Maintenance Of Obsessive-compulsive Disorder Research Articles

Adult attachment and OCD symptoms: the mediating role of intolerance of uncertainty and beliefs about losing control

ABSTRACT Objectives Attachment orientation has been argued to play a role in the development and maintenance of obsessive-compulsive disorder (OCD) symptoms, but this relationship has yet to be fully understood. Attachment orientation may also contribute to appraisals of uncertainty such as threatening and negative beliefs about the consequences of loss of control, constructs which may also be associated with OCD. The present study aimed to investigate whether intolerance of uncertainty (IU) and negative beliefs about losing control (BALC) mediate the relationship between attachment and OCD symptoms. Method Two hundred and five participants were recruited from the general community to undertake a cross-sectional online survey which included the Experiences in Close Relationships Scale-Revised, the Intolerance of Uncertainty Scale – 12 item, the Beliefs About Losing Control Inventory, and the Obsessive-Compulsive Inventory-Revised. Results Attachment anxiety, attachment avoidance, IU, and BALC were positively correlated with OCD symptoms. Both attachment dimensions were associated with IU and BALC. IU and BALC were found to be serial multiple mediators in the relationship between both attachment dimensions and OCD symptoms, though only the relationship between attachment anxiety and OCD remained significant when controlling for the corresponding attachment dimension. Conclusion The results suggest that IU and BALC may play a key role in the relationship between attachment and OCD symptoms.

Metacognitive profiles in children and adolescents with obsessive-compulsive disorder

It has been suggested that maladaptive metacognition (beliefs and strategies) is related to the development and maintenance of obsessive-compulsive disorder (OCD). The aims of the study were to explore whether subgroups of pediatric OCD patients could be identified based on self-reported generic metacognition, and to compare these potential subgroups with a non-clinical control group. Additionally, differences between subgroups were examined across demographic (age and sex) and clinical characteristics (OCD severity and insight, types of OCD symptoms, and co-occurring symptoms). The study included a pooled sample of 157 pediatric OCD patients (age 7–18 years) and 58 non-clinical controls. Latent profile analyses supported a model with three profiles characterized by low, moderate, and high levels of maladaptive metacognition relative to the control group. Children and adolescents with higher age, greater OCD severity, specific OCD symptoms (e.g., aggressive, sexual, somatic, religious, and self-rated obsessing symptoms), and/or co-occurring internalizing symptoms (including anxiety and depressive symptoms) had a higher probability of belonging to a group with higher levels of maladaptive metacognition. The emergent profiles indicate heterogeneity in metacognition and clinical expression among children and adolescents with OCD, suggesting that generic metacognition could be a possible treatment target for some of these patients.

Serotonergic agonism and pharmacologically-induced adolescent stress cause operant-based learning deficits in mice

BackgroundThe interplay between environmental stress and genetic factors is thought to play an important role in the pathogenesis and maintenance of obsessive-compulsive disorder (OCD). However, the relative contribution of these causative antecedents in the manifestation of cognitive inflexibility—a phenotype often seen in obsessive-compulsive (OC)- spectrum disorders—is not fully understood. MethodIn this study, we treated mice with 50 mg/L corticosterone (CORT, a glucocorticoid stress hormone) in their drinking water during adolescence. In adulthood, we assessed anxiety-like behaviour and locomotor activity; along with operant-based discrimination and reversal learning. RU-24969, a selective serotonin receptor 5-HT1A/1B receptor agonist, was used as an acute pharmacological model of OC-like behaviour. RU-24969 (5 mg/kg) was administered prior to each reversal learning testing session. ResultsWe found that acute treatment with 5 mg/kg RU-24969 induced stereotyped hyperlocomotion in vehicle- and CORT-treated mice. Furthermore, pre-treatment with CORT in adolescence produced subtle anxiety-like behaviour in adult mice, and also resulted in an impairment to late-stage discrimination learning and alterations to reversal learning. Finally, acute treatment with 5 mg/kg RU-24969 caused an impairment to early-stage reversal learning. ConclusionWhilst we revealed dissociable detrimental effects of adolescent CORT treatment and acute 5-HT1A/1B receptor agonism on discrimination and reversal learning, respectively, we did not find evidence of additive deleterious effects of these two treatments. We therefore suggest that while disrupted serotonergic signalling is likely to be involved in the cognitive phenotype of OC-spectrum disorders, distinct neuropathological pathways may be at play in mediating the role of stress as an antecedent in OCD and related illnesses.

Obsessive-Compulsive Symptom Dimensions and Their Relationships with Obsessive Beliefs: A Structural Equation Modeling Analysis.

Dysfunctional beliefs are central in the development and maintenance of obsessive-compulsive disorder (OCD) as well as its treatment. Yet, research suggests that not all dysfunctional beliefs are equally important for each of the symptom dimensions of OCD. However, results are inconsistent in that studies contradict each other regarding the associations between specific symptom dimensions and belief domains. The aim of the present study was to clarify which belief domain is specifically associated with which OCD symptom dimension. Results could help to tailor treatments more specifically to the patient's OCD symptom dimension. In- and outpatients with OCD (N = 328; 43.6% male and 56.4% female) filled out questionnaires on symptom dimensions of OCD (Obsessive-Compulsive Inventory Revised) and dysfunctional beliefs (Obsessive Beliefs Questionnaire). A structural equation model analysis was conducted to identify the associations between dysfunctional beliefs and symptom dimensions. Our results showed that perfectionism/intolerance of uncertainty was associated with hoarding and symmetry/ordering, (2) overestimation of threat/inflated responsibility was associated with checking compulsions, and (3) importance of thoughts/control of thoughts was associated with obsessing. These results were largely supported by a backward selection. Our results demonstrated associations of specific dysfunctional beliefs and specific OCD symptom dimensions. However, future studies are necessary to replicate these findings with other measures (e.g., clinician ratings).

The relevance of dysfunctional reasoning to OCD and its treatment: Further evidence for inferential confusion utilizing a new task-based measure

Background and objectivesPrevious research has highlighted the role of dysfunctional reasoning processes (i.e. “inferential confusion”) in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Inferential confusion has previously been found to be a unique predictor of OC symptoms and has shown specificity for OCD. However, these findings have primarily relied on a single self-report questionnaire, and only a limited number of experimentations have been conducted to establish the specificity of inferential confusion to OCD with alternate measures. The current paper demonstrates the relationship of inferential confusion with OCD symptoms in clinical samples by using a task-based measure of inferential confusion. MethodsSixty-four OCD participants, as well as thirty anxious and thirty-four healthy controls completed the recently developed Dysfunctional Reasoning Processes Task (DRPT) and related measures. Thirty-five OCD participants then completed sixteen sessions of cognitive-behavioural therapy (CBT) and completed the same measures post-treatment. ResultsAs predicted, dysfunctional reasoning was significantly more elevated for those with OCD relative to control groups. Reduced levels of dysfunctional reasoning during CBT were significantly associated with successful treatment outcome. LimitationsClinical implications should be interpreted with caution due to the relatively small sample size. ConclusionsOur findings support the notion that inferential confusion is an important cognitive factor particularly relevant to OCD that needs to be directly addressed as a mechanism of change in CBT.

Further validation of the Multidimensional Version of the Fear-of-Self Questionnaire in a Persian non-clinical and clinical obsessive-compulsive disorder sample.

Previous research has shown that vulnerable self-themes and feared self-perceptions may play an important role in the development and maintenance of obsessive-compulsive disorder (OCD). In particular, the recently validated Multidimensional Version of the Fear-of-Self Questionnaire (FSQ-MV) has shown strong relationships with OCD symptoms independent of cognitive constructs and negative mood in non-clinical samples. The current study aimed to further evaluate the validity and reliability of a Persian version of the FSQ-MV in OCD patients (N= 300), as well as non-clinical individuals (N= 300). Participants completed a set of scales evaluating feared self-perceptions and OCD-related symptoms/conditions. The results showed that the Persian version of the FSQ-MV replicated the three-factor structure of the original scale in non-clinical and OCD patients. The FSQ-MV and its subscales had excellent reliability. Additionally, the FSQ-MV was significantly associated with related cognitive constructs, as well as OCD symptoms and their severity, in both samples. The feared self, especially the corrupted feared self, was a significant unique predictor of OC symptomology, especially for repugnant obsessions, and OCD severity. The study confirmed the validity and reliability of the Persian version of the FSQ-MV. Moreover, cognitive conceptualizations may benefit from a consideration of the feared self in OCD, which may play an important role in its development, maintenance and severity.

An Integrative Model for Understanding Obsessive-Compulsive Disorder: Merging Cognitive Behavioral Theory with Insights from Clinical Neuroscience.

Several models have been proposed for the emergence and maintenance of obsessive-compulsive disorder (OCD). Although these models have provided important insights and inspired treatment development, no single model has yet sufficiently accounted for the complexed phenotype of the disorder. In the current paper, we propose a novel model that integrates elements from cognitive behavioral models of OCD with neurocognitive approaches to the disorder. This Reciprocal Interaction Model (RIM) for OCD is based on two assumptions: (a) similar observed symptoms can stem from different etiological processes; and (b) neuropsychological deficits (such as reduced response inhibition and overreliance on the habit formation system) and cognitive behavioral processes (such as temporary reduction in anxiety after engaging in compulsive behaviors) mutually affect each other such that abnormalities in one system influence the second system and vice-versa-creating a vicious cycle of pathological processes. Indeed, the bidirectional inhibitory connection between anxiety/obsessions and executive control is at the heart of the model. We begin by briefly reviewing the current models for OCD. We then move on to describe the RIM, the supporting evidence for the model, the model's predictions, and potential clinical implications.

Comparison of Metacognitions in Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, and Healthy Controls

IntroductionGeneralized anxiety disorder (GAD) and Obsessive compulsive disorder (OCD) are common psychiatric disorders. Researchers studying the pathophysiology of these two disorders evaluated the effect of metacognition. However, there is no research examining the metacognition differences of these two psychiatric conditions.ObjectivesThis study was performed to compare the metacognitions in OCD, GAD and healthy controls.MethodsThe sample of this study consisted of 158 GAD and 137 OCD patients aged 18-65 years who presented to outpatient psychiatry clinic and applied to the health committee 168 healthy controls without psychopathology. Sociodemographic data form, Meta-Cognitions Questionnaire-30 scale(MCQ-30), Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) were applied to the volunteer participants who met the criteria for participation in the study. The data obtained were evaluated statistically and subjected to statistical analysis.ResultsThe mean age was 31.89 ± 10.86 years and was 60.5% (n = 208) women. There was statistical difference between marital status, occupation and income(p <0.05). In addition, there was a statistically significant difference between MCQ-30 total and subscales, BDI and BAI (p <0.001). According to the comparison of OCD and GAD patients, ’positive belief’, MCQ-30 total and BAI scores were found to be statistically different (p <0.05), ’Uncontrollability and danger’, ’Cognitive Confidence’, ’Beliefs about The Need to Control Thoughts’, ’Cognitive Self-Consciousness’, BDI there was no statistical difference between them (p> 0.05).ConclusionsOur results are contributing to the understanding of the uncertainty of development and maintenance of OCD and GAD. Additionally, metacognitions could be important for the diagnosis and treatment of OCD and GAD.DisclosureNo significant relationships.

Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.

Deontological Guilt and Disgust Sensitivity Modulate Moral Behaviour.

ObjectiveDeontological Guilt (DG), and Altruistic Guilt (AG) emerge from the appraisal of violating an internalized rule or an altruistic principle, respectively. DG is strictly connected with Disgust Sensitivity and plays a key role in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Previous studies investigated how DG affects responses to hypothetical moral dilemmas, however how DG and Disgust Sensitivity interact modulating moral behavior is still unknown.MethodsSTUDY 1. 46 healthy participants performed an ecological paradigm in which people can spontaneously decide to lie to obtain a reward (egoistic lie) or give it away (altruistic lie) after three emotional inductions: DG, AG or neutral. Furthermore, OCD traits, Morality, Guilt Propensity and Disgust Sensitivity were assessed by means of questionnaires. STUDY 2. 27 participants from the original sample were retested during the COVID-19 lockdown in Italy to ascertain whether the pandemic modified traits related to morality, disgust, guilt or OCD symptoms and whether these changes modulated moral behavior (measured by a task in which cheating was associated to higher pay-offs).ResultsSTUDY 1. Compared to the neutral, after the DG induction participants produced less altruistic and more egoistic lies. This effect was stronger in participants with high Disgust Sensitivity. STUDY 2. During the COVID-19 lockdown participants became more sensitive to the Authority pillar of the Moral Foundations and more sensitive to Disgust: this increment in deontological morality affected (im) moral behavior depending on changes in Disgust Sensitivity.ConclusionsOur data suggest that people with high Disgust Sensitivity are more affected by deontological inductions which translate to higher immorality, supposedly by lowering their moral self-image. These results might have important clinical implications as they suggest that addressing Disgust Sensitivity in therapy, might also decrease the effect of guilt on patients’ behavior.

The impact of modifying obsessive-compulsive beliefs about perfectionism

Background and objectivesCognitive-behavioural models of obsessive-compulsive disorder (OCD) suggest that maladaptive beliefs about perfectionism play a key role in the development and maintenance of OCD. Cognitive-bias modification for interpretation bias (CBM-I) is an experimental procedure that can test this proposed causal relation. MethodsAs such, the current study investigated whether multiple CBM-I sessions administered in different contexts can modify perfectionism biases. Undergraduate students high in OCD-related perfectionism beliefs were randomly allocated to either an experimental (n = 44) or control (n = 44) training condition and completed self-report and behavioural measures of perfectionism and OCD symptoms. ResultsAs predicted, relative to the control condition, participants in the experimental condition exhibited a significant decrease in perfectionism beliefs, from baseline to after one CBM-I training session, which was maintained at one-week follow-up. Contrary to hypotheses, there were no significant differences between conditions on measures of OCD symptoms and perfectionistic behaviour. LimitationsIssues with the current study's behavioural measures may have precluded any differences between conditions. ConclusionsResults underscore the need to further refine cognitive-behavioural models of OCD to understand the precise causal relation between beliefs and symptoms.

The Assessment of Thought Fusion Beliefs and Beliefs About Rituals

Abstract. Background: According to the metacognitive model, two domains of metacognitive beliefs play a role in the development and maintenance of obsessive-compulsive disorder (OCD). The Thought Fusion Instrument (TFI) has been developed to measure metacognitive beliefs about the significance of intrusive thoughts. The Beliefs About Rituals Inventory (BARI) assesses metacognitive beliefs about the necessity of performing ritual behaviors. Studies assessing the psychometric properties of the TFI and BARI are scarce. There are no studies assessing the factor structure of the TFI and the BARI. Methods: In this study, we assessed the psychometric properties of the TFI and the BARI in nonclinical ( n = 141) and clinical populations (OCD [ n = 60], anxiety disorder [ n = 30], and autism spectrum disorder [ n = 50]). In the nonclinical population, the factor structure is also explored. Results: For both the TFI and the BARI, an explorative factor analysis revealed a one-factor solution, which now needs further exploration using confirmative approaches. The internal consistency appeared good, and they had a moderate test–retest reliability. Convergent and divergent validity of the instruments appeared sufficient, but more research is required to draw firm conclusions. The criterion validity turned out to be moderate for the BARI but low for the TFI in measuring OCD-specific metacognitions. Conclusions: Based on the explorative factor analysis, we hypothesize the TFI and the BARI to measure a single-factor construct. The current study shows that the TFI and the BARI are potentially suitable questionnaires to assess metacognitions in clinical and nonclinical populations. More research is required before clear recommendations can be made for the utility and use in clinical practice.

Is a Ruminative Thinking Style Related to Obsessive-Compulsive Symptom Severity Beyond Its Associations with Depressive and Anxiety Symptom Severity?

Previous studies suggest that a ruminative thinking style (RTS) is positively associated with the severity of obsessive-compulsive symptoms and might be involved in the maintenance of obsessive-compulsive disorder (OCD). We sought to replicate this association in a sample of individuals with OCD, controlling for depressive and anxiety symptom severity, and to extend previous studies by including an interview measure of obsessive-compulsive symptom severity. A sample of 140 individuals diagnosed with OCD participated in a cross-sectional observational study. Participants completed questionnaire measures of an RTS as well as obsessive-compulsive, depressive, and anxiety symptom severity. Obsessive-compulsive symptom severity was additionally assessed with an interview. When statistically controlling for depressive and anxiety symptom severity, an RTS continued to predict the questionnaire, but not the interview measure of obsessive-compulsive symptom severity. We discuss possible explanations for these mixed findings, emphasizing the unique aspects of each measure, and consider implications for further research on OCD.

Neurofunctional predictive biomarkers of cognitive-behavioral therapy during fear conditioning in patients with obsessive-compulsive disorder

IntroductionAltered fear learning processes could be mechanistically linked to the development and/or maintenance of obsessive-compulsive disorder (OCD). From a clinical perspective, the first-line psychological treatment for OCD is cognitive-behavioral therapy (CBT), which is based on the principles of fear learning. However, no previous functional magnetic resonance imaging (fMRI) studies have evaluated the predictive capacity of regional brain activations during fear learning on CBT response in patients with OCD.ObjectivesWe aimed at exploring whether brain activation during fear learning in patients with OCD are associated with CBT outcome.MethodsWe assessed 18 patients with OCD and 18 healthy participants during a 2-day experimental protocol where brain activation and skin conductance responses (SCR) where assessed during fear conditioning, extinction learning, and extinction recall within the fMRI scanner. Following the protocol, patients with OCD received CBT.ResultsWe found non-significant between-group differences in SCR during fear learning. Patients with OCD showed significantly diminished activation of the dorsal anterior cingulate cortex and the right insula during fear conditioning. Importantly, our analyses revealed a significant negative association between clinical improvement after CBT and activity at the right insula during fear conditioning (x = 39, y = 12, z = -11; t = 5.64; p<0.001; k = 928). This finding is displayed in Figure 1 below.ConclusionsPatients with OCD may require less fear-conditioned brain responses to achieve the same level of psychophysiological fear conditioning as healthy participants. Interestingly, insula activations during fear-conditioned responses may represent a potential predictor biomarker of response to CBT for OCD.DisclosureNo significant relationships.

Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design.

Obsessive–compulsive disorder (OCD) is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients (N = 8) who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD (CFT-OCD), and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances (post-treatment and follow-up data collection were carried out, respectively, at the beginning and in the middle of the Italian lockdown due to the COVID-19 pandemic), by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments.

Attentional bias of subliminal emotional faces in adolescents with obsessive-compulsive disorder

ABSTRACT Attentional bias to threatening information may play a vital role in the onset and maintenance of obsessive-compulsive disorder (OCD). This study aimed to explore whether adolescents with OCD exhibited attentional bias toward faces that express disgust or fear. Participants were 27 adolescents with a first-time primary diagnosis of OCD and 27 healthy controls. To assess OCD, depression, and anxiety symptoms, all participants completed the Yale–Brown Obsessive Compulsive Scale, the Hamilton Depression Scale, and the Hamilton Anxiety Scale, respectively, followed by the modified dot probe task. Repeated measures ANOVA revealed a main effect of validity type and a significant group × validity type interaction effect. The results of one sample t-tests showed that participants in the OCD group had an attentional bias toward both disgusted and fearful faces. Further analysis indicated that adolescents in the OCD group showed facilitated attention toward the fearful faces and difficulty disengaging from disgusted faces. Adolescents with OCD exhibited facilitated attention toward threat stimuli, and when they allocated attention to threat, they experienced difficulty disengaging from it. Treatment procedures to modify the attentional bias may be effective.

Dysfunctional reasoning processes and their relationship with feared self-perceptions and obsessive-compulsive symptoms: An investigation with a new task-based measure of inferential confusion

Previous research has highlighted the potential role of dysfunctional reasoning (i.e. “inferential confusion”) and feared self-perceptions in the development and maintenance of Obsessive-Compulsive Disorder (OCD). However, these investigations have primarily relied on self-report measures, and investigations into inferential confusion in relation to feared self-perceptions remain scarce. Also, previous investigations only pertain to a limited number of reasoning processes in inferential confusion (i.e. inverse reasoning) and fail to cover the entire spectrum of processes proposed to be relevant to OCD. In the present study, a new task-based measure, the Dysfunctional Reasoning Processes Task (DRPT), covering a wider range of dysfunctional processes, was used to investigate the relationship of inferential confusion with feared self-perceptions and symptoms of OCD. 172 undergraduate students completed computerized versions of the DRPT and self-report measures. Results showed that feared self-perceptions and OC-related beliefs sequentially mediated the relationship between inferential confusion and OC symptoms. Hence, without a feared self, the effect of inferential confusion on OC symptoms may be attenuated. These findings provide further evidence of the interrelationship between dysfunctional reasoning and feared self-perceptions and their potential role in the development and maintenance of OCD, emphasizing the need to address both in cognitive-behavioral treatment.

Metacognitive beliefs predict early response to pharmacological treatment in patients with obsessive-compulsive disorder.

Metacognitions, beliefs that monitor or control thoughts and coping, are considered to be important components for development and maintenance of obsessive-compulsive disorder (OCD). This study prospectively investigated whether metacognitive beliefs can predict early treatment response after serotonin reuptake inhibitor (SRI) initiation in patients with OCD. Drug-naïve or medication-free patients with OCD (N = 156) were assessed for various characteristics, including metacognitions. In total, 132 patients were followed for 4weeks, and their clinical responses to pharmacological treatment were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Early treatment response was defined as a 20% or greater reduction from the baseline Y-BOCS score at 4weeks. Logistic and linear regression analyses were performed to identify major determinants for the early treatment outcome. Among participants with OCD, 53 patients (40.15%) were early responders. The logistic regression model revealed two significant predictors, age (beta = - 0.113, p < 0.001) and "positive beliefs about worry," which refers to metacognitive beliefs concerning the benefits of engaging in worry (beta = - 0.067, p = 0.001), for identifying early responders. Moreover, in the linear regression model, lower "positive beliefs about worry" was also shown as a significant predictor for the degree of better early improvement (beta = - 0.566, p = 0.001). These results suggest that lower metacognition of "positive beliefs about worry" predicts improvement of obsessive-compulsive symptoms seen early on in the SRI treatment, and that pathological metacognitive belief would lead to delayed response to SRI treatment in OCD.

¿Qué papel juegan la evitación del daño y la sensación de inacabado en los síntomas obsesivos de orden y comprobación?

Several studies have attempted to establish the variables involved in the etiology and maintenance of Obsessive Compulsive Disorder (OCD). Harm avoidance and incompleteness have been recently proposed as two core motivational dimensions of the obsessive-compulsive symptomatology. The aim of the present study was to analyze the role of harm avoidance and incompleteness in their relation to the obsessive-compulsive symptoms. Thus, a Path analysis was performed on a sample of 267 individuals from the general population (74.5% women). Results showed that the association between harm avoidance and ordering and checking symptoms was largely mediated by the incompleteness, supporting a greater specificity of the latter in the OCD phenomenology. Future studies should confirm this finding in clinical samples.

Impact of childhood maltreatment on obsessive-compulsive disorder symptom severity and treatment outcome

ABSTRACT Background Preliminary evidence suggests childhood maltreatment to play a causal role in the development and maintenance of obsessive-compulsive disorder (OCD). However, both the effect of childhood maltreatment on the course of OCD treatment and the role of specific subtypes of maltreatment remain largely unknown. Objective This study aimed to investigate the relationship between childhood maltreatment and the severity and time course of OCD symptoms within a clinical sample of OCD patients (N = 68). We hypothesized that higher levels of childhood maltreatment in OCD patients would be associated with higher symptom severity and worse treatment outcomes. Method Assessments of childhood maltreatment, OCD symptomatology, and related variables were completed in a sample of OCD patients before and after inpatient treatment as well as at 6 month follow-up. Results Emotional abuse, sexual abuse and neglect were highly prevalent in our sample. Additionally, the severity of experienced childhood maltreatment was associated with higher OCD symptom severity, with the strongest association found for emotional abuse. Hierarchical linear models indicated that patients with childhood maltreatment showed higher OCD symptom severity at pre-treatment, post-treatment, and follow-up compared to patients without these experiences. However, childhood maltreatment did not moderate symptom improvement during treatment. Conclusion Thus, although childhood maltreatment is not related to treatment outcome, it is highly prevalent among OCD patients and childhood trauma survivors still show higher OCD symptom severity after treatment. Therefore, childhood maltreatment should be considered in psychological interventions in individuals with OCD.