH (Saving Inventory revised, Saving Cognition Inventory and Clutter Image Rating scale) demonstrate the efficacy of IBT in terms of symptom reduction. Overall, these results suggest that the creation of a virtual environment may be effective in the treatment of CH by helping the compulsive hoarders take action over their clutter.
  • Chapter
    This chapter describes the cognitive perspective of shared pathology of Obsessive Compulsive Disorder (OCD) and schizophrenia. It is an assumption that cognition is a neuropsychological faculty altered by the presence of OCD and schizophrenia (SCZ). The chapter explains that there are several functional similarities between OCD and SCZ. However, the differences between the conditions are particularly in the area of cognitive functioning. On the one hand, there are several cognitive processing tasks where both groups perform comparably. However, the intactness of cognitive functioning overall is clearly superior among patients with OCD. Regarding treatment, there are occasions when OCD and SCZ or SCZ-type symptoms co-occur. Under these circumstances, it appears that treatment must be focused more upon social functioning and methods of controlling schizophrenia spectrum symptoms before attention may be paid to OCD symptoms.
  • Article
    Full-text available
    The relationship between insight and the level of expressed emotion in patients with obsessive – compulsive disorder AYSE OZKIRIS , ALTAN ESSIZOGLU , GULCAN GULEC , GOKAY AKSARAY Ozkiris A, Essizoglu A, Gulec G, Aksaray G. The relationship between insight and the level of expressed emotion in patients with obsessive – compulsive disorder. Nord J Psychiatry 2014;68: 1 – 6. Aim: The aim of this study is fi rstly to compare the obsessive – compulsive disorder (OCD) patients with good insight and OCD patients with poor insight in terms of socio-demographic and clinical features; to investigate the relation between insight and the level of the expressed emotion (EE) in the patients; and lastly to specify the factors that predict level of insight. Methods: OCD patients with good insight and patients with poor insight were compared in terms of clinical features and the perceived EE level of the patients and the individuals that they live with in order to specify the factors that predict the insight level, and to investigate the relationship between insight level and EE. Results: It was found that the total Expressed Emotion Scale, total Level of Expressed Emotion (LEE), LEE-Emotional Response and LEE-Tolerance/Expectation subscale scores of the group comprised of patients with poor insight are higher than the other group. The results also show that the duration of illness and Yale – Brown Obsessive Compulsive Scale (Y-BOCS) total score predict insight level. Conclusions: This study shows that the level of EE perceived by the patients with poor insight and the person that he/she lives with, is higher than the group with good insight. The studies that investigate the relationship between the factors of insight level and EE level, which are indicated to determine the level of the illness severity and its chronicity, will enable the researchers to understand the importance of the role of the family on the treatment processes of OCD.
  • Article
    IntroductionDetecting OCDClinical assessment of obsessive-compulsive symptomsInsightAssessment of the risk of suicideDifferential diagnosis, comorbidities and related disordersConclusions References
  • Article
    Full-text available
    Overvalued ideation is a complicating factor in some cases of obsessive–compulsive disorder (OCD). Definitions of overvalued ideas are provided, distinguishing it from obsessions on the one hand to delusions on the other. Clinician-administered rating scales for evaluating overvalued ideas are discussed, and methods for addressing this aspect of OCD in treatment are covered.
  • Article
    Obsessive-compulsive disorder (OCD) with poor insight has severe consequences for patients; nonetheless, no randomized controlled trial has ever been performed to evaluate the effectiveness of any treatment specifically for poor-insight OCD. A new psychotherapy for OCD, the inference-based approach (IBA), targets insight in OCD by strengthening normal sensory-driven reality testing. The goal of the present study is to compare the effectiveness of this new treatment to the effectiveness of cognitive behavior therapy (CBT) for patients with OCD with poor insight. A randomized controlled trial was conducted, in which 90 patients with OCD with poor insight received either 24 CBT sessions or 24 IBA sessions. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS). Secondary outcome measures were level of insight, anxiety and depressive symptoms, and quality of life. Mixed-effects models were used to determine the treatment effect. In both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than the patients treated with CBT [estimated marginal mean = -7.77, t(219.45) = -2.4, p = 0.017]. Patients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight. © 2015 S. Karger AG, Basel.
  • Article
    Objectives The purpose of this study was to examine the potential relationship between OCD symptoms and the constructs of depression, anxiety, self-esteem, and commitment to exercise in community-based exercisers.Design and methodA mixed-methods approach was utilized. A sample of 64 female and 21 male participants (M age = 52.1 years) completed a series of online or written questionnaires related to the noted variables, while a subset of 10 participants participated in a qualitative interview to explain their OCD symptoms and exercise behavior.ResultsPearson correlations indicated all psychological constructs were significantly correlated with each other (absolute r's ranged from .27 to .78, all p's < .001), while a canonical correlation analysis revealed one significant function (Wilk's λ = .360, Rc = .80, p < .001). Set 1 (OCD symptoms) explained 36% of the variance in Set 2 (anxiety, depression, self-esteem and commitment to exercise), while Set 2 explained 64% of the variance in Set 1. Four primary themes were established from the qualitative data, including: 1) being involved in sport or physical activity from a young age, 2) high benefits versus low consequences of regular participation in exercise, 3) involvement in detail-oriented jobs, and 4) easy adjustments to unplanned deviations from an exercise schedule.Conclusions Overall, this research suggests that community-based exercisers with elevated OCD symptoms simply display a healthy attention to the frequency and detail of their physical activity, which facilitates them staying active across a variety of conditions.
  • Article
    The prevailing view is that individuals with obsessive-compulsive disorder (OCD) are able to think rationally about their obsessive concerns and are thus able to recognize them as senseless. However, clinical observations indicate that at least some obsessive-compulsives do not regard their symptoms as unreasonable or excessive, and their ideas have been characterized as overvalued or delusional. In the present paper the concepts of obsessions, overvalued ideas, and delusions are discussed and compared, and the available studies of insight among obsessive-compulsives are reviewed. It is concluded that obsessive-compulsive ideas can not satisfactorily be dichotomized according to patients' insight, and that the notion of a continuum of strength of obsessive-compulsive beliefs is more appropriate. The relationship between degree of obsessive-compulsive conviction and outcome of therapy remains unclear. Methodological issues that complicate our understanding of OCD are considered, and theories of delusions are examined in relation to their development in OCD.
  • La folie du doute delire du toucher Obsessive compulsive beliefs and treatment outcome Dysmorphic avoidance with disturbed bodily perception. A pilot study of exposure therapy Two year follow-up of behavioral treatment and maintenance for Body Dysmorphic Disorder
    • Paris
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    Behaviour Research and Therapy, 32, 343–353. LeGrand Du Salle, H. (1875). La folie du doute delire du toucher. Paris, France: Delahaye. Lelliott, P. T., Noshirvani, H. F., Basoglu, M., Marks, I. M., & Monteiro, W. O. (1988). Obsessive compulsive beliefs and treatment outcome. Psychological Medicine, 18, 697–702. Marks, I., & Mishan, J. (1988). Dysmorphic avoidance with disturbed bodily perception. A pilot study of exposure therapy. British Journal of Psychiatry, 152, 674–678. McKay, D. (1999). Two year follow-up of behavioral treatment and maintenance for Body Dysmorphic Disorder
  • Obsessive±compulsive disorder with psychotic features: a phenomenological analysis Beliefs and resistance in obsessive±compulsive disorder: obser-vations from a controlled trial
    • T R Insel
    • H S Akiskal
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    • L M Araujo
    • L A Hemsley
    • D R Marks
    Insel, T. R., & Akiskal, H. S. (1986). Obsessive±compulsive disorder with psychotic features: a phenomenological analysis. American Journal of Psychiatry, 143, 1527±1533. Ito, L. M., de Araujo, L. A., Hemsley, D. R., & Marks, I. M. (1995). Beliefs and resistance in obsessive±compulsive disorder: obser-vations from a controlled trial. Journal of Anxiety Disorders, 9, 269±281. Jaspers, K. (1913). Psicopathologia general (Allgemeine psychopatologie) (R. O. Saubidet, Trans.). Bueno Aires, Argentina: Beta Publishers.
  • Manual for the structured clinical interview for DSM-III-R with psychotic screen The Yale±Brown Obsessive±Compulsive Scale: interview versus self-report
    • R L Spitzer
    • J B W Williams
    • M Gibbon
    • M First
    • G Steketee
    • R Frost
    • K Bogart
    Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. (1991). Manual for the structured clinical interview for DSM-III-R with psychotic screen. Washington, DC: American Psychiatric Press. Steketee, G., Frost, R., & Bogart, K. (1996). The Yale±Brown Obsessive±Compulsive Scale: interview versus self-report. Behaviour Research and Therapy, 34, 675±684.
  • Article
    Twenty-two patients with Obsessive Compulsive Disorder (OCD) and 13 with Schizophrenia (SCZ) were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Self-Rated Symptom Scale (SRSS), and the Hoffer-Osmond Diagnostic Test (HOD). Unlike other studies which have looked at these two co-morbid conditions, this study investigated similarities in affect, thought and perceptual processes in two separate clinical groups. Results indicate that impairment of thought processes and perceptual deficits observed between the groups were statistically equivalent and clinically significant. The schizophrenia group obtained a total score above ten on the Y-BOCS and 60 on the SRSS, both higher than that expected for a group which is not generally associated with OCD. Both groups have a similar number of hospitalizations and a high celibacy rate. The findings are discussed in terms of OCD manifesting itself in many forms and the possibility of a new nosology.
  • Article
    Objective: Three issues relevant to revising the DSM-III-R criteria for obsessive-compulsive disorder were examined in a field trial: 1) the requirement that symptoms of obsessive-compulsive disorder be viewed by the patient as excessive or unreasonable, 2) the presence of mental compulsions in addition to behavioral compulsions, and 3) ICD-10 subcategories. Method: The authors studied symptom patterns of obsessive-compulsive disorder as well as strength of obsessive belief among 431 patients with obsessive-compulsive disorder at seven hospital outpatient clinics. Two methods of subject selection were used: consecutive entry of everyone who contacted the clinics for evaluation of obsessive-compulsive disorder and entry of patients with obsessive-compulsive disorder who had continuing contact with the clinics since before the field trial and who were still symptomatic. Primary measures were the Yale-Brown Obsessive Compulsive Scale and face-valid questions about fixity of obsessive-compulsive beliefs. Results: The large majority of patients were uncertain about whether their obsessive-compulsive symptoms were unreasonable or excessive, and most had both mental and behavioral compulsions. Results on the ICD-10 subcategories were equivocal. Conclu- sions: The present results converge with previous findings to indicate a broad range of insight among patients with obsessive-compulsive disorder. The DSM-III-R requirement for insight should be de-emphasized in DSM-IV, and mental rituals should be included in the definition of compulsions.
  • Article
    Behavioral treatment of body dysmorphic disorder (BDD) is vastly neglected in the behavioral literature. The primary target symptom associated with BDD is a preoccupation with a perceived physical defect that is not noticeable to others but that the individual attempts to correct by the use of cosmetic/dermatological products, plastic surgery, or mirror checking. Five BDD patients who received exposure, response prevention, and cognitive therapy were described. These 5 patients all refused pharmacotherapy and underwent either intensive (n=3) or weekly (n=2) behavior therapy. Patients in intensive therapy received 90-minute sessions 5 days per week whereas patients in weekly treatment received one 90-minute session per week. Four out of 5 patients improved on the Overvalued Ideation Scale (OVI) and on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) modified for BDD. Based on these case histories, behavior and cognitive therapy may be a suitable treatment approach for BDD.
  • Article
    The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is one of the most widely used measures of obsessive–compulsive disorder (OCD) symptoms (W. K. Goodman et al., 1989). The purpose of this study was to examine the dimensions underlying the Y-BOCS by performing a confirmatory factor analysis of the scale using responses from a large sample of patients. The results support a 2-factor model of OCD symptoms. The first factor reflected the degree of disturbance caused by OCD symptoms, and the second factor reflected the severity of OCD symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Provides simple but accurate methods for comparing correlation coefficients between a dependent variable and a set of independent variables. The methods are simple extensions of O. J. Dunn and V. A. Clark's (1969) work using the Fisher z transformation and include a test and confidence interval for comparing 2 correlated correlations, a test for heterogeneity, and a test and confidence interval for a contrast among k (>2) correlated correlations. Also briefly discussed is why the traditional Hotelling's t test for comparing correlations is generally not appropriate in practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    In recent investigations, body dysmorphic disorder (BDD) has been shown to share common etiological and symptom presentation to obsessive-compulsive disorder (OCD). When treating BDD, there have been some investigations suggesting that exposure with response prevention is effective in alleviating symptoms. Ten patients diagnosed with BDD participated in a study examining the effects of treatment and maintenance using exposure with response prevention. They received a standard behavior therapy protocol which consisted of exposure in vivo and in imagery, with response prevention. Symptom severity, depression, anxiety, and avoidance were assessed weekly during treatment. Following treatment, a 6-month maintenance program was instituted for five patients, with the other five serving as controls. Patients in the maintenance program were assessed bi-weekly with all measures and a 6-month follow-up was conducted. Patients improved for measures of avoidance, BDD symptoms, depression and anxiety when using exposure with response prevention. Although all patients remained symptom free at follow-up, those in the maintenance program continued to improve. Based on these results, BDD appears to be amenable to exposure with response prevention treatment. Additional treatment gains can be obtained when structured maintenance programs are implemented.
  • Article
    Forty-nine obsessive-compulsive ritualizers had clomipramine and live exposure therapy in a randomized controlled design. 29 pretreatment demographic, clinical, and psychophysiologic variables were examined as predictors of outcome using multiple regression analysis. Severity of rituals, social disability, male sex, checking rituals, bizarre and fixed obsessions, and severe and uncontrollable obsessions predicted poorer outcome. Patients who had been initially more severely ill habituated less to ritual-evoking stimuli in the laboratory and showed less improvement at all assessment points. Plasma desmethylclomipramine predicted improvement only during the active phase of treatment.
  • Article
    Full-text available
    Thirteen cases of Body Dysmorphic Disorder (BDD) were described. There were eight males (61.5%) and five females (38.5%) with ages ranging from 16 to 37 (mean=24.7). All patients were also diagnosed as obsessive compulsive disorder (OCD), according to DSM-III-R, with the exception of one. Patients were administered the Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory, Wechsler Intelligence Scale, Over-valued Ideation Scale and MMPI. The Phenomenology of BDD, its relationship to OCD, and the patients' responses to the above tests were reported. Due to the bizarreness of the symptoms and the secretiveness of the patients, it was suggested that clinicians be thoroughly aware of the disorder and inquire as to its presence during the initial consultation. Otherwise, these patients go unnoticed and they resort to treatment from dermatologists and plastic surgeons.
  • A 24-year old man with a seven-year history of continuous compulsive rituals associated with a delusional belief and auditory and visual hallucinations had failed to improve with non-behavioural treatments. Sixteen weeks of exposure in vivo and self-imposed response prevention not only considerably improved rituals but also resolved the delusional belief and dramatically reduced frequency of hallucinations. After a further 14 weeks of behaviour therapy combined with clomipramine and ECT the patient was free of rituals and hallucinations and remained so to two-year follow-up.
  • Article
    The Hamilton Rating Scale for Depression (HRSD) has emerged as a standard in the study of depression. However, despite its extensive use and the assumption that it is a single measure, integration of data produced in studies utilising the HRSD is difficult for several reasons. After a review of 688 relevant articles, tt was determined that approximately 42% contained referencing errors resulting in confusion over which administration procedures were actually implemented. Since its introduction, several alternate versions of the scale have emerged and alternate scoring methods, ad hoc revisions, or derivative versions of the scale have been applied. These and related problems with the HRSD are detailed along with suggestions for reducing the ambiguities that result from its continued use in depression research.
  • Article
    Full-text available
    The psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have recently been heavily examined. Specifically, a number of researchers have been interested in determining the factor structure of this scale to find whether it best forms a one, two, or three factor model. The present study continued this examination by considering different scaling models using confirmatory factor analysis with a sample of individuals diagnosed with Obsessive-Compulsive Disorder (OCD). One hundred and forty-six individuals diagnosed with OCD participated and were administered the Y-BOCS and scales measuring depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). It was found that the Y-BOCS forms two different two-factor models. One model consisted of an obsessions and compulsions factor; the other composed of disturbance and symptom severity factors. It was likewise found that depression and anxiety were related to both factors in one model (disturbance and symptom severity). The finding that depression was related to obsessions and anxiety to compulsions was found, as in a previous factor analysis of the Y-BOCS. These findings suggest that OCD may be best characterized as a multidimensional syndrome that may not be adequately examined by a single unitary factor as described in the Y-BOCS.
  • Article
    The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS: Goodman, Price, Rasmussen, Mazure, Fleischman, Hill, Heninger & Charney, 1989a, b, Archives of General Psychiatry, 46, 1006–1016), a widely used measure of obsessions and compulsions, is typically used by summing the items to yield a global measure of symptom severity. However obsessive-compulsive disorder (OCD) is characterized by two distinct groups of symptoms (i.e. obsessions and compulsions), and so it was hypothesized that OCD, as assessed by the Y-BOCS, may be two dimensional. In other words, the items assessing obsessions may be factorially distinct from the items assessing compulsions. A confirmatory factor analysis (CFA) was conducted using responses from 83 OCD patients to determine whether OCD as assessed with the Y-BOCS is unidimensional or forms two distinct dimensions. Results supported a two-factor solution, and suggest that items assessing obsessions should be scored as one subscale, and items assessing compulsions scored as a separate subscale. Depression, as assessed by the Beck Depression Inventory, (Beck, Ward, Mendelsohn, Mock & Erbaugh, 1961, Archives of General Psychiatry, 4, 561–571), was correlated with both subscales. Trait anxiety, as assessed by the State-Trait Anxiety Inventory (Speilberger, 1983, Manual for the State-Trait Anxiety Inventory (Form Y). Palo-Alto, CA: Consulting Psychologists Press), was correlated with the obsessions subscale but not with the compulsions subscale.
  • Article
    Advances in the treatment of obsessive-compulsive disorder (OCD) require reliable and valid measures of sufficient sensitivity to detect treatment effects. The present article critically reviews the instruments used in OCD treatment-outcome research. Behavioral methods, self-report inventories, and observer-rated scales are reviewed with respect to content, reliability, validity, and sensitivity to treatment effects. The latter was determined by meta-analyses of trials of behavior therapy (exposure plus response prevention) and clomipramine. Little is known about the psychometric properties of behavioral assessment methods, and they are used increasingly less often in outcome research, despite certain advantages. Self-report inventories tend to have acceptable reliability and validity, except for the SCL-90-R OC scale (and its predecessors) which has weak discriminant validity and appears to be essentially a measure of nonspecific distress. Little is known about the reliability and vatiduy of most observer-rated scales, despite the fact that they are popular in treatment outcome research. All measures appear sensitive to treatment effects, although observer-rated scales tend to yield larger effect sizes than self-report measures. For treatment outcome research, the Yale-Brown Obsessive Compulsive Scale (YBOCS) appears to be the best available instrument in terms of range of obsessive-compulsive features assessed, reliability, validity, and sensitivity to treatment effects. Computer-administered and self-report versions of the YBOCS have been developed, which appear promising but require further evaluation. The effects of treatment may be best understood by using measures of specific symptoms rather than relying on global measures of symptom severity. The YBOCS can be readily used for these purposes. The article concludes by considering additional requirements for a comprehensive assessment of obsessions and compulsions.
  • The BAI (Beck, Epstein, Brown & Steer, 1988) is a 21-item self-report instrument designed to assess physiological and cognitive aspects of anxiety. Internal reliability of this scale is good (a = 0.92), test±retest reliability is adequate
    • Beck
    • Bai
    Beck anxiety inventory (BAI). The BAI (Beck, Epstein, Brown & Steer, 1988) is a 21-item self-report instrument designed to assess physiological and cognitive aspects of anxiety. Internal reliability of this scale is good (a = 0.92), test±retest reliability is adequate (a = 0.75).
  • Article
    Obsessive-compulsive (OC) beliefs, resistance to the obsession and controllability of urges to ritualise, were examined in OC outpatients at baseline and subsequently in a controlled trial. Patients were randomised to nine weekly sessions of either (a) live plus imaginal exposure plus response prevention (Exi, n = 23) or (b) live exposure alone plus response prevention (Ex, n = 23). Patients were asked to carry out 90 min of daily self-exposure homework corresponding to Exi or Ex. At posttreatment, Exi patients changed less than Ex patients on resistance to obsessions (YBOCS) and on strength and fixity of beliefs. During follow-up, these measures remained more stable in Exi than in Ex and were more reduced than avoidance, though overall percentage of improvement on most measures since week 0 was similar in both treatment conditions. Change in beliefs did not relate to clinical outcome. OC patients may present typical OCD features despite having neither insight into OC beliefs nor resistance to accompanying rituals.
  • Article
    The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
  • Article
    Two groups of obsessive-compulsives who failed to respond to treatment, although they complied with its demands, are examined. Patients of the first group held a strong conviction that their fears were realisitic; the second group was composed of patients who manifested severe depression. In the first group, patients habituated within sessions but not between sessions. Neither form of habituation was shown in the second group. By contrast typical obsessive-compulsive patients who benefited from behavioral treatment showed both forms of habituation. It is proposed that different processes underlie the two forms of habituation. one autonomic and the other cognitive, involving different areas of the brain. The occurrence of within-session habituation is seen as a necessary, but not a sufficient condition for between-session habituation. Implications for treatment are briefly discussed.
  • Article
    In 26 depressed patients, a high correlation (0-89) was found between the Hamilton score and a psychiatrist's global rating and between the change (0-68) in these ratings during treatment. The Hamilton scale was able to differentiate at the o-01 level four degrees of severity based on the global rating. Limiting the range of severity measured was found to lower significantly the correlation between the ratings. A prospective examination of a six-item sub-scale of the Hamilton scale developed by Beck and associates failed to confirm its claimed improvement in sensitivity or validity.
  • Article
    A step-by-step analysis of Beck's and Hamilton's rating scales showed that both scales failed to differentiate adequately between moderate and severe depression measured by a global clinical assessment. Each item of the scales was tested for calibration, ascending monotonicity, and dispersion parallel to the clinical assessment. Twelve items of Beck's scale and six items of Hamilton's scale were found valid with respect to these criteria. Those items should be taken into account in future research for baseline ratings and for change ratings of depressive states quantitatively.
  • Article
    A case is described of intense aversion to personal body hair on the chest, legs and arms. Exposure methods of behavioural treatment were used, combined with interpretative ones. Exposure was found to facilitate self-exploration, which in turn led to the successful completion of exposure treatment. The circumstances under which exposure treatment can benefit from being combined with interpretative work are discussed.
  • Article
    The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
  • Article
    Full-text available
    Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as a rational and felt that their rituals warded off some unwanted or feared event (the content of their obsessions). The more bizarre the obsessive belief the more strongly it was defended and 12% of cases made no attempt to resist the urge to ritualize. Neither fixity of belief nor resistance to compulsive urges were related to duration of illness. Patients with bizarre and fixed obsessive beliefs responded as well to treatment (all but three received exposure), as did patients whose obsessions were less bizarre and recognized as senseless. There was no difference in outcome between patients who initially found it hard to control their obsessions or never resisted the urge to ritualize and those who initially could control obsessions or resist rituals. One year after starting treatment, patients whose obsessions and compulsions had improved with treatment recognized their irrationality more readily and controlled their compulsive urges more easily. Beliefs appeared to normalize as a function of habituation.
  • Article
    The authors review the literature on obsessive-compulsive disorder and present clinical vignettes to illustrate that delusions can arise in the course of this illness. These delusions do not signify a schizophrenic diagnosis but represent reactive affective or paranoid psychoses, which are generally transient. Using a phenomenologic analysis of 23 patients, the authors further argue that obsessive-compulsive disorder represents a psychopathological spectrum varying along a continuum of insight. Patients at the severe end of this spectrum are best described as having an "obsessive-compulsive psychosis." The authors discuss the implications of these considerations for DSM-III revisions.
  • Article
    The Hamilton Rating Scale for Depression has become a popular instrument for quantifying clinical assessments of the severity of depression in psychiatric research, and data on its psychometric properties continue to accumulate. Data are presented on item interrater reliability, internal consistency, concurrent validity, and ability to differentiate depressed from non-depressed groups. Recommendation for a reduced scale and for anchoring point guidelines are made.
  • Article
    The author describes a 21-year-old woman with persistent disabling dysmorphophobia (atypical somatoform disorder) that failed to respond to neuroleptics and heterocyclic antidepressants but resolved completely with the monamine oxidase inhibitor tranylcypromine.
  • Article
    The reliability and validity of the Yale-Brown Obsessive-Compulsive Scale were examined according to a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). Internal consistency was acceptable but was improved by deletion of items concerning resistance to obsessions and compulsions. Inter-rater reliability was excellent, but test-retest reliability over an average interval of 48.5 days was lower than desirable. The YBOCS demonstrated good convergent validity with most other measures of OCD, but divergent validity vis à vis depression was poor. Analyses of new items assessing avoidance and the duration of obsession-free and compulsion-free intervals indicated that only the avoidance rating added meaningfully to the full scale score. In future research the authors recommend deletion of the resistance items and inclusion of the avoidance item to yield a revised 9-item YBOCS total score.
  • Article
    Three issues relevant to revising the DSM-III-R criteria for obsessive-compulsive disorder were examined in a field trial: 1) the requirement that symptoms of obsessive-compulsive disorder be viewed by the patient as excessive or unreasonable, 2) the presence of mental compulsions in addition to behavioral compulsions, and 3) ICD-10 subcategories. The authors studied symptom patterns of obsessive-compulsive disorder as well as strength of obsessive belief among 431 patients with obsessive-compulsive disorder at seven hospital outpatient clinics. Two methods of subject selection were used: consecutive entry of everyone who contacted the clinics for evaluation of obsessive-compulsive disorder and entry of patients with obsessive-compulsive disorder who had continuing contact with the clinics since before the field trial and who were still symptomatic. Primary measures were the Yale-Brown Obsessive Compulsive Scale and face-valid questions about fixity of obsessive-compulsive beliefs. The large majority of patients were uncertain about whether their obsessive-compulsive symptoms were unreasonable or excessive, and most had both mental and behavioral compulsions. Results on the ICD-10 subcategories were equivocal. The present results converge with previous findings to indicate a broad range of insight among patients with obsessive-compulsive disorder. The DSM-III-R requirement for insight should be de-emphasized in DSM-IV, and mental rituals should be included in the definition of compulsions.
  • Article
    Full-text available
    Research evaluating the reliability of the Structured Clinical Interview for DSM-III-R (SCID) is reviewed. Reliability procedures and studies are examined. Several versions of the SCID are covered, including the SCID-I (axis I disorders), SCID-II (axis II disorders), SCID-Positive and Negative Syndrome Scale (SCID-PANSS; functional-dimensional assessment for psychotic disorders), and SCID-Upjohn Version (panic disorder). The SCID has been found to yield highly reliable diagnoses for most axis I and axis II disorders. Suggestions for future research on the SCID are offered, particularly with respect to (1) the lack of studies in which SCID diagnoses are compared with diagnoses from unstructured interviews or other structured-interview formats, and (2) the need for a more natural evaluation of this instrument. Also, the importance of establishing norms and obtaining reliability data for underserved clinical populations is discussed.
  • Article
    The purpose of this study was to systematically identify and characterize the demographic and clinical features of patients with obsessive compulsive disorder (OCD) and psychotic symptoms. From a total of 475 patients with DSM-III-R OCD evaluated and/or treated in an outpatient OCD clinic, 67 patients (14%) were identified as having psychotic symptoms in addition to OCD. Psychotic symptoms were defined as hallucinations, delusions, and/or thought disorder. Clinical and demographic data on these probands were collected from semistructured interviews and compared with data collected on the nonpsychotic OCD probands. We identified 27 (6%) of 475 probands with DSM-III-R OCD whose only psychotic symptom was lack of insight and high conviction about the reasonableness of the obsessions ("OCD without insight"). The remainder of the patients with psychotic symptoms and OCD met criteria for distinct DSM-III-R psychotic disorders as well as OCD: 18 probands (4%) had OCD and schizophrenia, 8 probands (2%) had OCD and delusional disorder. Fourteen patients (3%) met criteria for both OCD and schizotypal personality disorder. Compared with the OCD patients without psychosis, probands with OCD and psychotic features were more likely to be male, be single, have a deteriorative course, and have had their first professional contact at a younger age. The data suggest that these differences were largely due to those patients with OCD and schizophrenia-spectrum disorders and not those probands whose only psychotic symptom was complete conviction and lack of insight about their obsessions. There appears to be considerable heterogeneity in the clinical features of OCD patients who also have psychotic symptoms. The implications of these findings for understanding delusional states and for diagnostic classification are discussed.
  • Article
    Body dysmorphic disorder, preoccupation with an imagined defect in appearance, is included in DSM-III-R but has received little empirical study. The authors investigated the demographics, phenomenology, course, associated psychopathology, family history, and response to treatment in a series of 30 patients with the disorder. The patients (including 12 whose preoccupation was of probable delusional intensity) were assessed with a semistructured interview and the Structural Clinical Interview for DSM-III-R, and their family histories were obtained. The 17 men and 13 women reported a lifetime average of four bodily preoccupations, most commonly "defects" of the hair, nose, and skin. The average age at onset of body dysmorphic disorder was 15 years, and the average duration was 18 years. Seventy-three percent of the patients reported associated ideas or delusions of reference; 73%, excessive mirror checking; and 63%, attempts to camouflage their "deformities." As a result of their symptoms, 97% avoided usual social and occupational activities, 30% had been housebound, and 17% had made suicide attempts. Ninety-three percent of the patients had an associated lifetime diagnosis of a major mood disorder; 33%, a psychotic disorder; and 73%, an anxiety disorder. The patients generally responded poorly to surgical, dermatologic, and dental treatments and to adequate trials of most psychotropic medications, with the exception of fluoxetine and clomipramine (to which more than half had a complete or partial response). This often secret, chronic disorder can cause considerable distress and impairment, may be related to obsessive-compulsive disorder or mood disorder, and may respond to serotonin reuptake-blocking antidepressants.
  • Article
    Several studies have demonstrated the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (YBOCS) conducted by trained interviewers. The present study examined several aspects of a self-report YBOCS version relative to the usual interview format in two non-clinical samples (ns = 46 and 70) and in a clinical OCD sample (n = 36) and a clinical non-OCD group (n = 10). The self-rated instrument showed excellent internal consistency and test-retest reliability, performing somewhat better than the interview. There was good agreement between symptom checklist categories across the two versions, though clinical subjects reported more symptoms on the self-report form than on the interview. Some order effects were evident for non-clinical subjects only: those who received the self-report first scored lower on both self-report and interview than those who received the interview first. No order effects were observed in the clinical sample. The self-report version showed strong convergent validity with the interview, and discriminated well between OCD and non-OCD patients. Although more study is needed, particularly on clinical samples, these findings suggest that the self-report YBOCS may be a time-saving and less costly substitute for the interview format in assessing OCD symptoms.
  • Article
    A cognitive behavioural model of body image is presented with specific reference to body dysmorphic disorder (BDD). We make specific hypotheses from the model for testing BDD patients in comparison with: (i) patients with "real" disfigurements who seek cosmetic surgery; (ii) subjects with "real" disfigurements who are emotionally well adjusted; and (iii) healthy controls without any defect. There have been no randomised controlled trials of treatment for BDD and therefore the model has clear implications for the development of cognitive behavioural therapy. This was evaluated in a pilot controlled trial. Nineteen patients were randomly allocated to either cognitive behaviour therapy or a waiting list control group over 12 weeks. There were no significant pre-post differences on any of the measures in the waiting list group. There were significant changes in the treated group on specific measures of BDD and depressed mood. Cognitive behaviour therapy should be further evaluated in a larger controlled trial in comparison with another psychological treatment such as interpersonal therapy and pharmacotherapy.
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    The authors developed the Yale Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS), a 12-item semistructured clinician-rated instrument designed to rate severity of body dysmorphic disorder (BDD). The scale was administered to 125 subjects with BDD, and interviews with 15 subjects were rated by 3 other raters. Test-retest reliability was assessed in 30 subjects. Other scales were administered to assess convergent and discriminant validity, and sensitivity to change was evaluated in a study of fluvoxamine. Each item was frequently endorsed across a range of severity. Good interrater reliability, test-retest reliability, and internal consistency were obtained. BDD-YBOCS scores correlated with global severity scores but not with a measure of general psychopathology; they were modestly positively correlated with depression severity scores. Three factors accounted for 59.6 percent of the variance. The scale was sensitive to change in BDD severity. The BDD-YBOCS appears to be a reliable and valid measure of BDD severity and is a suitable outcome measure in treatment studies of BDD.
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    The authors developed and evaluated the reliability and validity of the Brown Assessment of Beliefs Scale, a clinician-administered seven-item scale designed to assess delusions across a wide range of psychiatric disorders. The authors developed the scale after reviewing the literature on the assessment of delusions. Four raters administered the scale to 20 patients with obsessive-compulsive disorder (OCD), 20 patients with body dysmorphic disorder, and 10 patients with mood disorder with psychotic features. Audiotaped interviews of scale administration conducted by one rater were independently scored by the other raters to evaluate interrater reliability. The scale was administered to 27 patients twice to determine test-retest reliability. Other insight instruments as well as scales that assess symptom severity were administered to assess convergent and discriminant validity. Sensitivity to change was assessed in a multicenter treatment study of sertraline for OCD. Interrater and test-retest reliability for the total score and individual item scores was excellent, with a high degree of internal consistency. One factor was obtained that accounted for 56% of the variance. Scores on the Brown Assessment of Beliefs Scale were not correlated with symptom severity but were correlated with other measures of insight. The scale was sensitive to change in insight in OCD but was not identical to improvement in severity. The Brown Assessment of Beliefs Scale is a reliable and valid instrument for assessing delusionality in a number of psychiatric disorders. This scale may help clarify whether delusional and nondelusional variants of disorders constitute the same disorder as well as whether delusionality affects treatment outcome and prognosis.
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    The treatment of Body Dysmorphic Disorder (BDD) has received little empirical attention despite evidence that BDD is a debilitating mental health problem. This open case series provides data on a new cognitive-behavioral treatment for BDD. Participants diagnosed with BDD were treated in small groups that met for 12 weekly 90-minute sessions. Patients improved significantly over the course of treatment, with reductions in both BDD and depression symptoms. This finding adds to a nascent literature documenting the potential efficacy of short-term cognitive-behavior therapy for patients suffering from BDD.