Mental Rituals Research Articles

Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients.

Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.

PREVALENCE OF THE SUBTYPES OF OBSESSIVE-COMPULSIVE DISORDER AMONG DIAGNOSED PATIENTS IN THE KURDISTAN REGION IN IRAQ

Background The clinical manifestation of obsessive-compulsive disorder (OCD) differs from patient to patient, indicating that the content of the obsessions and compulsions varies. Therefore, the present study aims to find the prevalence of the sub-types of OCD.
 Objectives This study addresses the association of the sub-types of obsessions and compulsion with gender, age, and marital status.
 Patients and MethodsSeventy-five patients with OCD from a psychiatric clinic, who were diagnosed through an unstructured interview, participated in this study, which utilized a retrospective research design. The data was obtained from the case files of the patients, where their diagnosis and the content of their obsessions and compulsion were specified.
 ResultsThe results showed that the most prevalent obsession in the sample was contamination obsessions. They were followed by religious, doubting, aggressive, symmetry, and sexual obsessions. As for compulsions, cleaning/washing was the most common among the participants, followed by mental rituals, whereas checking and arranging compulsions were the least common. The results also revealed that contamination obsession had a significant association with gender.

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Obsessive-compulsive disorder: conceptual and clinical aspects

Obsessive-compulsive disorder (OCD) is a chronic, prevalent, and disabling psychiatric disorder that affects people of all ages and may have been worsened by the COVID-19 pandemic. This study aims to review conceptual and clinical aspects of OCD, including its history, diagnosis, symptom dimensions, etiology, assessment, prevention, and treatment. The history of OCD shows the transition from religious to medical conceptions. The main symptoms of OCD involve the presence of obsessive thoughts and compulsive acts, which can manifest themselves in four dimensions: ‘contamination and cleanliness’, ‘order and symmetry’, ‘doubt and verification’, and ‘disgusting thoughts and mental rituals’. This heterogeneity in the manifestation of OCD can make it difficult to understand its causes and to compare treatment responses. OCD management involves symptom assessment; prevention through psychoeducation and reducing family accommodation; pharmacological and psychotherapeutic treatment. First-line treatments involves the administration of serotonin reuptake inhibitor drugs and/or cognitive-behavioral therapy, with exposure and ritual avoidance techniques, and cognitive reappraisal.

Geometry and the Gods: Theurgy in Proclus’s Commentary on the First Book of Euclid’s Elements

Abstract The gods that guard the poles have been assigned the function of assembling the separate and unifying the manifold members of the whole, while those appointed to the axes keep the circuits in everlasting revolution around and around. And if I may add my own conceit, the centers and poles of all the spheres symbolize the wry-necked gods (τῶν ίυγγικῶν θεῶν) by imitating the mysterious union and synthesis which they effect; the axes represent the connectors (συνοχάς) of all the cosmic orders … and the very spheres are likenesses of the perfecting divinities (τῶν τελεσιουργῶν θεῶν) … (Proclus 1992a, pp. 74–5; 1873, pp. 90–91)1 Proclus’s Commentary on the First Book of Euclid’s Elements contains one of the most important discussions of the nature of mathematical objects and preserves a wealth of historical information about mathematics from antiquity. However, large sections of the text have been neglected by scholars since the text’s first publication in the sixteenth century. Proclus expounds at length on correspondences between mathematical objects and the gods. At times he uses the language of “theurgy,” the ritual practices that later Neoplatonists insisted were necessary for the human soul to ascend to the intelligibles. The contention of this article is that the Commentary, taken as a whole, concerns the practice of “inner theurgy,” mental rituals used by advanced students to raise the soul beyond its assigned bounds. This practice can be traced back to Plotinus and the very beginnings of Neoplatonism; however, the particular methods presented by Proclus are his own development. This interpretation of the Commentary is supported by Proclus’s works Commentary on the Parmenides and Platonic Theology. Parts of the Commentary that have been studied carefully by modern scholars, especially the theory of the mathematical phantasia or imagination, will be shown to be crucial elements in Proclus’s theory and practice of inner theurgy.

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Introduction:Obsessive Compulsive Disorder(OCD) is a neurotic disorder characterized by recurring, intrusive, anxiety-provoking thoughts or images (obsessions) associated with repetitive, physical or mental rituals (compulsions) aimed at relieving anxiety. Its been found to be linked to poorer adaptive functioning and a poorer response to treatment. Despite recognition that adaptive functioning may be poor in significant proportion of patients,relationship between symptom severity and functioning is not well studied.AIM: To find correlation between symptom severity and global assessment of functioning.Method and methods:This is a cross-sectional, single point assessment study, including 78 patients aged 18 to 60 years, visiting outdoor department of Era's Lucknow Medical College. Cases having OCD according to ICD 10 criteria were included in the study. Those patients were excluded who were having some other psychiatric illness prior to the onset of obsessive compulsive disorder, patients diagnosed with medical and surgical illness requiring immediate intervention, those diagnosed with mental retardation and those not willing to give informed consent. YBOCS was applied to assess symptom severity while GAF was used to assess functioning in these patients.Result and conclusion: We found that symptom severity correlated with the global assessment of functioning. As severity increased it was seen that functioning of patients decline. Statistical data will be presented during the conference.

Neuromodulation via Deep Brain Stimulation in Obsessive-Compulsive Disorder—Present and Perspectives

Obsessive-compulsive disorder (OCD) is a highly heterogeneous condition. Obsessions and compulsions can vary substantially between patients (e.g., washing, checking, mental rituals, hoarding). Likewise, the neuropsychological mechanism underlying compulsivity can be manifold (e.g., harm avoidance, habit formation, cognitive inflexibility, behavioral disinhibition). While some patients experience a mild waxing and waning of symptoms in adulthood, others develop a severe chronic disorder from early childhood.

The use of esketamine in comorbid treatment resistant depression and obsessive compulsive disorder following extensive pharmacogenomic testing: a case report

BackgroundMajor depressive disorder (MDD) patients not responding to two or more different antidepressant treatments are currently considered to suffer from treatment resistant depression (TRD). Recently, intranasal esketamine has been approved by both the American Food and Drug Administration and European Medicines Agency for TRD and, more recently, in moderate to severe episode of MDD, as acute short-term treatment for the rapid reduction of depressive symptoms, which, according to clinical judgement, constitute a psychiatric emergency. There is currently no indication for obsessive–compulsive disorder (OCD) although recently published studies have already shown a rapid and significant reduction of OCD-like symptoms following ketamine administration. The etiology of OCD has not yet been fully elucidated but there is a growing evidence that glutamate signaling dysfunction in the cortico-striatal–thalamo-cortical circuitry plays an essential role. This case report exemplifies possible clinical effects of esketamine on both depressive and OCD symptoms.Case presentationWe present the case of a 39-year-old man suffering from TRD. During the first evaluation at our clinic, he also reported the presence of OCD spectrum symptoms, causing him to perform time-consuming mental rituals due to pathological doubts regarding the relationship with his wife as well as intrusive thoughts regarding his mental conditions. He underwent psychometric evaluations, therapeutic drug monitoring analysis, and pharmacogenomic tests. The overall results helped to explain patient’s treatment-resistance. Moreover, we observed a significant reduction in both depressive and OCD symptoms after administration of esketamine.ConclusionThis case underlines the importance of pharmacogenomic tests in profiling TRD patients and confirms the possible use of esketamine in the treatment of comorbid OCD.

A multi‐method examination of the link between obsessive‐compulsive symptomatology and emotion‐related impulsivity

Obsessive-compulsive disorder (OCD) is a condition marked by recurrent and distressing thoughts, images, and urges accompanied by repetitive physical or mental rituals. An emerging line of work suggests that emotion may be an important consideration when looking at the role of impulsivity across the spectrum of psychopathology, including OCD. The current study examined the relationship between obsessive-compulsive symptomatology (OCS) and impulsive cognitive and behavioural reactions to emotion using a multi-study, multi-method approach. Data were collected cross-sectionally online (Study 1) or via an in-person laboratory visit (Study 2). In Study 1, self-report measures of impulsivity and OCS were administered to a large, non-selected community sample (N=386). Study 2 extended these findings with a young adult sample (N=107) with clinically elevated OCS using self-report measures, clinical interview, and two behavioural symptom provocation tasks. Emotion-related impulsivity, but not non-emotion-related impulsivity, was associated with greater severity of OCS across symptom domains and across all modes of assessment. Impulsive cognitive responses to emotion were associated with greater obsession severity, while impulsive behavioural reactions to emotion were associated with greater compulsions. Emotion-related impulsivity also acted synergistically with a belief in the importance and control of thoughts, such that this established risk factor for OCD was associated with greater OCS severity only when behavioural reactivity to emotion was also present. Results highlight the importance of considering emotional context when studying impulsivity in OCD, and point to the potentially differential relationship between OCS and behavioural versus cognitive impulsive reactions to emotion. Emotion-related impulsivity (ERI) reflects a tendency to act impulsively in the context of strong emotions. ERI was associated with greater OCS across symptom domains and type of symptom assessment (self-report, interview, or symptom provocation). ERI also interacted with an established OCS risk factor, a belief in the importance and control of thoughts, to predict symptom severity, suggesting that it may be important to evaluate and address ERI alongside unhelpful beliefs in patients with OCS. Given the present study's cross-sectional nature, we cannot draw conclusions about the directionality of the ERI - OCS relationship, and while our study included individuals with clinically elevated OCS, results should be replicated in a fully clinical sample.

Revisiting the “obsessional slowness” syndrome

IntroductionObsessional slowness (OS) is a rare condition of disabling slow motor performance, first described in 1974, by Rachman, who documented 10 cases of “primary obsessional slowness”. Rachman argued that, although his patients with OS had Obsessive Compulsive Disorder (OCD), their motor symptoms were not related to the presence of motor-slowness-triggering obsessions/compulsions (e.g. checking and mental rituals). Whether OS truly is a distinct and “primary” entity is still a controversial issue, however.ObjectivesTo present and discuss the phenomenology of OS.MethodsCase reports of OS published in the literature, including Rachman’s descriptions.ResultsThe literature on OS is extremely limited, with no published, large-scale descriptive studies or randomized controlled trials. Some authors doubt that OS is a “primary” condition, pointing out the clear overlap between OS and catatonia and emphasizing that the latter disorder also occurs in non-schizophrenic patients, for example, ones with OCD. Additionally, OCD and depression often co-occur. Thus, in severe cases, it may be challenging to disentangle the separate contribution of both disorders to psychomotor slowness. It is also crucial to exclude the possibility that a patience has juvenile parkinsonism or other causes of motor slowness before diagnosing him/her with OS, given that the diagnostic approaches and treatment strategies for OS and the aforementioned disorders differ.ConclusionsOS seems to be a rare but often disabling motor manifestation of OCD, rather than a primary disease entity. However, some cases sit on the edge of current diagnostic criteria. Future research should help define OS more precisely.DisclosureNo significant relationships.

Treating Taboo or Forbidden Thoughts: Integrating Mindfulness, Acceptance, and Emotion Regulation Into an Exposure-Based Intervention.

Individuals with obsessive compulsive disorder (OCD) who struggle with taboo or unacceptable obsessions (i.e., aggressive, sexual, or religious intrusions) tend to rely upon mental rituals to regulate their distress and possess difficulties labeling and regulating their affective state. Moreover, these individuals respond poorly to exposure with response prevention when the treatment is grounded in emotional processing theory. To improve patients' therapeutic outcomes, clinicians can consider integrating mindfulness- and acceptance-based skills into an exposure-based treatment to: facilitate the identification and acceptance of covert ritualistic urges, improve the accuracy of emotion labeling, and increase the efficiency of emotion regulation efforts. Additionally, in line with inhibitory learning theory, clinicians can design exposures to violate expectancies to promote the maintenance of long-term gains. Through a case vignette, the current article will demonstrate how to integrate these strategies into a standard exposure with response prevention intervention to meet the needs of a patient with taboo thoughts.

SU71 - BDNF GENE AND OBSESSIVE COMPULSIVE DISORDER – DO SYMPTOM DIMENSIONS HAVE SPECIFIC GENETIC CORRELATES?

Background Obsessive Compulsive Disorder (OCD) is a common neuropsychiatric disorder with a worldwide 12-month prevalence ranging from 1% to 2% across studies (Weissman et al., 1995; Ruscio et al., 2010). Characterized by repetitive intrusive thoughts, images and impulses (obsessions) and repetitive behaviors or mental acts (compulsions), the clinical phenotype of OCD appears to be complex. Genetic etiology of Obsessive Compulsive Disorder (OCD) has been investigated extensively, with mixed results across candidate gene studies. In this study, we perform a case control analysis of association of a single nucleotide polymorphism rs6265(Val66Met) in Brain Derived Neurotrophic Factor gene, that has been previously implicated in a variety of psychiatric syndromes, and examine its association with symptom dimensions of OCD. Methods Patients (n=377) diagnosed with OCD by DSM IV – TR were recruited from a specialty OCD clinic at the NIMHANS, Bengaluru, INDIA. Patients were assessed on socio-demographic data, detailed history of illness, presence of common co-morbid disorders, family history of OCD and major psychiatric disorders, and treatment details. Patients were additionally assessed on Yale Brown Obsessive Compulsive Scale (YBOCS), Mini International Neuropsychiatric Interview plus (MINI plus) Clinical Global Impression scale (CGI). Control population (n=449) consisted of healthy individuals also of south Indian origin. MINI plus was administered to screen and rule out psychiatric diagnosis in this group. DNA samples were genotyped for polymorphism rs6265 (Val66Met) using Quantitative Real time PCR. Results Factor analysis yielded five factor solutions as the best fit for the data explaining 65% of the variance as follows - Factor-1 with robust loading on hoarding obsession (0.891) & collecting compulsions (0.913). Factor-2 with Obsessions of need for symmetry (0.821) & ordering compulsions (0.864). Factor-3 with Pathological doubts obsessions (0.824) & checking compulsions (0.819). Factor-4 with Sexual (0.680), religious (0.655) &aggressive obsessions (0.554), mental rituals compulsions (0.630) and Factor-5 with Contamination obsessions (0.919) & washing compulsions (0.893). The allele ‘A’ frequency was found to be significantly higher in the controls, as compared to cases suggesting a protective effect. Among the clinical variables tested in univariate analysis by genotype, factor-5 (contamination obsessions with washing compulsions) and factor 1 (hoarding), dimension scores was significantly lower in ‘A’ carriers in subjects with OCD compared to homozygous G carriers (GG). Discussion Our findings suggest a protective effect of the rarer Met allele in OCD. The lower factor-5 scores in Met carrier patients and its confirmation after controlling for the confounders further suggests a probable specific protective effect in contamination-washing dimension of OCD. This dimension, which is one of the most commonly observed clinical phenotype, may represent a more homogenous group, with specific biological underpinnings. Functional imaging studies show that the same sub-group of OCD patients demonstrate specific regional activation in ventromedial prefrontal regions in symptom provocation paradigm (Mataix-Cols et al., 2004). The Met allele of rs6265 has also been associated with volumetric reduction in the same region (Yu et al., 2009). These findings suggest a need for future imaging and genetic studies in specific symptom dimensions of OCD.

Comorbid Hoarding and Obsessive Compulsive Disorder Manifested During Early Childhood

This case report outlines the use of cognitive behavioral therapy (CBT) used to treat an 11-year-old female, “Gabriela,” with comorbid hoarding and obsessive compulsive disorder (OCD). Gabriela participated in treatment involving CBT and exposure and response prevention (ERP) sessions for OCD and hoarding, following a cognitive rehabilitation software program designed for cognitive impairment. Upon completion of the treatment, Gabriela no longer exhibited behaviors consistent with a comorbid hoarding and OCD diagnosis and demonstrated marked improvements in her presenting problems (mental rituals; hoarding items for magical thinking purposes). This case report supports the focus of research, continuing to explore hoarding and comorbidity diagnoses across the life span.

Obsessive–compulsive disorder as a disorder of attention

An influential model holds that obsessive–compulsive disorder (OCD) is caused (in part) by distinctive personality traits and belief biases. But a substantial number of sufferers do not manifest these traits. I propose a predictive coding account of the disorder, which explains both the symptoms and the cognitive traits. On this account, OCD centrally involves heightened and dysfunctionally focused attention to normally unattended sensory and motor representations. As these representations have contents that predict catastrophic outcomes, patients are disposed to engage in behaviors and mental rituals designed to forestall these outcomes or to produce more precise information. The same representations also cause the cognitive traits characteristic of sufferers.

Prevalence and correlates of obsessive-compulsive disorder and subthreshold obsessive-compulsive disorder among college students in Kerala, India.

Context:There are scarce data on the prevalence of adult obsessive-compulsive disorder (OCD) in India.Aims:The aim was to study the point prevalence of OCD and subthreshold OCD and its psychosocial correlates among college students in the district of Ernakulam, Kerala, India.Settings and Design:A cross-sectional survey of 5784 students of the age range of 18–25 years from 58 colleges was conducted.Materials and Methods:Students were self-administered the OCD subsection of the Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview for obsessive-compulsive symptoms (OCSs), and other relevant instruments to identify OCD, subthreshold OCD, and related clinical measures.Statistical Analysis:The point prevalence of OCD and subthreshold OCD was determined. Categorical variables were compared using Chi-square/Fisher's exact tests as necessary. Differences between means were compared using the ANOVA.Results:The point prevalence of OCD was 3.3% (males = 3.5%; females = 3.2%). 8.5% students (males = 9.9%; females = 7.7%) fulfilled criteria of subthreshold OCD. Taboo thoughts (67.1%) and mental rituals (57.4%) were the most common symptoms in OCD subjects. Compared to those without obsessive-compulsive symptoms (OCSs), those with OCD and subthreshold OCD were more likely to have lifetime tobacco and alcohol use, psychological distress, suicidality, sexual abuse, and higher attention-deficit/hyperactivity disorder symptom scores. Subjects with subthreshold OCD were comparable to those with OCD except that OCD subjects had higher psychological distress scores and academic failures.Conclusions:OCD and subthreshold OCD are not uncommon in the community, both being associated with significant comorbidity. Hence, it is imperative that both are identified and treated in the community because of associated morbidity.

A compulsion to throw away prescribed tablets in a case of childhood obsessive-compulsive disorder with attention deficit hyperkinetic disorder

Obsessive-compulsive disorder (OCD) is one of the most complex and disabling disorders presenting to a hospital setting. Its symptomatology can mimic other psychiatric disorders, especially in children, making it confusing for the treatment team. It is often associated with comorbidities such as tics, depression, and attention deficit hyperactivity disorder (ADHD). We hereby report an instance of ADHD-OCD co-occurrence in a 16-year-old boy, who presented with a 9-year history of restlessness, obsessions of contamination, symmetry, causing harm to others, setting fire, magical thoughts, with compulsions of washing, checking, ordering and arranging, counting and repeating, swallowing stones, mental rituals, and self-mutilating behavior. Independent of these repetitive rituals, there were multiple instances throughout his schooling where he would be in disciplinary trouble due to his hyperactivity, disorganization, and inattentiveness. The resulting distress from all the above symptomatology had led to two suicidal attempts. His presentation to us was the index presentation to a psychiatric setting, and following initiation of treatment, he developed a compulsion to throw away his prescribed tablets. The interesting aspects of the phenomenology and management will be discussed.

Effectiveness of In Virtuo Exposure and Response Prevention Treatment Using Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Study Based on a Single-Case Study Protocol.

Obsessive–compulsive disorder (OCD) is characterized by the presence of distressing, recurrent and intrusive thoughts, impulses, or doubts as well as behavioral or mental rituals. OCD has various subtypes, including the fear of contamination in which individuals fear bacteria, germs, disease, or bodily secretions, and engage in clinically significant cleaning and avoidance rituals. Cognitive–behavioral therapy (CBT) is an effective treatment for OCD and involves, among other therapeutic strategies, exposing patients to feared stimuli while preventing them to engage in compulsive behaviors. In recent years, virtual reality (VR) has shown the potential of in virtuo exposure with people suffering from anxiety disorders and OCD. The objective of this pilot study is to examine the effectiveness of a CBT program where exposure in conducted in virtuo. Three adults suffering from OCD with a dominant subtype of contamination were enrolled in a single-case design with multiple baselines across participants. The presence and intensity of obsessions and compulsions were assessed daily during baselines of 3-, 4-, or 5-week, and a 12-session treatment. Follow-up information was gathered after 4 and 8 months. Treatment outcome is assessed with visual inspection of the graphs and ARMA time-series analyses. Clinical information, self-reports, and details of the treatment are provided for each patient. Statistical analyses for the time-series data revealed a statistically significant improvement in all three participants, but global improvement is considered positive for only two. This study innovates in proving preliminary support for the usefulness of VR in the CBT of OCD with contamination features.

Altered emotion regulation in obsessive-compulsive disorder as evidenced by the late positive potential.

Obsessive-compulsive disorder (OCD) is associated with marked anxiety, which triggers repetitive behaviours or mental rituals. The persistence of pathological anxiety and maladaptive strategies to reduce anxiety point to altered emotion regulation. The late positive potential (LPP) is an event-related brain potential (ERP) that reflects sustained attention to emotional stimuli and is sensitive to emotion-regulation instructions. We hypothesized that patients with OCD show altered electrocortical responses during reappraisal of stimuli triggering their symptoms. To test our hypothesis, ERPs to disorder-relevant, generally aversive and neutral pictures were recorded while participants were instructed to either maintain or reduce emotional responding using cognitive distraction or cognitive reappraisal. Relative to healthy controls, patients with OCD showed enhanced LPPs in response to disorder-relevant pictures, indicating their prioritized processing. While both distraction and reappraisal successfully reduced the LPP in healthy controls, patients with OCD failed to show corresponding LPP modulation during cognitive reappraisal despite successfully reduced subjective arousal ratings. The results point to sustained attention towards emotional stimuli during cognitive reappraisal in OCD and suggest that abnormal emotion regulation should be integrated in models of OCD.

An epidemological study of obsessive compulsive disorder in adolescents from India

ObjectivesThere is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12–18years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse. Method7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule–Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment. ResultsIn the sample, 50.3% were males with a mean age of 15.2years (range of 12–18years). The response rate was 97.3% (7380 valid responses). 0.8% (n=61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p=0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p<0.01) suicide attempts (24.6 vs. 3.8%, p<0.01), ADHD (28 vs. 4%, p<0.001), sexual abuse (24.6 vs. 4.2%, p<0.01), and tobacco use (23 vs. 6.8%, p=0.01). They also reported greater psychological distress and poorer academic performance. ConclusionsOCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.

Further Support for Five Dimensions of Obsessive-Compulsive Symptoms

Attempts to explain the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) have resulted in three to six OCD symptom dimensions. This study aimed to clarify the nature of these symptom dimensions using a self-report instrument (Vancouver Obsessional Compulsive Inventory [VOCI]) in addition to the clinician-rated Yale-Brown Obsessive Compulsive Scale-Symptom Checklist (YBOCS-SC). Participants (N = 154) were recruited to a study designed to specifically assess OCD symptom dimensions. Symptoms assessed via the YBOCS-SC and the VOCI were subjected to principal components analysis (PCA). Linear regression was used to assess the relationship between the YBOCS-SC-derived symptom dimensions and the VOCI symptom subscales. PCA of the YBOCS-SC and the VOCI revealed five OCD symptom dimensions that explained 68% and 60% of the variance, respectively. The results also supported a distinction between the doubt/checking symptom dimension and the unacceptable/taboo thoughts dimension that includes mental rituals. The YBOCS-SC-derived symptom components were predicted by their respective VOCI symptom subscale scores.