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Psychometric properties and construct validity of the Obsessive-Compulsive Inventory- Revised: Replication and extension with a clinical sample

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The present study examined the psychometric properties and construct validity of the Obsessive-Compulsive Inventory--Revised (OCI-R) with the aim of replicating and extending previous findings, and addressing limitations of previous investigations. Individuals with OCD (n = 167) and other anxiety disorders (n = 155) completed the OCI-R, measures of OCD and related symptom severity, and measures of cognitive variables associated with OCD symptoms. Results indicate that the OCI-R is a psychometrically sound and valid measure of OCD and its various symptom presentations. Confirmatory factor analysis confirmed a six-factor solution. The instrument also evidenced good convergent validity, and performed well in discriminating OCD from other anxiety disorders. Theoretically consistent patterns of associations between OCI-R symptom-based subscales and OCD-related cognitive variables were found, and five of the six OCI-R subscales corresponded closely to identified OCD symptom dimensions. The OCI-R is recommended as an empirically validated instrument that can be used in a range of clinical and research settings for research on OCD.

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... However, the high comorbidity of OCD with depression and anxiety disorders (Baer et al., 2017;Lieb et al., 2019) suggests an alternative explanation for the relationship between an RTS and the severity of OC symptoms: It may be due to both constructs' associations with depressive and anxiety symptom severity. This explanation is supported by both depressive and anxiety symptom severity showing medium to large positive associations with OC symptom severity (e.g., Abramowitz & Deacon, 2006;Clark et al., 2005;Goodman et al., 1989a;Tellawi et al., 2016) as well as with an RTS (e.g., Merino et al., 2014;Merino et al., 2016;Nolen-Hoeksema, 2000;Rogers et al., 2019;Treynor et al., 2003;Yang et al., 2014). ...
... The Y-BOCS is an interview measure of OC symptom severity that is generally considered the gold standard (e.g., Grabill et al., 2008). Compared to the Obsessive-Compulsive Inventory-Revised (OCI-R; Foa et al., 2002;used by Grisham & Williams, 2009), which focuses on the distress associated with OC symptoms, the Y-BOCS also measures additional aspects of OC symptom severity, such as interference from or control over OC symptoms (Abramowitz & Deacon, 2006). Furthermore, when an RTS is assessed with a self-report questionnaire, using an interview measure of OC symptom severity has the additional advantage of reducing the possibility that associations with an RTS are due to common method variance (e.g., Podsakoff et al., 2003). ...
... The OCI-R has high reliability and good convergent validity (Foa et al., 2002;Gönner et al., 2008). Although the strength of its associations with measures of depressive symptom severity varies, its discriminant validity is generally acceptable (Abramowitz & Deacon, 2006;Foa et al., 2002;Gönner et al., 2008). In the present study, the OCI-R total score had high internal consistency, with Cronbach's α = .82. ...
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Previous studies suggest that a ruminative thinking style (RTS) is positively associated with the severity of obsessive-compulsive symptoms and might be involved in the maintenance of obsessive-compulsive disorder (OCD). We sought to replicate this association in a sample of individuals with OCD, controlling for depressive and anxiety symptom severity, and to extend previous studies by including an interview measure of obsessive-compulsive symptom severity. A sample of 140 individuals diagnosed with OCD participated in a cross-sectional observational study. Participants completed questionnaire measures of an RTS as well as obsessive-compulsive, depressive, and anxiety symptom severity. Obsessive-compulsive symptom severity was additionally assessed with an interview. When statistically controlling for depressive and anxiety symptom severity, an RTS continued to predict the questionnaire, but not the interview measure of obsessive-compulsive symptom severity. We discuss possible explanations for these mixed findings, emphasizing the unique aspects of each measure, and consider implications for further research on OCD.
... For each item, there is a 5-point scale ranging from 0 to 4 (from "not at all" to "extremely"), with total scores ranging from 0 to 72 and higher scores indicating a greater severity of OC symptoms. This scale has also been reported as having a good convergent validity (Abramowitz and Deacon, 2006;Hajcak et al., 2004) and being capable of distinguishing well between OCD and other specific anxiety disorders (Abramowitz and Deacon, 2006). In our study sample, the internal consistency (Cronbach's α) of the OCI-R was 0.93. ...
... For each item, there is a 5-point scale ranging from 0 to 4 (from "not at all" to "extremely"), with total scores ranging from 0 to 72 and higher scores indicating a greater severity of OC symptoms. This scale has also been reported as having a good convergent validity (Abramowitz and Deacon, 2006;Hajcak et al., 2004) and being capable of distinguishing well between OCD and other specific anxiety disorders (Abramowitz and Deacon, 2006). In our study sample, the internal consistency (Cronbach's α) of the OCI-R was 0.93. ...
Article
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Cyberchondria is a clinical entity of excessive and repetitive online health-related searches, associated with health anxiety, obsessive-compulsive symptoms and intolerance of uncertainty. Its relationships with depressive and somatic symptoms have not yet received much attention. The purpose of this study was to examine the individual and comparative effects of several psychopathology constructs on the severity of cyberchondria. Through an online platform, participants (N = 749) completed specific self-report measures assessing the severity of cyberchondria, anxiety, intolerance of uncertainty, depressive, somatic, and obsessive-compulsive symptoms. Standard and hierarchical multiple regression analyses were used to assess how well the independent variables influenced the levels of cyberchondria, before and after controlling for age, education, and sex. When measures of all constructs were included in the analysis, all were significant predictors of cyberchondria levels, except for anxiety. Health anxiety made the strongest contribution. When age, education and sex were controlled for, all measures except for anxiety were also significant predictors of cyberchondria severity. Our study confirms that health anxiety, obsessive-compulsive symptoms and intolerance of uncertainty are all associated with cyberchondria severity, with health anxiety making the strongest unique contribution. Depression and somatic symptoms also predicted cyberchondria severity.These findings have important implications for research and clinical practice.
... The OCIR contains six subscales: washing/contamination, checking, obsessions, neutralizing, ordering, and hoarding. Reliability of the OCIR has been established for both clinical (Abramowitz & Deacon, 2006;Foa et al., 2002) and nonclinical (Fullana et al., 2005) samples, in both English and Spanish (González et al., 2011). The clinical cutoff for the OCIR is 21 (Abramowitz & Deacon, 2006). ...
... Reliability of the OCIR has been established for both clinical (Abramowitz & Deacon, 2006;Foa et al., 2002) and nonclinical (Fullana et al., 2005) samples, in both English and Spanish (González et al., 2011). The clinical cutoff for the OCIR is 21 (Abramowitz & Deacon, 2006). For our study, we separated out the OCIR subscales into OCIR-hoarding (OCIR-H) and OCIR-nonhoarding (OCIR-NH), the latter of which was a composite of the other five subscales. ...
Article
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Hoarding disorder (HD) involves extreme difficulties discarding possessions and significant clutter in living areas. Although hoarding occurs worldwide, cross-cultural research remains in nascent stages, hampered in part by a lack of validated measures in non-English languages. We aimed to validate a Spanish translation of the Hoarding Rating Scale (HRS), a widely used measure of core HD symptoms. Our sample (N = 736) included participants responding in English (n = 548; 45.4% female; 7.9% Latinx) or Spanish (n = 188; 46.3% female; 79.9% Latinx) to questionnaires via Amazon’s Mechanical Turk. An item response theory (IRT) approach was used to test differential item functioning (DIF) of the English and Spanish HRS. We also examined convergent validity of each language version with other HD. Initial comparisons revealed that hoarding symptoms were elevated in the Spanish-speaking sample compared to the English-speaking sample. DIF tests flagged the clutter item for potential bias (McFadden’s β = .069), but closer examination revealed that the impact was negligible. The Spanish HRS was significantly linked with other hoarding measures (Saving Inventory-Revised: β = .497, p < .001; Obsessive–Compulsive Inventory-Revised–Hoarding Subscale: β = .329, p = .008), controlling for mood, anxiety, stress, and non-hoarding OCD symptoms. However, the Spanish HRS was not significantly associated with Clutter Image Rating scores. Findings supported the utility of the HRS to measure of HD symptoms in Spanish speakers, though cross-linguistic assessment of clutter and the applicability of clinical cutoffs with Spanish-speaking samples merits further study.
... and STAI-T (M = 51.37; SD = 9.32) were similar to that previously reported for clinical samples with anxiety and OCD (Abramowitz & Deacon, 2006;Khawaja & Yu, 2010;Yook et al., 2010) (see Figure 1). ...
... However, in this clinical sample with anxiety and OCD, no significant effects of IU (although means were in the expected direction) were observed for SCR to learned threat versus safe cues during same-day and next-day extinction training, or next-day reinstatement test. Notably, the majority of the sample in this study had higher than average IU (Abramowitz & Deacon, 2006;Khawaja & Yu, 2010;Yook et al., 2010), and maintained a differential SCR throughout the same-day extinction training phase (Steinman et al., 2022), similar to individuals with high IU in community samples . Thus, it is possible that IU-related effects on differential SCR are difficult to observe without the full range of IU scores (e.g. both the low and high end). ...
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Uncertainty-related distress is considered a hallmark of anxiety and obsessive compulsive disorders (OCD). Previous research in community samples has demonstrated that individuals with high Intolerance of Uncertainty (IU), the tendency to find uncertainty aversive, display altered threat extinction learning and retention. Here, we conducted an exploratory secondary analysis of an existing dataset (Steinman et al., 2022) to examine the extent to which IU in a clinical sample with anxiety and OCD predicts threat extinction learning and retention. Participants with an anxiety disorder and/or OCD completed a differential threat learning task across two days. SCR was used as an index of conditioned responding. No significant effects of self-reported IU were observed for differential SCR during any of the experimental phases. However, higher self-reported IU, while controlling for trait anxiety, was specifically associated with greater SCR overall during same-day and next-day extinction training. Such findings provide preliminary evidence that higher IU within clinical samples with anxiety and/or OCD may be associated with heightened arousal under uncertainty, and highlight IU as a promising treatment target for anxiety and OCD.
... Ratings are made on a 5-point Likert scale ranging from 0 (not at all distressed or bothered) to 4 (extremely distressed or bothered). The OCI-R has demonstrated good psychometric properties, and its brevity makes it an efficient screening tool that is widely used internationally (Abramowitz & Deacon, 2006;Aydin et al., 2014;Fullana et al., 2005;Gonner, Leonhart, & Ecker, 2008;Huppert et al., 2007;Peng, Yang, Miao, Jing, & Chan, 2011;Solem, Hjemdal, Vogel, & Stiles, 2010;Souza, Foa, Meyer, Niederauer, & Cordioli, 2011;Storch et al., 2010;Woo, Kwon, Lim, & Shin, 2010). ...
... The six-factor structure has been found to be stable in previous studies (Abramo witz & Deacon, 2006;Chasson et al., 2013;Huppert et al., 2007;Peng et al., 2011;Sulkowski et al., 2008), and the OCI-R total score correlates moderately and directly with clinician-rated measures of OCD severity (Peng et al., 2011;Sulkowski et al., 2008). Modest relations with measures of depressive symptoms have been found as well, reflecting shared method variance and comorbidity (Abramowitz & Deacon, 2006;Sulkowski et al., 2008). Finally, the OCI-R has demonstrated treatment sensitivity (McGuire et al., 2019). ...
Article
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The aim of this study is to replicate the findings from previous research about the psychometric properties of the Mandarin Chinese version of the Obsessive-Compulsive Inventory–Revised (OCI-R), which assesses the presence of symptoms obsessive-compulsive disorder and the distress associated with those symptoms. The final clinical sample included 80 participants from multiple psychiatric outpatient clinics in China. Participants completed the following questionnaires: the OCI-R, the Depression, Anxiety, and Stress Scale (DASS-21), the Yale-Brown Obsessive-Compulsive Scale–II (Y-BOCS-II), and the Clinical Global Impressions Scale, Severity (CGI-S). The Mandarin Chinese version of the OCI-R demonstrated good internal consistency for the total scale and each subscale. Good convergent and divergent validity was established. The Mandarin Chinese version of the OCI-R demonstrated good psychometric properties. Further research is needed to examine the factor structure of the Chinese version of the OCI-R and the extent to which it aligns with the original version.
... Participants (N = 49) with marked fear of snakes, spiders, and/or contamination-related threats were recruited from an undergraduate subject pool and the community. Prescreens included the Fear of Spiders/Snakes Questionnaire (FSQ) (Szymanski & O'Donohue, 1995) and the washing subscale of the Obsessive-Compulsive Inventory (OCI-R) (Abramowitz & Deacon, 2006). Those scoring ≥1.5 SDs above the prescreen mean were invited to a pre-treatment visit, and at this visit, those reporting peak distress ≥50/100 on either of two behavioral approach tasks (BATs) involving brief encounters with feared targets, and otherwise deemed eligible were invited to partake in treatment; non-qualifiers were debriefed (see Table A.1 in the appendix). ...
... However, procedures exactly mirrored those used in BAT-1. To enhance sensitivity, the BATs were abbreviated to 30 s. Secondary outcomes indexed change in phobic severity for each fear domain domain-specific symptoms, using the FSQ (Szymanski & O'Donohue, 1995) and OCI-R (Abramowitz & Deacon, 2006). ...
Article
Exposure therapy is highly effective for anxiety-related disorders, but there is a need for enhancement. Recent trials of adjunctive neuromodulation have shown promise, warranting evaluation of transcranial direct current stimulation (tDCS) as an augmentation. In a double-blind, placebo-controlled trial, contamination- and animal-phobic participants (N = 49) were randomized to active tDCS (1.7 mA, 20 min.; n = 27), or sham tDCS (1.7 mA, 30 sec.; n = 22), followed by 30 min. of in-vivo exposure. Active tDCS targeted excitation of the left mPFC and inhibition of the right dlPFC; polarity was counterbalanced for controls. We predicted tDCS would result in accelerated and better maintained gains, contingent on the subsequent in-session response, and baseline negative prognostic indicators. Consistent with predictions, tDCS promoted engagement and reductions in threat appraisals during exposure, and greater reductions in distress and threat appraisals through 1-month, although effects did not uniformly generalize. tDCS was most beneficial given high phobic severity, anxiety sensitivity, and a suboptimal early response. tDCS may promote engagement and response among individuals who are resistant or refractory to standard treatment. tDCS should be applied to more severe anxiety-related disorders, with parameters yoked to individual differences to improve outcomes in exposure-based interventions.
... It has high test-retest reliability, convergent validity, good internal consistency, and solid factor structure according to both clinical [11][12][13] and nonclinical cohorts [14,15]. OCI-R has performed well in discriminating OCD from anxiety disorders [11,16]. ...
... The OCI-R correlates with the widely-accepted OCD severity rating assessment scale, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) [16][17][18]. However, OCI-R covers a subset of the scales included in Y-BOCS and does not directly measure time occupied, interference, resistance, or control related to OCD (the remaining Y-BOCS subscales). ...
Article
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Purpose EGOS is an epidemiological obsessive–compulsive disorder (OCD) cohort in Sweden. Individuals contributed DNA for genotyping and sequencing and completed a Swedish translation of the Obsessive–Compulsive Inventory-Revised (OCI-R), a self-report questionnaire for assessing the severity of OCD. This study aimed first to evaluate the psychometric properties of the Swedish translation of the OCI-R and then shed light on the frequency, severity, and symptom dimensions of OCD comorbid with other psychiatric disorders. Methods OCI-R data were available for 1010 individuals diagnosed with OCD, and 124 individuals diagnosed with chronic tic disorders without OCD used as a comparison group. We first performed a confirmatory factor analysis to confirm the six-factor structure of OCI-R. Then, we estimated Cronbach’s α coefficient and the generalizability coefficient to evaluate the internal consistency of the OCI-R. We linked the data from the Swedish national registries to access and analyze psychiatric comorbidities of OCD. Results The Swedish translation of OCI-R demonstrated internal consistency and clear agreement with the OCI-R six-factor model. The mean total OCI-R score for females was significantly higher than for males. The most comorbid psychiatric condition to OCD were anxiety disorders (13.6%) and major depression (12%). Conclusion The Swedish translation of OCI-R was a valid and reliable measure for assessing the severity of OCD. We observed that individuals with OCD frequently had additional comorbid psychiatric disorders and that the severity of OCD was significantly higher in individuals with at least one additional psychiatric comorbidity as compared to individuals with no psychiatric comorbidity.
... However, the OCI-R is the most commonly used self-rating instrument for OCD 39 . Moreover, it has been recommended as a screening measure 58 and has shown good sensitivity and specificity in the German version 44,59 . However, results need to be verified using clinical interviews. ...
Article
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The COVID-19 pandemic has been associated with an increase in obsessive-compulsive disorder/symptoms (OCD/OCS). However, knowledge is limited regarding the trajectories of OCS during the pandemic as well as their predictors and mechanisms (e.g., experiential avoidance, EA). The aim of this study was to describe the trajectories of OCS and the identification of associated factors. We assessed 1,207 participants of the general population in March 2020 (t1) and June 2020 (t2). Pre-pandemic data was available from March 2014 for a subsample (n = 519). To define trajectories, we determined OCS status (OCS+/−). We performed a hierarchical multinomial logistic regression to investigate predictors of trajectories. Between t1 and t2, 66% of participants had an asymptomatic trajectory (OCS−/ OCS−); 18% had a continuously symptomatic trajectory (OCS+/OCS+). Ten percent had a delayed-onset trajectory (OCS−/OCS+), and the recovery trajectory group (OCS+/OCS−) was the smallest group (6%). Higher education reduced the odds of an OCS+/OCS− trajectory. OCS in 2014 was associated with increased odds of showing an OCS+/OCS+ or OCS−/OCS+ trajectory. When EA at t1 and change in EA from t1 to t2 were added to the model, higher EA at t1 was associated with increased odds of scoring above the cut score on one or more of the assessments. A higher decrease in EA from t1 to t2 reduced the probability of showing an OCS+/OCS+ and an OCS−/OCS+ trajectory. While the current data supports a slight increase in OCS during the pandemic, trajectories differed, and EA seems to represent an important predictor for an unfavorable development.
... The total score, ranging from 0 to 72, is then divided into subscales to reflect the severity of symptoms in the following six dimensions of OCD: washing, checking, ordering, obsessing, hoarding and neutralizing. The OCI-R demonstrates good internal consistency and test-retest reliability, along with strong convergent validity (Abramowitz & Deacon, 2006). ...
Article
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Background Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. Aim To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. Methods A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient ( r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. Results A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant – { r = 0.405, Sig. (two-tailed) = 0.001}. Conclusion Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms.
... Obsessive-compulsive symptoms were measured using the OCI-R (Foa et al., 2002), which lists 18 characteristic symptoms of OCD, with each rated on ATTENUATION OF EMOTIONS IN OCD a 0 (Not at all) to 4 (Extremely) scale regarding its prevalence during the last month. The OCI-R demonstrates good validity, test-retest reliability, and internal consistency in both clinical (Abramovitch et al., 2020;Abramowitz & Deacon, 2006;Foa et al., 2002) and non-clinical samples (Hajcak et al., 2004). Cronbach's alpha in our sample was .93. ...
Article
The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that OCD is associated with attenuated access to internal states. Here we explored the implications of this model in the realm of emotions. Participants with OCD, anxiety disorders, and non-clinical control participants completed the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), assessing two domains of emotional intelligence: Experiential emotional intelligence (EI), reflecting the ability to perceive and feel emotions accurately, and Strategic EI, reflecting the ability to understand and manage emotions correctly. As only Experiential EI requires accurate perception of one’s emotions for adequate performance, we predicted an interaction between group and EI area. Specifically, we predicted that compared to both anxiety disorders and healthy control participants, OCD participants would show a larger deficit in Experiential area of the MSCEIT relative to the Strategic area. Results were fully in line with this prediction. Moreover, supporting the specificity of the hypothesized deficit to OCD, participants with anxiety disorders did not differ from non-clinical control participants in their performance, and findings were not attributable to anxiety or depression levels. These results replicate and extend previous findings obtained with analogue samples and suggest that OCD is associated with attenuated access to emotional states, which may be partially compensated for by reliance on semantic knowledge of emotion.
... The subscales of OCI-R are washing, obsession, hoarding, ordering, checking, and undoing. The OCI-R has appropriate internal consistency and test-retest reliability (18)(19)(20)(21)(22). Early evidence suggests the sensitivity of OCI-R to treatment, but it seems that more evidence is needed in this regard (23). ...
Article
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Introduction: The purpose of the present study was to evaluate the factor structure, validity and reliability of the Partner-Related Obsessive-Compulsive Symptoms Inventory (PROCSI) in university students of Tehran. Materials and Methods: The present study included 459 married students who were selected through convenient sampling method from Tehran universities, such as Shahid Beheshti, Tehran, Shahed, Tarbiat Modares, Allameh Tabatabai, Amirkabir, Sharif and Kharazmi in the academic year of 2018-2019. This research was conducted in two steps. Firstly, after completing the translation steps, the final questionnaire was prepared. In the second stage, the PROCSI was implemented on students, along with Depression, Anxiety and Stress Scales (DASS), Dyadic Adjustment Scale (DAS), Relationship Beliefs inventory (RBI) and Obsessive Compulsive Inventory- Revised (OCI-R) scales.Data analyzed using descriptive statistics, Pearson correlation, Cronbach alpha coefficients, and the confirmatory factor analysis. The convergent and divergent validity were used based on the correlation of PROCSI with DAS, DASS, OCI-R, and RBI. The mentioned analyzes were performed based on SPSS 21 and Lisrel 8.80. Results:The internal consistency of PROCSI was in the range of 0.42 to 0.82. The confirmatory factor analysis of PROCSI showed that six factors of it have an appropriate fitness. Conclusion: It seems that it seems that the PROCSI has good validity and reliability to use in Iranian couples. Keywords Factor analysis Partner-Related Obsessive-Compulsive Symptoms Inventory Relational Obsessive Compulsive Disorder
... The OCI-R-K is another scale that evaluates the severity of obsessive-compulsive disorder symptoms (18). It is an 18-item scale, and each item is scored on a scale ranging from 0 to 4, with higher scores indicating higher symptom severity. ...
Article
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Introduction: Metacognitions are considered to be crucial factors for the development and maintenance of pathologic anxiety. The present case–control study aimed to examine how metacognitive beliefs are associated with the diagnostic status and subtypes of obsessive–compulsive disorder (OCD). In addition, we examined the pattern of changes in metacognitive beliefs after a 3-month pharmacological treatment in patients with OCD. Methods: A total of 562 cases with OCD and 236 healthy controls were assessed with the Metacognitions Questionnaire (MCQ) and various measures of OC symptom severity. Multivariate analyses of variance (MANOVAs) with covariates were conducted to explore the relationship between subdimensions of metacognitive beliefs and OCD disease status. In addition, for the OCD patients, Pearson's correlation was performed between baseline MCQ subdimensions and Obsessive–Compulsive Inventory-Revised-Korean subscales (OCI-R-K). Finally, in a subset of drug-free OCD patients ( n = 144), the MCQ was reassessed after 3 months of treatment and patterns of changes in subdimensions of the MCQ were examined. Results: Patients with OCD scored significantly higher on the four dimensions of the MCQ. There were significant associations between all MCQ subdimensions and OCI-R-K subscales. In the repeated-measure MANOVA, a significant group (non-responders vs. responders)-by-time interaction effect was found only for the negative beliefs about the uncontrollability and danger of worry (NB) subdimension ( F = 10.75; η ² = 0.072; p = 0.001). Conclusion: The presence of dysfunctional metacognitive beliefs in OCD subjects and their association with OCD characteristics suggest that dysfunctional metacognitions may play a crucial role in the pathophysiology of OCD. Improvement of metacognitive beliefs in the NB dimension may be a clinically meaningful correlate of good treatment response in the pharmacological treatment of OCD.
... A 36-item CSS, developed by Taylor et al. (2020), was employed to measure and understand COVID-19-related psychopathology and to identify people in need of mental health services. A 6-factor solution was identified, corresponding to scales assessing COVID-19-related stress and anxiety symptoms: (1) danger, (2) contamination fears, (3) fears about economic consequences, (4) xenophobia, (5) compulsive checking, and (6) traumatic stress symptoms about COVID-19 (Abramowitz & Deacon, 2006;Taylor, 2019;Taylor et al., 2020). However, for the purpose of this study, only four factors comprising 24 items were selected: COVID-19 danger, COVID-19 contamination fears, COVID-19 compulsive checking, and traumatic stress symptoms about COVID-19. ...
... This subscale was selected as a screening tool, rather than the total score, because it has been shown to more readily differentiate those with OCD from non-anxious controls (Foa et al., 2002). Furthermore, two of the six subscales contributing to the total score (neutralizing and hoarding) have demonstrated considerable psychometric and conceptual limitations (Abramowitz & Deacon, 2006;Hajcak, Huppert, Simons, & Foa, 2004). Approximately 68% of the sample met or exceeded the OCIR obsessing cut score of 4. Participants were 58% female, 64.5% White/Caucasian, 17.8% Asian or Pacific Islander, 8.4% African American, 0.9% American Indian, and 8.4% Other; 24.3% were Hispanic or Latino. ...
Article
Objectives: Obsessive-compulsive disorder (OCD) is a condition marked by recurrent and distressing thoughts, images, and urges accompanied by repetitive physical or mental rituals. An emerging line of work suggests that emotion may be an important consideration when looking at the role of impulsivity across the spectrum of psychopathology, including OCD. The current study examined the relationship between obsessive-compulsive symptomatology (OCS) and impulsive cognitive and behavioural reactions to emotion using a multi-study, multi-method approach. Design: Data were collected cross-sectionally online (Study 1) or via an in-person laboratory visit (Study 2). Methods: In Study 1, self-report measures of impulsivity and OCS were administered to a large, non-selected community sample (N = 386). Study 2 extended these findings with a young adult sample (N = 107) with clinically elevated OCS using self-report measures, clinical interview, and two behavioural symptom provocation tasks. Results: Emotion-related impulsivity, but not non-emotion-related impulsivity, was associated with greater severity of OCS across symptom domains and across all modes of assessment. Impulsive cognitive responses to emotion were associated with greater obsession severity, while impulsive behavioural reactions to emotion were associated with greater compulsions. Emotion-related impulsivity also acted synergistically with a belief in the importance and control of thoughts, such that this established risk factor for OCD was associated with greater OCS severity only when behavioural reactivity to emotion was also present. Conclusions: Results highlight the importance of considering emotional context when studying impulsivity in OCD, and point to the potentially differential relationship between OCS and behavioural versus cognitive impulsive reactions to emotion. Practitioner points: Emotion-related impulsivity (ERI) reflects a tendency to act impulsively in the context of strong emotions. ERI was associated with greater OCS across symptom domains and type of symptom assessment (self-report, interview, or symptom provocation). ERI also interacted with an established OCS risk factor, a belief in the importance and control of thoughts, to predict symptom severity, suggesting that it may be important to evaluate and address ERI alongside unhelpful beliefs in patients with OCS. Given the present study's cross-sectional nature, we cannot draw conclusions about the directionality of the ERI - OCS relationship, and while our study included individuals with clinically elevated OCS, results should be replicated in a fully clinical sample.
... OKB belirtilerinin değerlendirilmesinde yaygın olarak kullanılan Maudsley Obsesif Kompulsif Envanteri (Hodgson ve Rachman, 1977), Padua Envanteri Washington Eyalet Üniversitesi Revizyonu (Burns ve ark., 1996), Vancouver Obsesif Kompulsif Ölçeği (Thordarson ve ark., 2004) ve Obsesif Kompulsif Envanteri (Abramowitz ve Deacon, 2006) gibi öz bildirim araçları mevcuttur. OKB'nin belirli özelliklerini ya da genel belirti düzeyini değerlendiren bu ölçeklerin, oldukça tatmin edici psikometrik özelliklere sahip olduğu farklı çalışmalarda ortaya konmuştur (örn., Burns ve ark., 1996;Hodgson ve Rachman, 1977;İnözü ve Yorulmaz, 2013;Yorulmaz ve ark., 2015). ...
Article
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Yale-Brown Obsession Compulsion Scale (YBOCS) is one of the most commonly used instruments to assess the severity of symptoms related to Obsessive Compulsive Disorder (OCD) both in clinical settings and in empirical studies. Self-report version of this scale has been developed, considering the limitations such that the need of an administrator and time-consuming application of the semi-structured interview version. The aim of the present study was to examine the validity and reliability properties of Turkish version of YBOCS–Self Report both in clinical and nonclinical sample. Current study was carried out with 267 adult participants (117 patients diagnosed with OCD and 150 healthy controls) between the ages of 18 and 58 (M = 28.33, SD = 7.57). Participants were asked to fill out demographic information form and YBOCS–Self Report. In addition, YBOCS-Clinician Administered version was administered to some of the participants (n = 56) via semi structured interview. The results of the explanatory factor analysis revealed that YBOCS–Self Report had one factor structure measuring the severity of OCD symptoms. The internal consistency of the scale was found to be very good in clinical, nonclinical and overall sample. In addition, self-report version was highly correlated with clinician administered version; and acceptable validity was achieved in differentiating participants diagnosed with OCD from healthy controls. These findings revealed that Turkish version of YBOCS–Self Report is a valid and reliable instrument to assess the severity of OCD related symptoms both in clinical and non-clinical individuals. Self-report version, which is more practical in application and scoring, has good psychometric properties as well as clinician administered version.
... The scale measures the existence and distress of specific OCD symptoms with 18 questions on a 5-point scale of 0 (not all), 1 (a little), 2 (moderately), 3 (a lot), and 4 (extremely distressed). Previous studies of the English version have shown that the OCI-R measure has high internal consistency, good convergent and discriminant validity, and excellent test-retest reliability (Abramowitz & Deacon, 2006;Foa et al., 2002). The Chinese version has also displayed good psychometric properties (Chasson, Tang, Gray, Sun, & Wang, 2013;Peng et al., 2011). ...
Article
Family accommodation is a common, treatment‐relevant construct related to obsessive‐compulsive disorder (OCD) severity and treatment outcome. This initial study examined the nature, incidence, and clinical correlates of family accommodation in Chinese adults with OCD and their relative or person in a close relationship. One hundred four outpatients diagnosed with OCD completed self‐report measures of obsessive‐compulsive, anxiety, and depression symptoms. Additionally, the individuals with OCD and a relative completed a measure of family accommodation and impairment. Patient‐reports of family accommodation were significantly correlated with OCD symptomology and severity. A multiple linear regression indicated that OCD symptomology was a significant predictor of family accommodation, but anxiety, stress, and depression were not. In addition, the current Chinese sample demonstrated greater levels of family accommodation than previous English‐speaking samples. Potential explanations and implications of the high levels of reported family accommodation are discussed. Family accommodation could play a significant role in OCD development and/or maintenance in China. Future research considerations are discussed.
... We also applied the Emotion Regulation Questionnaire (ERQ) to measure reappraisal and suppression abilities (43,44). The Obsessive-Compulsive Inventory-Revised (OCI-R) was also used to measure OCD severity and dimensions (washing, checking, ordering, hoarding, obsessing, and neutralizing subscales) (45,46). The 10-items Perceived Stress Scale (PSS-10) was also applied to quantify selfperceived stress levels (10,47,48). ...
Article
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Obsessive-compulsive disorder (OCD) is associated with emotion regulation impairments, namely the frequent use of maladaptive strategies such as suppression and the decreased use of reappraisal strategies. Additionally, these patients exhibit elevated stress levels. Since stress exposure affects emotion regulation abilities, stress might influence the relationship between obsessive-compulsive symptoms and emotion regulation. In this study, we explored the effects of stress and obsessive-compulsive symptoms on emotion regulation in a sample of healthy and OCD individuals. We used self-reported psychometric scales to measure stress levels, obsessive-compulsive symptoms, and emotion reappraisal and suppression skills. We applied multiple regression and mediation analyses. Our results demonstrated that increased reappraisal scores were associated with higher suppression scores. Additionally, elevated stress values predicted increased scores for suppression and decreased scores for reappraisal. Furthermore, the reappraisal abilities resulted from a combination of a direct effect of obsessive-compulsive symptoms and an indirect effect of obsessive-compulsive symptoms mediated by stress. The reliance on suppression strategies and the difficulty in using reappraisal approaches are explained by stress levels and are not directly explained by obsessive-compulsive symptoms. This study highlights the necessity of targeting stress in current therapy-based treatments for OCD.
... Participants rate how each item has distressed or bothered them over the past month on a five-point scale from 0 (not at all) to 4 (extremely). The OCIR has good reliability and validity [47,50]. The internal consistency in this sample was α = 0.91. ...
Article
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Theoretical models suggest parent anxiety leads to increased anxiogenic parenting, an important etiological factor for child anxiety disorders. Evidence suggests that parents engage in anxiogenic parenting to reduce distress in response to their child’s anxiety; however, further study of this mechanism is needed. Cognitive risk factors, including distress intolerance, anxiety sensitivity, emotion-related impulsivity, and repetitive negative thinking are promising to examine as they impact emotion regulation. This study examined whether an indirect association between parent anxiety and anxiogenic parenting via these risk factors exists, and if child anxiety moderated this effect. Findings demonstrated evidence for an indirect association via distress intolerance in mothers at high levels of child anxiety, but not low levels. An unmoderated indirect effect via emotion-related impulsivity was found. Anxiety sensitivity and repetitive negative thinking did not demonstrate significant indirect effects. These findings suggest distress intolerance and emotional-related impulsivity may be targets for parent-focused child anxiety treatments.
... This 18-item scale has a total score ranging from 0 to 72 (with a higher score indicating greater symptom severity). The OCI-R has shown good psychometric properties for the total scale and subscales (Abramowitz & Deacon, 2006;Huppert et al., 2007) and is sensitive to change (Abramowitz et al., 2005). physical or psychological illnesses. ...
Article
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Background. Many individuals with obsessive‐compulsive disorder (OCD) do not receive professional treatment due to various idiosyncratic barriers. Internet‐based cognitive‐behavioral therapy (iCBT) is increasingly used to narrow treatment gaps, but the efficacy of such interventions without guidance of therapists has not been well studied. This study evaluated the efficacy of an unguided iCBT that includes third‐wave approaches for the treatment of OCD symptoms. Methods. A total of 128 individuals with self‐reported OCD symptoms were randomly allocated to either an intervention group (unguided iCBT) or to a care‐as‐usual (CAU) control group following an anonymous baseline assessment via an online survey. Eight weeks after inclusion, a reassessment was carried out online. The Yale‐Brown Obsessive‐Compulsive Scale served as the primary outcome parameter for detecting symptom changes in the per‐protocol sample with at least 60 minutes utilization. Results. The iCBT group showed a significantly stronger reduction of OCD symptoms with a medium effect size (η²p = 0.06) compared with the control condition. This effect was moderated by the general frequency of Internet usage (η²p = 0.08); the more time per day users spent online, the less they benefited from the intervention. Secondary outcomes revealed (1) a medium effect size on self‐esteem (η²p = 0.06); (2) no statistically significant effects on quality of life, depression symptoms, impulsivity, or social insecurity; and (3) good acceptability of the intervention. Conclusions. The current study provides evidence that unguided iCBT for OCD may be a viable option for individuals who experience treatment barriers. As non‐compliance remains a challenge, this topic needs further research.
... A modified version of the OCIR was used in the current study, and included twelve items that assess levels of obsessions, contamination/washing symptoms, symmetry concerns, and checking behaviors (Abramowitz & Deacon, 2006). The neutralizing and hoarding subscales included in the original OCIR were not used in the present report. ...
Article
There has been increasing recognition that classically defined psychiatric disorders cluster hierarchically. However, the degree to which this hierarchical taxonomy manifests in the distribution of one's daily affective experience is unknown. In 462 young adults, we assessed psychiatric symptoms across internalizing and externalizing disorders and then used cell-phone-based ecological momentary assessment (EMA) to assess the distribution (mean, standard deviation, skew, kurtosis) of one's positive and negative affect over 3-4 months. Psychiatric symptoms were modeled using a higher-order factor model that estimated internalizing and externalizing spectra as well as specific disorders. Individualized factor loadings were extracted, and path models assessed associations between spectra and syndromes, and daily affect. Internalizing and externalizing spectra displayed broad differences in the distribution of affective experiences, while within the internalizing spectrum, syndromes loading onto fear and distress subfactors were associated with distinct patterns of affective experiences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Each item is rated on a 5-point Likert scale from 0 (not at all) to 4 (extremely). It was reported that the OCI-R is able to differentiate OCD from anxiety disorders [50]. The internal consistency of the OCI-R in the present sample was 0.93. ...
Article
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Background: Cyberchondria denotes excessive and repeated online health-related searches associated with an increase in health anxiety. Such searches persist in those with cyberchondria, despite the negative consequences, resembling a pattern of compulsive Internet use. Objectives: The aim of the present study was to assess compulsive health-related Internet use in relation to cyberchondria while controlling for related variables. Method: Adult participants (N = 749) were recruited from an online platform. They completed questionnaires assessing the severity of cyberchondria (via the Cyberchondria Severity Scale [CSS]), compulsive Internet use adapted for online health-related seeking (via the adapted Compulsive Internet Use Scale [CIUS]), and levels of intolerance of uncertainty and anxiety, as well as depressive, somatic, and obsessive-compulsive symptoms. A logistic regression analysis was carried out to identify predictors of scores above a cutoff value on the CIUS, indicating compulsive health-related Internet use. Results: The regression output showed that only the CSS total score and sex made a unique, statistically significant contribution to the model, leading to the correct classification of 78.6% of the cases. Of the CSS subscales, compulsion and distress were the most strongly associated with compulsive health-related Internet use. Conclusions: The finding that the adapted CIUS scores are associated with cyberchondria indicates that cyberchondria has a compulsive component, at least in terms of health-related Internet use. It also suggests that compulsive health-related Internet use persists despite the distress associated with this activity. Males may engage in cyberchondria more compulsively than females. These findings have implications for research and clinical practice.
... Severity of obsessions and compulsions was assessed using the Yale-Brown Obsessive-Compulsive Scale [Y-BOCS (49,50)] and severity of depression using Beck Depression Inventory -II scale [BDI -II (51)]. OCD symptoms were also assessed dimensionally, using Obsessive-Compulsive Inventory revised [OCI-R, (52)], Dimensional Obsessive-Compulsive Scale [DOCS, (53)], and the Obsessive-Compulsive Trait Core Dimensions Questionnaire [OC-TCDQ, (54)]. These assessments were administered within 1 week of behavioral testing. ...
Article
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Individuals with obsessive-compulsive disorder (OCD) often have difficulty making decisions. Valuation and value-based judgements are particularly difficult. The mechanisms underlying these impairments are still poorly understood. Previous work has suggested that individuals with OCD require more information prior to making a choice during perceptual discrimination tasks. Little previous work has examined value-guided choice in OCD. Here we examined perceptual and value-based decision making in adults with OCD, using a novel task in which the two types of decision are tested in parallel using the same individually calibrated sets of visual stimuli (Perceptual and Value-based decision-making task, PVDM). Twenty-seven unmedicated participants with OCD (16 female) and thirty-one healthy controls (15 female) were tested. Data were analyzed using hierarchical drift-diffusion modeling (HDDM). Decision formation was altered in OCD, but differentially between genders: males with OCD, but not females, accumulated more information (i.e., were more cautious) and were less effective in evidence accumulation than age- and IQ-matched healthy males. Furthermore, males with OCD, but not females, were less likely than controls to adjust the process of evidence accumulation across decision contexts. These unexpectedly gender-dimorphic effects suggest that more attention should be paid to gender differences in studies of OCD, and of pathophysiology more broadly.
... [95% CI 0.86 to 0.89]). The OCI-R is sensitive to changes in OCD symptoms during treatment (Abramowitz et al., 2005) and it can distinguish between patients diagnosed with OCD from those with other anxiety disorders (AUC = 0.81) (Abramowitz & Deacon, 2006). A cut-off of 17 was used as the threshold for recovery in this trial, based on previous analyses of IAPT data (Veale et al., 2016) and the threshold for a reliable change was 13 points (Veale et al., 2016). ...
Article
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Objectives: Digital therapies such as internet-delivered cognitive behaviour therapy (ICBT) can improve treatment access for patients with common mental disorders, but are rarely used in the Improving Access to Psychological Therapies (IAPT) programme in the United Kingdom. The objective of this study was to evaluate an evidence-based ICBT intervention for obsessive-compulsive disorder (OCD-NET) in three IAPT services in an open trial. Methods: Consecutively referred patients with a primary diagnosis of OCD (n = 474) were offered OCD-NET. Symptoms of OCD, depression, anxiety, and level of functioning were measured weekly throughout treatment. Results: In the full intention to treat sample (n = 474), the intervention was associated with large reductions in self-reported OCD symptoms (d = 1.77), anxiety (d = 1.55) and depression (d = 0.8), as well as improvements in functional impairment (d = 0.51 to 0.72). Further, 35% of participants were in recovery at their last assessment, 25% achieved reliable improvement and 15% met criteria for both recovery and improvement. Among participants completing at least 4 modules (n = 261), corresponding to an adequate 'dose' of treatment, the rates of recovery (44%), reliable improvement (34%) and reliable recovery (21%) were higher. A majority of participants were satisfied with the online treatment and found the online materials helpful. Conclusions: OCD-NET is an effective treatment when delivered in regular care within the IAPT system. Challenges associated with implementing ICBT in regular health care are discussed.
... The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R; Foa et al., 2002) was used to examine if the content area conditions varied by OC symptoms. Past research has shown that the OCI-R has excellent internal consistency and acceptable convergent validity, but has lower discriminant validity (Abramowitz & Deacon, 2006). Cronbach's α for the current study was .89. ...
Article
Introduction: Cognitive models of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs about intrusive thinking contribute to the disorder's development and maintenance. However, the findings concerning one notable belief, thought-action fusion (TAF), have been inconsistent. Current conceptualizations of TAF may conflate constructs such as magical thinking, sensitivity, and thought content that are already the subject of informative, interdisciplinary literatures. Methods: To tease apart these constructs, adult participants (N = 249) reported their trait levels of sensitivity and magical thinking, and were randomly assigned to engage with an intrusive thought in one of three content areas. We hypothesized that morality-related content would lead to heightened maladaptive outcomes, but only in combination with higher trait levels of sensitivity and magical thinking. Results: Results indicated that morality-related content, along with sensitivity to morality, played more of a prominent role in maladaptive outcomes, with magical thinking being implicated in general outcomes like worry. Discussion: These findings suggest that the link between TAF and maladaptive outcomes may depend on which TAF elements are present for an individual. Sensitivity, in tandem with other TAF elements (e.g., morality-related content, magical thinking) is predictive of divergent outcomes (e.g., worrying, urges to neutralize) and thus may be an important target of future interventions aimed at reducing TAF, worrying, and/or OC symptoms.
... This test has high internal consistency. As reported by Foa et al., its Cronbach α for clinical and nonclinical samples ranges between 0.81 and 0.93; similar coefficients have also been reported by other researchers (Abramowitz & Deacon, 2006). Also, OCI-R shows good construct validity. ...
Article
Objective: Measuring, diagnosing, and determining the severity of the symptoms of Obsessive-Compulsive Disorder (OCD) is essential for studying mental health issues. This study aimed to determine the psychometric properties of the Persian version of the Dimensional Obsessive-Compulsive Scale (DOCS) in a non-clinical population. Methods: In this cross-sectional study, 252 residents of Tehran (Iran) were selected by cluster sampling method from different districts. They were asked to complete DOCS, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and Obsessive-Compulsive Inventory-Revised (OCI-R). SPSS v. 21 and LISREL statistical software were used for data analysis. Cronbach's alpha, exploratory and confirmatory factor analysis, Spearman correlation were also used. Results: The Internal consistency of DOCS was 0.916 based on the Cronbach α value. The correlations of DOCS with Y-BOCS and OCI-R were 0.57 and 0.55, respectively. Exploratory factor analysis showed four factors. Confirmatory factor analysis also showed that this four-factor and higher-order factor models had a good fit for the data. Conclusion: The present study indicated acceptable validity and reliability of DOCS in non-clinical populations in Iran. Therefore, this scale be used to screen people with OCD symptoms in non-clinical centers of mental health assessment.
... • Obsessive-Compulsive Inventory-Revised (OCI-R; Abramowitz & Deacon, 2006): The OCI-R questionnaire comprises 18 items evaluated on a five-point Likert scale. It assesses the tendency toward obsessions and compulsive behaviors, and it is composed of six factors: Washing, Obsessing, Hoarding, Ordering, Checking, and Mental Neutralizing. ...
Preprint
Background and aims. In the last thirty years, the continuously increasing number of studies investigating Exercise Addiction (EA) stimulated interest in developing instruments assessing the risk of exercise addiction (REA). One widely used tool is the Exercise Addiction Inventory (EAI) because it is a brief, easy-to-use, time-saving, and psychometrically validated tool. However, its items based on the Components Model of Addiction still lack some reoccurring symptoms associated with exercise addiction. This protocol report outlines the methods of developing and validating an expanded version of the EAI (EAI-3) in a large international sample.Methods. The EAI-3 will be administered to over 5000 regular exercisers in 15 languages through an online survey. The survey will also include questions from the Exercise Dependence Scale-Revised, the Obsessive-Compulsive Inventory-Revised, the SCOFF questionnaire, and the Ten Item Personality Inventory. We will investigate the factorial structure of the EAI-3 through confirmatory factor analysis. Moreover, we will test EAI-3’s measurement invariance across languages and gender. Finally, we aim to find a standard cutoff point for at-risk exercisers. Expected results. We expect to obtain a good fit of the EAI-3 structure and general measurement invariance. In addition, we expect associations with another EA measure and the other measures of mental health assessed in the study.Discussion and conclusions. We expect that the results will support an assessment tool useful in measuring the REA with greater accuracy and exhibiting reliability across gender and language (culture).
... The OCI-R yields a total score ranging from zero to 72, with higher scores indicating greater symptom severity. Validated in both nonclinical and clinical samples, the measure has been found to accurately discriminate people with OCD from those with anxiety disorders (Abramowitz and Deacon, 2006). ...
Article
There has been substantial concern about the mental health effects of the COVID-19 pandemic, particularly for those with obsessive-compulsive disorder (OCD) given the overlap between OCD symptoms (e.g., excessive handwashing) and appropriate disease prevention measures. However, the pandemic has demonstrated a heterogeneous mental health effects, suggesting that individual-level factors could play a role in buffering or exacerbating its deleterious impact. This study aimed to understand how individual differences in resilience were associated with trajectories of obsessive-compulsive, depression, and anxiety symptoms among healthy adults and those with OCD residing in New York City, considered the epicenter of the pandemic in the United States at its onset. The sample consisted of healthy individuals (n = 30) and people with OCD (n = 33) who completed clinical interviews and self-report questionnaires that assessed baseline resilience, OCD symptoms, depression, anxiety, and perceived positive effects of the pandemic at four assessment timepoints: baseline (April 2020) and one, two, and six months later. Linear mixed-effects growth models revealed that greater resilience was associated with stable trajectories of symptoms over time. Conversely, less resilience was associated with worsening obsessive-compulsive symptoms from the two-month to six-month assessment timepoints and worsening depressive symptoms at six months across both groups, and with worsening anxiety symptoms in individuals with OCD at six months. Resilience was correlated with the ability to appreciate “silver linings” of the pandemic. These findings highlight resilience as a potential treatment target for bolstering mental health outcomes among individuals with and without psychopathology during sustained and unprecedented periods of stress.
... The Obsessive-Compulsive Inventory-Revised (OCI-R) [66,67] is an 18-item self-report questionnaire assessing the Obsessive-Compulsive Disorder (OCD) symptoms on a five-point Likert scale (Not at all, A little, Moderately, A lot and Extremely), and total scores range from 0 to 72. The questionnaire comprises six subscales (Washing, Ordering, Hoarding, Mental Neutralizing, Obsessing, and Checking) composing an additional final total score. ...
Article
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Purpose Orthorexia Nervosa (ON) is characterised by excessive attention to a dietary regimen perceived as healthy. A critical factor in the distinction between ON and other eating disorders (EDs) is the dichotomy of quality-versus-quantity of food intake. We investigated whether specific types of diet or dieting frequency are associated with orthorexic features, explored the overlap between ON and EDs symptoms, and examined which constructs are predictive of ON after 6 months. Methods A total of 1075 students (75.1% female, mean age 20.9) completed a set of questionnaires assessing Orthorexia, Eating Disorders, Obsessions and Compulsions, Anxiety and Depression; 358 individuals (79.9 female, mean age 20.9) agreed to participate in the study and completed the same questionnaires after 6 months. Different regression models were defined to investigate our hypothesis. Results Findings suggest that ON is associated with the number and type of diets followed over a lifetime. Moreover, participants with EDs, body dissatisfaction, or a dysfunctional idea of thinness are more likely to report a greater degree of ON features. After 6 months, the best predictors of ON characteristics are the same ON characteristics assessed at the first administration, with a significant role in the ideal of thinness. Conclusions ON is more frequent in individuals with a previous diagnosis of EDs and in individuals who followed a restrictive diet or a vegan/vegetarian one; the number of lifetime diets, beliefs, and behaviors related to the ideals of thinness or body dissatisfaction is common features of ON. Moreover, considering that having ON features in the past is the best ON predictor in the present, we can presume that ON is a construct stable over time. Level of evidence Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).
Article
Incompleteness (INC) and Harm Avoidance (HA) are known core dimensions of obsessive-compulsive disorder (OCD). Emotional processing and inhibitory learning (IL) have both been proposed as viable mechanisms of exposure for the alleviation of HA, yet the relationship with INC remains unclear. This study evaluated differential manipulation responses to induced INC. The authors specifically tested whether targeting the key component of IL, expectancy violation generated by the discrepancy between an articulated prediction and the actual exposure experience, would lead to improved outcomes. A sample of undergraduates (N = 68) completed a series of behavioral tasks to induce INC, followed by manipulations (exposure with or without articulated predictions) to reduce INC reactions. Results show that modest changes were observed following reduction manipulations following INC induction. Furthermore, heightened HA predicted the changes of induced sensations. Mediation tests showed that articulation of predicted sensations mediated pre- to postreduction ratings. Clinical and research implications are discussed.
Article
Purpose: To describe women's experiences of perinatal obsessive-compulsive disorder (OCD) as written in their blogs. Study design and method: This qualitative descriptive study examined perinatal OCD blogs identified using Google search engine. Krippendorff's thematic content analysis method for qualitative data was used. The unit of analysis included segments of the bloggers' descriptions of their perinatal OCD. Clustering and dendrograms were used to group the data into themes. Results: Forty-three different posts from women in the United Kingdom, United States, Australia, and South Africa were analyzed. Five themes were identified that described women's experiences of perinatal OCD as told in their blogs: (1) Starting to tighten its grip during pregnancy, (2) Keeping horrific secrets all to themselves, (3) Tortured with terrifying images and thoughts, (4) Driven to compulsive behaviors to protect their infants, and (5) Long difficult road to recovery but so worth it. Clinical implications: Perinatal OCD is a hidden problem that can have negative consequences for mothers and for their infants and families if not diagnosed or if misdiagnosed. There are effective treatments for OCD, but first nurses and other health care providers need to identify the women who are struggling with this anxiety disorder. During the perinatal period nurses can screen women for OCD. Developing a trusting relationship with pregnant and postpartum women is critical for nurses so that their patients can feel safe enough to share their horrific secret thoughts.
Article
Background & Objectives: Existing studies suggest sleep problems are prevalent in obsessive-compulsive disorder (OCD). However, the nature of the relationship between sleep and obsessive-compulsive symptoms is unclear potentially due to variations in symptomatology among OCD subtypes. This study attempted to elucidate the sleep profiles of different OCD subtypes, the relationships of sleep problems with compulsive checking behaviours and the associated pathways involving anxiety and memory complaints. Design & Methods: In 191 university students, we tested the hypothesized model that objectively-measured sleep debt and self-report sleep disturbances would relate to memory complaints and an elevated level of anxiety, which would in turn be associated with increased checking behaviours, using structural equation modelling path analysis. Results We found that sleep debt and sleep disturbance significantly related to repeated checking behaviours, a typical symptom of OCD. These effects were mediated through subjective memory complaints and anxiety symptoms. In addition, we identified distinctive sleep profiles for different categories of OCD symptoms.
Article
Obsessive-compulsive symptoms (OCS) are frequently reported in clozapine-treated schizophrenia. Studies on the effects of OCS on cognitive abilities and quality of life (QoL) yielded contrasting results, ranging from benefits to adverse effects. We investigated the interactive effects of OCS and cognitive functioning on different aspects of QoL in clozapine-treated patients. 54 patients with schizophrenia underwent a neurocognitive, functional and psychopathological battery. Using moderation models, we examined the interplay between OCS and cognitive abilities on different QoL domains. We found several main effects and interactions between I.Q. and OCS on global QoL, as well as specific effects on psychological and environmental domains. Mild OCS have beneficial effects on QoL, but, as OCS become more severe in patients with more preserved cognitive abilities, the QoL drops steeply. Findings highlight the complex interplay between OCS and cognitive functioning, whose effects on QoL appear to depend on patients’ OCS severity and cognitive profile, as well as on the functional domain addressed. Our data may help to reconcile the seemingly contrasting results from previous studies, and shed a new light on the importance of evaluating OCS in schizophrenia, thus establishing specific interventions that can lead to consequent effects on social well-being and QoL.
Article
Although disgust proneness (DP) is increasingly recognized as a personality characteristic that confers risk for psychiatric conditions such as obsessive-compulsive disorder (OCD), the extent to which it reflects a time-varying (TV) or state-like factor versus a time-invariant (TI) or trait-like personality characteristic is unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 982) recruited through ResearchMatch completed the Disgust Propensity and Sensitivity Scale Revised (van Overveld, de Jong, Peters, Cavanagh, & Davey, 2006), a measure of three variants of DP including Somatic Disgust Sensitivity, Ruminative Disgust Sensitivity, and Disgust Propensity. A latent variable (trait-state-occasion) model was applied to all of the DP dimensions. The results showed that although estimates of TI factor variance and TV factor variance were both significant for Somatic Disgust, Ruminative Disgust, and Disgust Propensity, the proportion of TI factor variance (range from .68 to .82) for the DP dimensions was substantially and significantly greater than the amount of TV factor variance (range from .18 to .32). Furthermore, while TV factor stability was statistically significant for the DP dimensions, the size of the coefficients were only moderate in magnitude. Subsequent analysis then examined the extent to which TV or TI components of DP were associated with latent OCD symptoms at each of the six time points. The results showed that estimates of the regression weight for the TI DP factor were significant and larger than those for the TV factor which were often nonsignificant. These findings suggest that DP is largely TI, and it is this TI component that is most strongly associated with OCD symptoms.
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The lockdown due to the coronavirus pandemic may have exacerbated mental health problems. To what degree mental health may be affected by social isolation is still poorly known. We collected prospective data on students’ mental health in two instances: (i) in October and December 2019, and (ii) 6 months later, in April 2020 amidst the COVID-19 lockdown in Italy and in mid-May/June 2020, after the lifting of lockdown. A total of 358 Italian students aged 18-30 completed socio-demographic questionnaires and the Beck Depression Inventory – 2 (BDI-2), the Beck Anxiety Inventory (BAI), the Obsessive-Compulsive Inventory – Revised (OCI-R), the Eating Habits Questionnaire (EHQ), and the Eating Disorder Inventory-3 (EDI-3). We applied multiple regression models to evince any changes in the aforementioned questionnaire scores during and after lockdown with respect to the scores before lockdown. Students reported on average worse depressive symptoms during lockdown than 6 months before isolation (median increase in the BDI-2 score +2; IQR = -3, 6; β = 0.09 ± 0.03, p = 0.005), with students without any established diagnosis of psychopathology being affected the most. The regression models predict that 86.2% (IQR = 67.9, 91.4%) of students would not experience a clinically significant worsening of symptoms, while approximately 6% of our target population could develop more severe depressive symptoms. This study supports the view that depressive symptomatology may be aggravated during lockdown, but also highlights that after the lifting of lockdown any changes quickly vanished, as the BDI-2 scores were not different from the ones reported before lockdown.
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Measurement-based care (MBC), an evidence-based approach that has demonstrated efficacy for improving treatment outcomes, has yet to be investigated in clients with Autism Spectrum Disorder. The current paper investigates the use of MBC in autistic (n = 20) and non-autistic (n = 20) clients matched on age, sex, and presenting problem. Results of change score analysis indicated that utilizing routine symptom monitoring can enhance treatment evaluation. Autistic clients participated in significantly more sessions, made significantly less progress, and were less compliant with MBC than non-autistic clients. Though hierarchical linear modeling demonstrated no significant differences in treatment slope, results indicated moderate effect size. These results inform the use of MBC in community clinics, highlighting policy implications and need for targeted measurement.
Article
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illnessfor as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed tobe essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
Article
Introduction Obsessive-compulsive disorders (OCD) are common mental disorders, which – especially without treatment – may take a chronic course. Although they often remain undetected, there is a lack of short and valid screening instruments. With the Dimensional Obsessive-Compulsive Scale - Short Form (DOCS-SF) a screening instrument is available in Norwegian. The aims of the current analogue study were to develop and to validate English and German versions of the DOCS-SF. Methods In the online surveys, 304 German and 187 English-speaking students participated. In addition to the DOCS-SF, they answered a battery of established questionnaires on OCD, depression and anxiety. For determining retest reliability, 51 German students participated in another survey. Results Results confirmed the single factor structure of the DOCS-SF and indicated good internal consistency (α=.89) as well as retest reliability (r=.75). Concerning convergent validity, the DOCS-SF was strongly correlated with other OCD scales. Although correlations with anxiety were strong as well, correlations with measures of depression, health anxiety, disgust, and health-related well-being were significantly weaker. Discussion The DOCS-SF appears to be a short, reliable, and valid screening instrument for OCD. Subsequent studies should further investigate its divergent validity, and its diagnostic accuracy in clinical populations.
Article
Grit is associated with positive outcomes in nonclinical samples. However, no studies have examined grit in relation to psychopathology in patients with clinical mood or anxiety disorders. Research and clinical experience suggest that individuals who hoard struggle with characteristics associated with grit, such as task persistence, impulsivity, and self-control. The authors tested the hypothesis that hoarding symptoms are associated with less grit in a sample of individuals (N = 72) presenting for treatment to an anxiety disorders clinic. After covarying symptoms of the four mood and anxiety disorders most commonly comorbid with hoarding disorder (viz. depression, generalized anxiety, social anxiety, and obsessive-compulsive disorder), the authors found that hoarding symptoms were associated with less grit, and the effects were medium-to-large. These results indicate that grit is worthy of investigation in individuals with hoarding disorder using methodologies that permit inferences about causality, and with attention to clinical implications for prevention or treatment.
Article
The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used self-report measure of Obsessive-Compulsive Disorder (OCD) symptoms, yet its factor structure does not converge with contemporary dimensional models of OCD symptoms. In addition to assessing the four core OCD dimensions, the OCI-R includes hoarding and neutralizing factors. However, since its publication, hoarding has been designated as a separate disorder, and there are concerns about the neutralizing factor's reliability and validity. The aim of this study was to evaluate a syndromally valid modification of the OCI-R. Adult samples of individuals diagnosed with OCD (n=1087), anxiety related disorders (n=1306), and unselected community volunteers (n=423) completed the OCI-R and measures of anxiety and mood. Analyses excluded the 3 OCI-R hoarding items and suggested the removal of the 3 neutralizing items. Internal consistency, sensitivity and specificity to OCD clinical status, test-retest reliability, sensitivity to treatment, and convergent and discriminant validity were evaluated for the resultant 12-item scale (termed the OCI-12). The OCI-12 evidenced good to excellent psychometric properties. Clinical norms, severity benchmarks, and a clinical cutoff score were computed. In conclusion, the OCI-12 represents a syndromally valid update of the OCI-R with comparable psychometric properties and superior sensitivity and specificity.
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The COVID-19 pandemic has led to a public mental health crisis with many people experiencing new or worsening anxiety. Fear of contagion and the lack of predictability/control in daily life increased the risk for problems such as obsessive–compulsive disorder (OCD) in the general population. Pregnant women may be particularly vulnerable to such pandemic-related stressors yet the prevalence of OC symptoms in this population during the pandemic remains unknown. We examined the prevalence of OC symptoms in a sample of 4451 pregnant women in the USA, recruited via targeted online methods at the start of the pandemic. Participants completed self-report measures including the Obsessive–Compulsive Inventory-Revised and the Pandemic-Related Pregnancy Stress Scale. Clinically significant OC symptoms were present in 7.12% of participants, more than twice as high as rates of peripartum OCD reported prior to the pandemic. Younger maternal age, income loss, and suspected SARS-CoV-2 infection were all associated with higher OC symptoms. Two types of pregnancy-specific stress, pandemic-related and pandemic-unrelated, were both associated with higher levels of OC symptoms. Pandemic-related pregnancy stress predicted OC symptoms even after controlling for non-pandemic-related, pregnancy-specific stress. Elevated rates of OC symptoms were observed in women pregnant during the pandemic, particularly those experiencing elevated pandemic-related pregnancy stress. This type of stress confers a distinct risk for OC symptoms above and beyond pregnancy-specific stress and demographic factors. Healthcare providers should be prepared to see and treat more peripartum women with OC symptoms during this and future public health crises.
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Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ ( N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).
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Objective: The purpose of the present study was to evaluate the factor structure, validity, and reliability of the revised Relationship Obsessive-Compulsive Inventory (ROCI), with emphasis on Iranian culture. Method: The statistical sample consisted of 341 married students studying in Tehran universities in the academic year 2018-2019, who were selected by available sampling method. The New ROCI, Obsessive-Compulsive Inventory-Revised (OCI-R), Obsessive Beliefs Questionnaire (OBQ), Depression, Anxiety and Stress Scale (DASS), Dyadic Adjustment Scale (DAS), and Relationship beliefs inventory (RBI) were the tools of the present study. Results: The Content Validity Index (CVI) and Content Validity Ratio (CVR) of the new ROCI were good. Also, there was a significant and negative correlation between all subscales and the total score of the new ROCI with all subscales and the total score of the DAS, and there was also a significant positive correlation between the subscales and the total score of the new ROCI with the subscales and the total score of OBQ, OCI-R, RBI, and DASS. Also, the two factor model explained 54.50% of the variance in the new ROCI. Furthermore, all of the confirmatory factor analysis indices of the new ROCI were better than the original ROCI. The results of test-retest correlation of the factor one and two of ROCI were 0.85 and 0.78, respectively. Also, the Cronbach's alpha of the factor one and two of ROCI were 0.60 and 0.74, respectively. Conclusion: In general, it can be said that the new ROCI was different from the original ROCI, and the new ROCI had better indicators than the original ROCI.
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Introduction: The American Psychological Association's national surveys have revealed high levels of stress surrounding the political climate since the 2016 United States (U.S.) presidential election. The two current studies aimed to further evaluate the impact of political factors, such as social and economic conservatism and political party affiliation mismatch between individuals and their local or federal officials, on emotional experiences. Methods: Data for these studies were collected through Amazon's Mechanical Turk following the 2016 and 2018 U.S. elections. Results: Results from Study 1 revealed that following the 2016 presidential election, higher social and economic conservatism was associated with less political obsessions and lower levels of depression. Results from Study 2 also demonstrated that following the 2018 midterm elections, higher conservatism predicted lower depression, less political obsessions, lower levels of negative affect, and higher positive affect. Additionally, conservatism moderated the relationship between party affiliation mismatch between participants and their official in the U.S. House of Representatives and both anxiety and obsessive-compulsive symptoms. The relationship between mismatch of party affiliation for participants’ Senators and obsessive-compulsive symptoms was also moderated by conservatism. Discussion: These studies suggest that political factors, particularly conservatism, may impact emotional experiences and mental health symptoms during times of increased political polarization. Future studies should further explore the impact of political divisiveness on individual's stress levels and emotional well-being.
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In clinical trials of obsessive-compulsive disorder (OCD), clinical outcomes are generally measured using lengthy clinician-administered interviews. However, in routine clinical practice, many clinicians lack the time to administer such instruments. This study evaluated cut-offs for treatment response and remission in OCD using the self-rated Obsessive-Compulsive Inventory-Revised (OCI-R). Data from 349 patients in three clinical trials of cognitive behavior therapy for OCD were pooled for analysis. The OCI-R was compared to gold-standard criteria for response and remission based on the clinician-administered Yale-Brown Obsessive Compulsive Scale and the Clinical Global Impression Scale. The results showed that a ≥40% reduction on the OCI-R was the optimal cut-off for treatment response, with a sensitivity of 0.72 and a specificity of 0.79. For remission status, the optimal cut-off was ≤8 points on the OCI-R, with a sensitivity of 0.57 and specificity of 0.83. Results from additional analyses using the 12-item version of the OCI were similar. These cut-offs provide a simple and time-efficient way to help determine treatment response and remission in OCD when the administration of clinician-administered instruments is unfeasible.
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Although insight is widely studied in some disorders, research on insight in anxiety is limited. This study investigates clinical and cognitive insight and their relationship to symptoms and cognitive factors. A total of 175 participants with high trait anxiety completed an online self-reported measures and a reasoning task. No significant correlations between clinical and cognitive insight were found, suggesting the two constructs are distinct. Impaired clinical insight was significantly associated with reduced reports of symptoms, suggesting they are less likely to recognize that they have a problem. Impaired clinical insight was positively associated with negative metacognitive beliefs, suggesting they are likely to use unhelpful cognitions. Overall cognitive insight and self-reflection were positively associated with negative metacognition, suggesting that these individuals are more likely to have unhelpful metacognitive beliefs. Future research needs to explore the different constructs of insight and their relation to psychopathology and treatment outcomes in anxiety disorders.
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Background: Obsessive-compulsive disorder (OCD) is a debilitating and prevalent anxiety disorder. While the basal ganglia and frontal cortex are the most hypothesized brain regions involved, the exact pathophysiology is unknown. By observing the effects of proven treatments on brain activation levels, the cause of OCD can be better understood. Currently, the gold standard treatment for OCD is cognitive behavioural therapy (CBT) with exposure and response prevention (ERP). However, this is often temporally and geographically inaccessible, time-consuming, and costly. Fortunately, CBT can be effectively delivered using the internet (e-CBT) due to its structured nature thus addressing these barriers. Objective: This study will implement an e-CBT program for OCD and observe its effects on brain activation levels using functional magnetic resonance imaging (fMRI). It is hypothesized that brain activation levels in the basal ganglia and frontal cortex will decrease following treatment. Methods: Individuals with OCD will be offered a 16-week e-CBT program with ERP mirroring in-person CBT content that will be administered through a secure online platform. Efficacy of treatment will be evaluated using clinically validated symptomology questionnaires at baseline, week 8, and post-treatment (week 16). Using fMRI at baseline and post-treatment, brain activation levels will be assessed at resting state, and while exposed to anxiety-inducing images (i.e., dirty dishes if cleanliness is an obsession). The effects of treatment on brain activation levels and the correlation between symptom changes and activation levels will be analyzed. Results: The study received initial ethics approval in December 2020 and participant recruitment began in January 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, there have been 5 participants recruited. Data collection is expected to conclude by January 2022, and data analysis is expected to be completed by February 2022. Conclusions: The findings from this study can further our understanding of the causation of OCD, helping to develop more effective treatments for this disorder. Clinicaltrial: ClinicalTrials.gov NCT04630197; clinicaltrials.gov/ct2/show/NCT04630197.
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Objective: Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. Method: Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. Results: Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. Conclusions: Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.
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Obsessive-compulsive disorder encompasses a broad range of symptoms that represent multiple psychological domains, including perception, cognition, emotion, social relatedness, and diverse motor behaviors. The purpose of these analyses was to evaluate the correlational relationships of the symptoms of obsessive-compulsive disorder. This study examined the 13 a priori categories used to group types of obsessions and compulsions in the Yale-Brown Obsessive Compulsive Scale symptom checklist in two independent groups of patients with obsessive-compulsive disorder (N = 208 and N = 98). A principal-components factor analysis with varimax rotation was performed, followed by a series of other exploratory analyses. The two data sets yielded nearly identical results. Four factors--obsessions and checking, symmetry and ordering, cleanliness and washing, and boarding--emerged in each data set, in total accounting for more than 60% of the variance. Obsessive-compulsive disorder is a multidimensional and etiologically heterogeneous condition. The four symptom dimensions identified in this study are largely congruent with those identified in earlier reports. These factors may be of value in future genetic, neurobiological, and treatment response studies.
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The Obsessive Belief Questionnaire (OBQ) and the Interpretation of Intrusions Inventory (III) were designed to assess beliefs and appraisals considered critical to the pathogenesis of obsessions. In previous reports we have described the construction and psychometric properties of these measures. In this study a battery of questionnaires assessing anxiety, depression, and obsessive compulsive symptoms was completed by 410 outpatients diagnosed with obsessive compulsive disorder, 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Items from 6 theoretically derived subscales of the OBQ were submitted to factor analysis. Three factors emerged reflecting (1) Responsibility and threat estimation, (2) Perfectionism and intolerance for uncertainty, and (3) Importance and control of thoughts. A 44-item version (OBQ-44) composed of high-loading items from the 3 factors showed good internal consistency and criterion-related validity in clinical and non-clinical samples. Subscales showed less overlap than original scales. Factor analysis of the III yielded a single factor, suggesting the total score be used in lieu of the 3 rationally derived subscales. The scales performed well on tests of convergent validity. Discriminant validity was promising; hierarchical regression analyses indicated that the OBQ subscales and III generally predicted OC symptoms after controlling for general distress. A revision of the OBQ, the OBQ-44, is included in the appendix (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The Obsessive-Compulsive Inventory (OCI) is a new self-report instrument developed to address the problems inherent in available instruments for determining the diagnosis and severity of obsessive-compulsive disorder (OCD). The OCI consists of 42 items composing 7 subscales: Washing, Checking, Doubting, Ordering, Obsessing (i.e., having obsessional thoughts), Hoarding, and Mental Neutralizing. Each item is rated on a 5-point (0-4) Likert scale of symptom frequency and associated distress. One hundred and forty-seven individuals diagnosed with OCD; 58 with generalized social phobia; 44 with posttraumatic stress disorder; and 194 nonpatients completed the OCI and other measures of OCD, anxiety, and depression. The present article describes the psychometrics of the OCI including (a) scale construction and content validity, (b) reliability (internal consistency and retest reliability), and (c) convergent and discriminant validity. The OCI exhibited satisfactory reliability and validity with all 4 samples. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This article reports on the development of a revised version of the Obsessive-Compulsive Inventory (OCI; E. B. Foa, M. J. Kozak, P. Salkovskis, M. E. Coles, & N. Amir, 1998), a psychometrically sound, theoretically driven, self-report measure. The revised OCI (OCI-R) improves on the parent version in 3 ways: It eliminates the redundant frequency scale, simplifies the scoring of the subscales, and reduces overlap across subscales. The reliability and validity of the OCI-R were examined in 215 patients with obsessive-compulsive disorder (OCD), 243 patients with other anxiety disorders, and 677 nonanxious individuals. The OCI-R, which contains 18 items and 6 subscales, has retained excellent psychometric properties. The OCI-R and its subscales differentiated well between individuals with and without OCD. Receiver operating characteristic (ROC) analyses demonstrated the usefulness of the OCI-R as a diagnostic tool for screening patients with OCD, utilizing empirically derived cutscores.
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Previous researchers have classified obsessive-compulsive disorder (OCD) patients by the themes of their obsessions and compulsions (e.g., washing, checking); however, mental compulsions have not been adequately assessed in these studies. The authors conducted 2 studies using a large sample of OCD patients (N=132). In the 1st study, they categorized patients on the basis of symptom presentation, giving adequate consideration to mental compulsions. Five patient clusters were identified: harming, contamination, hoarding, unacceptable thoughts, and symmetry. Mental compulsions were most prevalent among patients with intrusive, upsetting religious, violent, or sexual thoughts. In the 2nd study, they compared response to cognitive-behavioral therapy across symptom categories, finding poorer outcomes among patients with hoarding symptoms compared with those with other symptom themes.
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• The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.
Chapter
It has been argued that the best way to develop effective psychological interventions is to understand the development and maintenance of the disorder in question, and then to devise treatments that reverse the maintaining mechanisms (Clark, 1997). Such an approach has proven successful in a range of psychological disorders including panic disorder (eg, Clark, 1986), bulimia nervosa (Wilson & Fairburn, 2002), and OCD (Abramowitz, 1997). This chapter first describes the purpose of cognitive-behavioral models of OCD and then goes on to discuss five cognitive-behavioral models that have been proposed to account for OCD symptomatology. Each of these models is presented in detail, and the empirical evidence evaluating them is reviewed. The existing research incorporates a range of methods including questionnaire studies and controlled experimental laboratory research. It is concluded that the data are largely consistent with the cognitive-behavioral approaches, but that important questions remain to be addressed. Implications of these models for the conceptualization and treatment of OCD are also discussed.
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The aim of this study was to examine the relationship between symptom presentation in obsessive–compulsive disorder (OCD) and dysfunctional beliefs hypothesized to relate to OCD. Five-hundred sixty two undergraduates completed self-report measures of OCD symptoms and OCD-related beliefs, as well as measures of social anxiety and depression. The tendency to overestimate threat significantly predicted the OCD symptom domains of washing, checking/doubting, obsessing, mental neutralizing, and hoarding. Perceived need to control one''s thoughts predicted obsessing. Perceived importance of thoughts predicted neutralizing. Perfectionism beliefs predicted ordering. Although the relationship between dysfunctional beliefs and OCD remained significant when controlling for social anxiety and depression, Threat Estimation and Perfectionism showed a moderate relationship with these variables as well. Thus, although some dysfunctional beliefs show a specific relationship to OCD, others may reflect broader forms of psychopathology.
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Psychologists often use tests to make clinical discriminations. The accuracy of those decisions depends on the discriminant validity of the tests on which they are based. However, traditional measures of discriminant validity do not reflect the accuracy of individual classifications. Although the effect of base rate on the accuracy of clinical discriminations has long been recognized, base rates have only recently been considered in clinical assessment. A scheme for determining the probabilities of valid test-based discriminations is discussed and related to several commonly used clinical tests. It is argued that such probabilities must be considered in routine clinical practice, not just in the assessment of very low base rate disorders.
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Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.
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Obsessive compulsive disorder (OCD) patients often have lifetime comorbid anxiety and depressive disorders. Incidence of lifetime OCD in other anxiety disorder patients, however, has not been fully investigated. In the current study, a structured diagnostic interview was administered to 454 patients with OCD, panic agoraphobia, or social phobia. Results indicated a relatively high level of lifetime anxiety disorders in OCD subjects but a much lower rate of lifetime OCD in other anxiety-disorder patients. Lifetime depression was not found to be different across the groups. The results are discussed in terms of possible vulnerability factors associated with OCD.
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Over the last few years there has been increased interest in worry. Most assessment up until now has been concerned with what people worry about and how much they worry rather than exploring reasons for worrying. Two questionnaires were developed to go beyond the content and intensity of worry. The first questionnaire, Why Worry?, contains 20 items and assesses reasons why people say they worry. Two types of reasons were found. First, subjects believe that worrying can prevent negative outcomes from happening, minimize the effects of negative events by decreasing guilt, avoiding disappointment, or provide distraction from thinking about things that are even worse. Second, people believe worrying has positive effects such as finding a better way of doing things, increasing control, and finding solutions. The second questionnaire, Intolerance of Uncertainty, consists of 27 items that assesses emotional, cognitive and behavioral reactions to ambiguous situations, implications of being uncertain, and attempts to control the future. The second study demonstrates the instruments' properties by distinguishing between levels of worry, by factor analysis describing the dimensions underlying the constructs, and by establishing appropriate relationships with measures of worry and emotional distress. The implications for current models of worry are discussed.
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Recent psychometric results suggested that the phenomenon of thought-action fusion (TAF) is implicated in obsessive compulsive disorder (OCD). The construct of TAF has two components: (a) the belief that thinking about an unacceptable or disturbing event makes it more likely to happen and (b) the belief that having an unacceptable thought is the moral equivalent of carrying out the unacceptable or disturbing action. The construct of TAF is explored, and its relevance to responsibility and obsessive-compulsive disorder examined. A highly reliable questionnaire to measure TAF has been developed, and psychometric data obtained from two studies are presented. TAF was higher in obsessional samples than in nonobsessional samples, particularly the belief that thinking about a negative event involving other people makes the event more likely to happen.You have heard that it was said, “Do not commit adultery”. But now I tell you: Anyone who looks at a woman and wants to possess her is guilty of committing adultery with her in his heart.
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A simple questionnaire was developed as an instrument for assessing the existence and extent of different obsessional-compulsive complaints. Two major types of complaint, checking and washing compulsions, and two minor types, slowness and doubting, were established. The final form of the questionnaire, and major properties, are presented.
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The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.
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The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
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The Padua Inventory (PI) consists of 60 items describing common obsessional and compulsive behavior and allows investigation of the topography of such problems in normal and clinical Ss. It was administered to 967 normal Italian Ss, ranging in age from 16 to 70 yr. Inventory consistency and 1-month reliability were satisfactory. Females reported more complaints, more intensely than males. Ss aged from 16 to 20 yr and Ss aged from 46 to 70 complain of more obsessions and compulsions than Ss of intermediate ages. Four factors were identified: impaired control of mental activities, becoming contaminated, checking behaviors, urges and worries of losing control over motor behaviors. The PI correlates with the Maudsley Obsessional-Compulsive Questionnaire (0.70), Leyton Obsessional-Compulsive Inventory (0.71 with Symptom and 0.66 with Trait scales) and Self-rating Obsessional Scale (0.61). Furthermore, it allows discrimination between a group of 75 outpatients with obsessive-compulsive disorders and a similar group of outpatients with other neurotic disorders. Relationships with fears and neuroticism traits were also found, reflected in moderately high correlations with the Fear Survey Schedule and the Neuroticism scale of the Eysenck Personality Questionnaire.
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In the present study, several hypotheses were examined regarding differences between subtypes of obsessive-compulsive ritualizers with respect to the types of cues for fears, the degree of fear and avoidance exhibited and parental characteristics. The sample consisted of 36 washers and 23 checkers. No differences on demographic variables were observed. Washers' fears were triggered more by environmental stimuli than checkers', whose fears tended to focus more on concern with preventing future harm. More fears and greater passive avoidance was exhibited by washers than by checkers. Checkers more often perceived their mothers as meticulous and demanding than did washers. The possible implications of these findings for the application of exposure treatment methods are discussed.
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The authors developed and evaluated the reliability and validity of the Brown Assessment of Beliefs Scale, a clinician-administered seven-item scale designed to assess delusions across a wide range of psychiatric disorders. The authors developed the scale after reviewing the literature on the assessment of delusions. Four raters administered the scale to 20 patients with obsessive-compulsive disorder (OCD), 20 patients with body dysmorphic disorder, and 10 patients with mood disorder with psychotic features. Audiotaped interviews of scale administration conducted by one rater were independently scored by the other raters to evaluate interrater reliability. The scale was administered to 27 patients twice to determine test-retest reliability. Other insight instruments as well as scales that assess symptom severity were administered to assess convergent and discriminant validity. Sensitivity to change was assessed in a multicenter treatment study of sertraline for OCD. Interrater and test-retest reliability for the total score and individual item scores was excellent, with a high degree of internal consistency. One factor was obtained that accounted for 56% of the variance. Scores on the Brown Assessment of Beliefs Scale were not correlated with symptom severity but were correlated with other measures of insight. The scale was sensitive to change in insight in OCD but was not identical to improvement in severity. The Brown Assessment of Beliefs Scale is a reliable and valid instrument for assessing delusionality in a number of psychiatric disorders. This scale may help clarify whether delusional and nondelusional variants of disorders constitute the same disorder as well as whether delusionality affects treatment outcome and prognosis.
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The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
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Although obsessive-compulsive disorder (OCD) has long been a unitary diagnosis, there is much recent interest in its potential heterogeneity, as manifested by symptom subgroups. This study evaluated existing models of symptom structure in a sample of 203 individuals with OCD. Using confirmatory factor analysis, we examined the ability of each model to account for two levels of data: a priori symptom groupings (second-order) and individual symptoms, identified by the Yale-Brown Obsessive Compulsive Scale symptom checklist. Four models were examined: a single-factor, a two-factor (i.e., obsessions and compulsions), and two multidimensional models, comprising three and four factors. Adequate fit was found solely for the four-factor model--specifying obsessions/checking, symmetry/ordering, contamination/cleaning, and hoarding--but only at the second-order level; it did not account for relationships among discrete symptoms. Parameter estimates showed within-factor heterogeneity, as well as overlap between factors, most notably the two representing checking and contamination-related symptoms. The implications of these findings are discussed. Results provide evidence for the multidimensionality of OCD symptoms, but suggest that a comprehensive model has yet to be identified. They also point to the inadequacy of groupings based solely upon overt behavioural similarities (e.g., 'checking'). Recommendations are made for future research.
Article
The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.
Article
Two studies examined the psychometric properties of the Obsessive-Compulsive Inventory-Revised (OCI-R; Psychol. Assessment 14 (2002) 485) in a nonclinical student sample. In Study 1, we investigated the factor structure and internal consistency of the OCI-R using a sample of 395 undergraduate students. At a second testing session 1 month later, 178 students completed the OCI-R. Test-retest reliability was examined using data from 94 students who completed the OCI-R in both sessions. Convergent validity was also assessed with the Maudsley Obsessive-Compulsive Inventory (MOCI). In Study 2, we further investigated the convergent and divergent validity of the OCI-R using a new sample of 221 students who completed a battery of measures of obsessive-compulsive symptoms, worry, and depression. There was a significant order effect for both the OCI-R and the MOCI: means of each measure were significantly lower when presented second. Despite the order effect, statistical analyses indicated that the OCI-R has adequate test-retest reliability for the full scale and subscale scores, solid factor structure, and high internal consistency. Convergent validity with other measures of obsessive-compulsive symptoms was moderate to excellent, and divergent validity was good. The results indicate that the OCI-R is a short, psychometrically sound self-report measure of obsessive-compulsive symptoms.
Article
Recently, experts have suggested that obsessive-compulsive disorder (OCD), a highly heterogeneous condition, is actually composed of distinct subtypes. Research to identify specific subtypes of OCD has focused primarily on symptom presentation. Subtype models have been proposed using factor analyses that yield dimensional systems of symptom categories, but not necessarily distinct subtypes. Other empirical work has considered the role of neuropsychological functioning and comorbidity as part of a comprehensive scheme for subtyping OCD. The identified dimensions from all of these studies have implications for the treatment of OCD. In this article, we review the research on subtypes of OCD, focusing on subtype schemes based upon overt symptom presentation and neuropsychological profiles. We also review research pertinent to alternative subtyping schemes, both conceptually and methodologically. The research is critically examined and implications for treatment are discussed. Recommendations for future investigations are offered.
Article
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is widely acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. Despite its popularity, a number of questions remain regarding the Y-BOCS' psychometric properties including: (a) whether obsessional and compulsive symptoms contribute independently to global OCD severity and (b) whether the Y-BOCS subscales are valid with respect to other measures of OCD. We examined these issues in a sample of 100 patients with a diagnosis of OCD. While our confirmatory factor analyses failed to reproduce any previously reported models of the Y-BOCS factor structure, exploratory factor analysis indicated a two-factor solution that assessed symptom severity (i.e., time, distress, and interference from obsessions and compulsions) as separate from resistance and control of obsessions and compulsions. In contrast to the Resistance/Control Subscale, the Severity Subscale demonstrated good psychometric properties and construct validity. Based on our findings we recommend revisions to scoring the Y-BOCS.
Article
Although hoarding is observed in some patients with obsessive-compulsive disorder (OCD), it has not been shown to share a specific relation with OCD. Across two studies, we found that (a) whereas the classic OCD symptoms of checking, rituals, and contamination intercorrelated consistently strongly with one another, hoarding related only moderately to both these OCD symptoms and to depression; (b) OCD patients were distinguished from both other patients and non-patients by classic OCD symptoms, but not by hoarding; and (c) whereas OCD symptoms showed consistent relations with Negative Affect, hoarding largely was uncorrelated with this dimension. These results do not support a specific OCD-hoarding relation but rather call into question the trend of considering it a specific symptom of OCD.
Article
The present study investigated the relation of compulsive hoarding to other obsessive-compulsive disorder (OCD) symptoms in a sample of 162 patients with OCD. Obsessions and compulsions reported on the Anxiety Disorders Interview Schedule for DSM-IV were submitted to an exploratory factor analysis. Results suggested a four-factor model: "Certainty," "Contamination," "Obsessions," and "Numbers/Ordering." Hoarding did not load on any factor. The sample was divided into three groups: pure hoarding, nonhoarding OCD, and mixed OCD and hoarding. The hoarding group endorsed significantly less anxiety, worry, stress, and negative affect on self-report measures than the mixed and nonhoarding groups. Although hoarding sometimes functions as a compulsion among individuals with OCD, hoarding in the absence of other OCD symptoms may be a clinically distinct syndrome.
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