Compulsive Checking Research Articles

Comparison of checking behavior in adults with or without checking symptom of obsessive-compulsive disorder using a novel computer-based measure

Easy to administer behavioral measures of checking are needed to improve the assessment of this hallmark feature of OCD. We recently developed a new computer-based behavioral assessment of OCD in a previous study. As a follow-up experiment for this method, the goal of this study was to examine whether the new computer-based behavioral assessment would be capable of differentiating behaviors in adults with OCD characterized by checking behavior from those without checking behavior. We compared 22 OCD patients with compulsive checking behaviors (OCD checkers), 17 OCD controls without checking behavior (OCD controls), and 31 healthy controls (HCs) on a novel computer-based behavioral measure of checking behavior. Despite similar levels of successfully completed tasks, OCD checkers demonstrated longer duration of checking behaviors than OCD controls or HCs. Interestingly, no differences were found between OCD controls and HCs in any of the dependent variables. Our new behavioral measure offers a novel, objective, and ecologically valid measure of checking behaviors in a sample of adults with OCD.

The impact of climate change on obsessive compulsive checking concerns

To investigate whether climate change has impacted on the nature of the obsessions or compulsions experienced by patients with obsessive compulsive disorder (OCD). The sample comprised 50 patients with OCD checking subtype who had presented at the Anxiety Disorders Clinic at The University of Sydney seeking treatment during the period March 2008 to November 2009. Details of the type of obsessions and compulsions directly related to climate change phenomena were identified. Fourteen of the 50 participants (28%) were identified as having OCD concerns directly related to climate change. The most frequent concerns involved electricity, water and gas wastage. Less frequent concerns included pets dying of thirst and one participant was concerned about house damage due to floors cracking, pipes leaking; roof problems and white ant activity. Compulsions included checking and rechecking pet water bowls, light switches, taps, stoves, skirting boards, pipes, roofs and wooden structures. While these behaviours are not particularly unusual for people with this condition, it was the rationale they provided for carrying them out that was surprising. Instead of checking and rechecking so as to prevent fire or flood, the rituals were specifically performed so as to reduce their global footprint, or respond to climate change-induced negative events. Our findings demonstrate that the types of obsessions and compulsions experienced by 28% of our sample were directly aligned with the current issue of climate change and the perceived dangers associated with this phenomenon. To our knowledge this represents the first documentation of the significant impact of climate change on the nature of the concerns experienced by people with OCD checking subtype. We suggest that mental health professionals need to be aware of, and assess for the presence of such concerns.

Mood as Input and Perseverative Worrying Following the Induction of Discrete Negative Moods

Previous research has demonstrated that a combination of negative mood and rigorous “as many as can” stop rules can be used to help explain a range of perseverative psychopathologies such as pathological worrying, compulsive checking, and depressive rumination (known as the mood-as-input hypothesis). The aim of the present study was to extend this work and examine whether specific emotions of the same valence will have similar or differential effects on task perseveration. The study experimentally induced discrete moods and manipulated task stop rules in an analog population. Results showed that perseveration at a worry-based interview task conformed to standard mood-as-input predictions in which perseveration was significantly greater when an “as many as can” stop rule was paired with a negative mood or a “feel like continuing” stop rule was paired with a positively valenced mood. The pattern of results revealed no significant inherent differences in processing depending on the type of discrete negative mood being experienced. These findings support a view of mood-as-input effects where overall valency is the important factor in determining perseveration.

Dysfunctional beliefs in the process of change of cognitive treatment in obsessive compulsive checkers

Cognitive behaviour therapy (CBT) is considered to be effective in the reduction of obsessive compulsive symptoms. However, questions remain as to how CBT works. Cognitive-behavioural models postulate that negative appraisals of intrusive thoughts and dysfunctional beliefs that give rise to them underlie the development and maintenance of obsessive-compulsive disorder (OCD). The current study aimed to study this hypothesis by investigating the processes of change over the course of cognitive treatment for OCD. Furthermore, a new theoretical approach and method for studying processes of change was presented. The participants were seven patients suffering from OCD with predominantly checking symptoms. Process variables (beliefs, anxiety and compulsions) were measured using idiosyncratic diaries and were analysed on an intra- and inter-individual level using dynamic systems methods. Results showed significant decreases in credibility of dysfunctional beliefs in six out of the seven participants, which is in line with the cognitive-behavioural model. Associations between process variables were in general medium to high. However, the actual patterns of change showed important intra- and interpersonal differences. Results indicated that different paths can lead to clinical recovery, and it was concluded that process studies that focus on individual trajectories of change can contribute to our understanding of OCD and its treatment. Furthermore, dynamic systems methods provide insight into intra-individual processes and shed a new light on variability.

Video telemetry and behavioral analysis discriminate between compulsive cleaning and compulsive checking in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) patients exhibit compulsive acts that share key characteristics that discriminate them from normal behaviors. In OCD, factor analysis of symptomatology has identified separate clusters ( contamination/cleaning; harming/checking; symmetry/ordering; hoarding). Here we used video analysis of the motor characteristics of OCD compulsions derived from two separate clusters, checking and cleaning, in order to determine whether behavioral differences exist in the way these two compulsions are performed. We compared 22 behavioral components (acts) of 12 OC-cleaning rituals and 25 OC-checking rituals. A normal activity with the identical theme was matched for each OC ritual as a control. For each ritual and control, we measured 22 parameters (such as the duration and frequency of act performance), and the levels of functionality, by evaluating the degree to which the act appears to contribute toward achieving its goal. We found that both OC-cleaning and OC-checking rituals differed from their respective control activity, and that they also differ between themselves in seven out of the 22 parameters. OC-cleaning involved increased repetition of functional activity whereas OC-checking involved a relatively increased non-functional activity. These results suggest that OCD cleaning and checking rituals are sufficiently different to justify their division into different subtypes and presumably are sub-served by different mechanisms. A better understanding of the relationship between those behavioral parameters derived from video-telemetry, and the parameters assessed by means of clinical and neurobiological tools, would improve our understanding of the nosological significance of compulsive symptoms and contribute to advancing endophenotypic exploration of the heterogeneity of OCD.

How checking as a cognitive style influences working memory performance

Compulsive checking is known to influence memory, yet there is little consideration of checking as a cognitive style within the typical population. We employed a working memory task where letters had to be remembered in their locations. The key experimental manipulation was to induce repeated checking after encoding by asking about a stimulus that had not been presented. We recorded the effect that such misleading probes had on a subsequent memory test. Participants drawn from the typical population but who scored highly on a checking-scale had poorer memory and less confidence than low scoring individuals. While thoroughness is regarded as a quality, our results indicate that a cognitive style that favours repeated checking does not always lead to the best performance as it can undermine the authenticity of memory traces. This may affect various aspects of everyday life including the work environment and we discuss its implications and possible counter-measures. Copyright © 2010 John Wiley & Sons, Ltd.

An Experimental Investigation of Factors Involved in Excessive Reassurance Seeking: The Effects of Perceived Threat, Responsibility and Ambiguity on Compulsive Urges and Anxiety

Excessive reassurance seeking is a common problem among individuals diagnosed with Obsessive-Compulsive Disorder (OCD). Given the proposed functional similarities between OCD-related reassurance seeking and compulsive checking (Rachman, 2002), it was hypothesized that some of the factors contributing to the onset and maintenance of episodes of these two behaviours might be shared, whereas other factors (e.g., ambiguity of feedback) may play a unique role in the persistence of reassurance seeking. The current experiment examined how manipulations of threat, responsibility, and ambiguity of feedback impacted upon non-clinical participants' (N = 176) anxiety and compulsive urges (to seek reassurance and to check) in a series of experimental vignettes. Consistent with hypotheses, higher levels of perceived threat, responsibility and ambiguity of feedback were associated with higher anxiety and compulsive urges. Results are discussed in terms of cognitive-behavioural models of, and treatments for OCD.

Impaired Executive Functioning in Subclinical Compulsive Checking with Ecologically Valid Stimuli in a Working Memory Task

We previously showed that working memory (WM) performance of subclinical checkers can be affected if they are presented with irrelevant but misleading information during the retention period (Harkin and Kessler, 2009, 2011). The present study differed from our previous research in the three crucial aspects. Firstly, we employed ecologically valid stimuli in form of electrical kitchen appliances on a kitchen countertop in order to address previous criticism of our research with letters in locations as these may not have tapped into the primary concerns of checkers. Secondly, we tested whether these ecological stimuli would allow us to employ a simpler (un-blocked) design while obtaining similarly robust results. Thirdly, in Experiment 2 we improved the measure of confidence as a metacognitive variable by using a quantitative scale (0–100), which indeed revealed more robust effects that were quantitatively related to accuracy of performance. The task in the present study was to memorize four appliances, including their states (on/off), and their locations on the kitchen countertop. Memory accuracy was tested for the states of appliances in Experiment 1, and for their locations in Experiment 2. Intermediate probes were identical in both experiments and were administered during retention on 66.7% of the trials with 50% resolvable and 50% irresolvable/misleading probes. Experiment 1 revealed the efficacy of the employed stimuli by revealing a general impairment of high- compared to low checkers, which confirmed the ecological validity of our stimuli. In Experiment 2 we observed the expected, more differentiated pattern: High checkers were not generally affected in their WM performance (i.e., no general capacity issue); instead they showed a particular impairment in the misleading distractor-probe condition. Also, high checkers’ confidence ratings were indicative of a general impairment in metacognitive functioning. We discuss how specific executive dysfunction and general metacognitive impairment may affect memory traces in the short- and in the long-term.

Danger Ideation Reduction Therapy for Obsessive–Compulsive Checking: Preliminary Findings

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive–compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive–compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.

Features of compulsive checking behavior mediated by nucleus accumbens and orbital frontal cortex

The quinpirole sensitization model of obsessive-compulsive disorder was used to investigate the functional role that brain regions implicated in a neuroanatomical circuit of obsessive-compulsive disorder may play in compulsive checking behavior. Following repeated injections of saline or quinpirole (0.5mg/kg, twice per week, ×8 injections) to induce compulsive checking, rats received N-methyl-d-aspartate lesions of the nucleus accumbens core (NAc), orbital frontal cortex (OFC) and basolateral amygdala, or sham lesions. When retested at 17days post-surgery, the results showed effects of NAc and OFC but not basolateral amygdala lesion. NAc lesions affected measures indicative of the amount of checking behavior, whereas OFC lesions affected indices of staying away from checking. The pattern of results suggested that the functional roles of the NAc and OFC in checking behavior are to control the vigor of motor performance and focus on goal-directed activity, respectively. Furthermore, similarities in behavior between quinpirole sham rats and saline NAc lesion rats suggested that quinpirole may drive the vigor of checking by inhibition of NAc neurons, and that the NAc may be a site for the negative feedback control of checking.

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

P.1.d.014 HFS and pharmacological inactivation of the globus pallidus and nucleus entopeduncularis differentially affect quinpirole-induced compulsive checking in rats

P.1.d.014 HFS and pharmacological inactivation of the globus pallidus and nucleus entopeduncularis differentially affect quinpirole-induced compulsive checking in rats

Evidence of Impaired Event-Based Prospective Memory in Clinical Obsessive–Compulsive Checking

AbstractBased on findings from subclinical OCD checking samples (Cuttler & Graf, 2007; 2008), Cuttler and Graf (2009) suggested that checking may develop to compensate for prospective memory failures. The present study provides the first evidence of prospective memory problems in a clinical sample of OCD checkers (n = 26) compared to a group of healthy controls (n = 26). Consistent with earlier work with subclinical samples, the OCD checkers performed more poorly on an event-based, but not a time-based, prospective memory task. However, the OCD checkers did not report more subjective prospective memory failures than controls and their confidence in prospective memory accuracy was higher than that of controls. An explanation of the inconsistent findings with regard to metamemory in clinical and subclinical OCD checking is provided. Further research assessing both subjective memory performance and the strategies understood to support memory is needed to clarify the contribution of prospective memory to OCD checking.

Don’t even think about checking: Mental checking causes memory distrust

Compulsive checking occurs in both physical and mental forms and is a common symptom of obsessive-compulsive disorder (OCD). Though there has been much recent attention devoted to research on physical checking, mental checking has been largely neglected. Previous research has reliably found that repeated physical checking reduces memory confidence, vividness and detail, while memory accuracy remains relatively unaffected. The current study examined memory accuracy and meta-memory in ( n = 62) undergraduate students for both physical and mental checks after repeated physical or mental checking of a stove. We hypothesized that repeated physical checking would lead to reductions in meta-memory for previous physical checks and that repeated mental checking would lead to reductions in meta-memory for previous mental checks. Results were consistent with hypotheses, in that checking in each modality led to significant decreases in all meta-memory variables for that modality but not the other. Results also showed that checking in each modality led to slight but significant declines in memory accuracy for that modality. Findings are discussed in terms of cognitive-behavioural models of and treatments for compulsive checking in OCD.

Feeling of doing in obsessive–compulsive checking

Research on self-agency emphasizes the importance of a comparing mechanism, which scans for a match between anticipated and actual outcomes, in the subjective experience of doing. This study explored the “feeling of doing” in individuals with checking symptoms by examining the mechanism involved in the experienced agency for outcomes that matched expectations. This mechanism was explored using a task in which the subliminal priming of potential action-effects (emulating outcome anticipation) generally enhances people’s feeling of causing these effects when they occur, due to the unconscious perception of a match between primed and observed outcomes. The main result revealed a negative relationship between checking and self-agency for observed outcomes that were primed prior to actions. This suggests that checking individuals fail to grasp the correspondence between actual outcomes of their actions and expected ones. We discuss the possible role of undermined self-agency in checking phenomena and its relationship with cognitive dysfunction.

Effect of curcumin on quinpirole induced compulsive checking: An approach to determine the predictive and construct validity of the model.

Background:Disorders of anxiety vary in severity to a wide extent, and obsessive-compulsive disorder (OCD) persists as the fourth most common form of mental illness and is reported to be associated with memory impairment, necessitating effective means of treatment.Aim:To study the effect of curcumin on OCD.Methods:The present study includes the determination of effect of curcumin at 5 and 10 mg/kg in quinpirole (0.5 mg/kg) -induced model of OCD, memory retention and brain monoamine levels in rats.Results:A significant improvement from the obsessive-compulsive symptoms induced by quinpirole was observed in curcumin treated rats; curcumin showed a protective effect on memory task. An increase in serotonin levels and a decrease in the dopamine levels were observed in curcumin treated rats.Conclusion:Curcumin treatment had shown a protective effect in OCD with considerable influence on brain monoamine levels, thus providing an evidence for the predictive and construct validity of the model.

Cognitive-Behavior Therapy for Compulsive Checking in OCD

There is substantial evidence for the effectiveness of psychological treatments for OCD, and various approaches have been widely recommended. These approaches tend to be characterized by exposure and response prevention (ERP) and also tend to be applied equally to all forms of OCD. Patients/clients (and some therapists) often find ERP to be a difficult treatment, and both dropout and refusal rates are unacceptably high. Based on specific cognitive conceptualizations of different manifestations of OCD, new and refined cognitive treatment methods are now available. The present article describes a specific cognitively based approach to the treatment of compulsive checking.

Staying on Top of Things Right from the Start

Our choice of partners, so they say, is subconsciously directed by an immune system aiming to making itself more diverse and robust. This strategy seems to work quite well if one looks at the highly complex structures that underlie human immunology, which still surprises with unexpected enigmas even after decades of intense research. Another recent proof of this phenomena is the study by Eller et al. 1 in this issue of JASN that describes a surprisingly aggravated course of glomerulonephritis in mice lacking the chemokine receptor CCR7. The family of chemokines and their receptors are important mediators of directional leukocyte trafficking under inflammatory and homeostatic conditions. Given the complexity of the immune system and the multitude of different leukocytes, guidance by the chemokine family is much needed to facilitate the interaction of the right leukocyte subsets at the right time and in the right location. CCR7 is particularly crucial in the initiation of antigen-specific immune responses.2 Upon encountering a danger signal, antigen-bearing dendritic cells upregulate CCR7 and become responsive to the corresponding ligands CCL19 and CCL21, which are expressed in secondary lymphoid organs. Likewise, naive T helper cells bear CCR7 on their surface and are similarly directed to lymph nodes and spleen. Here, these two cell types interact in a favorable environment to initiate …

Intolerance of uncertainty mediates the relationship between responsibility beliefs and compulsive checking

Both responsibility beliefs and intolerance of uncertainty have been implicated in compulsive checking behavior. Despite this, the exact relationship of these two variables with compulsive checking behavior is yet to be determined. Using a mixed sample of individuals consisting of compulsive checkers as well as non-clinical participants, we assessed the validity of a mediation model in which the relationship between responsibility beliefs and compulsive checking was mediated by intolerance of uncertainty. Although both responsibility beliefs and intolerance of uncertainty were correlated with the frequency of compulsive checking, the relationship between responsibility and checking was fully mediated by intolerance of uncertainty. Implications for the understanding of the relationship between these constructs, as well for conceptualisation of clinical checking problems are discussed.

Diagnosis and Treatment of PTSD-Related Compulsive Checking Behaviors in Veterans of the Iraq War: The Influence of Military Context on the Expression of PTSD Symptoms

This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behaviors that appear to be influenced by theater-specific combat duties and traumatic events. These cases represent what the authors believe to be an increasingly common expression of PTSD in veterans of the Iraq and Afghanistan wars. Both veterans were treated with prolonged exposure therapy, which includes imaginal and in vivo exposure to anxiety-provoking stimuli, processing of traumatic events, and self-assessment of anxiety. Treatment also included in vivo exposure with response prevention techniques borrowed from the literature on obsessive-compulsive disorder to address compulsive checking behaviors within the ecological context of each patient's symptom presentation. Measures related to PTSD and depression were obtained before, during, and after treatment. Treatment was associated with significant declines in symptom severity and improved functioning for both veterans. The unique nature of the conflict in the Middle East represents role challenges for soldiers that affect symptom presentation. Variations in symptom presentation can in turn complicate efforts to identify and appropriately address PTSD-related health concerns in this population. Thus, clinicians and researchers must remain cognizant of how theater-specific duties influence the manifestation and treatment of PTSD in order to provide optimal care to a new generation of veterans.