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Obsessive-Compulsive Symptoms and Daily Experiences of Posttraumatic Stress and Mental Contamination Following Sexual Trauma
Abstract
Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.
... This systematic review analysed different types of adverse circumstances and events, as well as sexual trauma, that are related to the appearance and severity of MC and, in turn, how the person experiences it as a victim or as a perpetrator. Overall, the majority of the analysed studies focus primarily on the association between MC and sexual trauma [3,5,12,23,25,27,[30][31][32]34,36,38]. However, significant findings have also emerged linking MC to other types of traumas [22,24,26,28,29,31,[33][34][35]. ...
... Fundamentally, research on MC related to disgust and other emotions, in the context of trauma, has been focused on analysing the intrusive thoughts associated with the memory and recalling of the trauma, considering the generated feeling of internal filthiness and the subsequent urge to wash. These intrusive thoughts, images and memories are central elements in the development of both PTSD and OCD, which, along the attempts to avoid stimuli that cause anxiety, are considered mediators in the appearance of MC and capable of generating a variety of different negative emotions [38,40]. ...
... Building on this line of inquiry, more recent work by Badour et al. [38] examined 41 women with a history of sexual trauma, conducting twice-daily assessments over 14 days to investigate the coping strategies they employedboth avoidant and approach-oriented-and their relationship with changes in mental contamination. Their findings revealed that women with more severe MC symptoms reported a more frequent use of a variety of coping strategies, including avoidant behaviours such as distraction, denial, giving up, self-blame, thought suppression, and washing behaviours, as well as approach strategies like emotional processing (identifying and understanding emotions) and emotional expression (openly sharing emotions). ...
Background: Mental contamination (MC) refers to feelings of internal filthiness associated with contamination obsessions. Ego-dystonic memories and thoughts can trigger MC, although it can also be activated by trauma, which is associated with the onset of post-traumatic stress disorder (PTSD). Research shows that MC, negative emotions and PTSD can occur simultaneously. Despite considerable interest from researchers and clinicians, to the best of our knowledge, no systematic review has been carried out on the relationship between disgust and other negative emotions with MC and PTSD. Therefore, we conducted this systematic review to summarise and synthesise the current understanding of these constructs in PTSD. The main objective of this study was to review the association between MC, post-traumatic stress disorder and trauma; the role of disgust and other negative emotions in these associations; and whether the relationship between MC and trauma is limited to traumatic sexual experiences.
... Although Pearson coefficients indicated weak relations, cleaning OCS showed the strongest significantly positive relationships with sexual abuse. This finding was supported by previous studies 29,30 and are generally explained as maladaptive behaviors or thoughts for coping with the "dirtiness" or "guilt", possibly related with childhood sexual abuse. At this point it is useful to mention mental contamination, which is defined as a feeling of internalized dirtiness, self-focused disgust or shame often leading to compulsive cleaning or washing. ...
Background: Obsessive compulsive symptoms (OCS), along with dissociative experiences (DE) are frequently acknowledged as coping strategies in individuals with childhood traumas (CT). Examining these relationships can highlight how early life traumatic events contribute to the emergence of psychopathologies in adulthood. In this study we aimed to investigate the associations between CT, OCS, and DE, and also examined whether DE and CT had a predictive value on OCS in a non-clinical sample of adults. Methods: Three hundred eighty-eight participants (80.7% females, %83.8 university graduates, 55.4% married individuals) between the age of 18-66 years (M=29.09, SD=7.43 years) and with no current psychiatric diagnosis or treatment were evaluated via socio-demographic information form, Padua Inventory (PI), Dissociative Experiences Scale (DES) and Childhood Traumas Questionnaire (CTQ). Results: Significant positive associations between CT, DE and OCS were observed. Multiple hierarchical regression analysis revealed CT and DE as predictors of adulthood OCS; and additionally, DE had a stronger predictive value with 28% of the variance whereas CTQ scores predicted approximately 3%. Conclusion: Early life adversities may be related to emotional dysregulation, which could subsequently be associated with adult psychopathologies and dissociative experiences, suggesting a possible mediating pathway. In order to propose definite causal relations, future studies with longitudinal designs focusing particularly on the timing, duration, and subtypes of early trauma and the appearance of symptoms in adulthood are needed. This article’s short podcast by AI (English) This article’s short podcast by AI (Turkish)
Mental contamination refers to feelings of dirtiness and/or urges to wash that arise without direct contact with a contaminant. Cognitive models propose that this results from "serious, negative misappraisals of perceived violations". However, the specific violation misappraisals most relevant to mental contamination have yet to be established empirically, in part due to the lack of a comprehensive validated inventory of violation appraisals. Therefore, this study's aim was to develop and validate such a measure. Items for the new Violation Appraisal Measure (VAM) were developed from qualitative interviews, theoretical models, and previous empirical work. An Exploratory Factor Analysis was conducted in a sample of (n = 300) undergraduate participants, which revealed a four-factor structure: Responsibility/Self-Blame, Permanence, Mistrust, and Self-Worth. The VAM showed excellent internal consistency (α = 0.90), good convergent (r = .50 to .64) and adequate divergent (r = -.01 to .46) validity and was predictive of mental contamination symptoms over and above existing related appraisal measures, ΔF(1,289) = 29.35, p < .001, ΔR2 = 0.06. A Confirmatory Factor Analysis in a second sample of (n = 300) undergraduate students confirmed strong model fit for the four-factor structure of the VAM. The development of the VAM is an important contribution to the search for empirically based cognitive mechanisms in mental contamination and other violation-related sequelae.
Dialectical behavioral therapy for complex posttraumatic stress disorders (DBT-PTSD) is a modular treatment program that was developed at the Central Institute for Mental Health at the University of Heidelberg, Germany in 2005–2021. DBT-PTSD is designed to meet the needs of patients with complex PTSD related to sexual or physical trauma in childhood and adolescence. It is specifically designed for patients suffering from severe emotional dysregulation, persistent self-injury, chronic suicidal ideation, severe dissociative symptoms and a markedly negative self-concept with a high level of guilt, shame, self-loathing and interpersonal problems. To address these different core symptoms, DBT-PTSD combines evidence-based therapeutic strategies: principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions and procedures for behavioral change. The treatment program is designed to be carried out in an outpatient (45 weeks) or residential (12 weeks) setting. The results from two randomized controlled trials showed large effect sizes across very different symptom domains and a significant superiority of DBT-PTSD over Cognitive Processing Therapy (CPT). Based on these results, DBT-PTSD is currently a promising evidence-based treatment program for all features of a complex PTSD after sexual abuse in childhood and adolescence.
Purpose: In understanding the profound and multifaceted impact of sexual violence, there is an emergent need to explore holistic therapeutic interventions. Massage therapy is being explored as a potential means of helping survivors heal, yet its effects are not thoroughly elucidated. This study aims to evaluate the benefits of massage therapy in the psychological support of survivors of sexual violence and rape.
Methods: For this purpose, a systematic review of studies in English and French was conducted, according to PRISMA guidelines, using the PubMed, ProQuest, Scopus and Cochrane databases. Based on the PICOS approach, to be eligible, studies have to include a massage-based intervention and involve a population that had experienced at least one rape or form of sexual violence. Risk of bias was assessed using the Mixed Methods Appraisal Tool (Hong et al., 2018).
Results: Eleven quantitative, qualitative and mixed studies were included in this review. They all conclude that therapeutic massage has a positive effect on the care of people who have suffered sexual violence
Discussion: The results suggest a large number of positive effects of using massage in the treatment of survivors of sexual violence. However, the small sample size and the diversity of the research protocols and measurement instruments make it difficult to generalize those results.
Conclusion: This systematic review supports the psychological, physical and social benefits of using massage to treat survivors of sexual violence. The small sample size, lack of representativeness and diversity of study types, experimental protocols and measurement instruments mean that future research is needed to better investigate the issue.
Background
Cognitive models of mental contamination (i.e. feelings of internal dirtiness without contact with a contaminant) propose that these feelings arise when individuals misappraise a violation. However, an operational definition of ‘violation’ and identification of specific violation misappraisals is limited.
Aims
This study’s aim was to elaborate on cognitive models using qualitative data from those with lived experience to fill these gaps.
Method
Twenty participants with a diagnosis of obsessive-compulsive disorder and/or a trauma history took part in a semi-structured interview about violation. Grounded theory was used to analyse interview transcripts.
Discussion
Three categories emerged, each with several themes – qualities of violation , violation-related appraisals , and violation-related behaviours . Different violation-related appraisals were associated with different emotions and urges. Specific self-focused appraisal sub-themes (i.e. permanence of consequences ; self-worth ; responsibility, self-blame and regret ) were most closely related to emotions tied to mental contamination. These findings support and expand upon existing cognitive models of mental contamination, identifying key violation-related appraisals and differentiating between mental contamination-related appraisals and those related to other emotional sequelae. Future quantitative and experimental research can evaluate the potential of these appraisals as intervention targets.
Background. Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. Methods. The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3,083, 94.2%) and OCD+PTSD (n = 191, 5.2%) who received CBT with ERP in two major intensive OCD treatment programs. Results. Although patients with OCD+PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD+PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant in PTSD. Limitations. Findings are limited by a naturalistic treatment sample with variation in treatment provision. Conclusions. Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD+PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.
Mental contamination (MC), an internal feeling of dirtiness that is typically experienced in the absence of contact with a physical contaminant, is increasingly recognized as a sequela of trauma. This scoping review identified 19 studies on MC among trauma survivors and aimed to (a) summarize qualitative research on the phenomenology of MC among trauma survivors, (b) examine how MC is operationalized and measured in studies of trauma survivors, (c) identify the nature and extent of research linking trauma exposure to MC, and (d) identify the nature and extent of research linking MC to other psychopathology among trauma survivors. Qualitative studies indicated relative coherence in the phenomenology of MC across trauma survivors. Quantitative studies showed strong evidence for a link between sexual assault and MC. There was also strong support for a relationship between MC and posttraumatic stress symptoms. Insufficient evidence exists for relationships between MC and obsessive-compulsive symptoms, depression, and suicidal thoughts and behaviors among trauma survivors. The cross-sectional design of most studies limits conclusions about the directionality of relationships between trauma, MC, and other psychopathology, including whether MC represents a transdiagnostic risk factor for psychological distress among trauma survivors.
Background
Obsessive‐compulsive symptoms (OCS) in youth are common, have heterogeneous manifestations, and have been shown to be associated with serious psychopathology. While early‐life trauma exposure is associated with increased risk for obsessive‐compulsive disorder (OCD), its association with different OCS and its clinical relevance for serious psychopathology is unclear. Here we aimed to evaluate associations among traumatic stressful events (TSE), OCS, and serious psychiatric conditions in community youth.
Methods
We studied nonmental‐help seeking youths from the Philadelphia Neurodevelopmental Cohort (N = 7054, aged 11–21, 54% females, 52% prepubertal), assessed for lifetime TSE exposure and OCS. Regression models investigated cross‐sectional associations of TSEs with OCS, and associations with depression, suicide ideation and psychosis. Models examined sex and puberty effects, controlling for age and socioeconomic status.
Results
Trauma exposure was associated with higher OCS rates, especially in females (Trauma × Sex interaction Wald = 7.93, p = 0.005) and prepuberty (Trauma × Puberty interaction Wald = 7.68, p = 0.006). TSEs were associated with all OCS manifestations, most prominently with bad intrusive thoughts (odds ratio [OR] = 1.63). Assaultive TSEs, especially sexual assault, showed stronger associations with OCS compared with nonassaultive TSEs. While TSEs and OCS were independently associated with depression, suicide ideation, and psychosis, a significant interaction was observed only in association with increased rates of psychosis (Trauma × OCS interaction Wald = 5.08, p = 0.024).
Conclusion
Early‐life trauma is associated with OCS in a dose‐response manner, more so in females and prepuberty. The trauma‐OCS association varied by load, type of trauma, and by OCS subtypes. Trauma‐OCS appears a detrimental combination in association with psychosis.
Research has yet to establish a relationship between posttraumatic mental contamination and suicide risk, despite theoretical overlap. The present study examined relationships between posttraumatic mental contamination and suicide risk via posttraumatic stress symptom clusters and appraisals of perceived burdensomeness and thwarted belongingness. Trauma-exposed participants (N = 183) completed measures of posttraumatic mental contamination, posttraumatic stress symptoms, thwarted belongingness, perceived burdensomeness, and suicide risk. Findings revealed significant indirect effects of posttraumatic mental contamination on suicide risk via all posttraumatic stress symptom clusters. Significant serial indirect effects of posttraumatic mental contamination on suicide risk were observed via posttraumatic avoidance and arousal/reactivity and, subsequently, via thwarted belongingness and perceived burdensomeness. Serial models via posttraumatic re-experiencing and negative cognitions/mood symptoms were nonsignificant. Results suggest that posttraumatic mental contamination may increase suicide risk via posttraumatic stress symptom severity, and maladaptive interpersonal appraisals may explain these links through distinct symptom pathways. Implications for posttraumatic suicide risk are discussed.
Background:
In cross-sectional studies, social support and posttraumatic stress disorder (PTSD) symptoms appear related, in that higher severity of PTSD is associated with lower social support and vice versa. Theoretical models of the causal direction of this relationship differ. Most longitudinal studies suggest that PTSD symptoms erode social support over time, although some suggest that higher social support is prospectively associated with decrease in PTSD symptom severity. It is unclear, though, how social support and PTSD affect each other in the short term. The purpose of this study was to test day-to-day relationships between PTSD and social support to elucidate how PTSD and social support influence each other.
Methods:
Using 1173 daily observations from 75 college women who met screening criteria for lifetime sexual assault and past-month PTSD, this study tested same-day and next-day relationships between PTSD and social support using mixed models.
Results:
Within-person analyses indicated that, when PTSD was higher than usual on a given day, social support was higher the next day. Between-person analyses suggested that people with generally higher social support tended to have lower PTSD symptoms on a given day, but average PTSD symptom severity was not associated with day-to-day fluctuations in social support.
Conclusions:
Rather than eroding in response to daily symptoms, social support might be sought out following increases in PTSD, and when received consistently, might reduce symptoms of PTSD in the short term. Interventions that increase college women's access to social support after sexual assault may thus be helpful in addressing PTSD.
The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria. (PsycINFO Database Record
Mental contamination, an internal sense of dirtiness that originates in the absence of physical contact with a stimulus, has been implicated in the exacerbation of posttraumatic stress (PTS) symptoms following sexual trauma. In addition, evidence suggests that associations between PTS-related risk factors and PTS symptoms may depend on the degree to which one can tolerate experiencing negative emotions. To better understand the association between mental contamination and PTS symptoms, we examined main and interactive effects of mental contamination and tolerance of negative emotions in relation to PTS symptoms, including specific symptom clusters, in a community sample of women who experienced sexual trauma (N = 101). Tolerance of negative emotions moderated the association between mental contamination and PTS symptoms (total symptom severity, intrusion cluster, and cognitive/mood alterations cluster). These results indicate that difficulties tolerating negative emotions may be a necessary condition for mental contamination to relate to PTS symptoms following sexual trauma.
The current investigation examined whether sexual objectification leads to perceived contamination in women victims, which, in turn, triggers sinful feelings. The results of three experiments provide converging support for these predictions. Female participants reported greater sinful feelings than their non-objectified counterparts, after receiving objectifying comments on their physical appearance from an alleged male partner (Experiment 1) or recalling a past experience of objectification (Experiments 2 and 3). Furthermore, perceived contamination mediated the effect of objectification on sinful feelings. We also found that perceived personal responsibility of being objectified moderated the above effects, such that the effects were only observed among participants who perceived themselves as highly responsible for objectification experience, but not among those who perceived low personal responsibility. These findings contribute to the literature by explaining why objectification elicits sinful feelings in female victims and who is more susceptible to this influence.
Traumatic or stressful life events have long been hypothesized to play a role in causing or precipitating obsessive-compulsive symptoms but the impact of these environmental factors has rarely been investigated using genetically informative designs. We tested whether a wide range of retrospectively-reported stressful life events (SLEs) influence the lifetime presence and severity of obsessive-compulsive symptoms (OCS) in a large Swedish population-based cohort of 22,084 twins. Multiple regression models examined whether differences in SLEs within twin pairs were significantly associated with differences in OCS. In the entire sample (i.e., both monozygotic [MZ] and dizygotic twin pairs), two SLEs factors, “abuse and family disruption” and “sexual abuse”, were significantly associated with the severity of OCS even after controlling for depressive symptoms. Other SLEs factors were either not associated with OCS (“loss”, “non-sexual assault”) or were no longer associated with OCS after controlling for depression (“illness/injury”). Within MZ pair analyses, which effectively control for genetic and shared environmental effects, showed that only the “abuse and family disruption” factor remained independently related to within-pair differences in OCS severity, even after controlling for depressive symptoms. Despite being statistically significant, the magnitude of the associations was small; “abuse and family disruption” explained approximately 3% of the variance in OCS severity. We conclude that OCS are selectively associated with certain types of stressful life events. In particular, a history of interpersonal abuse, neglect and family disruption may make a modest but significant contribution to the severity of OCS. Further replication in longitudinal cohorts is essential before causality can be firmly established.
Previous research has indicated a relation between obsessive-compulsive disorder (OCD), childhood traumatic experiences and higher levels of dissociation that appears to relate to negative treatment outcome for OCD. The aim of the present study is to investigate whether childhood trauma and dissociation are related to severity of OCD in adulthood. We also intend to examine the association between treatment resistance, dissociation, and each form of trauma.
Participants included 120 individuals diagnosed with OCD; 58 (48.3 %) of them met the criteria for treatment-resistant OCD (resistant group), whereas the other 62 (51.7 %) were labeled as responder group. The intensity of obsessions and compulsions was evaluated using Yale-brown obsessive-compulsive scale (Y-BOCS). All patients were assessed with the traumatic experiences checklist, dissociative experiences scale, beck depression inventory, and beck anxiety inventory.
Controlling for clinical variables, resistant group had significantly higher general OCD severity, anxiety, depression, trauma, and dissociation scores than the responders. Correlation analyses indicated that Y-BOCS scores were significantly related to severity of dissociation, anxiety, depression, and traumatic experiences. In a logistic regression analysis with treatment resistance as a dependent variable, high dissociation levels, long duration of illness, and poor insight emerged as relevant predictors, but gender, levels of anxiety, depression, and traumatic experiences did not.
Our results suggest that dissociation may be a predictor of poorer treatment outcome in patients with OCD; therefore, a better understanding of the mechanisms that underlie this phenomenon may be useful. Future longitudinal studies are warranted to verify if this variable represents predictive factors of treatment non-response.
A community sample of 391 adult women was screened for a history of sexual assault during childhood and assessed for lifetime and current mental disorders using a structured victimization history interview and the Diagnostic Interview Schedule. One third of the women had been victims of rape, molestation, or sexual assault not involving physical contact prior to the age of 18 years. Child rape victims were more likely than nonvictims to have ever met DSM-III diagnostic criteria for a major depressive episode, agoraphobia, obsessive-compulsive disorder, social phobia, and sexual disorders. Molestation victims were overrepresented on major depressive episode, obsessive-compulsive disorder, and sexual disorders. Noncontact child sexual assault was not a significant risk factor for any disorder. Child rape and molestation victims were more likely than victims of noncontact assault to have had crime-related posttraumatic stress disorder. Mental disorder lifetime prevalence risk ratios for child rape and molestation victims versus nonvictims ranged from 1.5 for major depressive episode to 6.7 for obsessive-compulsive disorder.
An important problem in multilevel modeling is what constitutes a sufficient sample size for accurate estimation. In multilevel analysis, the major restriction is often the higher-level sample size. In this paper, a simulation study is used to determine the influence of different sample sizes at the group level on the accuracy of the estimates (regression coefficients and variances) and their standard errors. In addition, the influence of other factors, such as the lowest-level sample size and different variance distributions between the levels (different intraclass correlations), is examined. The results show that only a small sample size at level two (meaning a sample of 50 or less) leads to biased estimates of the second-level standard errors. In all of the other simulated conditions the estimates of the regression coefficients, the variance components, and the standard errors are unbiased and accurate.
The common approach to the multiplicity problem calls for controlling the familywise error rate (FWER). This approach, though, has faults, and we point out a few. A different approach to problems of multiple significance testing is presented. It calls for controlling the expected proportion of falsely rejected hypotheses – the false discovery rate. This error rate is equivalent to the FWER when all hypotheses are true but is smaller otherwise. Therefore, in problems where the control of the false discovery rate rather than that of the FWER is desired, there is potential for a gain in power. A simple sequential Bonferroni-type procedure is proved to control the false discovery rate for independent test statistics, and a simulation study shows that the gain in power is substantial. The use of the new procedure and the appropriateness of the criterion are illustrated with examples.
Posttraumatic obsessions have been reported in a few studies and case series. However, as the patients described were chronic, and the onset of their posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) symptoms was dated some time previously, this hampers interpretation of the temporal, biological and psychological relationship of OCD following traumatic events. In the current paper we describe the emergence of posttraumatic obsessions a short time following the exposure to a traumatic event.
The emergence of posttraumatic obsessions, a few months after exposure to trauma, is described for five veterans. All the veterans participated in combat during the summer of 2006 (in the Second Lebanon War).
For all cases, OCD symptoms were initially related to the trauma but later became generalized and independent.
The course of the symptoms suggests a potential environmental role in the development of OCD following an exposure to a traumatic event. These observations suggest a biological linkage between exposure to trauma and OCD.
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Background:
Very few longitudinal studies have evaluated prospective neurodevelopmental and psychosocial risk factors for obsessive-compulsive disorder (OCD). Furthermore, despite the heterogeneous nature of OCD, no research has examined risk factors for its primary symptom dimensions, such as contamination/washing.
Method:
Potential risk factors for symptoms or diagnosis of OCD in adulthood and for specific adult obsessive-compulsive (OC) symptom dimensions were examined in the Dunedin Study birth cohort. The presence of obsessions and compulsions and psychological disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 26 and 32 years. Individuals with a diagnosis of OCD at either age (n=36) were compared to both a healthy control group (n=613) and an anxious control group (n=310) to determine whether associations between a risk factor and an OCD diagnosis were specific.
Results:
Childhood neurodevelopmental, behavioral, personality and environmental risk factors were associated with a diagnosis of OCD and with OC symptoms at ages 26 and 32. Social isolation, retrospectively reported physical abuse and negative emotionality were specific predictors of an adult OCD diagnosis. Of note, most risk factors were associated with OC symptoms in adulthood and several risk factors predicted specific OCD dimensions. Perinatal insults were linked to increased risk for symmetry/ordering and shameful thoughts dimensions, whereas poor childhood motor skills predicted the harm/checking dimension. Difficult temperament, internalizing symptoms and conduct problems in childhood also predicted specific symptom dimensions and lower IQ non-specifically predicted increased risk for most dimensions.
Conclusions:
The current findings underscore the need for a dimensional approach in evaluating childhood risk factors for obsessions and compulsions.
Shame is a predominant emotion for many interpersonal trauma (IPT) survivors and is associated with more severe posttraumatic stress disorder (PTSD) symptoms. Measurement challenges have led to difficulties in understanding the impact of trauma-related shame. The Trauma-Related Shame Inventory (TRSI) was developed to address this limitation, yet additional psychometric support is needed. The present study evaluated and provided psychometric support for the TRSI among women with IPT histories, although recommendations for improvement are discussed. The impact of trauma-related shame, relative to trait shame and trauma-related guilt, on PTSD symptoms was also studied, with results suggesting that trauma-related shame had the strongest association.
OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4,073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with comorbid conditions.
Individuals with comorbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) experience more severe OCD symptoms and poorer treatment response. Despite some evidence linking OCD symptom domains to trauma, only one study to date has examined typical OCD and PTSD presentations in individuals with OCD+PTSD, and findings were based on a non-clinical sample. The current study sought to replicate findings in a clinical sample of 1,014 patients diagnosed with OCD (n = 928), PTSD (n = 40), and OCD+PTSD (n = 46) in specialty OCD and anxiety treatment programs. Consistent with previous research, patients with OCD+PTSD reported more severe OCD but not PTSD symptoms and did not evidence a unique phenotypic presentation once symptom overlap and comorbid mood and personality disorders were considered. OCD+PTSD is equally as heterogenous as OCD and PTSD alone. Implications for the research and treatment of OCD+PTSD are discussed, and assessment and treatment recommendations are provided.
Mental contamination (MC)—feelings of dirtiness triggered by internal sources—is a potentially important yet understudied factor for survivors of sexual trauma. MC has been linked to disgust and other negative emotions (e.g., shame, guilt) cross-sectionally and in lab-based paradigms but not yet examined in ecological contexts. Additionally, links between MC and distinct negative emotions have not been studied systematically. The present study thus modeled relationships between MC and specific emotions both across and within days over a daily monitoring period. Forty-one females with sexual trauma history and associated MC completed twice-daily assessments of MC and seven emotions (disgust, shame, guilt, anger, hopelessness, sadness, anxiety) over two weeks via a smartphone app. Baseline MC and average daily MC were largely associated with higher daily averages of negative emotions. Concurrently, within-person changes in MC and negative emotions were also positively linked. Unexpectedly, intraindividual changes in MC were largely not associated with later negative emotions, whereas several emotions were negatively associated with later MC. Notably, MC among screened sexual trauma survivors was much more prevalent compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination are discussed.
Posttraumatic stress disorder (PTSD) co-occurs with obsessive-compulsive disorder (OCD) nearly 25% of the time, and rates of co-occurring OCD with PTSD are even higher. Several studies have examined the impact of co-occurring OCD and PTSD with many suggesting attenuated treatment response, yet findings regarding symptom presentation in this population are mixed. Given phenotypic, functional, and sometimes etiological overlap in OCD and PTSD, differential diagnosis and specialized treatment can be a complex yet important undertaking. This paper reviews the current literature on co-occurring OCD and PTSD, theoretical conceptualization for the intersection of OCD and PTSD; offers recommendations for differential assessment and cognitive behavioral treatment; and provides directions for future research on co-occurring OCD and PTSD.
Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are heterogeneous disorders that share common underlying factors, etiology, and symptoms. A small body of literature suggests common OCD symptom presentations may exist for this comorbid group, yet common comorbid PTSD symptom presentations remain unknown. The current study examined common symptom presentations in individuals with probable comorbid OCD + PTSD compared with those with a sole presentation of probable OCD or PTSD, controlling for overlapping symptoms, using a sample of 133 undergraduates. Individuals who exceeded cutoffs for probable OCD + PTSD endorse more severe OCD symptoms overall but report similar levels of PTSD symptoms compared with the respective diagnostic groups. Logistic regressions found that symptom domains present similarly overall in a comorbid presentation compared with the respective diagnostic groups, yet some OCD symptom domains were significantly more severe in the comorbid group compared with individuals with probable PTSD. Explanations for the unique contributions of symptoms are discussed, and clinical recommendations for addressing these domains are provided.
This study explored the connections between gender socialisation, cultural programming related to sexuality, and the sexual assault experiences of young women. We examined how young women’s sexual assault experiences, and their subsequent adjustment to these, are influenced by religion, conservative values, faith and spirituality. Fourteen sexual assault survivors shared the stories of their assault experiences, as well as their sexuality education, religious socialisation, and the consequences of both. The 14 women reported experiences with 26 different perpetrators, nearly all of whom were known to the survivors. Although some found their faith to be a source of strength when coping with their sexual assault, many claimed that their religious and conservative socialisation left them at risk for victimisation.
Extant research has found that patients with OCD+PTSD experience significantly worse symptoms, have higher treatment dropout rates, and are less responsive to treatment. While both disorders are characterized by intolerance of uncertainty (IU), it has been suggested that IU presents differently in OCD and PTSD. Specifically, individuals with OCD report greater struggles with prospective IU, or perceptions of threat related to future uncertainty, and individuals with PTSD report greater struggles with inhibitory IU, or inability to function in the face of uncertainty. However, it is not known how IU presents in patients with OCD+PTSD. Differences in IU were examined in patients with OCD+PTSD compared to OCD using a sample of 475 residential inpatients in an OCD and anxiety treatment program, and change in IU was examined as a potential mediator to symptom change across treatment. Patients with OCD+PTSD reported significantly greater inhibitory and prospective IU compared to patients with OCD and did not experience significant improvement in IU from baseline to discharge. In addition, they experienced significantly less OCD symptom improvement compared to patients with OCD. Whereas improvement in prospective IU partially explained OCD symptom improvement in patients with OCD, the same was not true for patients with OCD+PTSD. Findings suggest that IU should be of greater treatment focus when working with patients with OCD+PTSD; specific clinical recommendations are provided.
The role of stressful precipitating events has long been recognized in the genesis of obsessive-compulsive disorder (OCD). Posttraumatic stress disorder (PTSD) also necessitates the experience of a traumatic event (PTSD criterion A). Research has demonstrated a high degree of comorbidity between these two conditions. However, few studies have examined symptom overlap as a potential cause for this co-occurrence. Thus, the purpose of the present study was to examine symptom endorsement and overlap between OCD and PTSD using a sample of trauma exposed veterans. Veterans were administered self-report assessments, including the Dimensional Obsessive-Compulsive Scale (DOCS) and the PTSD Checklist for DSM-5 (PCL-5), as part of a routine clinical care at a Veteran's Administration hospital. Based on self-report assessment of clinical cut scores, 81% of participants met for probable PTSD and 74% for probable OCD. In addition, a series of chi square analyses revealed frequent overlap of endorsement across items with similar content. There is significant overlap between PTSD and OCD symptoms, and patients may find it difficult to differentiate between them on self-report measures. As such, caution should be used when using self-report solely to assess PTSD and OCD, particularly in traumatized samples.
Given the high degree of diagnostic overlap and limited empirical literature surrounding the comorbidity between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), appropriately conceptualizing the relationship between the comorbid symptoms and their impact on the treatment process can be challenging. This is especially true when the symptoms of the two disorders become functionally connected, with each symptom set maintaining the other. This article details the case of a veteran with comorbid PTSD and OCD who sought intensive trauma-focused treatment within the U.S. Veterans Health Administration. The dynamic relationship between his PTSD and OCD symptoms is described, along with its impact on trauma-focused treatment and the ability to maintain treatment gains. A novel attempt to integrate empirically based treatment strategies for OCD into intensive PTSD treatment, targeting both sets of symptoms simultaneously, is presented, along with implications for conceptualization and treatment of this comorbidity.
The most common symptom of obsessive compulsive disorder is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of ERP for CC and completed self-report measures and behavioral tasks assessing CC and MC at pre-treatment, post-treatment, and follow-up. As hypothesized, at pre-treatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pre-treatment MC predicted greater post-treatment CC, though this effect was only evident in one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pre-treatment disgust propensity also predicted treatment outcome, though the addition of pre-treatment disgust propensity as a covariate reduced the relationship between pre-treatment MC and post-treatment CC to non-significance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.
Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective analyses, or small sample sizes. The current study extended this research by comparing the clinical characteristics of individuals with OCD with and without a lifetime PTSD diagnosis in a large, naturalistic, longitudinal sample over the course of seven years. At baseline, individuals with comorbid lifetime PTSD reported significantly more severe symptoms of OCD (including symptom levels and insight), lower quality of life, and higher rates of comorbid lifetime mood and substance use disorders than participants without lifetime PTSD. Further, individuals with comorbid OCD and lifetime PTSD reported significantly more severe OCD symptoms over the course of seven years than those without lifetime PTSD. These results are largely consistent with the existing literature and support the need to consider PTSD symptoms in the assessment and treatment of OCD.
Mental contamination (MC), feeling dirty in the absence of a physical contaminant, has been linked to the basic emotion of disgust. Both MC and disgust have been associated with posttraumatic stress (PTS) and obsessive-compulsive (OC) symptoms occurring separately as well as together. However, there is no consensus on the specific ways in which these constructs interact with each other, PTS, or OC symptoms. Thus, this study sought to specify the associations between self-reported MC, disgust constructs, and OC symptoms amongst 250 undergraduates endorsing lifetime traumatic events. Results showed MC to significantly predict OC symptom severity above and beyond the effects of disgust propensity (DP) and disgust sensitivity (DS), controlling for gender, general negative affect, and PTS symptom severity, in both the large trauma-exposed sample and a subgroup (n = 49) endorsing PTS symptoms approximating DSM-5 criteria. Further, DS significantly moderated the strength of the association between DP and MC, controlling for gender, negative affect, PTS symptoms, and OC symptoms, such that higher levels of DS strengthened the conditional effects of DP on MC. These findings suggest that MC predicts OC symptom severity amongst trauma-exposed individuals, and that the interaction of disgust constructs contributes to MC in this population.
Research has linked mental contamination to symptoms of posttraumatic stress disorder (PTSD). However, less research has examined how mental contamination relates to other factors observed among individuals with these symptoms. This study examined relationships among mental contamination, posttraumatic stress (PTS) symptoms, mood-dependent risky behaviors, and help-seeking attitudes among 232 trauma-exposed undergraduates. Participants completed self-report measures of mental contamination, contact contamination, PTS symptoms, mood-dependent risky behaviors, and help-seeking attitudes. While accounting for effects of contact contamination, biological sex, and unwanted sexual contact, results indicated mental contamination was positively linked to PTS symptoms. When accounting for PTS symptoms, mental contamination demonstrated a significant positive relationship with negative mood-dependent risky behaviors, and a trend-level positive relationship with positive mood-dependent risky behaviors. Mental contamination was indirectly linked to greater risky behaviors (negative and positive) through increased PTS symptoms. Mental contamination also demonstrated a positive indirect effect on help-seeking attitudes through increased PTS symptoms. Mental contamination exhibited a negative direct effect on help-seeking attitudes, suggesting mental contamination was associated with reduced help-seeking attitudes even after accounting for a positive association between PTS symptoms and help-seeking attitudes. These findings underscore the importance of understanding mental contamination in relation to trauma exposure and associated pathology.
This 2-part study described the development and preliminary validation of the State Mental Contamination Scale (SMCS), a multi-item self-report measure of state mental contamination. In Study 1, community adults (N = 211) in the United States were randomly assigned to a pathogen disgust, moral disgust, or neutral condition and then completed the SMCS. Study 1 results supported a 1-factor structure of the SMCS items. Scores on the SMCS items evidenced good internal consistency and strong interitem correlations. SMCS scores were significantly greater following the 2 disgust conditions relative to the neutral condition and a full range of SMCS scores were found in the disgust conditions. An independent sample of community adults (N = 121) from the United States participated in Study 2 to extend Study 1 results. Study 2 results indicated that SMCS scores were manipulated independently of trait mental contamination, more strongly related to convergent than a discriminant measure, and shared unique variance with a criterion measure after controlling for convergent measures. The future use of the SMCS is discussed.
It is important to consider trauma-related sequelae in the etiology and maintenance of psychopathology, namely understudied disorders such as those belonging to the Obsessive-Compulsive Spectrum (OCS). This meta-analysis examined the association between past trauma exposure and current severity of OCS disorder symptoms. A systematic literature search was conducted with 24 (N = 4,557) articles meeting inclusion criteria. A significant overall effect size was obtained (r = .20), indicating that exposure to past trauma is associated with a higher severity of OCS symptoms, with a stronger association for females (β = 0.01, p < .001) but not varying as a function of relationship status. Four types of interpersonal trauma (violence, emotional abuse, sexual abuse, and neglect) were associated with OCS symptom severity (r = .19 −.24) and past trauma was significantly associated with more severe compulsions (r = .17), but not obsessions. Results suggest an important link between multiple types of past trauma exposure and OCS symptoms.
Obsessive–compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, the shared features of these conditions have been under-examined. Evaluation of the common aspects of posttraumatic and obsessive–compulsive (OC) symptoms could improve treatment responsivity for individuals with comorbid PTSD and OCD, for whom outcome is typically poorer than for those with either disorder alone. This study examined intolerance of uncertainty, inflated responsibility, and a global measure of posttraumatic cognitions as potential shared cognitive constructs that moderate distress associated with OC symptoms. A total of 211 undergraduate students reporting significant trauma histories participated. All participants completed measures of obsessive–compulsive symptoms and beliefs, as well as posttraumatic cognitions. Results indicated that posttraumatic cognitions moderated the relationship between inflated responsibility and intolerance of uncertainty, which in turn predicted all domains of obsessive–compulsive symptom distress (all βs > 0.41, all zs > 3.44). Further, posttraumatic cognitions alone significantly predicting OC symptoms related to doubting, obsessions, and neutralizing. These findings suggest that shared cognitive constructs play a role in co-occurring posttraumatic stress and OC symptoms, and thus may be a relevant treatment target when these disorders present simultaneously.
To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
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.
Background:
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods:
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results:
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions:
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
We examined whether childhood exposure to multiple types of potentially traumatic events (PTEs) relative to a single type of PTE is associated with a higher prevalence of psychiatric disorders and greater somatic discomfort in Korean adults. The Composite International Diagnostic Interview 2.1 (K-CIDI 2.1) was administered to 6027 subjects aged 18-74 years. Subjects who experienced a traumatic event before the age of 18 years, the childhood trauma exposure group, were compared with controls without childhood exposure to PTEs. In the childhood trauma exposure group, subjects who experienced only a single type of PTE and subjects who experienced two or more types of PTEs were compared further. Childhood exposure to PTEs was linked to a wide range of psychiatric comorbidities, with a higher risk for exposure to multiple types of PTEs than for exposure to a single type of PTE. Obsessive-compulsive disorder, generalized anxiety disorder, and somatoform disorder were significantly associated with exposure to multiple types of PTEs but not with exposure to a single type of PTE. Exposure to multiple types of PTEs was associated with reports of marked fatigue and pain. Future research should examine the psychiatric sequelae associated with various types of childhood PTEs.
Fear of contamination within obsessive compulsive disorder (OCD) is traditionally conceptualized as a physical phenomenon. Research has also supported the notion of mental contamination (MC), in which people feel contaminated in the absence of contact with a physical pollutant. In the last decades, a growing number of studies has been centered on the role of disgust propensity (DP) in contamination-related OCD (OCD-C) symptoms. However, the relationship between MC, DP and OCD-C symptoms has not been thoroughly explored. The aims of this study were: 1) to investigate the prevalence of MC in a sample of OCD-C patients; 2) to explore the association between MC, DP and OCD-C symptoms in a sample of OCD patients; 3) to analyze the role of MC as a mediator in this relationship. Sixty-three patients with OCD-C symptoms completed a series of self-report questionnaires that assessed mental contamination, disgust propensity, OCD symptoms, anxiety, and depression. Significant correlations were found between DP, MC and OCD-C symptoms, controlling for anxiety and depression. Mediation analysis indicated that MC plays a mediating role in the relationship between DP and OCD-C symptoms. These data support the need for specific assessment of MC in clinical settings, particularly where feelings of disgust are involved.
There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory—Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n=57), participants diagnosed with an anxiety disorder other than OCD (n=24) and in undergraduate student controls (n=410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n=30) and those whose OCD excluded concerns related to contamination fear (n=27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD.
Guilt related to combat trauma is highly prevalent among veterans returning from Iraq and Afghanistan. Trauma-related guilt has been associated with increased risk for posttraumatic psychopathology and poorer response to treatment. Trauma Informed Guilt Reduction (TrIGR) therapy is a 4-module cognitive-behavioral psychotherapy designed to reduce guilt related to combat trauma. The goals of this study were to describe the key elements of TrIGR and report results of a pilot study with 10 recently deployed combat veterans.
Ten combat veterans referred from a VA Posttraumatic Stress Disorder (PTSD) or mental health clinic completed TrIGR over 4 to 7 sessions. Nine veterans completed the posttreatment assessment.
This initial pilot suggests that TrIGR may help to reduce trauma-related guilt severity and associated distress. Changes in trauma-related guilt were highly correlated with reductions in PTSD and depression symptoms over the course of treatment, suggesting a possible mechanistic link with severity of posttraumatic psychopathology.
TrIGR warrants further evaluation as an intervention for reducing guilt related to traumatic experiences in combat.
Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.
It was recently proposed that feelings of contamination can arise in the absence of physical contact with a contaminant. Currently, there are limited data regarding this construct of ‘mental contamination’ although it is hypothesised to be relevant to obsessive–compulsive disorder (OCD) where compulsive washing in response to contamination fear is a common presentation (Rachman, 2006). This research examined the presence of mental contamination in OCD. Participants (N=177) with obsessive–compulsive symptoms completed questionnaires to assess mental contamination, OCD symptoms and thought-action fusion (TAF). Findings indicated that 46% of participants experienced mental contamination, and severity was associated with severity of OCD symptoms and TAF. Mental contamination in the absence of contact contamination was reported by 10.2% of participants. Similar findings were reported in a sub-sample of participants who had received a formal diagnosis of OCD (N=54). These findings suggest that mental contamination is a distinct construct that overlaps with, but is separate from, contact contamination, and provide preliminary empirical support for the construct.
It has recently been identified that feelings of contamination can arise in the absence of physical contact with a stimulus. This concept, known as 'mental contamination' has particular relevance to Obsessive Compulsive Disorder in which compulsive cleaning is a common symptom presentation. Experimental studies have begun to examine the psychopathology of mental contamination. The aims of the two experiments reported here were to explore the evocation and spontaneous decay of mental contamination.
In Experiment 1, a variant of the autobiographical memory task was used in which 40 non-clinical participants were asked to recall autobiographical memories associated with betrayal, harm, humiliation and violation of moral standards. In Experiment 2, 60 participants with moderate levels of mental contamination were asked to complete five short tasks designed to induce mental contamination, including recalling unwanted memories and images.
In both experiments, participants reported significant increases in mental contamination, anxiety, urges to wash and actual washing behaviour. In experiment 1, the effect of the induction decayed spontaneously. Experiment 2 found that re-evoking contamination and repeated washing led to the persistence of mental contamination.
The studies were conducted on non-clinical samples.
These findings demonstrated that repeated triggers may be causally connected to the maintenance of mental contamination fears in non-clinical samples.
Fear of contamination can be evoked following physical contact with a dirty, harmful or polluted item, person, or place (contact contamination) or in the absence of physical contact with a contaminant (mental contamination). The spread of contact contamination does not degrade over successive degrees of removal from the contaminated source. However, to date, the spread of mental contamination has not been empirically investigated. This study aimed to examine the spread and degradation of mental contamination.
The paradigm of Tolin et al. (2004) was adapted. Feelings of mental contamination were evoked, and participants were asked to transfer these feelings to an uncontaminated pencil by touching it (contact condition) and without touching it (no contact condition).
Seventy-two percent of participants in the contact condition and 48% participants in the no-contact condition reported being able to transfer contamination to a clean pencil, demonstrating that mental contamination transfers both with and without contact. In both conditions, the mental contamination subsequently spread to a series of 12 neutral pencils without degradation.
These findings suggest that mental contamination can be transmitted and spread in the absence of physical contact, similar to contact contamination.
Proposals are set out for the introduction of psychological analyses into the conventional study of comorbidity. It is suggested that in addition to the simple determination of the co-occurrence of two disorders, attention should be given to the psychological connectedness of the two disorders. Such connectedness can be assessed by: (a) behavioral analysis of the functional interdependence of the disorders, (b) assessing the person's subjective estimate of the degree to which the disorders are connected, (c) similarities in psychophysiological responsiveness to eliciting stimuli, and (d) semantic similarities. Examples from research on the connectedness of two or more fears are described, and the lack of correlation between subjective similarity and functional relatedness is noted. It is suggested that introduction of psychological analyses will serve to expand our grasp of the disorders concerned, flag possible complications, provide a better basis for prognoses, and help to improve treatment efficacy.
Disgust and mental contamination (or feelings of dirtiness and urges to wash in the absence of a physical contaminant) are increasingly being linked to traumatic event exposure and posttraumatic stress (PTS) symptomatology. Evidence suggests disgust and mental contamination are particularly relevant to sexual assault experiences; however, there has been relatively little direct examination of these relations. The primary aim of the current study was to assess disgust and mental contamination-based reactivity to an individualized interpersonal assault-related script-driven imagery procedure. Participants included 22 women with a history of traumatic sexual assault and 19 women with a history of traumatic non-sexual assault. Sexual assault and PTS symptom severity predicted greater increases in disgust, feelings of dirtiness, and urges to wash in response to the traumatic event script. Finally, assault type affected the association between PTS symptom severity and increases in feelings of dirtiness and urges to wash in response to the traumatic event script such that these associations were only significant among sexually assaulted individuals. These findings highlight the need for future research focused on elucidating the nature of the relation between disgust and mental contamination and PTS reactions following various traumatic events.
Trauma-related cognitions have been proposed to contribute significantly to posttraumatic stress disorder (PTSD) symptoms. Recent research suggests that feelings of mental pollution (feelings of dirtiness without physical contact) may also contribute to symptoms of PTSD in victims of sexual assault (Fairbrother & Rachman, 2004). The present study investigated the relation between mental pollution, PTSD cognitions, and PTSD symptoms in victims of sexual assault (N = 48). The results indicated that mental pollution was significantly related to PTSD symptoms even when statistically controlling for symptoms of anxiety and depression. However, subsequent analyses showed that the relation between feelings of mental pollution and PTSD symptoms was fully mediated by trauma-related cognitions. These findings are discussed in the context of a model in which feelings of mental pollution elicit specific negative cognitions that maintain PTSD symptoms in victims of sexual assault.
This paper explores the links between traumatic experiences, post-traumatic stress disorder and obsessive-compulsive disorder. The development of obsessions and compulsions following trauma is noted, with case examples. The similarities in some aspects of the two disorders are also highlighted. Comments are made on the possible causal pathways, and on treatment implications.
The aim of this study was to investigate the interrelationships between childhood trauma, attachment, alexithymia, and the severity of obsessive compulsive disorder (OCD) in a cohort of participants with OCD.
There is a growing body of research linking traumatic experiences in childhood with the development of OCD. The mechanisms involved in this association are not yet clear.
The sample was comprised of 82 people with OCD and 92 comparison participants. A cross-sectional design was used, utilizing internet-mediated administration of the Childhood Trauma Questionnaire - revised (CTQ-R); the Yale-Brown Obsessive Compulsive Scale - Self-Report (Y-BOCS-SR); the Experiences in Close Relationships Scale (ECR); and Toronto Alexithymia Scale (TAS-20). Partial least squares (PLS) analysis was used to determine significant paths between the constructs.
Results of PLS analysis supported all of the hypotheses made: there was a significant positive correlation between childhood trauma and attachment avoidance, which in turn was significantly positively associated with alexithymia. Alexithymia was significantly associated with the severity of OCD symptoms and the number of OCD symptoms. Mediational analysis showed that alexithymia significantly carried an influence from attachment avoidance to the severity of obsessions and the number of obsession symptoms.
There is a relationship between childhood trauma and OCD, however this relationship is not direct in nature but is influenced by peoples' past experiences with significant others and associated difficulties in emotional processing.
This paper provides information on the relation between victimization status, crime factors, posttraumatic stress disorder (PTSD), and several other psychological disorders among a community sample of women. Results indicated that victims of crime were more likely than nonvictims to suffer from PTSD, major depressive episode, agoraphobia, obsessive-compulsive disorder, social phobia, and simple phobia. Furthermore, life threat was associated with increased risk of major depression, agoraphobia, obsessive-compulsive disorder, and social phobia. Completed rape was strongly related to almost every disorder assessed, while robbery and burglary were not related to any disorder. When demographics, victimization status, and crime factors were entered hierarchically into multivariate logistic regressions with PTSD in the final step, associations between victimization status, other crime characteristics (e.g., life threat, injury), and non-PTSD Axis I disorders were greatly reduced. This suggests that PTSD may be an important mediating factor in the victimization-psychopathology relation for many disorders.