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Development of the scrupulosity inventory: A factor analysis and construct validity study
... Similarly, pastoral counseling, which recognizes the influence of religious upbringing and the potential for pathological religiosity, can serve as a valuable complement to standard treatments [12]. The ongoing development of specialized assessment tools, such as the Scrupulosity Inventory, enhances the understanding of this condition by capturing its unique clinical features and differentiating it from other OCD subtypes [13]. Ultimately, effective management of scrupulosity requires a holistic approach that integrates psychological, moral, and spiritual dimensions, ensuring that treatment addresses the full spectrum of patients' needs. ...
The paper introduces the "Founder Mode Entrepreneurial Experience" (FMEE), a novel therapeutic framework rooted in transpersonal psychology that reimagines entrepreneurial engagement as exposure therapy for individuals with Moral Scrupulosity Obsessive-Compulsive Disorder (OCD). FMEE emphasizes confronting ethical dilemmas, embracing imperfection, and navigating moral ambiguities through mission-driven entrepreneurial activities. This approach not only facilitates desensitization to scrupulosity-related triggers but also fosters resilience, self-efficacy, and a purpose-driven mindset. Integrating transpersonal practices such as mindfulness, altruism, and intuitive decision-making, FMEE bridges personal healing with meaningful social impact. The manuscript underscores FMEE's transformative potential as a practical and spiritually grounded intervention for reducing moral rigidity and fostering holistic well-being. Implications for OCD therapy, transpersonal psychology, and social entrepreneurship are discussed, along with future research directions at the intersection of psychology and mission-driven innovation.
Three estimation methods with robust corrections—maximum likelihood (ML) using the sample covariance matrix, unweighted least squares (ULS) using a polychoric correlation matrix, and diagonally weighted least squares (DWLS) using a polychoric correlation matrix—have been proposed in the literature, and are considered to be superior to normal theory-based maximum likelihood when observed variables in latent variable models are ordinal. A Monte Carlo simulation study was carried out to compare the performance of ML, DWLS, and ULS in estimating model parameters, and their robust corrections to standard errors, and chi-square statistics in a structural equation model with ordinal observed variables. Eighty-four conditions, characterized by different ordinal observed distribution shapes, numbers of response categories, and sample sizes were investigated. Results reveal that (a) DWLS and ULS yield more accurate factor loading estimates than ML across all conditions; (b) DWLS and ULS produce more accurate interfactor correlation estimates than ML in almost every condition; (c) structural coefficient estimates from DWLS and ULS outperform ML estimates in nearly all asymmetric data conditions; (d) robust standard errors of parameter estimates obtained with robust ML are more accurate than those produced by DWLS and ULS across most conditions; and (e) regarding robust chi-square statistics, robust ML is inferior to DWLS and ULS in controlling for Type I error in almost every condition, unless a large sample is used (N = 1,000). Finally, implications of the findings are discussed, as are the limitations of this study as well as potential directions for future research.
Bifactor measurement models are increasingly being applied to personality and psychopathology measures (Reise, 2012). In this work, authors generally have emphasized model fit, and their typical conclusion is that a bifactor model provides a superior fit relative to alternative subordinate models. Often unexplored, however, are important statistical indices that can substantially improve the psychometric analysis of a measure. We provide a review of the particularly valuable statistical indices one can derive from bifactor models. They include omega reliability coefficients, factor determinacy, construct reliability, explained common variance, and percentage of uncontaminated correlations. We describe how these indices can be calculated and used to inform: (a) the quality of unit-weighted total and subscale score composites, as well as factor score estimates, and (b) the specification and quality of a measurement model in structural equation modeling. (PsycINFO Database Record
The purpose of this study was to apply a set of rarely reported psychometric indices that, nevertheless, are important to consider when evaluating psychological measures. All can be derived from a standardized loading matrix in a confirmatory bifactor model: omega reliability coefficients, factor determinacy, construct replicability, explained common variance, and percentage of uncontaminated correlations. We calculated these indices and extended the findings of 50 recent bifactor model estimation studies published in psychopathology, personality, and assessment journals. These bifactor derived indices (most not presented in the articles) provided a clearer and more complete picture of the psychometric properties of the assessment instruments. We reached 2 firm conclusions. First, although all measures had been tagged "multidimensional," unit-weighted total scores overwhelmingly reflected variance due to a single latent variable. Second, unit-weighted subscale scores often have ambiguous interpretations because their variance mostly reflects the general, not the specific, trait. Finally, we review the implications of our evaluations and consider the limits of inferences drawn from a bifactor modeling approach.
Scrupulosity, or obsessive-compulsive symptoms related to religiosity or religion, is a common presentation of obsessive compulsive disorder (OCD), and it is important to elucidate its phenomenology and measurement. Today, the most widespread questionnaire for the assessment of scrupulosity is the Penn Inventory of Scrupulosity (PIOS). The current study examines the psychometric properties of the PIOS in outpatient, treatment-seeking patients. Results of a confirmatory factor analysis suggested an unsatisfactory fit for previously suggested factor structures. A follow-up exploratory factor analysis suggested that a bifactor model was the most suitable solution. In addition, the scores of the PIOS and its revised subscales were found to have moderate-good concurrent validity; however, its scores discriminated poorly between patients with scrupulous obsessions and patients with OCD and other repugnant obsessions. Group differences and receiver operating characteristics (ROC) analyses both indicated that the PIOS is more suitable in discriminating scrupulous obsessions in Christian patients but not in other religious groups (i.e., Jews, nonreligious patients). Additional analyses revealed that the co-occurrence of scrupulous and other repugnant obsessions is also moderated by religious affiliation. These results raise questions in terms of grouping scrupulosity with other repugnant obsessions and suggest for the need of culturally sensitive instruments of scrupulosity. (PsycINFO Database Record
The Receiver Operating Characteristic (ROC) analysis has been long used in Signal Detection Theory to depict the tradeoff between hit rates and false alarm rates of classifiers. In the last years, ROC analysis has become largely used in the medical community for visualizing and analyzing the performance of diagnostic tests. Our article points out some fundamental aspects of ROC analysis underlying the importance of using ROC analysis in evaluating the diagnostic validity of tests commonly used in clinical psychology. The main statistical programs available for this type of analysis, with their advantages and deficiencies are also discussed. In order to illustrate how ROC analysis works in clinical research, we also describe an application of ROC analysis in evaluating scales generally related to depression.
"This paper advocates a validational process utilizing a matrix of intercorrelations among tests representing at least two traits, each measured by at least two methods. Measures of the same trait should correlate higher with each other than they do with measures of different traits involving separate methods. Ideally, these validity values should also be higher than the correlations among different traits measure by the same method." Examples from the literature are described as well as problems in the application of the technique. 36 refs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
A simulation study compared the performance of robust normal theory maximum likelihood (ML) and robust categorical least squares (cat-LS) methodology for estimating confirmatory factor analysis models with ordinal variables. Data were generated from 2 models with 2-7 categories, 4 sample sizes, 2 latent distributions, and 5 patterns of category thresholds. Results revealed that factor loadings and robust standard errors were generally most accurately estimated using cat-LS, especially with fewer than 5 categories; however, factor correlations and model fit were assessed equally well with ML. Cat-LS was found to be more sensitive to sample size and to violations of the assumption of normality of the underlying continuous variables. Normal theory ML was found to be more sensitive to asymmetric category thresholds and was especially biased when estimating large factor loadings. Accordingly, we recommend cat-LS for data sets containing variables with fewer than 5 categories and ML when there are 5 or more categories, sample size is small, and category thresholds are approximately symmetric. With 6-7 categories, results were similar across methods for many conditions; in these cases, either method is acceptable. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Popular statistical software packages do not have the proper procedures for determining the number of components in factor
and principal components analyses. Parallel analysis and Velicer’s minimum average partial (MAP) test are validated procedures,
recommended widely by statisticians. However, many researchers continue to use alternative, simpler, but flawed procedures,
such as the eigenvaluesgreater-than-one rule. Use of the proper procedures might be increased if these procedures could be
conducted within familiar software environments. This paper describes brief and efficient programs for using SPSS and SAS
to conduct parallel analyses and the MAP test.
Exploratory factor analysis (EFA) is a complex, multi-step process. The goal of this paper is to collect, in one article, information that will allow researchers and practitioners to understand the various choices available through popular software packages, and to make decisions about "best practices" in exploratory factor analysis. In particular, this paper provides practical information on making decisions regarding (a) extraction, (b) rotation
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.
Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions comes from studies of psychiatric comorbidity, functional brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD.
One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer- versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation.
The patients studied were phenomenologically comparable (including the presence of 'pure' obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the 'hoarding' dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the 'sexual/religious obsessions' factor predicted poorer outcome with BT, especially when computer-guided.
BT is especially indicated for OCD patients with aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients' adherence and response to treatment.
For comparing nested covariance structure models, the standard procedure is the likelihood ratio test of the difference in fit, where the null hypothesis is that the models fit identically in the population. A procedure for determining statistical power of this test is presented where effect size is based on a specified difference in overall fit of the models. A modification of the standard null hypothesis of zero difference in fit is proposed allowing for testing an interval hypothesis that the difference in fit between models is small, rather than zero. These developments are combined yielding a procedure for estimating power of a test of a null hypothesis of small difference in fit versus an alternative hypothesis of larger difference.
When questionnaires include Likert scales, items endorsed by relatively few respondents may result from characteristics of examinees or the constructs under study. Researchers may collapse categories to increase cell sample size; however, effects of this practice have not been systematically investigated. A five-point ordinal scale was simulated where data included few responses in extreme categories. Different estimators were applied to sparsely distributed and collapsed category data; characteristics of sample size, number of categories, number of items including sparse data, and percentage of sparse data were manipulated. Collapsing categories were advantageous for ULSMV and WLSMV, yielding higher convergence rates, more accurate estimation of parameters and standard errors, and chi-square test rejection rates close to the nominal level. With many response categories (e.g., ≥5), treating sparse data as continuous and using MLMV may serve as an alternative, especially when a small percentage of total items contain low cell frequencies.
Co-occurrence of psychiatric disorders is well documented. Recent quantitative efforts have moved toward an understanding of this phenomenon, with the general psychopathology or p-factor model emerging as the most prominent characterization. Over the past decade, bifactor model analysis has become increasingly popular as a statistical approach to describe common/shared and unique elements in psychopathology. However, recent work has highlighted potential problems with common approaches to evaluating and interpreting bifactor models. Here, we argue that bifactor models, when properly applied and interpreted, can be useful for answering some important questions in psychology and psychiatry research. We review problems with evaluating bifactor models based on global model fit statistics. We then describe more valid approaches to evaluating bifactor models and highlight 3 types of research questions for which bifactor models are well suited to answer. We also discuss the utility and limits of bifactor applications in genetic and neurobiological research. We close by comparing advantages and disadvantages of bifactor models with other analytic approaches and note that no statistical model is a panacea to rectify limitations of the research design used to gather data.
The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is the most common measure of Obsessive-Compulsive symptom severity. The Y-BOCS interview is considered gold standard, but its self-rating format is increasingly used in clinical trials. Few studies investigated congruency and potential changes over treatment. This question is highly relevant, as a systematic bias might obscure results of clinical trials. We examined the relationship of self- and clinician-rated Y-BOCS scores in participants with obsessive-compulsive disorder in pre (N = 128), post, (4 weeks, n = 104) and follow-up (6 months, n = 98) assessments of a randomized-controlled clinical trial. We administered Y-BOCS interview via telephone paralleling online administration of the self-report form. Analyses showed medium-to-strong correlations of Y-BOCS interview and self-rating scores at pre-assessment. Patients rated symptoms lower than clinicians. Larger discrepancies were associated with hoarding and age. Congruency was inferior for obsessions relative to compulsions, largely owing to the “resistance against obsessions” item. Agreement strongly increased at post and follow-up. Though overall congruency between the two Y-BOCS forms was satisfactory, results suggest a “correction over time” effect. Such bias may distort the precise interpretation of treatment effects. Therefore, we made several suggestions to improve the reliability of change scores assessed with the Y-BOCS self-rating.
Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the components of CBT for OCD and then present a patient who relapses after making significant gains during a course of CBT. Likely explanations for the patient’s relapse, and methods for optimizing long-term treatment outcomes, are explored from the standpoint of research on learning and memory. These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the psychoeducational and cognitive therapy components.
To offer a practical demonstration of receiver operating characteristic (ROC) analyses, diagnostic efficiency statistics, and their application to clinical decision making using a popular parent checklist to assess for potential mood disorder.
Secondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews.
Internalizing Problems raw scores discriminated mood disorders significantly better than did age- and gender-normed T scores, or an Affective Problems score. Internalizing scores <8 had a diagnostic likelihood ratio <0.3, and scores >30 had a diagnostic likelihood ratio of 7.4.
This study illustrates a series of steps in defining a clinical problem, operationalizing it, selecting a valid study design, and using ROC analyses to generate statistics that support clinical decisions. The ROC framework offers important advantages for clinical interpretation. Appendices include sample scripts using SPSS and R to check assumptions and conduct ROC analyses.
This chapter provides an overview of the nature of obsessive–compulsive disorder (OCD) in adults, including definitions of relevant term(s), diagnostic criteria, reviews of comorbid conditions, epidemiology, and demographics. Other topics discussed include OCD symptoms and subtypes and age of onset and course of OCD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Scrupulosity, the obsessional fear of thinking or behaving immorally or against one's religious beliefs, is a form of obsessive-compulsive disorder that has been relatively understudied to date. Treating religious patients with scrupulosity raises a number of unique clinical challenges for many clinicians. For example, how does one distinguish normal beliefs from pathological scrupulosity? How does one adapt exposures to a religious patient whose fears are related to sinning? How far should one go in exposures in such cases? How and when does one include clergy in treatment? We address these issues and report a case example of the successful treatment of an ultra-Orthodox Jewish woman using the treatment principles that we recommend for religious individuals with scrupulosity.
Clinicians and researchers have pondered the intersection of obsessive–compulsive disorder (OCD) and psychosis. We examined the records of 395 individuals seeking treatment for OCD and classified participants according to their most frequent or distressing obsession and compulsion. All participants completed measures of fixity of belief, perceptual distortions, magical ideation, and psychotic symptoms. Results indicated that individuals who reported fear of harming self or others via overwhelming impulse or by mistake, and those with religious obsessions, had poorer insight and more perceptual distortions and magical ideation than did individuals with other types of obsessions. These results did not appear to reflect mere differences in OCD severity. Results are discussed in light of previous findings showing that psychotic-like symptoms are associated with attenuated treatment outcome in OCD. More research is needed to assess the absolute magnitude of psychotic-like features in OCD patients with impulse/mistake and religious obsessions and to examine whether these features interfere with standard cognitive–behavioral therapy.
The earliest descriptions of obsessive-compulsive disorder (OCD) were religious, as was the understanding of their origins. With the emancipation, religion in OCD was relegated to its status today: a less common symptom of OCD in most Western societies known as scrupulosity. The frequency of scrupulosity in OCD varies in the literature from 0% to 93% of cases, and this variability seems predicated on the importance of religious belief and observance in the community examined. Despite the similarities between religious ritual and compulsions, the evidence to date that religion increases the risk of the development of OCD is scarce. Scrupulosity is presented as a classic version of OCD, with obsessions and compulsions, distress, and diminished functioning similar to those of other forms of OCD. The differentiation between normal religiosity and scrupulosity is presented, and the unique aspects of cognitive-behavioral therapy in treating scrupulosity, especially in religious populations, are reviewed.
This study presents data on dimensional structure, reliability, convergent and divergent validity of the Padua Inventory (PI). In a sample (n = 430) of normal Dutch subjects. The dimensional structure and the strength of the factors were comparable to those found in the Italian sample. The reliability of the PI was found to be satisfactory. As hypothesized substantial correlations were found between the PI and related scales of the Maudsley Obsessive-Compulsive Inventory (MOCI) and between the PI and the subscales Sensitivity, Hostility and Depression of the revised version of the Symptom Checklist. Low correlations were found between the PI on the one side and the Eysenck Personality Questionnaire revised Extraversion, Psychoticism and Social Desirability scale on the other side. Finally, the mean score of the PI differs across the Italian, American and Dutch samples. This is of theoretical interest and deserves further study.
No consistent predictors of outcome have been identified for the pharmaco-therapy of obsessive-compulsive disorder (OCD). Recent factor analytic studies have identified meaningful symptom dimensions that may be related to response to serotonin reuptake inhibitors and other treatments.
A total of 354 outpatients with primary OCD were administered the Yale-Brown Obsessive Compulsive Scale Symptom Checklist, and its 13 main symptom categories were factor analyzed by using principal components analysis. The identified symptom dimensions were then entered into multiple regression models as outcome predictors of response to serotonin reuptake inhibitors and placebo response in a group of 150 nondepressed subjects who completed six double-blind, placebo-controlled trials with a serotonin reuptake inhibitor (clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine). Eighty-four patients received a serotonin reuptake inhibitor and 66, placebo.
The principal components analysis identified five factors that explained 65.5% of variance in outcome: symmetry/ordering, hoarding, contamination/cleaning, aggressive/checking, and sexual/religious obsessions. Serotonin reuptake inhibitors were significantly superior to placebo on all outcome measures. Initial severity of OCD was related to greater posttreatment severity of OCD. Higher scores on the hoarding dimension predicted poorer outcome following treatment with serotonin reuptake inhibitors, after control for baseline severity. No predictors of placebo response were identified. Exclusion of clomipramine did not modify the overall results, suggesting a cross-serotonin reuptake inhibitor effect.
The identified symptom dimensions are largely congruent with those identified in earlier reports. Patients with OCD vary in their response to treatment with serotonin reuptake inhibitors. The presence of hoarding obsessions and compulsions is associated with poorer response to serotonin reuptake inhibitors.
The objective of this study was to examine the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and behavioral therapy and to identify predictors of clinical outcome.
Sixty outpatients meeting DSM-II-R or DSM-IV criteria for OCD were followed up for 1 to 5 years (mean = 2.5 years). All of them received prolonged pharmacologic therapy with an SRI.
Thirty-seven patients (61.7%) completed an adequate behavioral treatment. At long-term assessment, 22 patients (36.7%) exhibited a global Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score greater than 16 or a final reduction in Y-BOCS global score of less than 35% and were considered nonresponders. Patients who completed behavioral therapy showed a significant decrease in Y-BOCS compulsions subscale score (p = .01), whereas no significant differences in either Y-BOCS global or obsessions subscale scores between those who did and those who did not undergo behavioral therapy were detected. Obsessions of sexual/religious content were the unique factor related to a poorer long-term outcome.
A substantial number of OCD patients showed persistent disabling symptoms at the long-term follow-up in spite of combined pharmacologic and behavioral treatment. Major benefits from behavioral therapy appeared to be the improvement of ritualistic behaviors. Sexual/religious obsessions predicted poorer long-term outcome, whereas short-term response to SRI treatment failed to achieve predictive value in the long-term course of OCD.
Religion has often been thought to play a part in the genesis of some cases of obsessive-compulsive disorder (OCD). In this study, we explored the relationship between religiosity, religious obsessions, and other clinical characteristics of OCD. Forty-five outpatients with OCD were evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Yale-Brown Obsessive-Compulsive Checklist (Y-BOCC) as well as the Religious Practices Index (RPI), which was developed for this study. On the basis of these evaluations, 42% of the patients were found to have religious obsessions. Despite differences in the frequency of religious obsessions found in this study compared with others, a factor analysis revealed the symptom dimensions to be similar to those found in other OCD samples. There was no significant difference in the overall severity of obsessions and compulsions between patients with and without religious obsessions. RPI scores did not differ significantly between groups. We failed to find a relationship between RPI scores or religious obsessions and any particular type of obsession or compulsion. A logistic regression analysis revealed that the sole predictor of the presence of religious obsessions was a higher number of types of obsessions. In conclusion, we failed to find a conclusive relationship between religiosity and any other clinical feature of OCD, including the presence of religious obsessions. On the other hand, we showed that the patients who tend to have a variety of obsessions are more likely also to have religious obsessions. Thus, religion appears to be one more arena where OCD expresses itself, rather than being a determinant of the disorder.
The present investigation reports on the development and psychometric evaluation of the Penn Inventory of Scrupulosity (PIOS), a 19-item self-report scale measuring religious obsessive-compulsive symptoms. Factor analysis yielded a two factor solution with the first subscale measuring fears about having committed sin, and the second measuring fears concerning punishment from God. Using a sample of college students, the PIOS was shown to be internally consistent and possess good convergent and discriminant validity. Highly devout participants evidenced higher scores on both PIOS subscales, but devout Jews evidenced fewer fears of sin and punishment from God compared to devout Protestants or Catholics. The PIOS has utility both as a research and clinical tool.
There is evidence that religion and other cultural influences are associated with the presentation of obsessive-compulsive symptoms, as well as beliefs and assumptions presumed to underlie the development and maintenance of these symptoms. We sought to further examine the relationship between Protestant religiosity and (1) various symptoms of obsessive-compulsive disorder (OCD) (e.g., checking, washing) and (2) OCD-related cognitions. Using self-report questionnaires, we compared differences in these OCD-related phenomena between highly religious Protestants, moderately religious Protestants, and atheist/agnostic participants drawn from an undergraduate sample. Highly religious versus moderately religious Protestants reported greater obsessional symptoms, compulsive washing, and beliefs about the importance of thoughts. Additionally, the highly religious evinced more obsessional symptoms, compulsive washing, intolerance for uncertainty, need to control thoughts, beliefs about the importance of thoughts, and inflated responsibility, compared to atheists/agnostics. Results are discussed in terms of the relationship between religion and OCD symptoms in the context of the cognitive-behavioral conceptualization of OCD.
Some patients with obsessive-compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature.
To investigate factors associated with treatment-refractoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD.
The factors associated with refractoriness of OCD were higher severity of symptoms since the onset of OCD (p<0.001), chronic course (p=0.003), lack of a partner (p=0.037), unemployment (p=0.025), low economic status (p=0.015), presence of obsessive-compulsive symptoms of sexual/religious content (p=0.043), and higher scores on family accommodation (p<0.001). Only the three latter variables remained significantly associated with treatment-refractoriness after regression analyses. Limitations: small sample size, the biases and drawbacks inherent to a case-control study, and the inclusion criteria used to define the study groups may have limited the generalisation of the results.
A major strength of this study is the systematic and structured evaluation of a vast array of variables related to the clinical expression of OCD, including epigenetic factors and ratings derived from instruments evaluating family accommodation. The presence of sexual/religious symptoms, low economic status and high modification on family function due to OCD were independently associated with treatment-refractoriness. Future longitudinal studies are warranted to verify if these variables represent predictive factors of treatment non-response.
The current study examined scrupulosity in 352 unselected college students as measured by the 19-item Penn Inventory of Scrupulosity (PIOS). Confirmatory factor analysis yielded support for a two-factor model of the 19-item PIOS. However, item-level analyses provided preliminary support for the validity of a 15-item PIOS (PIOS-R) secondary to the removal of items 2, 6, 15, and 10. The two domains of scrupulosity identified on the PIOS-R consisted of the Fear of Sin and the Fear of God. Both domains and total scrupulosity scores were strongly related to obsessive-compulsive symptoms. Scrupulosity also showed significant, but more modest correlations with a broad range of other measures of psychopathology symptoms (i.e., state anxiety, trait anxiety, negative affect, disgust sensitivity, specific fears). However, only obsessive-compulsive symptoms and trait anxiety contributed unique variance to the prediction of scrupulosity. Examination of specific obsessive-compulsive symptom dimensions revealed that only obsessions contributed unique positive variance to the prediction of Fear of God. However, OCD obsessions, washing, and hoarding symptoms contributed unique positive variance to the prediction of Fear of Sin. These findings are interpreted in the context of future research elucidating the relationship between scrupulosity and obsessive-compulsive symptom dimensions.