Obsessive-compulsive Disorder Obsessions Research Articles

Uncovering the Motor Dynamics of Obsessive-Compulsive Rituals Through Cluster Analysis.

Rituals represent a prominent human behavior in different contexts such as daily routines, life cycle stages, and psychopathology, for example, obsessive compulsive disorder (OCD) where they are referred to as compulsions. OCD compulsions differ from habitual behaviors and stereotypies regarding their formal features: acts repetition, the addition of nonfunctional acts, and attentional focus on basic motor units. This study aims to categorize OCD compulsions based on the motor patterns of acts repetition and inclusion of nonfunctional acts. We analyzed 28 video-recorded OCD compulsions; we adopted a cluster analytic model to identify distinct patterns within the data and determine cluster characteristics. Our findings revealed a moderate negative covariance between nonfunctionality and repetitiveness, indicating that as nonfunctionality increased, repetitiveness decreased. Three distinct clusters in OCD rituals were identified according to the motor pattern: "idiosyncratic rituals," characterized by strong incorporation of nonfunctional acts; "iterative rituals" showing high repetitiveness; and "routines," with minimal repetition and limited inclusion of nonfunctional acts. These motor patterns highlight evolutionarily conserved behavioral strategies aimed at coping with conditions of environmental unpredictability. The findings might allow fine-grained discrimination of ritual compulsions and help target personalized interventions.

Neurocomputational model of compulsivity: deviating from an uncertain goal-directed system.

Despite a theory that an imbalance in goal-directed versus habitual systems serve as building blocks of compulsions, research has yet to delineate how this occurs during arbitration between the two systems in obsessive-compulsive disorder. Inspired by a brain model in which the inferior frontal cortex selectively gates the putamen to guide goal-directed or habitual actions, this study aimed to examine whether disruptions in the arbitration process via the fronto-striatal circuit would underlie imbalanced decision-making and compulsions in patients. Thirty patients with obsessive-compulsive disorder [mean (standard deviation) age = 26.93 (6.23) years, 12 females (40%)] and 30 healthy controls [mean (standard deviation) age = 24.97 (4.72) years, 17 females (57%)] underwent functional MRI scans while performing the two-step Markov decision task, which was designed to dissociate goal-directed behaviour from habitual behaviour. We employed a neurocomputational model to account for an uncertainty-based arbitration process, in which a prefrontal arbitrator (i.e. inferior frontal gyrus) allocates behavioural control to a more reliable strategy by selectively gating the putamen. We analysed group differences in the neural estimates of uncertainty of each strategy. We also compared the psychophysiological interaction effects of system preference (goal-directed versus habitual) on fronto-striatal coupling between groups. We examined the correlation between compulsivity score and the neural activity and connectivity involved in the arbitration process. The computational model captured the subjects' preferences between the strategies. Compared with healthy controls, patients had a stronger preference for the habitual system (t = -2.88, P = 0.006), which was attributed to a more uncertain goal-directed system (t = 2.72, P = 0.009). Before the allocation of controls, patients exhibited hypoactivity in the inferior frontal gyrus compared with healthy controls when this region tracked the inverse of uncertainty (i.e. reliability) of goal-directed behaviour (P = 0.001, family-wise error rate corrected). When reorienting behaviours to reach specific goals, patients exhibited weaker right ipsilateral ventrolateral prefronto-putamen coupling than healthy controls (P = 0.001, family-wise error rate corrected). This hypoconnectivity was correlated with more severe compulsivity (r = -0.57, P = 0.002). Our findings suggest that the attenuated top-down control of the putamen by the prefrontal arbitrator underlies compulsivity in obsessive-compulsive disorder. Enhancing fronto-striatal connectivity may be a potential neurotherapeutic approach for compulsivity and adaptive decision-making.

The association between childhood trauma and motor structure in obsessive-compulsive rituals: An ethological and evolutionary approach.

Ethological models have highlighted a specific motor structure of compulsions in obsessive-compulsive disorder (OCD), based on the rigid repetitions of acts, and with the adaptive significance of facing unpredictable conditions. Such an evolutionary mechanism might explain the robust association between childhood traumatic experiences (CTEs) and OCD. However, a relationship between CTEs and the motor structure of compulsions has not been investigated yet. The first objective of the study was to confirm a specific motor structure of OCD compulsions with respect to control behaviors; the second objective was to assess a possible association between the motor structure of compulsions and CTEs severity. Thirty-two OCD outpatients (13 female, Mage = 44.50 years, SE = 19.71) and 27 healthy controls (10 female, Mage = 37.62 years, SE = 16.20), matched for sex and age, provided a videotape of their compulsions and corresponding ordinary acts, respectively. Behavior was scored with the software "Observer." Participants were administered the Yale-Brown Obsessive Compulsive Scale and the Childhood Trauma Questionnaire. A dependent t test was used to compare the motor structure of behavior between the groups; Pearson's correlations to investigate associations between motor parameters and CTEs. Compulsions showed a specific motor structure due to the repetition of functional and nonfunctional acts. CTEs severity was especially associated with the repetition of functional acts, independently from OCD severity. Our findings, in confirming a peculiar motor structure for OCD compulsions, hint for the first time at a link between CTEs and compulsive repetition of functional acts, which would represent a plastic developmental response to CTEs unpredictability. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review.

Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.

What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations.

The Diagnostic and Statistical Manual 5th ed. defines obsessions in obsessive-compulsive disorder (OCD) as frequent, persistent, intrusive, unwanted thoughts that provoke anxiety and distress and lead to attempts to neutralize them with either thoughts or actions. However, no systematic review has yet evaluated characteristics that are specific to obsessions occurring in OCD. The aim of the current systematic review and meta-analysis was to investigate the specific features of obsessions occurring in OCD by comparing them to both obsessionally and non-obsessionally-themed intrusions in non-clinical and other clinical populations. Based on a registered protocol, 832 records were found, of which 15 were included in the systematic review and meta-analysis, with a total of 1891 participants. Obsessionally-themed intrusions that occur among those with OCD caused more distress, guilt, negative emotion and interference as compared to similarly-themed intrusions that occur within the general population. The distinction between obsessionally-themed intrusions among those with OCD as compared to those occurring in anxiety and depressive disorder primarily revolves around a higher level of persistence, pervasiveness and distress associated with their occurrence. Further, unacceptability, uncontrollability, ego-dystonicity, alienness, guilt, the form of the intrusion, association with the self and lack of any basis in reality also differentiates between obsessions and intrusions occurring in other disorders. Obsessions share many characteristics with thoughts occurring in other disorders and can be distinguished using a combination of characteristics specific to individual disorders.

Treating Obsessive-Compulsive Disorder by Invasively Modulating Thoughts, Feelings, or Both

The defining characteristic of pathological compulsions is that they are carried out to reduce momentary distress, even though performing the compulsive act or thought is rationally not in the individual’s true best interest. This inability to flexibly adapt is a prominent component of obsessive-compulsive disorder (OCD) and closely related illnesses such as Tourette syndrome and is also observed in substance use disorders ( 1 Figee M. Pattij T. Willuhn I. Luigjes J. van den Brink W. Goudriaan A. et al. Compulsivity in obsessive-compulsive disorder and addictions. Eur Neuropsychopharmacol. 2016; 26: 856-868 Crossref PubMed Scopus (111) Google Scholar ). Following the 20th century experience with ablative procedures such as capsulotomy, deep brain stimulation (DBS) was applied to the treatment of OCD. Electrodes are most commonly placed within the anterior limb of the internal capsule (ALIC), modulating cortico-basal ganglia-thalamo-cortical parallel white matter loops relevant to limbic, associative, and motor functions, respectively. ALIC stimulation has proven to be a highly effective treatment for severe OCD ( 2 Smith AH, Mayberg HS, Figee M (in press): Neuromodulation and psychiatric disorders. In: Nestler EJ, Charney DS, editors. Neurobiology of Mental Illness, 6th ed. New York: Oxford University Press. Google Scholar ). DBS to a different anatomical location, the subthalamic nucleus (STN), was initially developed for Parkinson’s disease, but positive early experience in patients with comorbid Parkinson’s disease and OCD led to research establishing high-frequency stimulation straight to the STN as clinically efficacious for OCD ( 3 Mallet L. Polosan M. Jaafari N. Baup N. Welter M.L. Fontaine D. et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008; 359: 2121-2134 Crossref PubMed Scopus (687) Google Scholar ). In a similar manner, promising early pilot studies led to further exploration of other targets. These include the bed nucleus of the stria terminalis, the “extended amygdala” located between the ALIC and STN targets ( 4 Mosley P.E. Windels F. Morris J. Coyne T. Marsh R. Giorni A. et al. A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder. Transl Psychiatry. 2021; 11: 190 Crossref PubMed Scopus (38) Google Scholar ). More recently, evidence has emerged for the effectiveness of stimulation delivered deeper in the midbrain than the STN, adjacent to the ventral tegmental area (VTA)—a source of dopaminergic projections to the cortex (via the medial forebrain bundle [MFB]) and a recipient of proposed regulatory projections back from the cortex (via the “supralateral MFB”) ( 5 Meyer D.M. Spanier S. Kilian H.M. Reisert M. Urbach H. Sajonz B.E. et al. Efficacy of superolateral medial forebrain bundle deep brain stimulation in obsessive-compulsive disorder. Brain Stimul. 2022; 15: 582-585 Abstract Full Text Full Text PDF Scopus (3) Google Scholar ). SEE CORRESPONDING ARTICLE ON PAGE 1010 SEE CORRESPONDING ARTICLE ON PAGE 1010 The Rostral Zona Incerta: A Subcortical Integrative Hub and Potential Deep Brain Stimulation Target for Obsessive-Compulsive DisorderBiological PsychiatryVol. 93Issue 11PreviewThe zona incerta (ZI) is involved in mediating survival behaviors and is connected to a wide range of cortical and subcortical structures, including key basal ganglia nuclei. Based on these connections and their links to behavioral modulation, we propose that the ZI is a connectional hub for mediating between top-down and bottom-up control and a possible target for deep brain stimulation for obsessive-compulsive disorder. Full-Text PDF

Multi-modality connectome-based predictive modeling of individualized compulsions in obsessive-compulsive disorder

BackgroundWhile previous neuroimaging studies are mainly focused on dichotomous classification of obsessive-compulsive disorder (OCD) from controls, predicting continuous severity of specific symptom is also pivotal to clinical diagnosis and treatment. MethodsWe applied a machine-learning approach, connectome-based predictive modeling, on functional and structural brain networks constructed from resting-state functional magnetic resonance imaging and diffusion tensor imaging data to decode compulsions and obsessions of fifty-four patients with OCD. ResultsWe successfully predicted individualized compulsions with a positive model of structural brain network and with a negative model of functional brain network. The structural predictive brain network comprises the motor cortex, cerebellum and limbic lobe, which are involved in basic motor control, motor execution and emotion processing, respectively. The functional predictive brain network is composed by the prefrontal and limbic systems which are related to cognitive and affective control. Computational lesion analysis shows that functional connectivity among the salience network (SN), the frontal parietal network and the default mode network, as well as structural connectivity within the SN are vital in the individualized prediction of compulsions in OCD. LimitationsThere was no external validation of large samples to test the robustness of our predictive model. ConclusionsThese findings provide the first evidence for the predictive role of the triple network model in individualized compulsions and have important implications in diagnosis, prognosis and treatment of patients with OCD.

Clinical characteristics of transformation obsessions in obsessive-compulsive disorder: A psychopathological study.

The obsession of turning into another person (transformation obsessions [TO]), and its related compulsions have been initially conceptualised as a form of mental contamination. Nevertheless, it has remained understudied in the current obsessive-compulsive disorder (OCD) literature. In parallel, disturbances of the self have been identified as markers of prodromal psychosis in patients with schizophrenia. Based on the later association, this study aimed to investigate the sociodemographic and clinical correlates of TO. In all, 1001 OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used to compare 48 OCD patients with TO with 953 OCD patients without TO. A repression model investigated the relationships between the presence of current TO and statistically significant univariate test outcomes. Participants with TO presented an overall younger age, a longer period of time between the onset of the OCD symptoms and an OCD diagnosis, greater severity of the sexual/religious dimension and increased suicidality symptoms. These results indicate that TO may be better conceptualised as a form of forbidden/taboo thoughts rather than contamination. While no significant associations with psychotic features (e.g. decreased insight) were observed, TO patients displayed increased suicidality, overall younger age and a significantly larger disparity between seeking treatment and OCD diagnosis. This demonstrates that further clinical awareness and research into TO as an OCD symptom is most needed.

Imbalance in functional and structural connectivity underlying goal-directed and habitual learning systems in obsessive-compulsive disorder.

An imbalance between the goal-directed and habitual learning systems has been proposed to underlie compulsivity in obsessive-compulsive disorder (OCD). In addition, the overall balance between these systems may be influenced by stress hormones. We examined the multimodal networks underlying these dual learning systems. Both functional and structural measures indicated reduced connectivity within the goal-directed subnetwork (FC: P = 0.042; SC-FN: P = 0.014) and reduced connectivity between the goal-directed and habitual subnetworks (FC: P = 0.014; SC-FA: P = 0.052), but no differences within the habitual subnetwork in patients with OCD compared with controls. Path modeling indicated that anatomical connectivity in the goal-directed subnetwork influenced compulsive symptoms (R2 = 0.41), whereas functional connectivity within the habit subnetwork and between goal-directed and habitual subnetworks influenced obsessive symptoms (R2 = 0.63). In addition, the relationship between anatomical connectivity in the goal-directed subnetwork and compulsion was moderated by the stress hormone ACTH (adrenocorticotropic hormone), such that at low levels of ACTH greater connectivity resulted in lower compulsion, but at high levels of ACTH this relationship was reversed. These results provide new insights into the neural correlates of the imbalance between dual learning systems, and their relationship with symptom dimensions in patients with OCD. It may further support the reconceptualization of OCD as "compulsive-obsessive disorder," with a greater focus on the transdiagnostic dimension of compulsivity.

Examining weekly relationships between obsessive-compulsive and eating disorder symptoms

BackgroundDespite the severity and high rate of co-occurrence between eating disorders (ED) and obsessive-compulsive disorder (OCD), less is known regarding the longitudinal sequencing of their comorbidity and whether and how their symptoms may influence one another over time. The current study sought to answer these questions by testing if a bidirectional, longitudinal relationship exists between ED symptoms and OCD obsessions and compulsions. MethodsWe examined the relationship between ED symptoms, obsessions and compulsions across five time points, each one week apart using auto-regressive cross-lagged panel modeling. The final sample consisted of 358 individuals from the community with moderate levels of ED and OCD symptoms, the majority of whom identified as White and male. ResultsBivariate correlations revealed that ED symptoms, obsessions and compulsions were associated with one another across the five weeks. Two cross-lagged panel models indicated that ED symptoms predicted OCD symptoms at numerous time points and vice versa. However, we found this significant longitudinal associations across only certain weeks. Notably, the models found that only ED symptoms and OCD obsessions predicted one another across different time points across the five weeks; ED symptoms and OCD compulsions did not predict one another. Limitations. Due to the non-clinical nature of the sample, there is limited generalizability to clinical populations. ConclusionsOur results provide preliminary evidence that there is a bidirectional, longitudinal relationship between ED symptoms and OCD symptoms among a community sample, particularly with respect to cognitive as opposed to behavioral symptoms.

Повторювана та стереотипна поведінка при розладах аутистичного спектра та лобних епілепсіях: обговорення клінічного випадку.

Background: Autism spectrum disorders (ASD) have a prevalence of 1-2% among the world's child population and belong to the spectrum of neurodevelopmental disorders. ASD are characterized by significant genetic and clinical polymorphism, in particular comorbidity with neurological and mental disorders. In 15 - 30% of children with ASD, epilepsy is diagnosed throughout life. Repeated movements and vocalizations in ASD are often similar and require differential diagnosis with motor and vocal phenomena in the structure of epileptic seizures, with motor and vocal tics, in particular with Tourette's disorder, obsessions and compulsions in obsessive-compulsive disorder. The polymorbidity of ASD complicates the typology of recurring motor and vocal phenomena. Polymorphism of repetitive movements and vocalizations is also inherent in developmental encephalopathy. Objective : to investigate clinical polymorphism, variants of motor phenomena during 6 years of life in a child with dual diagnosis of ASD and frontal epilepsy. Materials and methods: A child with ASD and frontal focal epilepsy was observed for 6 years on the basis of the Department of Mental Disorders of Children and Adolescents of the Scientific Research Institute of Psychiatry of the Ministry of Health of Ukraine. The child underwent a comprehensive psychiatric and neurological examination every three months. For the diagnosis and assessment of the course of mental disorders, DAWBA and K-SADS-PL were used. To assess autistic symptoms, ADOS and ADI-R were used, and tics symptoms were YGTSS, and obsessive-compulsive disorders in children with ASD were CYBOCS ASD. The cognitive functioning of the child was assessed using PEP-R and the test WISC, the socially adaptive behavior of Vineland and SRS. Every six months and during unscheduled visits, an EEG study was conducted with a mathematical analysis of the results. Results: Child autism in a child was diagnosed in accordance with the ICD-10 diagnostic criteria, according to the results of a semi-structured interview with parents - ADI-R and assessment of current behavior by ADOS. During the period of controlled observation, epileptic paroxysms were characterized by the absence of complete loss of consciousness, polymorphism of seizures with numerous motor and vocal phenomena, which differentiated with symptoms of ASD, tics, obsessive-compulsive disorders. Stereotypic movements in the form of automatically repeated actions were observed in the proximal extremities, looked like a continuation and repetition of previous performed and daily performed automatic actions. The episodes of involuntary grimaces with distorted facial muscles during the first two years of observation looked like a violent act of activity, and not like epileptic paroxysms. EEG results also did not confirm the diagnosis of epilepsy. Dynamic, longitudinal monitoring of the clinical pathomorphism of repeated motor and vocal phenomena, analysis of therapeutic responses to treatment at different time periods: aripiprazole, guanfacin, sertraline, lamotrigine, analysis of symptoms that are qualified as comorbid, a gradual increase in focal epileptiform changes in the EEG allowed to diagnose frontal epilepsy with autism spectrum disorder. Conclusions: Most children with ASD have vocal and motor phenomena that may resemble symptoms of comorbid mental disorders. Repeated movements and vocalizations in ASD, as manifestations of tics, obsessive-compulsive disorders, are difficult to differentiate; they can be superimposed in the case of comorbidity disorders. With the appearance of specific epileptic activity and epileptic seizures in such patients, it is necessary to conduct differential diagnosis with developmental encephalopathy. The frontal form of epilepsy can be accompanied by seizures without complete loss of consciousness with characteristic automatic repeated stereotypic movements that have significant variability throughout life. The given clinical case supports the point of view that ASD and epilepsy are manifestations of a single pathological process - impaired neurodevelopment.

Recent Developments in the Habit Hypothesis of OCD and Compulsive Disorders.

This chapter aims to familiarise the reader with a diverse and fast-growing literature concerning the role that habits play in obsessive-compulsive disorder (OCD). Core concepts will be introduced, including how the balance between habits and a more deliberate form of action selection (goal-directed control) has traditionally been measured and how cross-species translation, neuroscience tools, and computational modelling have been used to build on these basic principles and reveal core mechanisms under study today. Next, the application of these methods to the study of OCD and related disorders will be detailed, converging on a theory that enhanced habit expression, and indeed compulsions in OCD, might arise from deficits in goal-directed control systems. These basic findings will be contextualised in terms of major tide changes in the field, including the shift from categorical disease frameworks to dimensional ones. Mechanistically, recent research concerning how goal-directed deficits arise, perhaps through failures in the construction of a mental model, are discussed along with studies critically evaluating our ability to measure habits in humans, in a laboratory setting. The chapter ends with a nod to the future, focusing on the need for clinically oriented, longitudinal, and intervention-based research that aim to translate what is now a wealth of cross-sectional mechanistic insights to the clinic.

From Habits to Compulsions: Losing Control?

In recent years, there has been a trend in psychiatry to try and explain disorders of action in terms of an over-reliance on the habitual mode of action. In particular, it has been hypothesized that compulsions in obsessive-compulsive disorder are driven by maladaptive habits. In this paper, I argue that this view of obsessive-compulsive disorder does not fit the phenomenology of the disorder in many patients, and that a more refined conceptualization of habit is likely to be helpful in clarifying the distinctions between disorders of action. There are thus two aims to this paper. The first is to highlight the issues pertaining to the view that compulsions are the result of an over-reliance on the habitual mode of action, leading to a loss of agentive control. The second aim is to examine the view of agentive control implicit in those accounts, and see how other conceptions of agentive control might do a better job at accounting for the distinct ways in which persons suffering from pathologies of action may be said to lack control.

The dimensional structure of the Yale-Brown Obsessive-Compulsive Scale for Pathological Gambling: functional differences between true compulsions and compulsive behavior

ABSTRACT The present study examined the factorial structure of the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) to delineate similarities and differences between thoughts and behavior related to pathological gambling (PG) versus obsessive-compulsive disorder (OCD). The PG-YBOCS was administered in its self-report version in 265 individuals with gambling problems. A factor analysis revealed a two-dimensional structure. The first dimension represented gambling severity; the second dimension reflected resistance to thoughts/urges and behavior. The first but not the second dimension was strongly correlated with depression and the severity and functional relevance of gambling problems. When the standard factor structure (thoughts vs. behavior) was adopted, depression, which is correlated with obsessions but not compulsions in OCD, was correlated with both subscales. Length of illness, a correlate of compulsions in OCD, showed no association with gambling. The present study corroborates factor analyses on the Y-BOCS, demonstrating the existence of an independent resistance dimension. Unlike in OCD, no evidence for independent factors tapping thoughts versus behaviors was obtained, which likely reflects the addictive rather than compulsive nature of problem gambling. Specific correlates of thoughts and behavior in OCD were not confirmed in gambling, further speaking for functional differences between the two disorders.

The effect of distress on the balance between goal-directed and habit networks in obsessive-compulsive disorder

The classical cognitive-behavioral theory of obsessive-compulsive disorder (OCD) holds that compulsions are performed to reduce distress that is evoked by obsessions, whereas a recent neuroscience-inspired theory suggests that compulsivity results from a disbalance between goal-directed and habit-related neural networks. To bridge these theories, we investigated whether the balance between goal-directed and habit networks in patients with OCD was affected during psychological distress. Twenty-three OCD patients and twenty-three healthy controls participated in a controlled stress induction paradigm using the socially evaluated cold-pressor test in a crossover design. Stress responses were evaluated through cortisol levels, blood pressure, and anxiety ratings. Functional connectivity of the caudate nucleus and posterior putamen was assessed using seed region analysis of resting-state functional magnetic resonance imaging data, which are hubs of the goal-directed and habit network, respectively. Stress induction increased blood pressure and psychological stress measures across groups and resulted in blunted cortisol responses in patients. Furthermore, patients showed a blunted reduction in connectivity between the caudate nucleus and precuneus during psychological distress, which was positively correlated with compulsivity but not obsession severity. The posterior putamen showed no significant group differences in distress-induced connectivity. These results suggest that compulsivity in OCD is associated with altered connectivity between the goal-directed and default mode networks during psychological distress.

Association Splitting for Obsessive-Compulsive Disorder: A Systematic Review

Background: Association splitting is a cognitive technique that targets obsessions in obsessive-compulsive disorder (OCD) by weakening biased semantic associations among OCDrelevant concepts. Objective: In this systematic review, we examine studies on the efficacy of association splitting for reducing OCD symptoms. Methods: Following PRISMA guidelines, six studies were included, with diversity in sample characteristics, mode of administration (i.e., self-help vs therapist-assisted), language of administration, comparator groups, etc. Results: Results indicated that association splitting, as a self-help intervention, was efficacious in reducing overall OCD symptom severity, specific OCD symptoms (i.e., sexual obsessions), subclinical unwanted intrusions, and thought suppression, with small-to-large effect sizes (e.g., across relevant studies, ds = .28-1.07). Findings were less clear when association splitting was administered on a therapist-assisted basis as an add-on to standard cognitive-behavior therapy (CBT). Nonetheless, across studies, the majority of participants reported high acceptability, ease of comprehension, and adherence to daily association splitting practice. Conclusion: Although association splitting is an efficacious and acceptable self-help intervention for OCD symptoms, future studies should include appropriate comparison groups, conduct longitudinal assessments, examine efficacy for different symptom dimensions, and assess changes in semantic networks as proof of mechanistic change. There should also be greater representation of marginalized groups in future studies to assess association splitting’s utility in circumventing barriers to face-to-face CBT. Ethical considerations are also discussed.

Obsessive-Compulsive Disorder, Sexual Obsessions and Sexual (Dys) Function: A Narrative Review

Introduction: obsessions are common symptoms of Obsessive-Compulsive Disorder (OCD) that can cause great distress and can focus on various sexual themes: unwanted sexual thoughts, thoughts of violent sexual behaviour, obsessions about the fear of engaging in homosexual activity or sex with animals. Our aim is to discuss the findings from previous studies about sexual obsessions and sexual dysfunction in OCD, analyse compulsive sexual behaviour disorder and the sexual dysfunction associated with the pharmacological treatment of OCD. Material and Methods: A literature research was conducted using the “PubMed” database and the search equation was built using the terms: Obsessive Compulsive Disorder; Sexual Obsessions; “Compulsive Behaviour” and Sexual Function; 18 articles were selected for the discussion of this narrative review. Results and Discussion: Several studies have been conducted on sexual function in individuals with OCD. obsessions comprise intrusive, recurrent and persistent thoughts, images or concerns about sexual matters that do not usually prompt sexual behaviour. orientation obsessions and the related distress may be misunderstood as being the result of a sexual identity conflicts. obsessions and obsessive thoughts about self-impurity play a role in sexual dysfunction in OCD as well as relationship difficulties and pharmacological management of the disease. Some studies suggest an association between OCD and compulsive sexual behaviour disorder, however, repetitive sexual thoughts in compulsive sexual behaviour are egosyntonic, whereas the obsessions in OCD are egodystonic. Conclusions: The occurrence of sexual obsessions in OCD should be recognised and understood as an ordinary and non-threatening OCD symptom. The more specific neurobiological characteristics of OCD and its treatment seem to influence sexual function in unique ways. A better understanding of sexual function in OCD may help clinicians to choose treatments more suited to the specific needs of these patients.

Transdiagnostic variations in impulsivity and compulsivity in obsessive-compulsive disorder and gambling disorder correlate with effective connectivity in cortical-striatal-thalamic-cortical circuits

Individual differences in impulsivity and compulsivity is thought to underlie vulnerability to a broad range of disorders and are closely tied to cortical-striatal-thalamic-cortical function. However, whether impulsivity and compulsivity in clinical disorders is continuous with the healthy population and explains cortical-striatal-thalamic-cortical dysfunction across different disorders remains unclear. Here, we characterized the relationship between cortical-striatal-thalamic-cortical effective connectivity, estimated using dynamic causal modelling of resting-state functional magnetic resonance imaging data, and dimensional phenotypes of impulsivity and compulsivity in two symptomatically distinct but phenotypically related disorders, obsessive-compulsive disorder and gambling disorder. 487 online participants provided data for modelling of dimensional phenotypes. These data were combined with 34 obsessive-compulsive disorder patients, 22 gambling disorder patients, and 39 healthy controls, who underwent functional magnetic resonance imaging. Three core dimensions were identified: disinhibition, impulsivity, and compulsivity. Patients’ scores on these dimensions were continuously distributed with the healthy participants, supporting a continuum model of psychopathology. Across all participants, higher disinhibition correlated with lower bottom-up connectivity in the dorsal circuit and greater bottom-up connectivity in the ventral circuit, and higher compulsivity correlated with lower bottom-up connectivity in the dorsal circuit. In patients, higher clinical severity was also linked to lower bottom-up connectivity in the dorsal circuit, but these findings were independent of phenotypic variation, demonstrating convergence towards behaviourally and clinically relevant changes in brain dynamics. Effective connectivity did not differ as a function of traditional diagnostic labels and only weak associations were observed for functional connectivity measures. Together, our results demonstrate that cortical-striatal-thalamic-cortical dysfunction across obsessive-compulsive disorder and gambling disorder may be better characterized by dimensional phenotypes than diagnostic comparisons, supporting investigation of quantitative liability phenotypes.

Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions

Background/ObjectiveUnwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (Mage=29.84, SD=11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to “do something”, to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.

AN INVESTIGATION INTO THE PHENOMENOLOGY OF REWARD AND HABIT IN OCD: LOOKING FOR SOCIODEMOGRAPHIC AND CLINICAL CORRELATES

Introduction Emerging neurobiological evidence suggests that the boundaries between compulsive symptoms in obsessive-compulsive disorder (OCD) and both addictive and habitual behaviors may not be impervious as previously though. For instance, attenuated activity in the nucleus accumbens during reward anticipation in OCD patients compared with healthy controls has been reported. 1 This effect was most pronounced in patients with contamination fears. 1 There is also evidence of an increased tendency to form both avoidance and “rewarding” habits in OCD, leading to the hypothesis that OCD compulsions are in fact overlearned habits. 2 Nevertheless, we are not aware of any phenomenological study attempting to investigate to contribution of reward and/or habit processes to compulsive behaviors in OCD and whether they are associated to any specific sociodemographic or clinical correlates. Methods To help filling this gap, 73 OCD patients attending a university-based clinic had their most clinically significant compulsive behaviors assessed with (1) the Temporal Impulsive Compulsive Scale (TICS), a self-report instrument that measures how frequently (from 0=never to 4=always) positive (rewarding) and negative affective states are experienced before, in anticipation, during, and after the OCD patients’ compulsive behavior; and (2) the Self-Report Habit Index (SRHI) a self-report instrument that assesses perceptions of habit strength (including prior behavior, automaticity, and identity expression). Patients were also assessed with a (3) a modified version of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) to measure severity of compulsive symptoms (including avoidance), and (4) the Obsessive-Compulsive Inventory-Revised (OCI-R), to provide severity of symptoms across obsessions, washing, checking, ordering, neutralization and hoarding dimensions. Additional instruments were selected on the basis of whether they were thought to measure other aspects of reward and/or punishment and fear including: (5) the Temporal Experience of Pleasure Scale (TEPS); (6) the Behavioral Inhibition/Activation Scales (BIS/BAS); (7) the Urgency, Premeditation, Perseverance, Sensation seeking, and Positive Urgency scale (UPPS-p); (8) the Obsessive Beliefs Questionnaire (OBQ-44); and (9) the Intolerance of Uncertainty Scale (IUS-12). Results Reward in anticipation and after the performance of OCD compulsive behaviors in the TICS correlated positively with anticipatory (r=0.25; p=0.03) and consummatory (r=0.28; p=0.02) pleasure in the TEPS, respectively. In terms of symptom content, anticipated reward (i.e., predicted positive affect prior to initiating compulsive behavior as measured on the TICS) correlated positively with severity of washing symptoms (r=0.24; p=0.04) and negatively with checking (r=-.024; p=0.04) and neutralization symptoms (r=0.25; p=0.03). In contrast, habit strength correlated positively with checking (r=0.27; p=0.02), hoarding (r=0.36; p=0.01), and ordering (r=0.29; p=0.13) and negatively with BIS scores (r=-0.26; p=0.03). Conclusions Our preliminary findings suggest that the ability to experience reward in anticipation and after the performance of OCD compulsions may be partially depend on whether patients are able to experience anticipatory and consummatory pleasure in domains other than those related to OCD compulsions. We were also able to confirm the finding that OCD patients with washing symptoms experience greater reward in anticipation of their OCD compulsions. In contrast, the greater the severity of checking, hoarding and ordering, the more habitual features the OCD compulsions tend to display.