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PubMed2000

Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1.

Worry is the central characteristic of Generalized Anxiety Disorder (GAD) and obsessions are a central feature of Obsessive-Compulsive Disorder (OCD). There are strong similarities between these disorders: repetitive cognitive intrusions, negative emotions, difficulty dismissing the intrusion and finally, loss of mental control. Direct comparisons between obsessions and worries are almost non-existent in the literature but key distinctions have been proposed. The study attempted to specify the differences between obsessive intrusive thoughts and worry in a nonclinical population across a series of variables drawn from current models (appraisal, general descriptors and emotional reactions). 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Within-subject comparisons demonstrated significant differences on several variables: frequency, duration, percentage of verbal and image content, interference, egodystonic nature, stimuli awareness, emotions, etc. Most of these differences remained significant after controlling for frequency of thought. Discriminant analysis demonstrated a low classification error rate when using nine variables to categorize thoughts as obsessions or worries. Results generally support the differences postulated in the literature with the exception that obsessive intrusive thoughts are better controlled. The egodystonic/egosyntonic dimension emerged as an important variable in understanding obsessions and worry.

Adult↗
PubMed2000

Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 2.

Differences between obsessions and worry have been clearly demonstrated on several variables [Langlois, F., Freeston, M. H., & Ladouccur, R. (2000). Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1. Behaviour Research and Therapy, 38, 157-173.]. Previous factor analysis of obsessions or worries have typically been used in developing measures for OCD and GAD symptoms. These studies generally support the distinctiveness of obsessions and worries but there have been no direct comparisons of the factor structure of obsession and worry on the same measure. This study aimed to compare the general structure of worry and obsessional intrusions. It also attempted to identify the relations between the respective factors identified in the appraisals of intrusions and the factor structures of coping strategies used in reaction to the thoughts. 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Different factor structures were obtained for worry and obsessive intrusive thoughts. However, the factor structure for the strategies used to counter the thoughts were highly similar for both types of thought. Furthermore, regression analysis identified interesting relationships between the strategies, the thought characteristics and appraisal. Thus, despite the ability to find differences between obsessive intrusive thoughts and worry, and even to accurately categorize them based on these differences, there may in fact exist common processes that are shared over much of a continuum. Sharp differences in the processes involved may only become clear in prototypical cases. The implications for models of cognitive intrusion are discussed.

Adaptation, Psychological↗
PubMed1988

Obsessive-compulsive beliefs and treatment outcome.

Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as a rational and felt that their rituals warded off some unwanted or feared event (the content of their obsessions). The more bizarre the obsessive belief the more strongly it was defended and 12% of cases made no attempt to resist the urge to ritualize. Neither fixity of belief nor resistance to compulsive urges were related to duration of illness. Patients with bizarre and fixed obsessive beliefs responded as well to treatment (all but three received exposure), as did patients whose obsessions were less bizarre and recognized as senseless. There was no difference in outcome between patients who initially found it hard to control their obsessions or never resisted the urge to ritualize and those who initially could control obsessions or resist rituals. One year after starting treatment, patients whose obsessions and compulsions had improved with treatment recognized their irrationality more readily and controlled their compulsive urges more easily. Beliefs appeared to normalize as a function of habituation.

Adult↗
PubMed2002

Risperidone-induced obsessive-compulsive symptoms: a series of six cases.

Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT and D receptors. Open-label reports and one controlled study suggest that risperidone addition is effective in patients with obsessive-compulsive disorder refractory to treatment with serotonin reuptake inhibitors. However, risperidone has also been implicated in the production or exacerbation of obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases; psychotic depression, one case) in which risperidone was effective in the treatment of the psychotic symptoms but produced obsessive-compulsive symptoms (four cases) or caused exacerbation of previous obsessive-compulsive symptoms (two cases). In all but one case, obsessive-compulsive symptoms emerged shortly after initiation of risperidone treatment with a dose above 3 mg/day. The mechanisms and risk factors for risperidone and other atypical antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be dose-dependent and are probably produced by serotoninergic-dopaminergic imbalance. Close monitoring of the patients receiving risperidone, especially those vulnerable to the development of obsessive-compulsive symptoms, may be of value. Gradual escalation and low final dose may be helpful.(2) (2)

Adult↗
PubMed2005

Psychopathology of obsessive-compulsive disorder: a phenomenological approach.

Until the beginning of the 20th century, the idea of obsession found in the literature was mostly a broad and unspecific one, and it has, to some extent, persisted in this form until the present day. At the same time, however, Esquirol and Westphal began to develop a concept of obsession in the strict sense, and Jaspers used the phenomenological method as a basis to give it its final form. The concept of obsession in the strict sense represents the formal and nosologically specific core symptom of obsessive-compulsive disorder. In conjunction with the distinction between primary and secondary obsessions, obsession in the strict sense is proving helpful in differential diagnosis, but it can also serve as a guideline in the further phenomenological investigation of obsessive-compulsive disorder. It is shown how the interaction between personality, affect and release situation develops the obsessive-compulsive disorder. The clarification of these aspects with the patient can at the same time be the starting point of psychotherapeutic treatment.

Affect↗
PubMed1991

Symptoms of eating disorders in patients with obsessive-compulsive disorder.

OBJECTIVE: This study was designed to explore potential overlap of the symptoms of obsessive-compulsive disorder and eating disorders. METHOD: The authors administered a structured, self-rating scale, the Eating Disorder Inventory, to 59 outpatients at an obsessive-compulsive disorder clinic and to 60 sex-matched normal volunteers. The Eating Disorder Inventory has been previously validated as a reliable measure of the specific cognitive and behavioral dimensions of the psychopathology typical of patients with eating disorders. The scores of the patients with obsessive-compulsive disorder and of the healthy comparison subjects were compared with those of 32 female inpatients with anorexia nervosa (N = 10) or bulimia nervosa (N = 22) who had also been given the inventory. RESULTS: The patients with obsessive-compulsive disorder scored significantly higher than the healthy comparison subjects on all eight subscales of the Eating Disorder Inventory: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears. Relative to the healthy subjects, male patients with obsessive-compulsive disorder had more symptoms than female patients with obsessive-compulsive disorder. The scores of the female patients with obsessive-compulsive disorder were midway between those of the 32 female patients with eating disorders and those of the 35 female normal subjects. CONCLUSIONS: These results suggest that patients with obsessive-compulsive disorder display significantly more disturbed eating attitudes and behavior than healthy comparison subjects and that they share some of the psychopathological eating attitudes and behavior that are common to patients with eating disorders.

Adult↗
PubMed1992

Onset of obsessive-compulsive disorder in pregnancy.

OBJECTIVE: Although the role of pregnancy and childbirth in postpartum psychosis and depression has been studied, the association between pregnancy and obsessive-compulsive disorder has not been specifically addressed. The authors evaluated the role of pregnancy in the onset of obsessive-compulsive disorder. METHOD: Female patients with obsessive-compulsive disorder (N = 106) completed a questionnaire assessing age at onset of symptoms, marital status, number of children, age at each pregnancy, and life events associated with the onset of obsessive-compulsive disorder. RESULTS: Of the 106 women, 42 were childless and 59 had at least one child each; five others were also childless but had had abortions (N = 4) or a miscarriage (N = 1). Of the 42 women without children, 12 (28.6%) had first experienced obsessive-compulsive symptoms between the ages of 13 and 15 years, but there were two peaks of onset for the women with children: ages 22-24 and 29-32 years. Of the 59 patients with children, 23 (39.0%) had experienced symptom onset during pregnancy; this was the first pregnancy for 12, the second pregnancy for eight, and the third pregnancy for three. Four of the five women who had had abortions or a miscarriage had experienced the onset or an exacerbation of obsessive-compulsive symptoms during pregnancy. CONCLUSIONS: The association between pregnancy and the onset of obsessive-compulsive symptoms in these female patients highlights the need for further research on psychological and biological factors associated with pregnancy and obsessive-compulsive disorder.

Abortion, Induced↗
PubMed1996

Are fluoxetine plasma levels related to outcome in obsessive-compulsive disorder?

OBJECTIVE: In obsessive-compulsive disorder, the relationship between blood levels of serotonin reuptake inhibitors and clinical outcome is unclear. In a multicenter trial, the authors examined the relationship between steady state plasma levels of fluoxetine and norfluoxetine (determined after 7 weeks of treatment), and their sum, and clinical outcome. METHOD: Ratings of symptom severity of obsessive-compulsive disorder (Yale-Brown Obsessive Compulsive Scale scores) were obtained at baseline and after 13 weeks for 200 adult outpatients with moderately severe obsessive-compulsive disorder treated with fluoxetine doses of 20 mg/day (N = 68), 40 mg/day (N = 64), and 60 mg/day (N = 68). RESULTS: Mean plasma levels of fluoxetine and norfluoxetine were statistically significantly higher with higher dose. Statistical analyses revealed no significant relationship for plasma level of either molecule or their sum in predicting endpoint percent change in obsessive-compulsive scores. Plasma levels of patients with a marked response (decrease of 50% or more in obsessive-compulsive score) did not differ significantly from those of nonresponders (less than a 25% decrease in obsessive-compulsive score). No hint was seen of a therapeutic window or of a relationship limited to one gender or within the lowest dose group (20 mg/day). However, since S-norfluoxetine is a much more potent serotonin reuptake inhibitor than R-norfluoxetine, the absence of chiral (stereospecific) assays in this study limits the results. CONCLUSIONS: Steady state plasma levels of fluoxetine and norfluoxetine are not related to clinical outcome in patients with obsessive-compulsive disorder. Individual patients can be told only that the optimum dose of fluoxetine for them will be the dose that produces the largest therapeutic effect with the smallest side effect burden. Future studies should examine the predictive utility of measures of serotonergic neuronal function and, if plasma levels of norfluoxetine are examined, the use of chiral assays.

Adolescent↗
PubMed1980

Genetic factors in obsessive-compulsive neurosis? A rare case of discordant monozygotic twins.

There has been considerable interest in the strength of genetic predisposition to obsessive-compulsive neurosis in spite of the tendency in North America to view this disorder as entirely psychogenic. Both American and British papers have remarked on the rarity of the coincidence of obsessive-compulsive neurosis and the occurrence of MZ twins. An analysis of published reports indicates that, of those cases for which both zygosity and diagnosis can be firmly established, ten are concordant and only four discordant. Errors in previous studies that disqualify them from serious consideration include: failure of the investigators to establish zygosity with some degree of certainty; failure to distinguish between obsessive-compulsive neurosis and a mixed neurosis; and a tendency to confuse obsessive-compulsive neurosis with obsessive-compulsive personality or "obsessive traits". MZ female twins discordant for obsessive-compulsive neurosis are presented and their life histories are discussed. Although the twins were very similar in early childhood, their personality characteristics diverged remarkably, beginning at age 11, with the result that the symptomatic twin became shy, sensitive, cautious, conservative, and religious; whereas her asymptomatic sister became outgoing, confident, and adventuresome. The findings on psychiatric examination and on detailed psychological testing indicate that the obsessive-compulsive neurosis in the affected twin was clearly a phychogenic disorder.

Adolescent↗
PubMed2005

Clinical expression of obsessive-compulsive disorder in women with bipolar disorder.

OBJECTIVE: To study clinical and psychopathological features of obsessive-compulsive disorder (OCD) in women with bipolar disorder (BD). METHODS: Fifteen outpatients with concurrent bipolar disorder I (80.0%) or II (20.0%) and obsessive-compulsive disorder were studied. Most of them (80.0%) sought treatment for bipolar disorder. They were ascertained by means of the Structured Clinical Interview for DSM-IV (SCID/P), semi-structured interviews to investigate obsessions, compulsions and sensory phenomena that may precede compulsions and an additional module for the diagnosis of chronic motor and vocal tics. Severity of symptoms was assessed by the Yale-Brown Obsessive-Compulsive Rating Scale, Hamilton Depression Rating Scale and Young Mania Rating Scale. RESULTS: Obsessive-compulsive disorder presented early onset (before the age of 10) in 9 (60%) cases, preceded bipolar disorder in 10 (66.7%) and displayed chronic waxing and waning course in 13 (86.7%) of them. There was wide overlap between types of obsessive-compulsive symptoms and all patients experienced sensory phenomena preceding the compulsions. There was no clear-cut impact of depressive and manic episodes on the intensity of obsessive-compulsive symptoms, which increased in depression and decreased in mania in 40.0% of the cases, had the opposite pattern in 26.7% of the patients and fluctuated inconsistently in the rest of them. Tics disorders were diagnosed in 5 (33.3%) patients. CONCLUSIONS: Our results suggest that in women with comorbid bipolar disorder and obsessive-compulsive disorder the latter presents features that may be typical of the association of the two disorders, such as early onset and sensory phenomena preceding compulsions. A prospective controlled study is necessary to confirm these observations, due to some limitations of our study: small exclusively female sample, heterogeneity concerning the type of bipolar disorder and the disorder that determined sought of treatment and retrospective non-controlled design.

Adult↗
PubMed2005

[Epidemiology of obsessive-compulsive disorder: a review].

Epidemiological surveys are important because clinical samples are subject of several selection biases. Sociodemographic factors and clinical aspects of the morbid condition itself influence help seeking behaviors. Due to the egodystonic nature of obsessive-compulsive disorder, sufferers tend to hide their symptoms and avoid or delay treatment seeking. However, most of our current knowledge about obsessive-compulsive disorder is based on clinical samples, which do not represent the totality of cases. A conventional Medline, PsychoInfo and Lilacs review of epidemiological studies on obsessive-compulsive disorder from 1980 to 2004 was conducted, using the following keywords: "epidemiology", "obsessive-compulsive disorder", "populational surveys" and "prevalence". Studies from different countries show an average point-prevalence of 1% and lifetime prevalence of 2-2.5% for obsessive-compulsive disorder. In contrast with clinical samples, most populational samples have a predominance of females and cases with only obsessions. The frequent comorbidity with other mental disorders, particularly depression and other anxiety disorders, has also been found in cases from the community, which have an association with substances misuse as well. Many sufferers are not been treated, particularly the "pure" cases. Indicators of functional incapacitation show a considerable negative impact of obsessive-compulsive disorder. It is necessary to increase the awareness about obsessive-compulsive disorder symptoms in the community and among health professionals, in order to increase help seeking, as well as the proper identification and treatment of this rather serious medical condition.

Comorbidity↗
PubMed1992

Childhood obsessive compulsive disorder.

Childhood obsessive compulsive disorder has recently been recognized as being more common than previously believed, supporting epidemiologic studies in adults that found rates far higher than clinical studies have suggested. Clinically, presentation is generally similar to that for adult patients, but compulsions may occur in the absence of obsessions although both obsessions and compulsions are common. Symptoms typically change over time, but almost all subjects at some time experienced excess washing as one of their symptoms. There is an increased rate of obsessive compulsive disorder and of motor tics in the relatives of children with obsessive compulsive disorder. As with Tourette's disorder, partial voluntary control of symptoms is usual. Prospective follow-up studies show continued disability from obsessive compulsive disorder and continued comorbidity with affective disorders. Obsessive compulsive symptoms are selectively associated with several childhood onset neurologic disorders such as Tourette's disorder and Sydenham's chorea, both presumed to be basal ganglia disorders. The implication of this association is that there may be hard-wired complex behaviors subsumed by basal ganglia frontal cortical pathways that are inappropriately released in obsessive compulsive disorder.

Adolescent↗
PubMed1990

[Psychopathology and the clinical course of schizophrenia associated with obsessive disorders].

Based on psychopathological and clinicocatamnestic studies made in 96 patients suffering from schizophrenia associated with obsessions running mainly an attack-like course the psychopathological characteristics of obsessions were specified and their relation to other psychopathological disorders was determined. In part of cases, obsession underwent qualitative changes acquiring the character of disturbances similar to value judgements, delirium and catatonic stereotypies. The typology of obsessions associated with schizophrenia was elaborated; two types of obsessions were distinguished: obsessions with goal-oriented protection measures and obsessions with the development of disturbances superficially similar to catatonic stereotypies. Obsessions and their course were found to be related to the degree of personality changes.

Adolescent↗
PubMed1994

Fluvoxamine versus clomipramine in the treatment of obsessive compulsive disorder: a multicenter, randomized, double-blind, parallel group comparison.

BACKGROUND: To examine the efficacy of fluvoxamine and clomipramine in obsessive compulsive disorder and to compare their tolerabilities. METHOD: In this multicenter, randomized, double-blind trial, fluvoxamine (100-250 mg/day) was compared with clomipramine (100-250 mg/day) for 10 weeks in the treatment of 66 psychiatric outpatients, aged 18 to 65 years, with a diagnosis of obsessive compulsive disorder. The main efficacy variable was the Yale-Brown Obsessive Compulsive Scale; secondary variables were the National Institute of Mental Health Global Obsessive Compulsive Scale and the Clinical Global Impressions-Improvement scale. RESULTS: Seventeen patients withdrew prematurely, 6 in the fluvoxamine group and 11 in the clomipramine group. In the intent-to-treat population (34 fluvoxamine patients and 30 clomipramine patients), there were no significant differences with respect to the mean reduction in total Yale-Brown Obsessive Compulsive Scale score (last observation carried forward) at any time-point; a mean reduction of 8.6 (33%) was seen in the fluvoxamine group and 7.8 (31%) in the clomipramine group. Similar results were obtained in virtually all secondary variables. The only exception was the obsession-free interval for the Yale-Brown Obsessive Compulsive Scale, which was significantly longer in the fluvoxamine group, especially in a population of patients with disease of > 12 months' duration (F = 5.298, df = 1, p = .026). Adverse events were mostly tolerable; 9 patients (5 receiving fluvoxamine, 4 receiving clomipramine) withdrew due to adverse events related to treatment. CONCLUSION: Fluvoxamine and clomipramine were equally effective in the treatment of obsessive compulsive disorder. Both agents were well tolerated; fluvoxamine produced fewer anticholinergic side effects and caused less sexual dysfunction than clomipramine, but more reports of headache and insomnia.

Adult↗
PubMed1998

[Depression with obsession of contrast content].

Twenty depressed patients (according to ICD-10) with obsessions of contrast content (homicidophobia--4 patients, suicidophobia--12, other contrast obsessions--4 cases) were examined. The affective disorders belonged to polar areas of a depressive spectrum: anxious depressions (with a prevalence of manifestations of positive affectivity in the form of somatopsychic hyperstesia) and existential depressions (with domination of manifestations of negative affectivity in the form of alienation of the vital functions). In anxious depressions there were compulsive obsessions of contrast content (12 patients), while in existential ones impulsive obsessions (8 cases). Compulsive obsessions of contrast contents (fear of a lack of self-control pronounced in the form of the attacks of lissophobia) were formed at the height of an anxious-depressive affect. Impulsive obsessions of contrast contents (fear of self-damage with elements of an obsessive drive to its realization) were formed during depressive devitalization and were exceeded by suicidal ideas. Comorbidity of depressive and obsessive manifestations was realized by a peculiar type of interrelations with formation of "convergent" symptoms which reflected an increase of severity of depressive disorders.

Adult↗
PubMed1997

Phenomenological and pharmacological study of provoked obsessive/anxiety symptoms in obsessive-compulsive disorder: a preliminary study.

BACKGROUND: Inclusion of obsessive-compulsive disorder (OCD) as an anxiety disorder in DSM-i.v. assumes that anxiety is the primary symptom of OCD; however, persuasive empirical evidence in support of this view has not been presented yet. In the present study we hypothesized that provoked anxiety symptoms respond better to intravenous diazepam than would provoked obsessions. We, therefore, reasoned that anxiety symptoms are secondary symptoms of OCD. METHODS: To test the hypothesis we designed a double-blind, randomized, placebo-controlled crossover study. Patients underwent four experimental conditions in which the sequence of symptom provocation and i.v. injection of (placebo or diazepam) were alternated. Baseline and i.v. injection-induced symptom changes were assessed using visual analogs. RESULTS: Obsessions and anxiety correlated strongly for all four experimental conditions in which the sequence of the symptom provocation and diazepam i.v. injections was alternated. i.v. diazepam injection before and after symptom provocation failed to preferentially modulate anxiety symptoms over obsessions. Unexpectedly, in the group in which i.v. diazepam injection preceded the symptom provocation, reduction of mean obsessions was even more pronounced. CONCLUSIONS: Strong correlations between anxiety and obsessions at baseline, during symptom provocation, and after i.v. diazepam infusion suggest that anxiety and obsessions are tightly coupled phenomena in OCD.

Adult↗
PubMed2005

The impact of personality on symptom expression in obsessive-compulsive disorder.

Previous research conducted on the five-factor model of personality (FFM) in obsessive-compulsive disorder (OCD) has demonstrated that community and clinical participants score significantly higher than controls on the domains and facets of neuroticism and extraversion and selective facets of agreeableness and conscientiousness. However, studies have yet to examine the extent to which personality traits, as assessed by the FFM, are associated with the specific symptoms of OCD. The purpose of this study was to examine further the personality predictors of obsessive-compulsive symptoms in clinical participants using the facets of the FFM. Patients with a DSM-IV diagnosis of OCD (N = 56) completed the Revised NEO Personality Inventory, the Yale Brown Obsession Compulsion Scale, and the Beck Depression Inventory. Lower scores on openness to ideas were uniquely associated with greater obsession severity, whereas lower openness to actions was uniquely associated with greater compulsive severity. In contrast with past research that has emphasized the association between neuroticism and extraversion and dimensionally rated obsessive-compulsive symptoms, this study demonstrates the specific associations between selective facet traits of openness and clinical obsessions and compulsions. Whereas tendencies toward negative affectivity may confer a nonspecific vulnerability to the development of OCD, facets of openness may impact on the particular expression and severity of obsessive-compulsive symptoms.

Adult↗
PubMed2005

Obsessions and compulsions in Asperger syndrome and high-functioning autism.

BACKGROUND: Obsessive-compulsive behaviours are common and disabling in autistic-spectrum disorders (ASD) but little is known about how they compare with those experienced by people with obsessive-compulsive disorder (OCD). AIM: To make such a comparison. METHOD: A group of adults with high-functioning ASD (n=40) were administered the Yale-Brown Obsessive-Compulsive Scale and Symptom Checklist and their symptoms compared with a gender-matched group of adults with a primary diagnosis of OCD (n=45). OCD symptoms were carefully distinguished from stereotypic behaviours and interests usually displayed by those with ASD. RESULTS: The two groups had similar frequencies of obsessive-compulsive symptoms, with only somatic obsessions and repeating rituals being more common in the OCD group. The OCD group had higher obsessive-compulsive symptom severity ratings but up to 50% of the ASD group reported at least moderate levels of interference from their symptoms. CONCLUSIONS: Obsessions and compulsions are both common in adults with high-functioning ASD and are associated with significant levels of distress.

Adult↗