No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The Overvalued Ideas Scale: development, reliability and validity in obsessive-compulsive disorder
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.
... In line with the dimensional definition of insight proposed in the DSM-5, it has also been argued that insight in OCRDs exists on a continuum ranging from ego-dystonic obsessions to overvalued ideas, to delusions (Foa et al., 1995;Kozak & Foa, 1994;Neziroglu et al., 1999). Overvalued ideation (OVI) refers to "an unreasonable and sustained belief that is maintained with less than delusional intensity" (DSM-5;American Psychiatric Association, 2013). ...
... Research indicates that 15%-36% of patients with OCD have reduced insight, depending on the definitions of insight and the assessment tools used to measure it (Alonso et al., 2008;Catapano et al., 2010;De Berardis et al., 2005;Eisen & Rasmussen, 1993;Eisen et al., 2001;Foa et al., 1995;Hood et al., 2019;Insel & Akiskal, 1986;Marazziti et al., 2002;Matsunaga et al., 2002;Türksoy et al., 2002). Common measures of insight employed in the context of OCRDs include the Overvalued Ideas Scale (OVIS; Neziroglu et al., 1999), the Brown Assessment of Beliefs Scale (BABS; Eisen et al., 1998), and Item 11 of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Türksoy et al., 2002). Although the Beck Cognitive Insight Scale (BCIS; was developed in the context of schizophrenia, it has also been used in OCD populations. ...
... The COGINS. Based on the literature on cognitive insight and OVI in OCRDs (for instance, Neziroglu et al., 1999), as well as similar conceptualizations of cognitive insight according to the inference-based approach, a list of potential questionnaire items measuring cognitive insight was generated. The items were formulated independently by two OCD experts (Kieron O'Connor and Frederick Aardema), who then discussed the best ones to be kept, which resulted in an initial item set of 22 items representing different aspects of cognitive insight in OCRDs. ...
Research suggests that individuals with obsessive-compulsive and related disorders (OCRDs) with lower insight show a poorer response to cognitive behavioral therapy and might benefit from alternative treatments. However, there are inconsistencies in the literature regarding the definition and measurement of insight. This study endeavored to evaluate the psychometric properties of the Cognitive Obsessional Insight Scale (COGINS), a novel self-report measure of cognitive insight in OCRDs. The sample comprised 166 participants with a diagnosis of obsessive-compulsive disorder or body dysmorphic disorder enrolled in clinical trials. Participants completed the COGINS and a questionnaire battery at baseline and post-treatment. The COGINS demonstrated good internal consistency, test–rest reliability, convergent validity with other OCRD-specific measures of insight, positive associations with OCRD symptomatology, and had a moderating effect on treatment response. The COGINS is a valid and reliable practical tool to measure cognitive insight in OCRDs and might help toward clarifying the role of cognitive insight in this population.
... The ability to demonstrate knowledge of: 1. Phenomenology of overvalued ideas, define and recognize overvalued ideation (poor or absent insight) Evidence: MA: Neziroglu, 2008 • CSS: Eisen et al., 2004;Phillips et al., 2012• ThP: Yaryura-Tobias, 2004Veale, 2002• TrPN : McKay et al., 2015 2. The theoretical background of the development of overvalued ideas Evidence: MA: McKenna, 1984 • RCS: Neziroglu et al., 2001 • ThP: Jaspers, 1913;Yaryura-Tobias, 2004;Veale, 2002 • TrPN : Kozak and 3. The different types of OCD symptom correlates of overvalued ideation Evidence: CSS: Eisen et al., 2004;Phillips et al., 2012• ThP: Yaryura-Tobias, 2004• TrPN : Kozak and Foa, 1994 4. Overvalued ideation assessment methods Evidence: RCT : Goodman et al., 1989a,b • RCS: Neziroglu et al., 1999a • PS: Eisen et al., 1998 • CR: Neziroglu and Khemlani-Patel, 2003 5. Overvalued ideation-related clinical features that are associated with poorer adherence and CBT treatment outcome Evidence: RCS: Neziroglu et al., 2001 • CQS: Kozak and Foa, 1994 6. Different specialty CBT approaches to the treatment of overvalued ideation in OCD and what approaches yield the best outcome Evidence: RCS: Main-Wegielnik, 2010;Twohig et al., 2006 • CQS: Neziroglu et al., 2010;Pinto et al., 2007 7. Appropriate and helpful use of ''naturalistic'' CBT (i.e., outside office in feared situations) for OCD associated with overvalued ideation Evidence: RCS: 8. When intensive outpatient or residential treatment is needed for OCD associated with overvalued ideation Evidence: SR and MA: Veale et al., 2016 • CQS: Wilson et al., 2014 9. How overvalued ideation may lead to noncompliance, excessive reassurance seeking, or avoidance Evidence: TM : Neziroglu et al., 2009 10. ...
... Clinical features of overvalued ideation-related OCD that may complicate/impede treatment Evidence: RCS: Neziroglu et al., 1999c 11. Criteria for assessment of degree of change in overvalued ideation Evidence: PS: Neziroglu et al., 1999a;Mataix-Cols et al., 2016 • TM : Sookman andSteketee, 2010 Specialty Competencies The ability to: 1. Help the patient to identify overvalued ideation and the internal and external cues that provoke these, and to enable the patient to overcome reluctance to disclose and discuss these (e.g., due to shame) Evidence: RCS: Neziroglu et al., 2001 • TrPN : Neziroglu andStevens, 2002 2. Assess symptoms of overvalued ideation using different standardized measures Evidence: RCT : Goodman et al., 1989a,b • PS: Eisen et al., 1998;Neziroglu et al., 1999a 3. Create and maintain a positive therapeutic relationship as the patient with overvalued ideation may feel that his/her cognitions and feelings are being challenged, leading to reluctance to engage in treatment Evidence: RCS: Neziroglu et al., 1999c;Vogel et al., 2006 4. Provide an explanation of the phenomenology, etiology and maintenance of overvalued ideation symptoms, to apply this in a case formulation, and to explain the rationale for specific CBT interventions to address these ideas and related symptoms to the patient Evidence: RCS: Neziroglu et al., 2001 • ThP: Veale, 2002 9. Identify how cognitive therapy can be utilized to reduce overvalued ideation Evidence: RCS: Neziroglu et al., 2001 • CQS: Wilson et al., 2014• TM : Neziroglu et al., 2013 10. Use ERP to address overvalued ideation including ''overpractice'' Evidence: RCS: Neziroglu et al., 2001Neziroglu et al., , 1999b • CQS: Wilson et al., 2014• TrPN : McKay et al., 2015 11. ...
... Clinical features of overvalued ideation-related OCD that may complicate/impede treatment Evidence: RCS: Neziroglu et al., 1999c 11. Criteria for assessment of degree of change in overvalued ideation Evidence: PS: Neziroglu et al., 1999a;Mataix-Cols et al., 2016 • TM : Sookman andSteketee, 2010 Specialty Competencies The ability to: 1. Help the patient to identify overvalued ideation and the internal and external cues that provoke these, and to enable the patient to overcome reluctance to disclose and discuss these (e.g., due to shame) Evidence: RCS: Neziroglu et al., 2001 • TrPN : Neziroglu andStevens, 2002 2. Assess symptoms of overvalued ideation using different standardized measures Evidence: RCT : Goodman et al., 1989a,b • PS: Eisen et al., 1998;Neziroglu et al., 1999a 3. Create and maintain a positive therapeutic relationship as the patient with overvalued ideation may feel that his/her cognitions and feelings are being challenged, leading to reluctance to engage in treatment Evidence: RCS: Neziroglu et al., 1999c;Vogel et al., 2006 4. Provide an explanation of the phenomenology, etiology and maintenance of overvalued ideation symptoms, to apply this in a case formulation, and to explain the rationale for specific CBT interventions to address these ideas and related symptoms to the patient Evidence: RCS: Neziroglu et al., 2001 • ThP: Veale, 2002 9. Identify how cognitive therapy can be utilized to reduce overvalued ideation Evidence: RCS: Neziroglu et al., 2001 • CQS: Wilson et al., 2014• TM : Neziroglu et al., 2013 10. Use ERP to address overvalued ideation including ''overpractice'' Evidence: RCS: Neziroglu et al., 2001Neziroglu et al., , 1999b • CQS: Wilson et al., 2014• TrPN : McKay et al., 2015 11. ...
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
... The ability to demonstrate knowledge of: 1. Phenomenology of overvalued ideas, define and recognize overvalued ideation (poor or absent insight) Evidence: MA: Neziroglu, 2008 • CSS: Eisen et al., 2004;Phillips et al., 2012• ThP: Yaryura-Tobias, 2004Veale, 2002• TrPN : McKay et al., 2015 2. The theoretical background of the development of overvalued ideas Evidence: MA: McKenna, 1984 • RCS: Neziroglu et al., 2001 • ThP: Jaspers, 1913;Yaryura-Tobias, 2004;Veale, 2002 • TrPN : Kozak and 3. The different types of OCD symptom correlates of overvalued ideation Evidence: CSS: Eisen et al., 2004;Phillips et al., 2012• ThP: Yaryura-Tobias, 2004• TrPN : Kozak and Foa, 1994 4. Overvalued ideation assessment methods Evidence: RCT : Goodman et al., 1989a,b • RCS: Neziroglu et al., 1999a • PS: Eisen et al., 1998 • CR: Neziroglu and Khemlani-Patel, 2003 5. Overvalued ideation-related clinical features that are associated with poorer adherence and CBT treatment outcome Evidence: RCS: Neziroglu et al., 2001 • CQS: Kozak and Foa, 1994 6. Different specialty CBT approaches to the treatment of overvalued ideation in OCD and what approaches yield the best outcome Evidence: RCS: Main-Wegielnik, 2010;Twohig et al., 2006 • CQS: Neziroglu et al., 2010;Pinto et al., 2007 7. Appropriate and helpful use of ''naturalistic'' CBT (i.e., outside office in feared situations) for OCD associated with overvalued ideation Evidence: RCS: 8. When intensive outpatient or residential treatment is needed for OCD associated with overvalued ideation Evidence: SR and MA: Veale et al., 2016 • CQS: Wilson et al., 2014 9. How overvalued ideation may lead to noncompliance, excessive reassurance seeking, or avoidance Evidence: TM : Neziroglu et al., 2009 10. ...
... Clinical features of overvalued ideation-related OCD that may complicate/impede treatment Evidence: RCS: Neziroglu et al., 1999c 11. Criteria for assessment of degree of change in overvalued ideation Evidence: PS: Neziroglu et al., 1999a;Mataix-Cols et al., 2016 • TM : Sookman andSteketee, 2010 Specialty Competencies The ability to: 1. Help the patient to identify overvalued ideation and the internal and external cues that provoke these, and to enable the patient to overcome reluctance to disclose and discuss these (e.g., due to shame) Evidence: RCS: Neziroglu et al., 2001 • TrPN : Neziroglu andStevens, 2002 2. Assess symptoms of overvalued ideation using different standardized measures Evidence: RCT : Goodman et al., 1989a,b • PS: Eisen et al., 1998;Neziroglu et al., 1999a 3. Create and maintain a positive therapeutic relationship as the patient with overvalued ideation may feel that his/her cognitions and feelings are being challenged, leading to reluctance to engage in treatment Evidence: RCS: Neziroglu et al., 1999c;Vogel et al., 2006 4. Provide an explanation of the phenomenology, etiology and maintenance of overvalued ideation symptoms, to apply this in a case formulation, and to explain the rationale for specific CBT interventions to address these ideas and related symptoms to the patient Evidence: RCS: Neziroglu et al., 2001 • ThP: Veale, 2002 9. Identify how cognitive therapy can be utilized to reduce overvalued ideation Evidence: RCS: Neziroglu et al., 2001 • CQS: Wilson et al., 2014• TM : Neziroglu et al., 2013 10. Use ERP to address overvalued ideation including ''overpractice'' Evidence: RCS: Neziroglu et al., 2001Neziroglu et al., , 1999b • CQS: Wilson et al., 2014• TrPN : McKay et al., 2015 11. ...
... Clinical features of overvalued ideation-related OCD that may complicate/impede treatment Evidence: RCS: Neziroglu et al., 1999c 11. Criteria for assessment of degree of change in overvalued ideation Evidence: PS: Neziroglu et al., 1999a;Mataix-Cols et al., 2016 • TM : Sookman andSteketee, 2010 Specialty Competencies The ability to: 1. Help the patient to identify overvalued ideation and the internal and external cues that provoke these, and to enable the patient to overcome reluctance to disclose and discuss these (e.g., due to shame) Evidence: RCS: Neziroglu et al., 2001 • TrPN : Neziroglu andStevens, 2002 2. Assess symptoms of overvalued ideation using different standardized measures Evidence: RCT : Goodman et al., 1989a,b • PS: Eisen et al., 1998;Neziroglu et al., 1999a 3. Create and maintain a positive therapeutic relationship as the patient with overvalued ideation may feel that his/her cognitions and feelings are being challenged, leading to reluctance to engage in treatment Evidence: RCS: Neziroglu et al., 1999c;Vogel et al., 2006 4. Provide an explanation of the phenomenology, etiology and maintenance of overvalued ideation symptoms, to apply this in a case formulation, and to explain the rationale for specific CBT interventions to address these ideas and related symptoms to the patient Evidence: RCS: Neziroglu et al., 2001 • ThP: Veale, 2002 9. Identify how cognitive therapy can be utilized to reduce overvalued ideation Evidence: RCS: Neziroglu et al., 2001 • CQS: Wilson et al., 2014• TM : Neziroglu et al., 2013 10. Use ERP to address overvalued ideation including ''overpractice'' Evidence: RCS: Neziroglu et al., 2001Neziroglu et al., , 1999b • CQS: Wilson et al., 2014• TrPN : McKay et al., 2015 11. ...
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illnessfor as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed tobe essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
... An overvalued idea (OVI) is "an unreasonable and sustained belief that is maintained with less than delusional intensity," (5th ed.; DSM-V; American Psychiatric Association, 2013). A number of authors (Hollander, 1993;Kozak and Foa, 1994;Neziroglu et al., 1999) consider the strength of a belief as one of the prominent features characterizing overvalued ideas. Overvalued ideas are irrational, unreasonable beliefs that are held with strong conviction, and the person lacks insight or the ability to attribute the belief to the disorder (i.e. ...
... Foa et al. (1995) developed the "Fixity of Beliefs" questionnaire, which evaluates the strength to which OCD patients recognize that their obsessions and compulsions are unreasonable or irrational. Lastly, Neziroglu et al. (1999) developed the Overvalued Ideas Scale (OVIS), assessing the main beliefs associated with OCD. It measures the following components of an overvalued belief: strength, reasonableness, accuracy, perception of others' views, acknowledgement of differing views, general fixity of belief, and insight. ...
... The OVIS (Neziroglu et al., 1999) is a 10-item clinician administered scale that evaluates the extent of a patient's obsessions and associated compulsions on several different continua. Reliability and validity data indicate a total internal consistency of 0.95 and a test-retest reliability of 0.93. ...
In Obsessive Compulsive Disorder (OCD), overvalued ideas (OVI) are considered poor prognostic indicators in adults. To date, OVI has not been studied in an adolescent population with OCD, nor has it been examined in relation to obsessive-compulsive beliefs. To investigate the relationship between OVI and specific cognitions, fifty-five adolescents with OCD (35 male; 20 female; age range 13–17 years; M=14.05 years, SD=1.75 years) participated. It was predicted that OVI would be associated with symptom severity and would moderate obsessive-compulsive beliefs and functional disability. Results showed that OVI was associated with symptom severity, but did not moderate the relationship with any OC beliefs or functional domains. To evaluate the role of OVI in treatment outcome, thirteen adolescents completed a cognitive-behavioral treatment program. Severity of their OCD symptoms, OVI, degree of functional impairment and quality of life were assessed. It was expected that all variables would change in response to treatment. Further, it was expected that OVI would mediate treatment outcome for all measures of obsessive-compulsive symptom and belief assessments. Results indicated that there was clinically significant change in symptom severity and functional disability, as well as beliefs regarding responsibility/overestimation of threat. Treatment, assessment, and methodological recommendations for this population are offered.
... 8 Clinical scales, such as the Over Valued Ideas Scale (OVIS) can be used to measure insight in patients with OCD. [8][9][10][11][12][13] Notably, OVIS measures overvalued ideas, including items measuring to which extent beliefs are "unshakable." ...
... In addition, patients were submitted to relevant clinical scales (e.g., OVIS for OCD and SAPS for or good insight (OVIS < 6) and OCD with strong beliefs or poor insight (OVIS ≥ 6). [8][9][10][11][12][13] In the psychosis group, we used the Scale for the Assessment for Negative Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) 18 and the Calgary Depression Scale (CDS). 19 Doses of prescribed antipsychotic and antidepressant treatments were converted to olanzapine 20 and fluoxetine equivalents. ...
... 8 Clinical scales, such as the Over Valued Ideas Scale (OVIS) can be used to measure insight in patients with OCD. [8][9][10][11][12][13] Notably, OVIS measures overvalued ideas, including items measuring to which extent beliefs are "unshakable." ...
... In addition, patients were submitted to relevant clinical scales (e.g., OVIS for OCD and SAPS for or good insight (OVIS < 6) and OCD with strong beliefs or poor insight (OVIS ≥ 6). [8][9][10][11][12][13] In the psychosis group, we used the Scale for the Assessment for Negative Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) 18 and the Calgary Depression Scale (CDS). 19 Doses of prescribed antipsychotic and antidepressant treatments were converted to olanzapine 20 and fluoxetine equivalents. ...
Disruption of conscious access contributes to the advent of psychotic symptoms in schizophrenia but could also explain lack of insight in other psychiatric disorders.
In this study, we explored how insight and psychotic symptoms related to disruption of consciousness. We explored consciousness in patients with schizophrenia, patients with obsessive-compulsive disorder (OCD) with good vs. poor insight and matched controls. Participants underwent clinical assessments and performed a visual masking task allowing us to measure individual consciousness threshold. We used a principal component analysis to reduce symptom dimensionality and explored how consciousness measures related to symptomatology.
We found that clinical dimensions could be well summarized by a restricted set of principal components which also correlated with the extent of consciousness disruption. More specifically, positive symptoms were associated with impaired conscious access in patients with schizophrenia whereas the level of insight delineated two subtypes of OCD patients, those with poor insight who had consciousness impairments similar to patients with schizophrenia, and those with good insight who resemble healthy controls.
Our study provides new insights about consciousness disruption in psychiatric disorders, showing that it relates to positive symptoms in schizophrenia and with insight in OCD. In OCD, it revealed a distinct subgroup sharing neuropathological features with schizophrenia. Our findings refine the mapping between symptoms and cognition, paving the way for a better treatment selection.
... This inconsistency could be due to the methodology used, specifically the use of instruments that conceptualize insight in different ways, with most of the studies evaluating the relationship between insight and clinical and sociodemographic variables in OCD using just a single measurement of insight. The main instruments used to measure insight in clinical practice are: item 11 of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS-11), which evaluates veracity awareness and absurdity of obsessions and compulsions 28 ; the Brown Assessment of Beliefs Scale (BABS) 29 and the Overvalued Ideas Scale (OVIS), 30 which evaluate obsessive thoughts from a multidimensional perspective 31 ; and the Scale to Assess Unawareness of Mental Disorder (SUMD) 32 which evaluates the awareness of having a disorder, the effects of medication, and the social consequences of having the disorder. To our knowledge, only one study (Shimshoni et al 31 ) has broadly assessed insight using several instruments, all of them specific to OCD. ...
... The clinician assesses different aspects of the main belief or beliefs over the previous week, including bizarreness, belief accuracy, fixity, reasonableness, effectiveness of compulsions, pervasiveness of belief, reasons others do not share the belief, and stability of the belief. 30 For the Spanish version of the OVIS used in this study, Roncero Sanchis 35 reported Cronbach α of 0.88 in her doctoral thesis. (3) SUMD: This scale was designed to assess insight in psychotic patients, but its use has been extended to other disorders. ...
Insight is considered a multidimensional concept and, in the context of obsessive-compulsive disorder (OCD), impairment in insight has been widely reported to be associated with severity and other clinical and sociodemographic variables. However, the studies concerning insight in OCD have produced heterogenous data as a result of the scales used to measure insight. To overcome this heterogeneity, the study presented here used 4 different widely used and validated insight scales. The objective was to evaluate various aspects of insight using these scales to identify the relationships between different aspects of insight and clinical and sociodemographic variables to assess which scale or scales might possess greater efficiency in clinical practice. For this purpose, a descriptive, observational, and cross-sectional study of 81 patients in treatment in a mental health center was conducted. Patients were evaluated using the Brown Assessment of Beliefs Scale, the Overvalued Ideas Scale, the Scale of Unawareness of Mental Disorders, the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impressions Scale, the Global Assessment of Functioning Scale, and the Rey-Osterrieth Complex Figure Test. The results reported significant relationships between insight and scores on the Yale-Brown Obsessive Compulsive Scale (Thoughts, Compulsions, and Total scales), Clinical Global Impressions Scale, and the Global Assessment of Functioning Scale, and significant differences with regard to sex, level of education, working status, and course of the disorder. A correlation analysis was conducted to assess the relationships among the 4 insight scales. The results of this analysis suggest that the scales that measure insight in a multidimensional way (Brown Assessment of Beliefs Scale and Overvalued Ideas Scale) provide more information about the severity of the disorder in patients with OCD.
... Insight in OCD patients was assessed in a continuum between entirely logical obsessions and fully extreme and irrational obsessions (34,35). Overvalued ideas, which are in obsessiondelusion spectrum, were measured using the Overvalued Ideas Scale (OVIS) (36). Moreover, OVIS and eleventh item of YBOC-S were used to determine level of insight (36). ...
... Overvalued ideas, which are in obsessiondelusion spectrum, were measured using the Overvalued Ideas Scale (OVIS) (36). Moreover, OVIS and eleventh item of YBOC-S were used to determine level of insight (36). OVIS was applied via face-to-face interview method. ...
Objective:
The primary aim of the current study was to investigate different aspects of theory of mind (ToM), including social-cognitive (ToM-reasoning) and social-perceptual (ToM-decoding) in obsessive-compulsive disorder (OCD). We also aimed to investigate the relationship between ToM, neurocognition and a number of clinical variables including overvalued ideas, schizotypal personality traits, level of insight, and disease severity.
Method:
Thirty-four patients who have been diagnosed with OCD according to DSM-IV and 30 healthy controls were included in the study. All participants were given a neuropsychological battery including tasks measuring ToM-reasoning, ToM-decoding and other neurocognitive functions. Schizotypal Personality Questionnaire (SPQ), Yale Brown Obsession and Compulsion Scale (YBOC-S) and Overvalued Ideas Scale (OVIS) were also administered to the participants.
Results:
Patients with OCD showed significant deficits in both aspects of ToM. ToM performances of patients showed a significant positive correlation with neurocognitive functions. When controlled for general cognition factor, patient-control difference for ToM-reasoning (F = 3,917; p = 0,05), but not ToM-decoding, remained statistically significant. ToM-reasoning impairment of patients was significantly related to the severity of OCD symptoms and poor insight (p = 0,026 and p = 0,045, respectively). On the other hand, general cognitive factor (β = 0,778; t = 3,146; p = 0,04) was found to be the only significant predictor of ToM-reasoning in OCD patients in the multiple linear regression model.
Conclusion:
OCD is associated with ToM impairment, which is related to schizotypal traits, disease severity and poor insight, yet neurocognitive deficits also significantly contribute to this finding. However, ToM-reasoning impairment could be considered as a relatively distinct feature of OCD, which is partly separate from general cognitive deficits.
... Such conceptualisation of insight and the associated beliefs calls for an assessment instrument that would be easy to use in clinical practice. In a previous paper (Brakoulias & Starcevic, 2010), we demonstrated inconsistencies, poor definitions of scale items and their excessive overlap in existing scales that measure beliefs such as the Fixity of Beliefs Scale (Lelliott, Noshirvani, Basoglu, Marks, & Monteiro, 1988), Brown Assessment of Belief Scale (BABS) (Eisen et al., 1998) and Overvalued Ideas Scale (OVIS) (Neziroglu, Mckay, Yaryura-Tobias, Stevens, & Todaro, 1999). We then proposed that beliefs are best characterised by a small number of clearly defined features, that is, conviction, fixity, fluctuation, resistance, awareness of the inaccuracy of the belief and ability to attribute the belief to an illness or disorder (Brakoulias & Starcevic, 2010). ...
... The MINI has been validated against other widely used structured diagnostic interviews and its psychometric properties have been good (Sheehan et al., 1997;Sheehan & Lecrubier, 2010). Other relevant assessments included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1989), OVIS (Neziroglu, Stevens, Mckay, & Yaryura-Tobias, 2001;Neziroglu, Mckay, Yaryura-Tobias, Stevens, & Todaro, 1999) and Symptom Checklist 90 Revised (SCL-90R) (Derogatis, 1994). The Y-BOCS is regarded as a 'gold standard' semi-structured interview for assessing OCD severity. ...
Objectives:
To examine the psychometric characteristics of the Nepean Belief Scale (NBS), a short clinician-administered scale that assesses the characteristics and intensity of beliefs in obsessive-compulsive disorder (OCD).
Methods:
The NBS was administered by two clinicians to 27 subjects with OCD as part of a larger study that included a comprehensive assessment using the Yale-Brown Obsessive Compulsive Symptom Scale (Y-BOCS), the Overvalued Ideas Scale (OVIS) and the Symptom Checklist 90-Revised (SCL-90R). Test-retest reliability of the NBS was assessed by administering the scale 5 days after initial administration.
Results:
The 5-item NBS proved easy to use with an assessment time of less than 5 min. Its interrater reliability revealed 99.5% concordance, while the kappa for test-retest reliability was 0.98 (95% CI = 0.95-1.00). Cronbach alpha coefficient for internal consistency was 0.87. The NBS was found to have excellent convergent and discriminant validity.
Conclusions:
Preliminary results suggest that the NBS could be a useful shorter alternative to the currently more widely used instruments for assessing beliefs such as the OVIS and the Brown Assessment of Belief Scale. The NBS has clear instructions and definitions, excellent interrater reliability and convergent validity, and it more accurately measures belief-related insight.
... Overvalued Ideas Scale (OVIS). The OVIS (Neziroglu, McKay, Yaryura-Tobias, Stevens, & Todaro, 1999) is an 11-item clinician-administered measure that assesses the degree of overvalued ideation related to the individual's OCD symptoms in the past week. Each item can be rated on a scale from 1 to 10. ...
... The scale possesses acceptable psychometric properties, demonstrating good internal, test-retest, and interrater reliability, as well as good convergent validity. However, there is a relative lack of strong evidence for the discriminant validity (especially with depressive and anxiety symptoms), and OVIS scores tend to demonstrate stronger stability for individuals with greater overvalued ideation (Neziroglu et al., 1999). Furthermore, the OVIS exhibited better predictive validity when compared to item No. 11 on the Y-BOCS (Neziroglu, Stevens, McKay, & Yaryura-Tobias, 2001). ...
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.
... Insight into OCD symptoms was measured with the Overvalued Ideas Scale (OVIS). The OVIS (Neziroglu, McKay, Yaryura-Tobias, Stevens, & Todaro, 1999) is a 10 item clinician administered scale that assesses the severity of OCD-related over-valued ideation. The concept of overvalued ideas can be considered equivalent to poor or absent insight as described in DSM-5 (Neziroglu et al., 1999). ...
... At follow-up mental health care utilization during the two years between wave 3 and wave 4 was recorded. Follow-up data on OCD symptom severity (as measured by the YBOCS severity scale (Goodman et al., 1989)) were present in 220 (87%) participants and on insight (measured by the OVIS (Neziroglu et al., 1999)) in 192 (76%) participants. ...
Objective Some patients with Obsessive Compulsive Disorder (OCD) think that their obsessive-compulsive beliefs are true. These patients have OCD with poor or absent insight, a clinical profile that poses a challenge to the clinician. The purpose of this study is to characterize the clinical profile of poor insight OCD and study the impact of poor insight on the two year course of OCD. Method Data were analysed of 253 adult patients with OCD, participating in the prospective naturalistic Netherlands Obsessive Compulsive Disorder Association (NOCDA) Study. Insight was measured using a standardized instrument, the Overvalued Ideas Scale. Results Good, fair, poor and absent insight occurred at every severity level of OCD. Poor insight was associated with higher OCD symptom severity, more chronicity, more comorbidity and predicted poor outcome at two-year follow-up, independently of treatment, severity of OCD- and depressive symptoms, age of onset, comorbidity and chronicity of OCD. Conclusions More severe and more complex symptoms characterize OCD with poor insight. Poor insight occurs at every severity level of OCD and appears to be an independent phenomenon which predicts poor outcome in OCD. Future work should determine whether improving insight causes better outcome in OCD.
... The Overvalued Ideas Scale (OVIS) was used to assess insight into OCD symptoms. The OVIS is designed to assess the severity of overvalued ideas in OCD in the previous week (30). The concept of overvalued ideas can be considered equivalent to the specifiers poor or absent insight as described in DSM-5. ...
Objective
Patients with obsessive-compulsive disorder (OCD) and poor insight show higher symptom severity, lower quality of life (QoL), and a reduced treatment response compared to patients with good insight. Little is known about changes in insight. This study explored the course of insight and its association with OCD severity and QoL among 253 patients with OCD participating in the prospective naturalistic Netherlands Obsessive Compulsive Disorder Association (NOCDA) Study.
Results
In 70% of the participants with available insight data, the level of insight changed during the four-year course. Insight was most variable in participants with poor insight. Improvement of insight scores was statistically significantly associated with improvement of Y-BOCS scores (r = 0.19), but not with changes in QoL scores. Change in insight in the first 2 years was not statistically significantly predictive of OCD severity or QoL at four-year follow-up.
Conclusion
These findings suggest that patients’ levels of insight may change during the natural four-year course of OCD and that improvement in the level of insight have a positive association with improvement in OCD severity.
... There are a number of scales that measure insight in adults such as the Over-Valued Ideas Scale (OVIS [9]), the Brown Assessment of Beliefs Scale (BABS [10]), and the Beck Cognitive Insight Scale (BCIS [11]). Despite being well-validated and widely used in research, these measures are rarely used to inform clinicians' decisions regarding how to direct treatment plans. ...
Individuals with mental disorders possess varying levels of clinical insight—the degree to which one understands that they are afflicted with a mental disorder and that their symptoms are manifestations of this psychopathology. Although clinical insight in OCD is thought to play an especially important role in determining various clinical characteristics and treatment outcomes, insight has not been sufficiently addressed developmentally, the importance of which this review will elucidate. Findings from this review suggest that clinical insight is typically associated with more complex cases and worse treatment outcomes across the life course, and also reveal nuances between pediatric and adult OCD cases with low insight. Implications of these findings, future research directions, and recommendations for the field are discussed.
... The score ranges from 10 to 100. OVIS can be used to measure the strength of BDD patients' belief in the existence of defects.117 Adequate ...
Body dysmorphic disorder (BDD) is a psychiatric condition characterized by profound concern about a minor or imagined defect in the appearance of individuals and increased preoccupation with the imagined/perceived defect. Individuals with BDD often undergo cosmetic intervention for the perceived imperfection but rarely experience improvement in their signs and symptoms following such treatment. It is recommended that aesthetic providers evaluate individuals face-to-face and screen for BDD with approved scales preoperatively to determine the candidate's suitability for the procedure. This contribution focuses on diagnostic and screening tools and measures of disease severity and insight that providers working in non-psychiatric settings can utilize. Several screening tools were explicitly developed for BDD, while others were designed to evaluate body image/dysmorphic concern. The BDD Questionnaire (BDDQ)-Dermatology Version (BDDQ-DV), BDDQ-Aesthetic Surgery (BDDQ-AS), Cosmetic Procedure Screening Questionnaire (COPS), and Body Dysmorphic Symptom Scale (BDSS) have been explicitly developed for BDD and validated in cosmetic settings. Limitations of screening tools are discussed. Given the increasing use of social media, future revisions of BDD instruments should consider incorporating questions relevant to patients' behaviors on social media. Current screening tools can adequately test for BDD despite their limitations and a need for updates.
... The insight is graded as follows: 0 = excellent (fully rational thinking), 1= good insight (readily acknowledges absurdity or excessiveness but has some lingering doubts), 2 = fair insight (reluctantly admits absurdity, but waivers; has some unrealistic fear but no fixed conviction), 3 = poor insight (overvalued ideas; maintains they are not unreasonable or excessive, but acknowledges validity of contrary evidence), and 4 = lack of insight (delusional). Other helpful tools assisting in the assessment of insight in OCD are The Brown Assessment of Beliefs Scale (BABS) [35] and the Overvalued Ideas Scale (OVIS) [31]. ...
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD’s clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder.
This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
... An alternative explanation, which was raised by van Oudheusden et al., is that these factor items are measuring OCD related egosyntonicity instead of free will [17]. Interestingly, van Oudheusden et al. also found that higher scores of ownership were associated with poorer insight according to the Overvalued Ideas Scale [17,41]. It is known that a poorer insight on OCD relates to egosyntonic symptoms [42]. ...
Background: Individuals with obsessive–compulsive disorder (OCD) often feel compelled to perform (compulsive) behaviors, thus raising questions regarding their free will beliefs and experiences. In the present study, we investigated if free will related cognitions (free will beliefs or experiences) differed between OCD patients and healthy subjects and whether these cognitions predicted symptom changes after a one‑year follow up. Methods: Sixty OCD outpatients were assessed for their beliefs in and experiences of free will at baseline and after one year of treatment. A subsample of 18 OCD patients had their beliefs compared to 18 age and gender matched healthy controls. A regression analysis was performed to investigate whether free will cognitions at baseline were able to predict long‑term OCD severity scores. Results: Patients with OCD and healthy controls do not seem to differ in terms of their beliefs in free will (U= 156.0; p= 0.864). Nonetheless, we found significant negative correlation between (i) duration of illness and strength of belief in determinism (ρ= ‑0.317; p= 0.016), (ii) age and perception of having alternative possibilities (ρ= ‑0.275; p= 0.038), and (iii) symptoms’ severity and perception of having alternative possibilities (ρ= ‑0.415; p= 0.001). On the other hand, the experience of being an owner of ones’ actions was positive correlated with the severity of symptoms (ρ= 0.538; p < 0.001) and were able to predict the severity of OCD symptoms at the follow up assessment. Conclusions: Older individuals or those with a greater severity of symptoms seem to have a perception of decreased free will. In addition, patients with a longer duration of illness tend to have a lower strength of belief in determinism. Finally, the experience of being the owner of the compulsions, along with the baseline severity of symptoms, can be a predictor of a worse outcome in the OCD sample.
Keywords: Obsessive–Compulsive Disorder, Free Will, FWI, SAPF
... Non-specific secondary outcome measures were the Beck Anxiety Inventory [46] Beck Depression Inventory [47]. Clinician-rated secondary outcome measures included the Current Functioning Assessment (CFA) [48] and the Overvalued Ideation Scale (OVIS) [49]. Dichotomous secondary outcome measures with cut-off points based on international consensus among experts in the field of OCD [50] were: (a) treatment response status, as defined by a decrease on the YBOCS between pre-and post-test of at least 35%, (b) remission status, as defined by a YBOCS post score ≤12, (c) relapse status, as defined by no longer meeting criteria for treatment response or remission at follow-up in comparison to treatment status established at post-test, and (d) treatment refusal and dropout rates. ...
Introduction:
Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas.
Objective:
The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention.
Methods:
This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale.
Results:
All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test.
Conclusions:
I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated.
... The OVIS was developed by Nezirog lu et al. with the aim of providing a quantitative assessment of the level of insight in OCD. 20 After the development of the scale, the authors evaluated Overvalued Ideas as a reliable indicator of poor insight in OCD and patients with an OVIS score of X 6 were considered to have ''OCD with poor insight.'' This 11-item scale, scored between 1 and 10, is scored by the interviewer, taking specific beliefs into consideration. ...
Objective:
To date, no study has investigated whether autogenous and reactive obsessive-compulsive disorder (OCD) types are different entities in terms of oxidative stress and inflammatory processes. The aim of this study is to compare them in terms of these features.
Methods:
The study was conducted in subjects with reactive OCD (n=19), autogenous OCD (n=14), and a control group (n=17). All participants were non-smokers. Sociodemographic data were collected and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Obsessive Beliefs Questionnaire (OBQ), and Overvalued Ideas Scale (OVIS) were administered. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), paraoxonase (PON1), total oxidant status (TOS), and total antioxidant status (TAS) were measured.
Results:
There were no significant differences in TAS, TOS, or oxidative stress index (OSI) between the OCD and control groups. PON1 and hs-CRP levels were higher in the OCD group, whereas IL-6 and IL-10 levels were lower. Comparison across the three groups revealed no differences in TAS, TOS, OSI, or PON1 levels; however, hs-CRP was significantly higher while IL-6 and IL-10 were significantly lower in the reactive group compared to controls.
Conclusion:
Our results show that, although inflammatory processes may play a role in OCD, the autogenous and reactive subtypes do not differ from each other in these respects. The classification of OCD into autogenous and reactive subtypes should be reevaluated.
... Psychotropic medication was assessed using the TIC-P (33), measuring use of all types of psychotropic medication in the previous 6 months (at baseline and follow-up). Insight in OCD was measured using the Overvalued Ideas Scale (OVIS) (40). ...
Background: Few studies have investigated which patients with obsessive-compulsive disorder (OCD) do not recover through regular cognitive behavior therapy or pharmacotherapy and subsequently end up in intensive treatment like day treatment or inpatient treatment. Knowing the predictors of intensive treatment in these patients is significant because it could prevent intensive treatment. This study has identified predictors of intensive treatment in patients with OCD.
Methods: Using 6-year longitudinal data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA), potential predictors of intensive treatment were assessed in patients with OCD (n = 419). Intensive treatment was assessed using the Treatment Inventory Costs in Patients with Psychiatric Disorders (TIC-P). Examined potential predictors were: sociodemographics, and clinical and psychosocial characteristics. Logistic Generalized Estimating Equations was used to estimate to what extent the various characteristics (at baseline, 2- and 4-year assessment) predicted intensive treatment in the following 2 years, averaged over the three assessment periods.
Results: Being single, more severe comorbid depression, use of psychotropic medication, and a low quality of life predicted intensive treatment in the following 2 years.
Conclusions: Therapists should be aware that patients with OCD who are single, who have more severe comorbid depression, who use psychotropic medication, and who have a low quality of life or a drop in quality of life are at risk for intensive treatment. Intensive treatment might be prevented by focusing regular treatment not only on OCD symptoms but also on comorbid depression and on quality of life. Intensive treatment might be improved by providing extra support in treatment or by adjusting treatment to impairments due to comorbid depressive symptoms or a low quality of life.
... [6,7] Insight in OCD is better conceptualized in cognitive terms and is evaluated along several dimensions, measured by scales to assess belief system. [8,9] Insight varies with respect to different demographic factors such as age, year of education, occupation, and clinical variables such as age of onset, duration and course of illness, and family history of psychiatric, thus influencing severity and duration of illness. [10][11][12][13][14][15][16] Studies reveal that insight also varies among different symptom dimensions of OCD. ...
BACKGROUND: Degree of insight in Obsessive Compulsive Disorder (OCD) varies with different symptom dimensions of OCD and not much of studies are done in this area. There is need to study insight in more detail in patients of OCD along with psychopathology and functioning.
AIMS: To study and compare Psychopathology and Functioning in Patients of Obsessive Compulsive Disorder with Good and Poor Insight.
METHOD: This is a cross sectional study and 94 patients fulfilling diagnostic criteria for OCD on the basis of the ICD10-DCR were assessed on Yale- Brown obsessive compulsive scale (Y-BOCS), Dimensional Yale- Brown obsessive compulsive scale (DY-BOCS), Brown Assessment of Belief Scale (BABS) and Social and Occupational Functioning Assessment Scale (SOFAS).
RESULTS: A total of 94 patients of OCD were assessed and 76 (81 %) patient had good insight (BABS < 12) where as 18 (19%) had poor insight (BABS ≥ 12). Duration of illness (P = 0.007) and duration of untreated illness (P = 0.006) was significantly longer in poor insight group. Compulsions subscale score (P = 0.003), mean total score (P = 0.014) and SOFAS mean score (0.001) was significantly higher in poor insight. Mean score of clinical severity in dimension of aggression, sexual and religious obsession was significantly higher (P = 0.001) in good insight group.
CONCLUSION: Majority of patient with predominant symptoms as aggression, sexual and religious obsessions belonged to good insight group. Patients with poor insight had higher severity of illness, longer duration of illness and duration of untreated illness.
... Calculated scores on the OVIS range from 0 to 10, with higher scores representing more overvalued ideas. The overvalued idea is accepted as a reliable indicator of poor insight, and with an OVIS score equal to or higher than six, a patient is considered to have "OCD with poor insight" (27)(28)(29). The OVIS total score was measured to evaluate insight dimensionally. ...
... Neziroğlu et al. [32] to assess the degree of insight in OCD. OVIS consists of 11 Likert-type items that are rated between 1 and 10. ...
INTRODUCTION: The treatment of obsessive-compulsive disorder (OCD) aims to neutralize obsessions and improve insight, in consideration of the information that OCD patients have positive beliefs about anxiety and do not rely on their attention and memory. Nevertheless, there are a limited number of studies about the relationship of insight with metacognitions and types of obsessive beliefs among OCD patients. This study aims to investigate those relationships.
METHODS: This study was conducted with a patient group, 101 OCD patients, and 52 healthy volunteers in the control group. All participants were given the Sociodemographic Data Form, Hamilton Depression Rating Scale (HDRS), Obsessional Beliefs Questionnaire (OBQ-44) and Metacognition Questionnaire (MCQ-30). The patient group also received the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Overvalued Ideas Scale (OVIS). According to OVIS scores, the patient group was separated into two groups; poor insight and good insight.
RESULTS: The average scores of positive beliefs and cognitive confidence subscales of MCQ-30 were credible among the patient and healthy control groups. Patients with poor and good insight did not differ with regard to severity of obsessions, compulsions, depression, duration and beginning type of the disorder and other clinical and demographic variables and average scale scores. Patients with poor insight had higher average scores of MCQ positive beliefs than patients with good insight; however, the difference was not significant despite being close to the statistical significance verge. Depression severity of patients was higher than controls.
DISCUSSION AND CONCLUSION: Study results demonstrates that, contrary to common belief, certain metacognitions of patients and controls were comparable. No significant relationship was found between insight and metacognition in OCD. There is a need for qualitative studies with larger samples and more demographic and clinical data regarding insight. Additionally, the role of insight in OCD is arguable and the deterministic role of the level of insight in clinical approach and treatment should be questioned.
... OVI has also been referred to as fixidity of beliefs (Foa & Kozak, 1995). The research into the nature of OVI as a complicating factor in OCD has not been extensive, although there are measures available to assess for its presence (Eisen et al., 1998;Neziroglu, McKay, Yaryura-Tobias, Stevens, & Todaro, 1999). The conceptualization of OVI as part of OCD suggests, however, that the ability to discern the likely outcome from exposure-based procedures is an impediment to processing the intervention, akin to the problems evident with co-occurring schizotypy (see, for example, McKay & McKiernan, 2005). ...
Obsessive–compulsive disorder (OCD) is a serious psychiatric disorder that is associated with significant functional impairment. While efficacious psychological and pharmacological treatments exist, many individuals do not receive these interventions but rather are treated with inappropriate therapies. Indeed, there are ways that nonevidence‐based treatments may worsen symptoms, contributing to continued disability. This article evaluates conceptual bases for existing treatments that may lead to harm when applied to OCD in adults. Harmful treatments include cognitive behavioral interventions not expressly tailored for OCD, misapplication of evidence‐based treatments for the disorder, as well as interventions that lack a basic experimental foundation to support their application. Future directions for better understanding factors that lead to worsening of obsessive–compulsive symptoms in this complex disorder are suggested.
... Aşırı Değer Verilmiş Düşünce Ölçeği (ADDÖ): OKB'de içgörü düzeyinin değerlendirilmesi amacıyla Neziroglu ve ark. [32] tarafından geliştirilmiştir. ADDÖ 11 Likert tipi maddeden oluşur, her madde 1-10 arasında puanlanır. ...
... Recent developments such as ICBT or computer-delivered CBT decrease direct therapist contact, and the therapy can be delivered Y-BOCS [64] The Y-BOCS symptom checklist assesses for current, past and principal symptoms of OCD-helps identify targets of therapy The Y-BOCS severity scale is considered the gold standard for assessing severity of OCD. It is helpful in monitoring of symptoms -has expert consensus defined cut-offs for diagnosis, severity, treatment response [65] OCI-R [66] 18-item self-report measure used for assessing severity across dimensions MOCI [67] 30-item self-report scale with dichotomous responses used for screening and severity FOCI [68] Self-report questionnaire-with 2 parts for screening and severity rating Leyton obsessional inventory [69] 69-item self-report questionnaire for assessing obsessional symptoms and traits DY-BOCS [70] Assesses for severity across various symptom dimensions Dimensional Obsessive-Compulsive scale [71] 20-item self-report scale to assess severity of symptoms along 4 dimensions Scales to assess insight in OCD YBOCS, Item 11 [64] Single item -rates insight between 0-4 BABS [72] 7-item clinician-administered scale to assess the degree of conviction and insight into beliefs OVIS [73] 11-item clinician-administered scale to assess severity of overvalued ideation Assessment of related constructs FAS [74] 13-item clinician-administered scale to screen and monitor family accommodation OBQ [75] 44-item self-report to assess beliefs underlying development and maintenance of OCD MCQ-30 [76] Self-report questionnaire which assesses beliefs about thinking DPSS [77] 16-item scale for assessing the tendency and emotional impact of disgust University of São Paulo Sensory Phenomena Scale [78] Self-report scale which includes checklist and assessment of severity for sensory phenomena in OCD subjects in the home atmosphere. The principles of CBT are similar to that of office-based CBT, but the major part of the intervention is done by logging to a website and administering online self-help material. ...
... Thus, patients with OCD may present diverse psychopathological features regarding levels of insight, ego dystonicity and conviction about their own symptoms. The similarity, inconsistency, complexity, and/or overlapping of the cited conceptual constructs (and others, as "beliefs, " "overvalued ideas, " and even "delusional thoughts") (8,(31)(32)(33)(34) have led researchers to confound the cited concepts and to use these terms very loosely, since adequate instruments to assess them are not often used. ...
Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive–compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD.
Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight (n = 148), and those with scores above the 75% percentile composed the group with poor insight (n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant.
Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics (p = 0.05); higher untreated time interval (p < 0.001); higher total Yale–Brown obsessive–compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale–Brown obsessive–compulsive scale total and dimensional scores (p from 0.04 to 0.001); higher prevalence of contamination/cleaning (p = 0.006) and hoarding (p < 0.001) symptoms dimensions; more prevalent sensory phenomena (p = 0.023); higher levels of depression (p = 0.007); and more prevalent comorbidity with bipolar affective disorder (p = 0.05) and post-traumatic stress disorder (PTSD) (p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15).
Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to conventional OCD treatments. Studies based on neurobiological aspects such as neuroimaging and neuropsychology may help to elucidate more consistently the role of insight in patients with OCD and the repercussions concerning available treatments.
... [8][9][10][11] Symptom insight (i.e., an individual's recognition that obsessions/compulsions are problematic symptoms of an OCD diagnosis rather than true, natural, or protective beliefs/behaviors) is an important clinical feature of OCD. [12][13][14] Given that the presence of impairment is included in diagnostic criteria for OCD, failure to recognize or admit impairment observed by other family members may also represent an additional marker of illness awareness that has not been adequately explored in pediatric OCD. Prior to intervention, insight and avoidance are strongly correlated, 15 and both factors are associated with greater OCD severity. ...
Objective:
Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but have not been sufficiently examined in pediatric OCD. The present study examines the impacts of avoidance, insight, and impairment recognition concordance, on cognitive behavioral therapy (CBT) outcomes, as well as impacts of CBT on insight and avoidance, in a large sample of OCD-affected youth.
Method:
Data from 573 OCD-affected youth enrolled in CBT trials was aggregated. The Children's Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child- and parent-ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was utilized to identify variables associated with treatment response.
Results:
Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when post-treatment insight and avoidance were worse.
Conclusion:
Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.
... or the Over-Valuated Ideation Scale (OVIS;Neziroglu, McKay, Yaryura-Tobias, Stevens, & Todaro, 1999), which measure the fixation and insight into the ideations on several dimensions(Brakoulias & Starcevic, 2011). This may have helped to differentiate between obsessive ideations and schizotypal and psychotic symptoms in relation to insight and fixation.A third limitation of Study I is the use of different methods for diagnosis between the samples. ...
Most studies on the relationship between OCD and psychosis report that 8–26% of patients with schizophrenia meet criteria for OCD, with similar reports of psychotic symptoms in patients with OCD. These co-occurring conditions are important to study because of their impact and severity. In fact, OCD patients report a lower quality of life than do any other psychiatric disorders except patients with schizophrenia.
The empirical basis regarding the relationship between OCD and psychosis is weak.
Treatment studies on OCD usually exclude patients with psychotic disorders. Therefore, we do not know how comorbid OCD and psychosis affect OCD treatment outcome. We also do not know whether the subclinical psychotic symptoms, as reported by OCD patients included in treatment trials, affect treatment outcome. Furthermore, most studies on comorbid OCD in psychotic disorders used samples of chronic patients, which introduce several limitations related to the effects of illness duration, institutionalization, and aggravation or induction of OCD following use of antipsychotics. Therefore, the occurrence and clinical characteristics of OCD in patients with first-episode psychosis (FEP) is unknown, as is this group’s prognosis and treatment options.
Therefore, this thesis aims to explore:
1. The role of psychotic symptoms in the treatment of non-psychotic patients with OCD
2. The prevalence and characteristics of OCD in FEP
3. The course of FEP in patients with and without comorbid OCD
4. The effect of cognitive behavioral therapy for OCD in a patient with comorbid schizophrenia
The results showed that sub-clinical psychotic symptoms do not influence the effect of
exposure therapy for OCD (Paper I). However, sub-clinical psychotic symptoms were associated with depressive symptoms, which could require additional treatment. We also
found that OCD is a significant comorbid disorder in FEP (Paper II) and that members of this group are younger and report more depressive symptoms than do FEP patients without comorbid OCD. Comorbid OCD also seems to have a negative impact of the general course of symptoms and function level in patients with FEP (Paper III), as they report less improvement (global functioning and general symptoms) from baseline to one-year follow-up. In conclusion this thesis suggests that comorbid OCD and psychosis are common comorbid disorders. Comorbid OCD in psychosis could be treated successfully with exposure therapy (Paper IV), however, additional treatment may be necessary for residual symptoms such as depression. There is need for more controlled studies of ERP on comorbid OCD in patients with psychotic disorders.
... Whether hoarding as part of OCPD differs from hoarding as part of OCD has remained largely unclear. One potential difference is in whether hoarding behaviour is seen as part of one's character (OCPD) or recognised as disproportionate (OCD) [39]. Hoarding behaviour has been described in several organic and mental disorders with different connotations, such as obsessions or compulsions in OCD, loss of energy in major depressive disorder (MDD), delusions in schizophrenia spectrum or other psychotic disorders, restricted interests in autism spectrum disorder (ASD), and cognitive deficits in major neurocognitive disorders [40,41]. ...
This brief review deals with the various issues that contributed to the creation of the new Diagnostic and Statistical Manual condition of hoarding disorder (HD) and attempts at reviewing its pharmacotherapy. It appears that after the newly founded diagnosis appeared in the literature as an autonomous entity, distinct from obsessive-compulsive disorder, drug trials are not being conducted and the disorder is left in the hands of psychotherapists, who on their part, report fair results in some core dimensions of HD. The few trials on HD specifically regard the serotonin-noradrenaline reuptake inhibitor venlafaxine, and, possibly due to the suggestion of a common biological background of HD with attention-deficit/hyperactivity disorder, the psychostimulant methylphenidate and the noradrenaline reuptake inhibitor atomoxetine. For all these drugs, positive results have been reported, but the evidence level of these studies is low, due to small samples and non-blind designs. Regretfully, there are currently no future studies aiming at seriously testing drugs in HD.
... Severity of obsessive-compulsive symptoms was measured with the Yale-Brown Obsessive-Compulsive Severity Scale (Y-BOCS; Range 0-40; Cronbach's α for this sample: 0.926) [14]. The degree of insight into OCD symptoms was assessed with the Overvalued Ideas Scale (OVIS; Range 0-10; Cronbach's α: 0.663) [15]. The Beck Anxiety Inventory (BAI; Range: 0-63; Cronbach's α: 0.933) and Beck Depression Inventory (BDI; Range: 0-63; Cronbach's α: 0.912) were used to assess severity of comorbid anxiety and depressive symptoms respectively [16,17]. ...
Background
The aim of this study was to explore perceptions of free will in the repetitive behaviors of patients with obsessive-compulsive disorder (OCD) and to explore their relation with core clinical characteristics.
Methods
Experiences of free will were assessed with the Symptomatology And Perceived Free will rating scale (SAPF) in 295 subjects with a lifetime diagnosis of OCD. Patients’ scores on the SAPF were subjected to an explorative principal axis factor analysis (PAF). Factor scores were regressed on five OCD symptom dimensions and on seven clinical variables: illness duration, severity of OCD, insight, anxiety and depression, suicidal ideation and quality of life.
Results
The PAF revealed three factors: the perceived ability to control and change one’s course of action when faced with an obsession or compulsion (the “alternative possibilities” factor); the experience of obsessions or compulsions as intentional (the “intentionality” factor); and the experience of being the source or owner of the obsessions or compulsions (the “ownership” factor). Lower scores on the “alternative possibilities” factor were associated with lower scores on the washing dimension (β = 0.237, p = 0.004) and higher scores on the precision dimension (β = − 0.190, p = 0.025) and independently associated with longer illness duration (β = − 0.134, p = 0.039), higher illness severity (β = − 0.298, p < 0.001) and lower quality of life (β = 0.172, p = 0.046). Lower scores on the “intentionality” factor were independently associated with lower quality of life (β = 0.233, p = 0.027). Higher scores on the “ownership” factor were associated with higher scores on the precision dimension (β = 0.207, p = 0.023) and independently associated with poorer insight (β = 0.170, p = 0.045).
Conclusions
The most notable finding of this study is that a diminished experience of free will in OCD is associated with core clinical characteristics: illness duration and severity, insight and quality of life.
... Eisen et al., 2004;Phillips et al., 2007Phillips et al., , 2012Reese et al., 2011a;Silverstein et al., 2015;Toh et al., 2017c. All but one of these studies used the well-validated Brown Assessment of Beliefs Scale (BABS; Eisen et al., 1998) Neziroglu et al., 1999). Phillips et al. (2012) also demonstrated significant group differences in the distribution of insight scores, with the majority of BDD participants demonstrating poor or absent insight (72% BDD, 16% OCD), and the majority of OCD participants demonstrating good or excellent insight (55% OCD, 15% BDD). ...
Objective:
Current nosology conceptualises body dysmorphic disorder as being related to obsessive-compulsive disorder, but the direct evidence to support this conceptualisation is mixed. In this systematic review, we aimed to provide an integrated overview of research that has directly compared body dysmorphic disorder and obsessive-compulsive disorder.
Method:
The PubMed database was searched for empirical studies which had directly compared body dysmorphic disorder and obsessive-compulsive disorder groups across any subject matter. Of 379 records, 31 met inclusion criteria and were reviewed.
Results:
Evidence of similarities between body dysmorphic disorder and obsessive-compulsive disorder was identified for broad illness features, including age of onset, illness course, symptom severity and level of functional impairment, as well as high perfectionism and high fear of negative evaluation. However, insight was clearly worse in body dysmorphic disorder than obsessive-compulsive disorder, and preliminary data also suggested unique visual processing features, impaired facial affect recognition, increased social anxiety severity and overall greater social-affective dysregulation in body dysmorphic disorder relative to obsessive-compulsive disorder.
Conclusion:
Limitations included a restricted number of studies overall, an absence of studies comparing biological parameters (e.g. neuroimaging), and the frequent inclusion of participants with comorbid body dysmorphic disorder and obsessive-compulsive disorder. Risks of interpreting common features as indications of shared underlying mechanisms are explored, and evidence of differences between the disorders are placed in the context of broader research findings. Overall, this review suggests that the current nosological status of body dysmorphic disorder is somewhat tenuous and requires further investigation, with particular focus on dimensional, biological and aetiological elements.
... outpatient treatment from a clinic that featured long and high intensity sessions to accommodate ERP and address her concerns. Jennifer had to travel about 1.5 (Beck, Steer & Brown, 1996) 16 10 Quality of Life Inventory (Frisch, 1994) 1.25 10 University of Rhode Island Change Assessment Scale (DiClemente & Hughes, 1990) 8.79 Overvalued Idea Scale (Neziroglu et. al., 1999) 7.9 5 Physical Appearance-Related Teasing Scale-Revised (Thompson et. al., 1991) 8 4 Rosenberg Self-Esteem Scale (Rosenberg, 1965) 11 8 The Disgust Scale-Revised (Olatunji et. al., 2007) 50 30 Self-Consciousness Scale (Scheier & Carver, 1985) 47 37 Other As Shame Scale (Goss, Gilbert & Allan, 1994) 26 20 Experience of Shame Scale (Andre ...
Body dysmorphic disorder affects 2.4% of the U.S. adult population, with the most common age of onset between 12 and 13 years. However, research in the area of adolescent BDD is minimal. This case study describes the intensive approach of treatment used for a 14-year-old female diagnosed with BDD. Treatment included an individualized course of cognitive behavioral therapy and exposure and response prevention. BDD symptoms decreased after 27 full-day sessions in an outpatient clinic. In addition, general levels of anxiety decreased and level of functioning increased. Tailoring standard treatments and utilizing developmentally appropriate techniques were significant factors for the adolescent’s success. Implications for future research and treatment are discussed.
Objective
To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD.
Methods
We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient’s home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists.
Results
In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P <0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties.
Conclusions
In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.
Background:
The exploration of metacognition in relation to anxiety has received considerable attention in recent decades. Research indicates that it plays a role in the development and maintenance of anxiety disorders while also providing benefits, including the ability to assess situations, modify behaviors, and make informed decisions.
Summary:
We propose that having an awareness of a disorder, also known as insight, is related to metacognition in anxiety. This relationship stems from the ability it provides individuals to recognize their mental state through reflection on personal experiences. We discuss the impact of insight and metacognition on decision-making, treatment-seeking behaviors, and coping strategy selection.
Key messages:
Understanding the concept of insight in anxiety disorders, as compared to other mental disorders like psychosis, requires exploring its complexities while carefully considering the balance of harms and benefits. While the medicalization of symptoms in psychosis is widely regarded as clearly beneficial, evaluating the role of insight in anxiety disorders demands a more nuanced understanding. Gaining a fuller perspective on patients' beliefs can impact their behaviors and decision-making. Clinicians can achieve this by encouraging active self-reflection to increase awareness, which includes evaluating both severity and impact on daily functioning. This also involves expressing experiences and exploring attributions of anxiety. This practical approach enables clinicians to understand engagement and treatment-seeking behaviors, allowing them to tailor treatment plans and develop effective coping and management strategies. Ultimately, this knowledge promotes a deeper comprehension of insight into anxiety disorders.
Цель: представить обзор данных отечественных и зарубежных авторов XIX–XXI вв., занимавшихся проблемой дифференциации сверхценных образований. Результаты: на основании проведенного анализа данных литературы выделены главные направления, объединяющие достаточно противоречивые взгляды исследователей на психопатологические особенности сверхценных образований. Проведен анализ границ понятия, основных критериев диагностики и психопатологических особенностей феномена сверхценных образований.
Introduction
The Nepean Beliefs Scale by Brakoulias et al. is an interview-based multidimensional instrument that measures pathological beliefs in various psychiatric disorders. This study examined the reliability and validity of Nepean Beliefs Scale (NBS) for delusions and overvalued ideas in patients with chronic-phase schizophrenia. Methods: Multiple raters at two healthcare settings examined the beliefs of 28 individuals with schizophrenia using the NBS. Concurrently, PANSS, PDI-21, BCIS, PHQ-9 and GAD-7 were administered.
Results
The NBS had high reliability and correlation with relevant scales.
Discussion
The NBS was found to have sufficient reliability and validity for assessing the pathological beliefs of patients with chronic schizophrenia. Although NBS is an easy-to-instruct instrument, it should be noted that appropriate explanations and examples should be added to instructions to obtain reliable responses from patients with chronic schizophrenia.
Background:
Poor insight in obsessive compulsive disorder (OCD) is associated with higher symptom severity, more comorbidities, and worse response to treatment. This study aims to elucidate underlying mechanisms of poor insight in OCD by exploring its neurobiological correlates.
Methods:
Using a symptom provocation task during functional MRI, we compared brain activation of patients with poor insight (n=19; 14 female, 4 male), good/fair insight (n=63; 31 female, 32 male) and healthy controls (n=42; 22 female, 20 male) using a Bayesian region-of-interest and a general linear model whole-brain approach. Insight was assessed using the Overvalued Ideas Scale.
Results:
Compared with patients with good/fair insight and healthy controls, patients with OCD and poor insight showed widespread lower task-related activation in frontal areas (subgenual anterior cingulate cortex, ventromedial prefrontal cortex, dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, supplementary motor area, precentral gyrus), parietal areas (posterior parietal cortex, precuneus), middle temporal gyrus and insula. Results were not driven by inter-individual differences in OCD symptom severity, medication usage, age of disorder onset or state distress levels.
Conclusions:
During symptom provocation, OCD patients with poor insight show altered activation in brain circuits that are involved in emotional processing, sensory processing and cognitive control. Future research should focus on longitudinal correlates of insight and/or use tasks that probe emotional and sensory processing and cognitive control.
Definitions of clinical insight have changed over the course of the 20th century. Indeed, when viewed from a historical lens, the clinical literature contains multiple and diverse conceptualizations of insight. Yet, in contemporary clinical discourse, insight is typically conceived as the extent to which a person identifies as having a mental disorder that requires treatment. The present study traced the evolution of the clinical insight concept during the mid-to-late 20th century. In doing so, this project demonstrated the application of psychological research methods to the study of scholarly and scientific discourses in psychology. We conducted a systematic analysis of 125 archival texts from the 1940s to the 1990s. Qualitative and quantitative data analysis revealed diverse conceptualizations of insight that evolved over time. The transition to the 1990s was marked by shifts from conceptualizations of insight as awareness of self-experience to definitions focusing on awareness of a mental disorder. Additional analyses revealed between-decade differences in the extent to which insight was viewed as continuous and diachronic, as well as in reference to mental components and mechanisms. Discussion of these findings addresses the clinical and societal implications of shifting insight definitions, including ways in which these shifts have informed clinical research and practice.
Background
Assessing insight among OCD-affected youth has been limited by the absence of a multi-item measure for this population. The present study outlines the development of the Measure of Insight for Obsessive-Compulsive Disorder (MI-OCD), presents initial findings, and explores conceptual challenges.
Methods
Along with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the 7-item MI-OCD was administered to 178 OCD-affected youth aged 7–19 (mean age = 13.5, SD = 2.8; 55% female) presenting for assessment across three OCD-specialty clinics. Items 4–7 were only completed by those with an identified feared outcome (61%).
Results
MI-OCD items were positively correlated with the CY-BOCS’ insight question, but were not related to age or avoidance. Correlations and factor analysis indicated items coalesced around concepts of symptoms as unwanted (1–3) and symptoms as useful/valid (4–7), although factor fit and internal consistency was sub-optimal. Most youth perceived their symptoms as unwanted (positively correlated with severity), while the extent to which youth perceived symptoms as useful was more varied (not associated with severity).
Discussion
Insight remains a challenging construct to assess in youth given various developmental, psychological, and environmental confounds. The MI-OCD may be useful in the context of evaluating and addressing individual barriers to treatment engagement over time.
Background
Previous studies examining potential relationships of impaired insight with severity obsessive-compulsive (O-C) symptoms and depressive symptoms in patients diagnosed with obsessive-compulsive disorder (OCD) have produced mixed results. Here, we examined differences in these clinical characteristics and their changes after treatment in adult patients with OCD who have poor insight (OCD-PI) versus in those who have good insight (OCD-GI).
Methods
Fifty-nine full-text articles were screened for eligibility with 20 studies ultimately being included in the present meta-analysis.
Results
The OCD-PI and OCD-GI groups differed from each other with respect to O-C symptom (p < 0.001, g > 0.7) and depressive symptom (p < 0.001, g = 0.614) severity. Significant and moderate correlations were observed between insight and treatment outcomes (O-C symptoms, r = 0.33; depressive symptoms, r = 0.47). Exploratory meta-regression showed that methodological factors influenced the magnitudes of inter-group O-C symptom differences.
Conclusions
The current meta-analysis indicates that poorer insight is associated with more severe O-C and depression, and less improvement of symptoms in patients with OCD. Insight impairment may be a critical and core OCD-related deficit.
Background: Obsessive Compulsive Disorder (OCD) is among the top ten devastating mental disorders. Psychiatric nurses have significant roles in its diagnosis and management.
Aim of the study: to investigate the effects of insight with obsessive beliefs and metacognition appraisal on the severity of symptoms among patients with OCD.
Subjects and methods: This case-control study was conducted in the outpatient clinics at El Maamoura Mental Health Hospital. It included 69 OCD patients recruited from the setting, and 69 age- and gender-matched healthy controls. A self-administered questionnaire Yale Brown OCD Scale, Overvalued Ideas Scale (OVIS), and Metacognitions Questionnaire (MCQ-30) was used in data collection. The fieldwork was from October 2020 to March 2021.
Results: Most patients were diagnosed with OCD at <30 years age (78.3%), and 39.1% tried self-management. OCD patients’ scores of Yale Brown, OVIS, and MCQ-30 were significantly higher than controls (p<0.001). A significant positive correlation was found between Yale Brown severity and OVIS insight scores (r=0.459). The multivariate analysis revealed that OVIS score is the strongest independent positive predictor of the Yale Brown severity score, while good family relations is a negative predictor. As for the MCQ-30, the control thoughts score was a positive predictor, and the self-consciousness score a negative predictor.
Conclusion and recommendations: OCD patients have poorer insight and more maladaptive metacognitive beliefs in comparison with healthy controls. Although poor insight has a significant negative impact on OCD severity, the effects of metacognition still need further research. The study recommends training programs to improve the insight of OCD patients. Further research addressing the role of metacognition in OCD is warranted.
Objective
There is substantial research examining insight in psychotic disorders and in some nonpsychotic disorders. However, there has been little attention given to many nonpsychotic disorders. Research on insight in psychosis distinguishes between cognitive and clinical insight. In most studies examining insight in nonpsychotic disorders, definitions and assessments of insight vary significantly. The purpose of this review is to suggest a definition of insight in nonpsychotic disorders such that it can be used across different disorders.
Method
We systematically review the extant literature of insight in nonpsychotic disorders and analyze the assessments used in order to determine how well they capture these two types of insight. Then, we discuss how these two constructs can provide better understanding of the phenomenology of insight in nonpsychotic disorders.
Results
The systematic search resulted in 99 articles. These articles used 17 different methods of measuring insight, containing 127 questions. Results of the content analysis of items suggested that measures of insight used in nonpsychotic disorders do not distinguish between cognitive and clinical insight, but that most questions (90%) can indeed be reliably differentiated.
Conclusion
We provide a multidimensional model of cognitive and clinical insight in nonpsychotic disorders, emphasizing the complexity of assessment and the importance of accurately defining insight. Such definitions have important theoretical and clinical implications, offering a better understanding of the concept of insight in nonpsychotic disorders.
Background:
Childhood obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric condition, with varied symptom presentations that have been differentially associated with clinical characteristics and treatment response. One OCD symptom cluster of particular interest is religious symptoms, including fears of offending religious figures/objects; patients affected by these symptoms have been characterized as having greater overall OCD severity and poorer treatment response. However, the extant literature primarily examines this symptom subtype within adults, leaving a gap in our understanding of this subtype in youth.
Method:
Consequently, this study examined whether presence of religious symptoms in OCD-affected children and adolescents (N = 215) was associated with greater clinical impairments across OCD symptoms and severity, insight, other psychiatric comorbidity, family variables, or worse treatment response.
Results:
Results found that youth with religious OCD symptoms presented with higher OCD symptom severity and exhibited more symptoms in the aggressive, sexual, somatic, and checking symptom cluster, as well as the symmetry, ordering, counting, and repeating cluster. Religious OCD symptoms were also significantly associated with poorer insight and higher family expressiveness. No differences in treatment response were observed in youths with versus without religious OCD symptoms.
Conclusion:
Ultimately, youths with religious OCD symptoms only differed from their OCD-affected counterparts without religious symptoms on a minority of clinical variables; this suggests they may be more comparable to youths without religious OCD symptoms than would be expected based on the adult OCD literature and highlights the importance of examining these symptoms within a pediatric OCD sample.
Background
Group cognitive–behavioural therapy (G‐CBT) for hoarding disorder (HD) may be an intervention of choice, considering its efficacy, low costs, and impact on comorbid anxiety and depression. But although G‐CBT and modifications of G‐CBT have been applied, none has assessed G‐CBT efficacy at follow‐up. In the current open‐label pilot study, we tested the efficacy of G‐CBT at posttreatment and 6‐month follow‐up and whether the inclusion of targeted reasoning and self‐identity components added to G‐CBT efficacy.
Methods
Participants (n = 16) with the HD according to the DSM‐5 criteria without major comorbid conditions and not requiring immediate medical intervention were retained. The intervention included a 20‐week G‐CBT with the inclusion of modules on reasoning and self‐identity.
Results
Very large/large effect sizes, depending on the outcome measure, were observed at posttreatment. Also, HD severity decreased from posttreatment to 6‐month follow‐up. All participants showed reliable change from pretreatment to follow‐up.
Conclusions
The results emphasize the efficacy of G‐CBT with additional targeted reasoning and self‐components.
Cognitive distortions and biases are essential in understanding and treating obsessive compulsive disorder (OCD) according to cognitive-behavioral treatment (CBT) models, which have dominated the understanding and treatment of OCD. The Obsessive Beliefs Questionnaire (OBQ) has been used extensively as a measure of cognitive beliefs relevant in OCD. It demonstrates good internal consistency and criterion-related validity in both clinical and nonclinical samples. This chapter examines what measures of the obsessions and dysfunctional beliefs are available that could aid in the assessments of cognitive aspects and what value they have demonstrated in the treatment of OCD. In contrast to the OBQ, which was designed to assess general beliefs (traits) relevant to OCD, the Interpretation of Intrusions Inventory (III) is a semi-idiographic self-report questionnaire designed to measure immediate appraisals (states) or interpretations of intrusions. Some divergence in beliefs is found in various cultures since ethnicity, religion, and other aspects of culture could influence the expression of OCD.
This chapter briefly reviews research on early attempts to treat hoarding, explains the basis for recently developed treatments for hoarding disorder (HD) (the cognitive behavioral model of HD), and describes the treatment, including the role of insight and motivation along with strategies for addressing the specific manifestations of HD (excessive acquisition, disorganization, and difficulty discarding). Early studies of psychological treatment for hoarding employed standard exposure based methods designed for obsessive compulsive disorder (OCD). These treatments assumed hoarding to be a subtype of OCD, and that cognitive behavior therapy (CBT) for OCD would be the treatment of choice. Recent evidence suggests that both genetic and neurobiological factors play a role in hoarding. Deficits in the way information is processed characterize people who hoard. A major component of hoarding disorder involves the beliefs about and meanings given to possessions. These beliefs and features form the backdrop for hoarding and will become the major focus in treatment.
The bygone notion of a “fixed idea” has evolved into an appreciation for overvalued beliefs, automatic thoughts, irrational beliefs, and dysfunctional attitudes and the role they can play in the lives of many clients. Overvalued beliefs are common and can be destructive when they guide the client toward extreme emotional reactions, disruptive behavioral patterns or create negative views of self or others. Overvalued beliefs become problematic when they are not aligned with commonly accepted views of reality, they are rigidly maintained despite insufficient evidence, and they create maladaptive self-perpetuating patterns. A metaphor is used to explain how minor puddles can evolve into major potholes, creating lasting damage. The destructive power of puddles shares some similarities with the subtle influence of overvalued beliefs on a client’s emotional and interpersonal functioning. Psychotherapy can help clients to confront the misguided accuracy, limited utility, and exaggerated potency of their beliefs. Therapy can help clients to disengage from the directive power of their beliefs, learning to tolerate various thoughts without reacting at an emotional or behavioral level.
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.
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)
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)
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.
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.
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.
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.
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.
Synopsis
Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as 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.
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.
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.
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.
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.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.