Article

Assessing Sexual Orientation Symptoms in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT)

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Abstract

Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one’s sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current manuscript details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure’s twelve items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears, Factor 2: Somatic Checking), and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.

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... It is important to note that such avoidance in heterosexual individuals with OC concerns about sexual orientation is rarely motivated by homophobia. In a recent psychometric validation of a measure of OC concerns about sexual orientation with a large sample of 1399 heterosexual college students, scores on this measure were not significantly correlated with scores on another measure of negative and prejudiced attitudes toward gay and lesbian individuals (Williams et al., 2017). Rather, heterosexual individuals with OC concerns about sexual orientation are mainly concerned about no longer being able to enjoy romantic, intimate heterosexual relationships, should their sexual orientation transform against their will (Williams, 2008;Williams, Wetterneck, Tellawi, & Duque, 2015b). ...
... respectively. Williams et al., 2017) The SORT is a self-report measure of OC concerns about sexual orientation (Williams et al., 2017). The SORT contains 12 items (e.g., "I worry that my sexual orientation may change"). ...
... respectively. Williams et al., 2017) The SORT is a self-report measure of OC concerns about sexual orientation (Williams et al., 2017). The SORT contains 12 items (e.g., "I worry that my sexual orientation may change"). ...
Article
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Disgust has been shown to perform a “disease-avoidance” function in contamination fears. However, no studies have examined the relevance of disgust to obsessive–compulsive (OC) concerns about sexual orientation (e.g., fear of one’s sexual orientation transforming against one’s will, and compulsive avoidance of same-sex and/or gay or lesbian individuals to prevent that from happening). Therefore, we investigated whether the specific domain of contamination-based disgust (i.e., evoked by the perceived threat of transmission of essences between individuals) predicted OC concerns about sexual orientation, and whether this effect was moderated/amplified by obsessive beliefs, in evaluation of a “sexual orientation transformation-avoidance” function. We recruited 283 self-identified heterosexual college students (152 females, 131 males; mean age = 20.88 years, SD = 3.19) who completed three measures assessing disgust, obsessive beliefs, and OC concerns about sexual orientation. Results showed that contamination-based disgust (β = .17), responsibility/threat overestimation beliefs (β = .15), and their interaction (β = .17) each uniquely predicted OC concerns about sexual orientation, ts = 2.22, 2.50, and 2.90, ps < .05. Post hoc probing indicated that high contamination-based disgust accompanied by strong responsibility/threat overestimation beliefs predicted more severe OC concerns about sexual orientation, β = .48, t = 3.24, p < .001. The present study, therefore, provided preliminary evidence for a “sexual orientation transformation-avoidance” process underlying OC concerns about sexual orientation in heterosexual college students, which is facilitated by contamination-based disgust, and exacerbated by responsibility/threat overestimation beliefs. Treatment for OC concerns about sexual orientation should target such beliefs.
... While a case study, clinical observations, and recent findings also suggest that it may be possible for sexual minority individuals to have sexual orientation obsessions about one's orientation changing to a heterosexual orientation, the emphasis here is on the more prevalent presentation of the heterosexual experience of sexual orientation obsessions (Goldberg, 1984;Williams et al., 2018). Individuals with sexual orientation obsessions often doubt and question the significance and meaning of their thoughts and come to interpret these thoughts as indicating they are a sexual minority (Williams, 2008). ...
... It is well established that an adversarial political climate surrounding the LGBQ+ community can create opportunities for resilience or distress (e.g., Russell & Richards, 2003); similar to the coping mechanism of sexual orientation rumination possibility leading to either resilience or distress (Galupo & Bauerband, 2016;Hatzenbuehler, 2009). On the other hand, because research suggests that most individuals experiencing sexual orientation obsessions are predominately heterosexual and not LGBQ+ (Williams et al., 2018), these obsessions appear to develop less as a coping mechanism or reaction to stigma and more as a result of overestimation of negative outcomes (Rachman, 1997) and misinterpretation of one's thoughts (Salkovskis, 1985). Lastly, regarding the last level of Figure 1, if individuals experiencing sexual orientation rumination or sexual orientation obsessions experience associated stress, the origin of that stress appears to differ based on consistency with other aspects of one's sexual orientation, including patterns of social and emotional connection, fantasy, and arousal. ...
... The obsessions, by nature, tend to be inconsistent with an individual's historical patterns of sexual thoughts, attractions, and arousal. However, clinicians must also be careful not to rely too heavily on this distinction, as initial evidence has suggested that individuals struggling with sexual orientation obsessions may eventually identify as LGBQ+ despite initial distress, or experience sexual orientation obsessions and sexual orientation rumination concurrently (Williams et al., 2018). ...
Article
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Two concepts that describe repetitive thoughts regarding an individual’s sexual orientation—sexual orientation rumination and sexual orientation obsessions—have been introduced into the research literature. Despite the fact that these concepts have similarities, important distinctions exist with regard to their theoretical underpinnings, development, and catalyst of stress. As these concepts have never been teased apart in the research literature, understanding how these concepts are similar and different is particularly important. To this end, the present overview synthesizes the current literature regarding these concepts with the purpose of providing a decisional framework for differentiating sexual orientation rumination and sexual orientation obsessions and suggesting areas of future research.
... McCloskey's hypothesis that homosexuality would not be a topic of obsessive thinking in a non-homophobic society is dependent on and limited to the studies that have examined SO-OCD in heterosexual patients to the detriment of LGBTQA+ people. However, previous research has pointed to the existence of LGBTQA+ people who obsess about their sexual identity as well (e.g.,Williams et al. 2018; ...
Thesis
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This study is broadly an exploration of how people who suffer from sexual orientation OCD (SO-OCD) and gender identity OCD (GI-OCD) use language to construct their identity, and how that process is framed by (hetero)normative idealogies. Instead of writing the abstract of the study (which you can find on page 4), I will highlight the different chapters that might be the most interesting for different readers: PSYCHOLOGISTS WORKING ON OCD should especially read: - CHAPTER 1 where I review the literature on OCD, and especially section 1.4 where I identify the gap my project fills. - CHAPTER 3 where I operationalize the concept of the feared self not as a fixed cognitive construct, but one that is discursively negotiated through language. - CHAPTERS 6-9 a detailed analysis of OCD sufferers' language use and how they construct their identity by distancing themselves from their feared self. - CHAPTER 10 is really where my argument comes together. I interpret the linguistic findings from chapters 6-7 through queer theory and Foucauldian self-governmentality. I especially argue that by distancing from a feared self, OCD sufferers run towards what I call an "idealized pure self" that is always and only the identity they wish to embody. This idealized self is constituted by a strong adherence to heteronormative understandings of gender and sexuality. The idea of a "pure self" is inscribed withing a sociocultural frame that has constructed sexuality as the locus of the "true self". In addition, I challenge the assumption that homophobia is the sociocultural factors causing SO-OCD. I demonstrate that this assumption doesn't account for LGBTQA+ OCD sufferers who obsess about being not LGBTQA+. As such, I suggest to conceptualize OCD not as a fear of "becoming" something that is socially taboo, but rather as a fear of "losing" something that is socially cherished. This fear of becoming or losing are two sides of the same coin that are shaped by (hetero)normative Discourses. Thus, the sociocultural factor shaping SO-/GI-OCD fears is argued to be tied to the notion of normativity. - CHAPTER 11: summarizes the whole study and section 11.3 explicitly states the contributions to the research on OCD SOCIOLINGUISTS INTERESTED IN LANGUAGE, GENDER, SEXUALITY & CORPUS LINGUISTICS should read: - Chapter 2 reviews Foucault's work on self-governmentality, queer theory and how all of this can be operationalized through linguistics - One of the major contributions of my thesis to sociolinguistics is a methodological one. In fact, I triangulated corpus-assisted discourse analysis with ethnographic approaches. Chapter 4 describes how I constructed a forum and conducted a 18 month long ethnography (or netnography), and CHAPTER 5 describes the methodic steps in my analysis. - CHAPTERS 6-9 are a detailed accounts of my participants' language use. - CHAPTER 10 interprets the findings through queer theory (see above), and section 10.5 suggests an additional way to conceptualize normativity in the field of language, gender and sexuality. - CHAPTER 11 gives a summary of everything, and sections 11.4 and 11.5 explicitly highlight the contributions to sociolinguistics and avenues for future research.
... Table 1 also displays the OCD-related outcome measures used in each of the six studies. These were: the clinicianadministered version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) [37,38] and its self-report version (Y-BOCS-SR) [ [42]; the Sexually Intrusive Thoughts Scale (SIT) [43]; as well as the White Bear Suppression Inventory (WBSI) [44]. The Y-BOCS and Y-BOCS-SR, both assess the severity of obsessions and compulsions as a total score, differing only in their format of administration; in the former, the clinician assesses the severity of participants' most significant types of OCD symptoms identified from a large checklist, while in the latter, participants peruse examples of different types of obsessions and compulsions prior to responding. ...
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The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a widely used clinician-rated measure for assessing obsessive-compulsive symptoms. Although numerous studies have supported its reliability and validity, improved phenomenological understanding of obsessive-compulsive disorder (OCD) suggests the need for modifications to item content, structure, and scoring. Consequently, the Yale-Brown Obsessive Compulsive Scale – Second Edition (Y-BOCS-II) was developed. While the Y-BOCS-II shows initial promise, minimal data exist in examining the psychometric properties of the Y-BOCS-II English version. In response, the Y-BOCS-II was administered to 61 adult patients with a principal diagnosis of obsessive-compulsive disorder. The internal consistency for the scores on the Obsession Severity (α = .83), Compulsion Severity (α = .75), and Total Severity (α = .86) scales were acceptable to good. The inter-rater reliability for the severity scale scores was excellent (ICC = .97 - .99) and the test-retest reliability was acceptable (r = .64 - .81). Strong convergent validity was observed between the Y-BOCS-II Total Severity scale and other measures of obsessive-compulsive symptom severity and related impairment. Good divergent validity was supported by non-significant correlations between the Total Severity score and measures of anxiety and impulsiveness, though a moderate correlation was observed with depressive symptoms. Collectively, the Y-BOCS-II generally possesses sound psychometric properties and appears to be a viable alternative to the original Y-BOCS.
Article
Objective: Three issues relevant to revising the DSM-III-R criteria for obsessive-compulsive disorder were examined in a field trial: 1) the requirement that symptoms of obsessive-compulsive disorder be viewed by the patient as excessive or unreasonable, 2) the presence of mental compulsions in addition to behavioral compulsions, and 3) ICD-10 subcategories. Method: The authors studied symptom patterns of obsessive-compulsive disorder as well as strength of obsessive belief among 431 patients with obsessive-compulsive disorder at seven hospital outpatient clinics. Two methods of subject selection were used: consecutive entry of everyone who contacted the clinics for evaluation of obsessive-compulsive disorder and entry of patients with obsessive-compulsive disorder who had continuing contact with the clinics since before the field trial and who were still symptomatic. Primary measures were the Yale-Brown Obsessive Compulsive Scale and face-valid questions about fixity of obsessive-compulsive beliefs. Results: The large majority of patients were uncertain about whether their obsessive-compulsive symptoms were unreasonable or excessive, and most had both mental and behavioral compulsions. Results on the ICD-10 subcategories were equivocal. Conclu- sions: The present results converge with previous findings to indicate a broad range of insight among patients with obsessive-compulsive disorder. The DSM-III-R requirement for insight should be de-emphasized in DSM-IV, and mental rituals should be included in the definition of compulsions.
Article
Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD), often classified in a broader symptom dimension that includes aggressive and religious obsessions, as well. Indeed, the Dimensional Obsessive-Compulsive Scale (DOCS) Unacceptable Thoughts Scale includes obsessional content relating to sexual, violent, and religious themes associated with rituals that are often covert. However, there is reason to suspect that sexual obsessions differ meaningfully from other types of unacceptable thoughts. We conducted two studies to evaluate the factor structure, initial psychometric characteristics, and associated clinical features of a new DOCS scale for sexually intrusive thoughts (SIT). In the first study, nonclinical participants (N=475) completed the standard DOCS with additional SIT questions and we conducted an exploratory factor analysis on all items and examined clinical and cognitive correlates of the different scales, as well as test-retest reliability. The SIT Scale was distinct from the Unacceptable Thoughts Scale and was predicted by different obsessional cognitions. It had good internal consistency and there was evidence for convergent and divergent validity. In the second study, we examined the relationships among the standard DOCS and SIT scales, as well as types of obsessional cognitions and symptom severity, in a clinical sample of individuals with OCD (N=54). There were indications of both convergence and divergence between the Unacceptable Thoughts and SIT scales, which were strongly correlated with each other. Together, the studies demonstrate the potential utility of assessing sexually intrusive thoughts separately from the broader category of unacceptable thoughts. Copyright © 2015. Published by Elsevier Ltd.
Article
Several studies have demonstrated the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (YBOCS) conducted by trained interviewers. The present study examined several aspects of a self-report YBOCS version relative to the usual interview format in two non-clinical samples (ns = 46 and 70) and in a clinical OCD sample (n = 36) and a clinical non-OCD group (n = 10). The self-rated instrument showed excellent internal consistency and test-retest reliability, performing somewhat better than the interview. There was good agreement between symptom checklist categories across the two versions, though clinical subjects reported more symptoms on the self-report form than on the interview. Some order effects were evident for non-clinical subjects only: those who received the self-report first scored lower on both self-report and interview than those who received the interview first. No order effects were observed in the clinical sample. The self-report version showed strong convergent validity with the interview, and discriminated well between OCD and non-OCD patients. Although more study is needed, particularly on clinical samples, these findings suggest that the self-report YBOCS may be a time-saving and less costly substitute for the interview format in assessing OCD symptoms.
Article
• The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.
Article
Sexual orientation obsessions in OCD (SO-OCD) are common but under-recognised and frequently misdiagnosed. SO-OCD may include worries of experiencing an unwanted change in sexual orientation, fears that others may perceive one as a member of the lesbian, gay, bisexual, transgendered (LGBT) community, or fear that one has hidden same sex desires. The phenomenology of SO-OCD is described and contrasted with internalised homophobia/heterosexism. Examples of SO-OCD and related obsessions and compulsions are provided. Cognitive behavioural treatment of SO-OCD with exposure and ritual/response prevention (Ex/RP) is described using psycho-education, in vivo exposure, imaginal exposure, and ritual/response prevention, along with mindfulness/acceptance approaches. Due to the extreme distress caused by sexual orientation symptoms, it is important that clinicians properly identify and treat this manifestation of OCD. 3
Article
Although sexual obsessions in obsessive-compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions in OCD are particularly distressing due to the ego-dystonic nature of the obsessions and, often, stigma surrounding a same-sex orientation. The purpose of this study was to better understand distress in people suffering from sexual orientation obsessions in OCD. Data were collected online (n = 1,176) and subjects were 74.6 % male, 72.0 % heterosexual, and 26.4 % with an OCD diagnosis from a professional. The survey consisted of 70 novel questions that were assessed using a principal components analysis and the items separated into six components. These components were then correlated to distress among those with a prior OCD diagnosis and sexual orientation obsessions. Results indicated that sexual orientation obsessions in OCD were related to severe distress, including suicidal ideation. Implications of these findings and future directions for research are discussed.
Article
The Threat (Part 1, Chapter 1) […] The bisexual resembles the spy in that he or she moves psychosexually freely among men and among women. The bisexual also resembles the traitor in that he or she is in a position to know the secrets of both camps, and to play one against the other. The bisexual, in short, is seen as a dangerous person, not to be trusted, because his or her party loyalty, so to speak, is nonexistent. And if one lacks this sort of loyalty, one is so far outside the human sexual pale that one is virtually nonexistent. […] In our society, with its strong negative view of homosexual behavior of any kind, it is quite understandable when bisexuals, or "closet" homosexuals, disguise their beha-vior. But bisexuality is not disguised homosexuality, nor is it disguised heterosexuality. It is another way of sexual expression. Although it contains elements of both heterosexual and homosexual behavior, it is a way of being, in and of itself, a way neither better nor worse than the more accepted ways of healthy heterosexuality and healthy homosex-uality. To most heterosexuals and homosexuals, the bisexual is an alien being whose dual sex-uality opens up the possibility of their own sexual ambiguity. They cannot understand the bisexual's ability to share their own preferences but not their own aversions. The heterosexual's erotic preferences and aversions usually do not permit an under-standing of the homosexual. Homosexuals as well are baffled by attraction to the op-posite sex. This creates two distinct camps from which banners can be flown. And though they may be ideological threats to each other, the two camps are as clearly dis-tinct as, in the heyday of the cold war, the American eagle and the Russian bear. Their threat to each other is familiar, and the battle lines are clear-cut. The wish to avoid conflict is natural and essential to life. Without peace of mind (if only of the kind available to the Sunday golfer), madness nips at our heels. Should we fail to defend ourselves, it will go for our throats. In our time, peace of any kind may be available only to the few who know themselves – and the many who keep their heads "securely" in the sand. Denial is one of the classic mechanisms by which this brand of security is sustained. For the heterosexual male, for example, the homosexual male's behavior may contain components of his own, but denial of the homosexual's label (and thence his role) is relatively easy. The heterosexual is not free to identify beyond certain vague, "neuter" acts, such as kissing or being fellated. But this same male confronted with a bisexual male must, if only unconsciously, deal with his own possible sexual ambiguity. The reason he is relieved to hear that the bisexual does not exist is that he thereby avoids his own inner conflict. If a homosexual male finds other males attractive, that fact has nothing to do with the heterosexual. But if a bisexual male finds both men and women attractive, that does have something to do with him in a way too close for comfort. The possibility of identification then is considerably broader. When the head in the sand comes up for air, what it sees may be unbearable.
Article
Sexual orientation symptoms in OCD (SO-OCD) are common but under-recognized and frequently misdiagnosed. SO-OCD may include worries of experiencing an unwanted change in sexual orientation, fears that others may perceive one as a member of the lesbian/gay/ bisexual/transgendered (LGBT) community, or fear that one has hidden same-sex desires. In this paper, research to date on SOOCD is reviewed, and the phenomenology of SO-OCD is described and contrasted with internalized homophobia/heterosexism (IH). Examples of SO-OCD and related obsessions and compulsions are provided. Cognitive behavioral treatment of SO-OCD is detailed using psychoeducation, in vivo exposure, imaginal exposure, ritual/response prevention, and mindfulness/acceptance approaches. Due to the extreme distress caused by sexual orientation symptoms, it is important that clinicians properly identify and treat this manifestation of OCD.
Article
Abstract Objective: Determine the extent to which personal, behavioral, and environmental factors are associated with HIV/STI testing and disclosure. Participants: 930 HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. Methods: Correlates of testing and disclosure significant in bivariate analyses (p<0.05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. Results: About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. Conclusions: Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.
Article
More than a decade may pass between the onset of obsessive-compulsive disorder (OCD) symptoms and initiation of treatment. One explanation may be health care professionals' limited awareness of OCD symptom presentations. We assessed mental health care providers' ability to identify taboo thoughts as manifestations of OCD. A random sample of 2,550 American Psychological Association members were asked to give diagnostic impressions based on 1 of 5 OCD vignettes: 4 about taboo thoughts and 1 about contamination obsessions. Three-hundred sixty (14.1%) providers completed the survey. The overall misidentification rate across all vignettes was 38.9%. Rates of incorrect (non-OCD) responses were significantly higher for the taboo thoughts vignettes (obsessions about homosexuality, 77.0%; sexual obsessions about children, 42.9%; aggressive obsessions, 31.5%; and religious obsessions, 28.8%) vs the contamination obsessions vignette (15.8%). Mental health professionals commonly misidentify OCD symptom presentations, particularly sexual obsessions, highlighting a need for education and training.
Article
Background: Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. Currently, the cognitive-behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP); however, clinical impression and some empirical data suggest that certain OCD symptoms are more responsive to treatment than others. Methods: Prior work identifying symptom dimensions within OCD is discussed, including epidemiological findings, factor analytic studies, and biological findings. Symptom dimensions most reliably identified include contamination/cleaning, doubt about harm/checking, symmetry/ordering, and unacceptable thoughts/mental rituals. The phenomenology of each of these subtypes is described and research literature is summarized, emphasizing the differential effects of EX/RP and its variants on each of these primary symptom dimensions. Results: To date it appears that EX/RP is an effective treatment for the various OCD dimensions, although not all dimensions have been adequately studied (i.e. symmetry and ordering). Conclusions: Modifications to treatment may be warranted for some types of symptoms. Clinical implications and directions for future research are discussed.
Article
Reviews how sexual orientations have been measured historically, and provides a review of the strengths and limitations of each measure. Measures of sexual orientation are categorized as: (1) dichotomous, (2) bipolar (such as the Unsey Scale), (3) multidimensional (such as the Mein Scale), and/or (4) orthogonal (such as the scale proposed by Shively and DeCecco). A new measure of sexual orientation, the Sell Assessment of Sexual Orientation, is proposed based upon this review. Finally, methods of scoring and summarizing the proposed measure are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The criterion validity of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) was investigated by pairing blind BDI-II administrations with the major depressive episode portion of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I; M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1997) in a sample of 137 students receiving treatment at a university counseling center. Student BDI-II scores correlated strongly ( r=.83) with their number of SCID-I depressed mood symptoms. A BDI-II cut score of 16 yielded a sensitivity rate of 84% and a false-positive rate of 18% in identifying depressed mood. Receiver operating characteristic analyses were used to produce cut scores for determining severity of depressed mood. In a second study, a sample of 46 student clients were administered the BDI-II twice, yielding test-retest reliability of .96. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Background: Despite the increasing dissemination of treatment for Obsessive–Compulsive Disorder (OCD) in the past decade, the majority of individuals with OCD are not receiving appropriate treatment. This study examined rates of treatment utilization and barriers to treatment in an internet sample of individuals with self-reported OCD. Methods: One hundred and seventy-five participants completed an online survey examining OCD symptoms, psychosocial measures, barriers to treatment, and treatment utilization. Results: Sixty percent of the sample reported receiving treatment for their OCD symptoms. The majority of participants who sought pharmacotherapy received SSRIs, whereas the majority who sought psychotherapeutic treatment received “talk therapy.” The cost of treatment, lack of insurance coverage, shame, and doubt that treatment would be effective were the most commonly endorsed barriers to treatment among the sample. Conclusions: Findings demonstrated relatively low treatment utilization rates among the sample, with many participants receiving treatments other than the gold-standard medication and psychotherapy treatments (i.e. SSRIs and cognitive behavioral therapy, respectively). Furthermore, a large portion of the sample endorsed many barriers to treatment seeking, such as logistic and financial barriers; stigma, shame, and discrimination barriers; and treatment perception and satisfaction barriers. This study highlights the need for more effective treatment dissemination in OCD. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.
Article
Background: Several studies have identified discrete symptom dimensions in obsessive-compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC). This study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Because these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called "pure obsessions" may have been overlooked. Method: Participants (N = 201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms, as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis. Results: Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts). Conclusions: This study suggests that the concept of the "pure obsessional" (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria.
Article
Presented is a case report of exposure and ritual prevention (EX/RP) therapy administered to a 51-year-old, White, heterosexual male with sexual-orientation obsessions in obsessive-compulsive disorder (OCD). The patient had been previously treated with pharmacotherapy, resulting in inadequate symptom reduction and unwanted side effects. OCD symptoms included anxiety about the possibility of becoming gay, mental reassurance, and avoidance of other men, which resulted in depressive symptoms and marital distress. The patient received 17 EX/RP sessions, administered twice per week. The effect of treatment was evaluated using standardized rating instruments and self-monitoring by the patient. OCD symptoms on the Yale-Brown Obsessive Compulsive Scale (YBOCS) fell from 24 at intake to 3 at posttreatment and to 4 at a 6-week follow-up, indicating minimal symptoms. Improvement also occurred in mood, quality of life, and social adjustment. Issues concerning the assessment and treatment of homosexuality-themed obsessions in OCD are highlighted and discussed.
Article
Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD) that may be particularly troubling to patients. However, little research has examined concerns surrounding sexual orientation, which includes obsessive doubt about one's sexual orientation, fears of becoming homosexual, or fears that others might think one is homosexual. The present study reports rates and related characteristics of individuals with sexual orientation obsessions in a clinical sample. Participants from the DSM-IV Field Trial (n=409; Foa et al., 1995) were assessed with the Yale-Brown Obsessive Compulsive Symptom Checklist and Severity Scale (YBOCS). We found that 8% (n=33) reported current sexual orientation obsessions and 11.9% (n=49) endorsed lifetime symptoms. Patents with a history of sexual orientation obsessions were twice as likely to be male than female, with moderate OCD severity. Time, interference, and distress items from the YBOCS obsessions subscale were significantly and positively correlated with a history of obsessions about sexual orientation. Avoidance was positively correlated at a trend level (p=0.055). Obsessions about sexual orientation may be associated with increased distress, interference, and avoidance, which may have unique clinical implications. Considerations for diagnosis and treatment are discussed.
Article
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989) is acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. A number of areas where the Y-BOCS may benefit from revision have emerged in past psychometric studies of the Severity Scale and Symptom Checklist. Therefore, we created the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) by revising the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format. One hundred thirty treatment-seeking adults with OCD completed a battery of measures assessing OCD symptom severity and typology and depressive and anxious symptomology. Interrater and test-retest reliability were assessed on a subsample of participants. The Y-BOCS-II showed strong internal consistency for the Symptom Checklist (Kuder-Richardson-20 = .91) and Severity Scale (alpha = .89). Test-retest and interrater reliabilities were both high (intraclass correlations > .85). Confirmatory factor analyses did not show adequate fit with previous models of the Y-BOCS. Exploratory factor analysis revealed a two-factor solution generally consistent with the Obsession and Compulsion Severity subscales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of worry and depressive symptoms. Taken together, the Y-BOCS-II has excellent psychometric properties in assessing the presence and severity of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS-II may provide an alternative method of assessing symptom presence and severity.
Article
Despite the increasing dissemination of treatment for Obsessive-Compulsive Disorder (OCD) in the past decade, the majority of individuals with OCD are not receiving appropriate treatment. This study examined rates of treatment utilization and barriers to treatment in an internet sample of individuals with self-reported OCD. One hundred and seventy-five participants completed an online survey examining OCD symptoms, psychosocial measures, barriers to treatment, and treatment utilization. Sixty percent of the sample reported receiving treatment for their OCD symptoms. The majority of participants who sought pharmacotherapy received SSRIs, whereas the majority who sought psychotherapeutic treatment received "talk therapy." The cost of treatment, lack of insurance coverage, shame, and doubt that treatment would be effective were the most commonly endorsed barriers to treatment among the sample. Findings demonstrated relatively low treatment utilization rates among the sample, with many participants receiving treatments other than the gold-standard medication and psychotherapy treatments (i.e. SSRIs and cognitive behavioral therapy, respectively). Furthermore, a large portion of the sample endorsed many barriers to treatment seeking, such as logistic and financial barriers; stigma, shame, and discrimination barriers; and treatment perception and satisfaction barriers. This study highlights the need for more effective treatment dissemination in OCD.
Article
This paper reviews published randomized trials in North America to determine whether minority groups are underrepresented in clinical trials of OCD. A search of the literature produced 40 randomized trials of both adults and children with OCD, conducted in the U.S. and Canada from 1989 to 2009 (N = 3777). The groups included in this review were Caucasians/European Americans, Black/African-Americans, Hispanic/Latino-Americans, Asian-Americans, Others, and Unknown. Of these, 22 of 40 trials reported ethnic/racial information or data was available by request. We focused on the 21 trials from 1995 to 2008 providing ethnic/racial information, and among those (N = 2221), 91.5% of participants were Caucasian, 1.3% were African-American, 1.0% were Hispanic, 1.6% were Asian, 1.5% were Other, and 3.1% were Unknown. We conclude that minorities are underrepresented in North American OCD trials. Therefore, it is not known if empirically validated treatments are effective for these groups. Recommendations for improving recruitment of minorities for future studies are discussed.
Article
Self-regulation is a complex process that involves consumers’ persistence, strength, motivation, and commitment in order to be able to override short-term impulses. In order to be able to pursue their long-term goals, consumers typically need to forgo immediate pleasurable experiences that are detrimental to reach their overarching goals. Although this sometimes involves resisting to simple and small temptations, it is not always easy, since the lure of momentary temptations is pervasive. In addition, consumers’ beliefs play an important role determining strategies and behaviors that consumers consider acceptable to engage in, affecting how they act and plan actions to attain their goals. This dissertation investigates adequacy of some beliefs typically shared by consumers about the appropriate behaviors to exert self-regulation, analyzing to what extent these indeed contribute to the enhancement of consumers’ ability to exert self-regulation.
Article
The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.
Article
The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.
Article
Three issues relevant to revising the DSM-III-R criteria for obsessive-compulsive disorder were examined in a field trial: 1) the requirement that symptoms of obsessive-compulsive disorder be viewed by the patient as excessive or unreasonable, 2) the presence of mental compulsions in addition to behavioral compulsions, and 3) ICD-10 subcategories. The authors studied symptom patterns of obsessive-compulsive disorder as well as strength of obsessive belief among 431 patients with obsessive-compulsive disorder at seven hospital outpatient clinics. Two methods of subject selection were used: consecutive entry of everyone who contacted the clinics for evaluation of obsessive-compulsive disorder and entry of patients with obsessive-compulsive disorder who had continuing contact with the clinics since before the field trial and who were still symptomatic. Primary measures were the Yale-Brown Obsessive Compulsive Scale and face-valid questions about fixity of obsessive-compulsive beliefs. The large majority of patients were uncertain about whether their obsessive-compulsive symptoms were unreasonable or excessive, and most had both mental and behavioral compulsions. Results on the ICD-10 subcategories were equivocal. The present results converge with previous findings to indicate a broad range of insight among patients with obsessive-compulsive disorder. The DSM-III-R requirement for insight should be de-emphasized in DSM-IV, and mental rituals should be included in the definition of compulsions.
Article
Construct validity is one of the most central concepts in psychology. Researchers generally establish the construct validity of a measure by correlating it with a number of other measures and arguing from the pattern of correlations that the measure is associated with these variables in theoretically predictable ways. This article presents 2 simple metrics for quantifying construct validity that provide effect size estimates indicating the extent to which the observed pattem of correlations in a convergent-discriminant validity matrix matches the theoretically predicted pattern of correlations. Both measures, based on contrast analysis, provide simple estimates of validity that can be compared across studies, constructs, and measures meta-analytically, and can be implemented without the use of complex statistical procedures that may limit their accessibility.
Article
Two studies examined the psychometric properties of the Obsessive-Compulsive Inventory-Revised (OCI-R; Psychol. Assessment 14 (2002) 485) in a nonclinical student sample. In Study 1, we investigated the factor structure and internal consistency of the OCI-R using a sample of 395 undergraduate students. At a second testing session 1 month later, 178 students completed the OCI-R. Test-retest reliability was examined using data from 94 students who completed the OCI-R in both sessions. Convergent validity was also assessed with the Maudsley Obsessive-Compulsive Inventory (MOCI). In Study 2, we further investigated the convergent and divergent validity of the OCI-R using a new sample of 221 students who completed a battery of measures of obsessive-compulsive symptoms, worry, and depression. There was a significant order effect for both the OCI-R and the MOCI: means of each measure were significantly lower when presented second. Despite the order effect, statistical analyses indicated that the OCI-R has adequate test-retest reliability for the full scale and subscale scores, solid factor structure, and high internal consistency. Convergent validity with other measures of obsessive-compulsive symptoms was moderate to excellent, and divergent validity was good. The results indicate that the OCI-R is a short, psychometrically sound self-report measure of obsessive-compulsive symptoms.
Article
The present study examined the psychometric properties and construct validity of the Obsessive-Compulsive Inventory--Revised (OCI-R) with the aim of replicating and extending previous findings, and addressing limitations of previous investigations. Individuals with OCD (n = 167) and other anxiety disorders (n = 155) completed the OCI-R, measures of OCD and related symptom severity, and measures of cognitive variables associated with OCD symptoms. Results indicate that the OCI-R is a psychometrically sound and valid measure of OCD and its various symptom presentations. Confirmatory factor analysis confirmed a six-factor solution. The instrument also evidenced good convergent validity, and performed well in discriminating OCD from other anxiety disorders. Theoretically consistent patterns of associations between OCI-R symptom-based subscales and OCD-related cognitive variables were found, and five of the six OCI-R subscales corresponded closely to identified OCD symptom dimensions. The OCI-R is recommended as an empirically validated instrument that can be used in a range of clinical and research settings for research on OCD.