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PubMed1994

A Self-Rated Scale for Obsessive-Compulsive Disorder.

The Self-Rated Scale for Obsessive-Compulsive Disorder is an objective 35-item questionnaire that measures the severity of obsessive-compulsive disorder (OCD). Scale construction employed both rational and empirical item-selection procedures and utilized the responses of 127 diagnosed obsessive-compulsive subjects. A cross-validation study that used 40 obsessive-compulsive subjects found high internal consistency and significant correlations between the new scale and two clinician-rated measures of OCD. Principal components analysis of the combined subject sample (167 obsessive-compulsive subjects) identified four orthogonal components: distressing thoughts, rituals, perfection, and fear of contamination. In conclusion, the Self-Rated Scale for Obsessive-Compulsive Disorder appears to be a comprehensive, easy-to-use, and psychometrically sound instrument for measuring severity of OCD.

Adult↗
PubMed1993

History of eating disorders in female patients with obsessive-compulsive disorder.

The prevalence of eating disorders was assessed in a casenote study of 105 female patients with obsessive-compulsive disorder (OCD). A previous history of anorexia nervosa was found in 12 (11%). Patients with a previous history of eating disorders (OCD-AN) had an earlier onset of OC symptoms than other patients. Among OCD-AN patients, the anorexia nervosa and obsessive-compulsive disorders had a similar age of onset. The comorbidity of the two syndromes among females may point to common vulnerability factors. Patients with early onset OCD may be at increased risk of developing eating disorders. The assessment of OCD in young female patients should include a careful check for evidence of eating disorders.

Adult↗
PubMed1995

The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology.

Anorectic and bulimic patients (n = 100) were interviewed using the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). All patients reported preoccupations and rituals related to their eating disorder ranging from mild to severe symptomatology, with mean scores in the moderate range. The preoccupations were more severe than the rituals; however, the rituals were still time-consuming, distressing, and interfered with functioning. Both preoccupations and rituals were largely ego syntonic. The YBC-EDS is an easy to administer interview which characterizes and quantifies preoccupations and rituals associated with eating disorders. It is useful both for research and clinical purposes.

Adaptation, Psychological↗
PubMed1995

Obsessive-compulsive disorder, trichotillomania, and anorexia nervosa: a case report.

We report a case study of an 18-year-old female who presented with symptoms associated with several discrete diagnostic syndromes: obsessive-compulsive disorder, trichotillomania, major depression, and anorexia nervosa. Improvement in each occurred after treatment with the serotonin selective reuptake inhibitor, fluoxetine, suggesting that such syndromes share a common serotonin neurotransmitter disturbance. Furthermore, the combined effects of medication and psychotherapy resulted in improvement in assertiveness, sense of security, self-worth, flexibility, and self-regulation. We discuss the pharmacological and psychotherapeutic implications of possible psychophysiologic similarities among the previously mentioned syndromes.

Adolescent↗
PubMed2002

Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controls.

There is relatively little data on the link between childhood trauma and obsessive-compulsive/putative obsessive-compulsive spectrum disorders. The revised Childhood Trauma Questionnaire (CTQ), which assesses physical, emotional, and sexual abuse as well as physical and emotional neglect, was administered to female patients with obsessive-compulsive disorder (OCD; n = 74; age: 36.1 plus minus 16.3), TTM (n = 36; age: 31.8 plus minus 12.3), and a group of normal controls (n = 31; age: 21.5 plus minus 1.0). The findings showed a significantly greater severity of childhood trauma in general, and emotional neglect specifically, in the patient groups compared to the controls. Although various factors may play a role in the etiology of both OCD and trichotillomania (TTM), this study is consistent with some evidence from previous studies suggesting that childhood trauma may play a role in the development of these disorders.

Adolescent↗
PubMed2004

The structure of obsessionality among young adults.

Although the phenomenology of obsessive-compulsive disorder (OCD) is well understood, less is known about the structure of obsessive symptoms in non-clinical populations. The present study examines the factorial structure of the Leyton Obsessional Inventory short form (LOI-SF) in a sample of 1,015 undergraduate college students. Four factors were extracted describing concerns about contamination (labeled the Contamination factor); repeating behaviors or uncomfortable thoughts or doubts (labeled the Doubts/Repeating factor); checking behaviors, too much attention to detail, honesty concerns, strict conscience and strict routine (labeled the Checking/Detail factor); and taking a long time to dress and to hang up and put away clothing, as well as belief in extremely unlucky numbers (labeled Worries/Just Right factor). Self-report measures of anxiety and ADHD symptoms were correlated positively with these factors, particularly with the checking/detail factor. The prevalence, symptom structure, and patterns of comorbidity seen in this sample of unselected college students are similar to the patterns seen in adolescents with OCD, suggesting that obsessional symptoms and OCD may exist along a continuum.

Adolescent↗
PubMed2007

Anxiety symptoms and perceived performance in medical students.

Medical students represent a highly educated population under significant pressures. During the transition to clinical settings in the third year, they may experience a loss of external control and may counter this with an increase in obsessionality and/or other anxiety symptoms. Our study examines the phenomenology of obsessive-compulsive and other anxiety symptoms in medical students at two U.S. medical schools and relates these symptoms to self-perception of performance. Subjects anonymously completed a battery of questionnaires regarding obsessive-compulsive symptoms, attentional problems, anxiety symptoms, depressive symptoms, and perceived performance in medical school. A factor analysis of obsessional symptoms showed four primary factors: checking/doubts, contamination, long time/detail, and unpleasant thoughts/worries. These four factors were similar to those found among college students and other nonclinical populations. Anxiety, attentional, and depressive symptoms were highest in the third-year medical students. In contrast, obsessional symptoms were highest in the first-year students and lower for subsequent years. Perceived performance was not significantly correlated with obsessionality, although lower perceived performance was associated with higher levels of anxiety and depressive symptoms. Students with lower perceived performance in medical school were significantly more likely to be female, depressed, or older. The progressive decrease in number of obsessional symptoms across years and the lack of correlation with perceived performance suggest that these symptoms may be developmentally appropriate, and perhaps adaptive. In contrast, other anxiety symptoms appear to be maladaptive responses to external stressors.

Adolescent↗
PubMed2007

Factor analysis of the Yale-Brown Obsessive Compulsive Scale in a family study of obsessive-compulsive disorder.

Our objective in this study was to determine whether symptoms of obsessive-compulsive disorder (OCD) cluster into groups that can usefully subclassify OCD. Psychiatrists or psychologists interviewed 221 subjects using the Lifetime Anxiety Version of the Schedule for Affective Disorders and Schizophrenia (SADS-LA) for the diagnosis of DSM-IV disorders, and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for OCD symptoms. We analyzed 16 symptom categories from the Y-BOCS using exploratory factor analysis to identify latent symptom dimensions. The relationship between these symptom dimensions and clinical characteristics and familiality was investigated. A four-factor model emerged as the best classification of OCD symptoms in the Y-BOCS. These factors were labeled Pure Obsessions, Contamination, Symmetry/Order, and Hoarding. The contamination factor was least likely to be associated with other Axis I disorders. Whereas no significant relationship was found between the factor scores of probands and the presence of OCD in their first-degree relatives, the Symmetry/Order and Hoarding factors did breed true. Hoarding was found to predict poorer treatment response. A four-factor classification of OCD features best describes the symptom patterns of a sample of patients with OCD. There were specific clinical correlates for these factors, and significant intrafamilial sib-sib correlations were found for the Symmetry/Order and Hoarding factors.

Adult↗
PubMed2007

Obsessive-compulsive disorder versus body dysmorphic disorder: a comparison study of two possibly related disorders.

The relationship between obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) is unclear. BDD has been proposed to be an OCD-spectrum disorder or even a type of OCD. However, few studies have directly compared these disorders' clinical features. We compared characteristics of subjects with OCD (n=210), BDD (n=45), and comorbid BDD/OCD (n=40). OCD and BDD did not significantly differ in terms of demographic features, age of OCD or BDD onset, illness duration, and many other variables. However, subjects with BDD had significantly poorer insight than those with OCD and were more likely to be delusional. Subjects with BDD were also significantly more likely than those with OCD to have lifetime suicidal ideation, as well as lifetime major depressive disorder and a lifetime substance use disorder. The comorbid BDD/OCD group evidenced greater morbidity than subjects with OCD or BDD in a number of domains, but differences between the comorbid BDD/OCD group and the BDD group were no longer significant after controlling for BDD severity. However, differences between the comorbid BDD/OCD group and the OCD group remained significant after controlling for OCD severity. In summary, OCD and BDD did not significantly differ on many variables but did have some clinically important differences. These findings have implications for clinicians and for the classification of these disorders.

Adult↗
PubMed2007

Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder.

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36+/-8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes--autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.

Adolescent↗
PubMed2007

Sequential cognitive-behavioral therapy for children with obsessive-compulsive disorder with an inadequate medication response: a case series of five patients.

Few data have been reported on the efficacy of cognitive-behavioral therapy (CBT) for youth with obsessive-compulsive disorder (OCD) who have not responded to prior treatment with medication. Given this, we report an open trial of CBT for children who have remained symptomatic following medication trials. Five children with OCD who had an inadequate response to psychotropic medications (e.g., limited response and/or unable to be titrated to a complete dose due to side effects) received treatment in a 3-week intensive CBT program. Assessments were conducted at baseline and after treatment. All participants were classified as treatment responders (much improved or very much improved) and the severity of clinician-rated OCD symptoms and impairment significantly decreased after the intervention. Although a number of limitations of this preliminary report exist, this study provides preliminary support for the utility of an intensive intervention for youth with OCD who have had an inadequate response and/or adverse side effects.

Adolescent↗
PubMed2004

Understanding and treating incompleteness in obsessive-compulsive disorder.

Incompleteness-the troubling and irremediable sense that one's actions or experiences are not "just right"--appears to underlie many of the symptoms of obsessive-compulsive disorder (OCD). Because incompleteness may reflect basic sensory-affective dysfunction, it presents a challenge to clinicians wishing to apply cognitive-behavioral treatments. In this article, I review ways of adapting well-demonstrated treatment principles to this condition. A case is presented and then used to discuss challenges in conducting cognitive-behavioral therapy with this population. Behavioral methods aimed at habituation (e.g., exposure and ritual prevention [ERP]) are probably more applicable than conventional cognitive techniques. However, even these may result in modest long-term gains; relapse is a probability if they are not actively practiced after treatment cessation.

Adult↗
PubMed2004

Cognitive-behavioral therapy for children who have obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a relatively chronic and impairing disorder in children and adolescents. Whereas childhood OCD was largely ignored in the past, major advances in the identification and treatment over the past 20 years have led to a significant upsurge in the prevalence of youngsters seeking treatment for this problem. The present article describes the use of exposure-based cognitive-behavioral therapy (CBT) for the treatment of childhood OCD. Although the phenomenology of OCD is largely consistent across the age span, traditional adult CBT approaches have been modified for use with children and adolescents in order to address those developmental differences that do exist. The case example describes the use of CBT for a child who has OCD and highlights these developmental considerations, including age-appropriate techniques to address family involvement in the disorder and the impact of symptoms on the psychosocial functioning of the patient.

Adolescent↗
PubMed2005

Explanatory style change in supportive-expressive dynamic therapy.

Change in explanatory style (measured by the Attributional Style Questionnaire [ASQ]) has often been considered specific to cognitive therapy (CT). We used data from 59 patients who had received supportive-expressive (SE) dynamic therapy after meeting DSM-III-R criteria for a depressive spectrum disorder and who had completed the ASQ at intake and termination of treatment. We found that depressive symptoms decreased significantly and that explanatory style became more optimistic over the course of treatment. Furthermore, change in ASQ correlated with change in depression. There was some evidence suggesting that ASQ at termination predicted level of depression at follow-up.

Adult↗
PubMed2005

Thought disorder in patients with obsessive-compulsive disorder.

We examined the presence of disordered thinking/perception in patients with obsessive-compulsive disorder (OCD). Recently, an obsession model has been proposed, which classifies obsessions into two different subtypes: autogenous obsessions and reactive obsessions (Lee & Kwon, 2003). Based on this model, we hypothesized that OCD patients primarily displaying autogenous obsessions as opposed to reactive obsessions would display more severely disordered thinking/perception. We compared 15 OCD patients primarily displaying autogenous obsessions (AOs), 14 OCD patients primarily displaying reactive obsessions (ROs), 32 patients with schizophrenia (SPRs), and 28 patients with other anxiety disorders (OADs) with respect to thought disorders as assessed by the Comprehensive System of the Rorschach Inkblot Test. Results indicated that both AOs and SPRs displayed more severe thought disorders compared to ROs or OADs. Theoretical and clinical implications are discussed.

Adolescent↗
PubMed1981

Anality: a theory of erotism and characterology.

The psychogenesis of anality is in the psychosexual events of the second year of life. An analysis of that phase of development centers on the biological determinants of psychological development, specifically on the erotization of the excretory functions. The social structures interfering with this process are examined. The interrelationship of feces, child, and penis are analyzed within the context of the total libidinal spectrum of development and object relations. Bipolarity is seen as an integral facet of the anal character, manifested in the retentive-eliminative continuum and in the aggressive-erotic divergences. These trends are examined in detail vis-à-vis the ultimate ossification of the anal adult. In this context, the percept of anal-sadism is introduced and alternate interpretations of the phenomenon are suggested. Various characteristics frequently associated with anal characterology are discussed and an attempt is made to demarcate the status (as integral or peripheral) of these traits. Sociocultural contingencies of anality are also considered, particularly with regard to Western institutions. The major pathological maladaptions related to anality are detailed. These include the obsessions and rigid superego development, paranoia, and homosexuality. The status of anality is then evaluated from the ego-psychological perspective, and interpersonal and societal factors are considered. What emerges is a unitary construct of anality which incorporates both erotism and characterology.

Defense Mechanisms↗