Obsessive-compulsive Disorder Behaviors Research Articles

Non-delusional pathological jealousy as an obsessive-compulsive spectrum disorder: Cognitive-behavioural conceptualization and some treatment suggestions

Pathological jealousy (PJ) is not defined as a unitary syndrome, but as a symptom of different disorders. After a definition of PJ, diagnostic criteria for PJ subtypes and its differentiation from normal jealousy are discussed. Based on a description of the clinical picture of non-delusional PJ in a functional analysis format, a cognitive-behavioural conceptualization of non-delusional PJ as an obsessive-compulsive spectrum disorder (OCSD) is presented. The emphasis is on phenomenological overlap with obsessive-compulsive disorder (OCD), including similarities of jealous intrusions with obsessions, of jealous checking, reassurance seeking and avoidance of jealousy-provoking situations with compulsive rituals and passive avoidance in OCD, and finally of the “illusion of control” in PJ (belief that safeguarding love relationships by control is possible) with magical thinking/superstitious behaviour in OCD. Some treatment suggestions based on an OCSD formulation of non-delusional PJ are outlined.

Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder

Paediatric obsessive-compulsive disorder (OCD) is a common, yet under-recognized, neuropsychiatric illness in both clinical and community settings. Symptoms tend to be hidden or misunderstood by affected youth, and parents may inadvertently accommodate OCD, thus worsening its severity. These symptoms may include compulsive reassurance seeking, confessing and 'just right' rituals, in addition to more classic OCD behaviours. Fortunately, numerous psychometric measures are available to assist in clinical assessment of this disorder and its sequelae. Once properly diagnosed, paediatric OCD is highly treatable with empirically proven approaches including cognitive-behaviour therapy (CBT) and serotonin reuptake inhibitor (SRI) medications. Clinically meaningful symptom improvement is the norm following these strategies, although full remission is not, as symptoms tend to wax and wane over time. Paediatric OCD is highly co-morbid with other anxiety disorders, tic disorders, depression and attention-deficit hyperactivity disorder, which also require specific attention. For moderate to severe OCD, an interdisciplinary approach combining individual and family CBT with SRI trials is recommended. For severe treatment-refractory illness, early evidence supports the benefit of augmenting agents, such as atypical antipsychotics and potentially those with glutamatergic activity. Clinical outcome assessment in paediatric OCD should always include broad domains of individual and family functioning, in addition to symptom improvement.

OCD and Cognitive Illusions

Evidence suggests that obsessive–compulsive disorder (OCD) could be associated with cognitive biases and deficits, and such deficits may inform us about characteristic OCD thinking and behaviour. Information processing research has suggested, for example, that mnestic and executive dysfunctions (Greisberg and McKay, in Clin Psychol Rev 23:95–117, 2003), may account for organizational problems. Lack of cognitive flexibility in problem-solving (Chamberlain et al., in Am J Psychiatry 163:1282–1284, 2006; Chamberlain et al., in Am J Psychiatry 164:335–338, 2007) and decision-making (Volans, in Br J Social Clin Psychol 15:305–317, 1976; Fear and Healy, in Psychol Med 27(1):199–208, 1997) may encourage hesitancy. In this contribution we review the role of common cognitive illusions in OCD. Although found in the general population, cognitive illusions, particularly when present in combination, could help our understanding of the origin and the maintenance of OCD. We focus discussion on thinking illusions (conjunction fallacy, confirmation bias, illusory correlation, illusion of control, biases in deductive and causal reasoning), judgement illusions (availability and representativeness, anchoring effect, validity effect), and memory illusions (associative memory illusions, effects of labelling and misinformation effect) and their relationship with OCD. In conclusion, we draw some clinical implications and suggestions.

Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: An exploratory study of 1001 patients

A substantial number of patients with obsessive-compulsive disorder (OCD) report compulsions that are preceded not by obsessions but by subjective experiences known as sensory phenomena. This study aimed to investigate the frequency, severity, and age at onset of sensory phenomena in OCD, as well as to compare OCD patients with and without sensory phenomena in terms of clinical characteristics. We assessed 1,001 consecutive OCD patients, using instruments designed to evaluate the frequency/severity of OC symptoms, tics, anxiety, depression, level of insight and presence/severity of sensory phenomena. All together, 651 (65.0%) subjects reported at least one type of sensory phenomena preceding the repetitive behaviors. Considering the sensory phenomena subtypes, 371 (57.0%) patients had musculoskeletal sensations, 519 (79.7%) had externally triggered “just-right” perceptions, 176 (27.0%) presented internally triggered “just right,” 144 (22.1%) had an “energy release,” and 240 (36.9%) patients had an “urge only” phenomenon. Sensory phenomena were described as being as more severe than were obsessions by 102(15.7%) patients. Logistic regression analysis showed that the following characteristics were associated with the presence of sensory phenomena: higher frequency and greater severity of the symmetry/ordering/arranging and contamination/washing symptom dimensions; comorbid Tourette syndrome, and a family history of tic disorders. These data suggest that sensory phenomena constitute a poorly understood psychopathological aspect of OCD that merits further investigation.

D1 and D2 dopamine receptor antagonists decrease behavioral bout duration, without altering the bout's repeated behavioral components, in a naturalistic model of repetitive and compulsive behavior

Nest building behavior in the pregnant female rabbit (Oryctolagus cuniculus) is a model for compulsive behavior in Obsessive Compulsive Disorder (OCD). This behavior comprises a cycle of repeated, stereotyped components (collecting straw, entering nest box and depositing the straw there, returning to collect more straw), which itself is repeated 80+ times in a single bout that lasts approximately 50min. The bout, in turn, is repeated if necessary, according to the rabbit's perception of whether or not the nest is finished. We administered SCH23390 (5–100μg/kg; D1/D5 antagonist) or raclopride (0.05–1.0mg/kg; D2/D3 antagonist), subcutaneously to day 28 pregnant female rabbits, 30 or 60min before placing straw inside their home cage. At doses that minimally affected ambulatory behavior in open field (5–12.5μg/kg SCH23390, 0.5–1.0mg/kg raclopride), both antagonists dramatically reduced bout duration while not significantly affecting the initiation of straw carrying behavior, the sequential performance of the individual cycle components, maximum cycle frequency, or the total number of bouts performed. These results point to an important role for dopamine neurotransmission for the prolonged expression of a normal, repetitive and compulsive-like behavior. Moreover, the finding that dopamine receptor antagonists decrease the time spent engaged in repetitive behavior (without significantly altering the form of the repetitive behavior itself) suggests a possible explanation for why neuroleptics can be clinically effective for treating OCD.

Forgetting what you have checked: A link between working memory impairment and checking behaviors in obsessive-compulsive disorder

BackgroundCompulsive checking behaviors are common in obsessive-compulsive disorder (OCD). Several authors have suggested that these checking rituals could be related to memory deficits. Our aim was to test whether patients with OCD show working memory impairment in relation to their checking behavior. MethodsWe evaluated the verbal and visuospatial components of patients’ and controls’ working memory using the reading span and backward location span tests. Checking behaviors were measured by recording participants’ eye movements during an image comparison task using a non-invasive, infra-red TOBII 1750 eyetracker. Participants were seated, head-free, in a natural position in front of the eyetracker screen where the images were displayed. ResultsPatients with OCD made more gaze moves to compare images than controls. Both patients’ working memory spans were reduced, and the patients’ deficit in the comparison task was negatively related to their working memory spans. ConclusionsThis work demonstrates that checking behavior in OCD is linked to a general reduction of the patients’ verbal and visuospatial working memory span.

Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD), in its severe form, can cause tremendous disability for affected patients. To evaluate the results following bilateral radiosurgical anterior capsulotomy for severe medically refractory OCD. We performed gamma knife anterior capsulotomy (GKAC) on 3 patients with extreme, medically intractable OCD. According to our protocol, all patients were evaluated by at least 2 psychiatrists who recommended surgery. The patient had to request the procedure, and had to have severe OCD according to the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patient ages were 37, 55, and 40 years, and pre-radiosurgery YBOCS scores were 34/40, 39/40, and 39/40. Bilateral lesions were created with 2 4-mm isocenters to create an oval volume in the ventral internal capsule at the putaminal midpoint. A maximum dose of 140 or 150 Gy was used. There was no morbidity after the procedure, and all patients returned immediately to baseline function. All patients noted significant functional improvements, and reduction in OCD behavior. Follow-up was at 55, 42, and 28 months. The first patient reduced her YBOCS score from 34 to 24. One patient with compulsive skin picking and an open wound had later healing of the chronic wound and a reduction in the YBOCS score from 39 to 8. At 28 months, the third patient is living and working independently, and her YBOCS score is 18. Within a strict protocol, gamma knife radiosurgery provided improvement of OCD behavior with no adverse effects. This technique should be evaluated further in patients with severe and disabling behavioral disorders.

Content and correlates of checking related to symptoms of obsessive compulsive disorder and generalized anxiety disorder

In addition to the central role of compulsive behaviors in obsessive compulsive disorder (OCD), recent data have documented the presence of compulsive behaviors in individuals with generalized anxiety disorder (GAD). However, there is a lack of information about potential similarities and differences with regard to the quality, or content, of checking associated with worry and obsessions. The two studies presented herein are an initial step towards gathering this information. Findings of Study 1, from a large unselected undergraduate sample, showed that symptoms of OCD and GAD were both significantly associated with checking behaviors. However, while OCD symptoms were associated with checking related to both objects and interpersonal situations, GAD symptoms were only significantly associated with interpersonal checking. Findings of Study 2, using a separate sample, suggest links between interpersonal checking and features characteristic of GAD, namely emotion regulation difficulties, and between object checking and a cognitive feature of OCD, namely thought-action fusion. In summary, the current studies add to a growing body of literature suggesting that checking may be important in numerous forms of psychopathology, while also suggesting that the nature and function of checking may differ for various symptom profiles.

Are There Between-Country Differences in Motor Behavior of Obsessive-Compulsive Disorder Patients?

Cross-cultural factors attributed to obsessive-compulsive disorder (OCD) that are widely investigated around the world are mostly epidemiological, with no respect to the impact of culture on the structure of OCD behavior itself. Nine Israeli and nine British OCD patients with respective non-OCD individuals were compared. To determine whether OCD symptoms are consistent across cultures, similarities in behavior were analyzed, as well as differences due to a country effect. In each country, nine OCD patients and nine non-OCD individuals were videotaped while performing the task that the patients attributed to their behavior. Except for a significantly higher rate of repetition and higher performance of idiosyncratic acts, patients from both Israel and the United Kingdom showed high levels of similarities in 22 out of 24 parameters. Compared with Israeli subjects, British OCD patients had significantly longer chains of idiosyncratic acts, and a twice-higher prevalence of brief (1-2 second) idiosyncratic acts. Between-country differences were mild, possibly overridden by the conspicuous impact of OCD pathology, resulting in a similar OCD phenotype. These results qualitatively and quantitatively emphasize the universal appearance of the compulsions in OCD symptoms.

ADHD prevalence and association with hoarding behaviors in childhood-onset OCD

It has been suggested that attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), both neurodevelopmental disorders with onset in childhood, are highly comorbid, but previous studies examining ADHD and OCD comorbidity have been quite variable, partly because of inconsistency in excluding individuals with tic disorders. Similarly, ADHD has been postulated to be associated with hoarding although this potential relationship is largely methodologically unexplored. This study aimed to examine the prevalence of ADHD among individuals with childhood-onset OCD but without comorbid tic disorders, as well as to examine the relationship between clinically significant hoarding behaviors (hoarding) and ADHD. ADHD prevalence rates and the relationship between ADHD and hoarding were examined in 155 OCD-affected individuals (114 probands and 41 relatives, age range 4-82 years) recruited for genetic studies and compared to pooled prevalence rates derived from previously published studies. In total, 11.8% met criteria for definite ADHD, whereas an additional 8.6% had probable or definite ADHD (total=20.4%). In total, 41.9% of participants with ADHD also had hoarding compared to 29.2% of participants without ADHD. Hoarding was the only demographic or clinical variable independently associated with ADHD (odds ratio=9.54, P<0.0001). ADHD rates were elevated in this sample of individuals with childhood-onset OCD compared to the general population rate of ADHD, and there was a strong association between ADHD and clinically significant hoarding behavior. This association is consistent with recent studies suggesting that individuals with hoarding may exhibit substantial executive functioning impairments and/or abnormalities, including attentional problems.

Suicidal ideation in patients with obsessive–compulsive disorder

The risk factors for suicidal behaviour in obsessive-compulsive disorder (OCD) have been less studied compared than in other anxiety disorders. In the present study, we examined the demographic and clinical correlates of current suicidal ideation (SI) in patients with OCD. Forty-four patients were grouped into those with ( n = 23) and without current SI ( n = 21) as assessed by the Scale for Suicidal Ideation. The Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) was used to assess the obsessive–compulsive (OC) symptomatology. Following Bonferroni correction, only the severity of depression differed significantly between the two groups. The presence of major depression and aggressive obsessions, the level of hopelessness, and the severity of OC symptomatology were significant predictors of current SI in patients with OCD. The relatively low frequency of some comorbid Axis I disorders is based on small sample size and therefore may be vulnerable to type II error. We did not examine the relationship between the recent suicidal attempts and OCD. Also, we did not assess the effect of impulsivity in the occurrence of SI in patients with OCD. Associated depression, hopelessness, and aggressive obsessions might play an important role in the occurrence of SI in patients with OCD. However, future studies with a psychological autopsy design are required to systematically determine the presence for OCD among those who have completed suicide.

Why do people seek reassurance and check repeatedly? An investigation of factors involved in compulsive behavior in OCD and depression

Excessive reassurance-seeking (ERS) is a common problem among both obsessive-compulsive and depressed populations. However, the content and cognitive processes involved in ERS may differ in these populations according to the unique cognitive and behavioral characteristics demonstrated by each group. To assess factors involved in the onset, maintenance and termination of ERS and repeated checking, the current investigation employed a semi-structured interview with non-depressed obsessive-compulsive disorder (OCD) respondents ( n = 15), clinically depressed individuals without OCD ( n = 15), and healthy control participants ( n = 20). Results showed that whereas individuals with OCD reported seeking reassurance primarily about perceived general threats (e.g., fire, theft), the depressed group reported seeking reassurance primarily about perceived social threats (e.g., abandonment, loss of support). Clinical participants reported greater anxiety, sadness and perceived threat in association with ERS and repeated checking than healthy control participants. These findings are discussed in terms of cognitive-behavioral models of OCD and depression.

Obsessive–compulsive disorder: a disorder of pessimal (non‐functional) motor behavior

To determine whether in addition to repetitiveness, the motor rituals of patients with obsessive-compulsive disorder (OCD) involve reduced functionality due to numerous and measurable acts that are irrelevant and unnecessary for task completion. Comparing motor rituals of OCD patients with behavior of non-patient control individuals who were instructed to perform the same motor task. Obsessive-compulsive disorder behavior comprises abundant acts that were not performed by the controls. These acts seem unnecessary or even irrelevant for the task that the patients were performing, and therefore are termed 'non-functional'. Non-functional acts comprise some 60% of OCD motor behavior. Moreover, OCD behavior consists of short chains of functional acts bounded by long chains of non-functional acts. The abundance of irrelevant or unnecessary acts in OCD motor rituals represents reduced functionality in terms of task completion, typifying OCD rituals as pessimal behavior (antonym of optimal behavior).

The Mouse Who Couldn't Stop Washing: Pathologic Grooming in Animals and Humans

The basic science literature is replete with descriptions of naturally occurring or experimentally induced pathological grooming behaviors in animals, which are widely considered animal models of obsessive-compulsive disorder (OCD). These animal models rely largely on observed similarities between animal behaviors and human OCD behaviors, and on studies of animal pathological grooming disorders that respond to serotonin enhancing drugs. However, current limitations in assessment of complex cognition and affect in animals precludes the field's ability to match the driving primary processes behind observable phenomenology in animal "OCD" with human behavioral disorders. We propose that excessive grooming behaviors in animals may eventually prove to be equally, or possibly more relevant to, other conditions in humans that involve pathological grooming or grooming-like behaviors, such as trichotillomania, body dysmorphic disorder, olfactory reference syndrome, compulsive skin-picking, and onychophagia. Research is needed to better understand pathological grooming behaviors in both humans and animals, as animal models have the potential to elucidate pathogenic mechanisms and inform the treatment of these psychiatric conditions in humans.

Development of a computer-based behavioral assessment of checking behavior in obsessive-compulsive disorder

Objective The goal of the current study was to develop and obtain preliminary psychometric data for a computer-based behavioral measure of compulsive checking behavior in a sample of patients with obsessive-compulsive disorder (OCD). Method We examined performance on a novel behavioral measure in 30 patients with OCD and 27 matched healthy controls. In the computerized assessment, participants navigated through two virtual environments (home and office) using a joystick and head-mounted display. The experiment consisted of three phases: training, distraction, and the main task. After the training and distraction phases, participants were instructed to check the virtual environments freely as if they were in their natural environment. Primary dependent variables in the current study included several indices of frequency and duration of checking behaviors. We examined construct validity for the task by comparing the novel behavioral measures with standardized self-report and interviewer-rated measures. Results Results indicated that (1) OCD patients demonstrated significantly greater problems with compulsive checking compared to controls, and (2) performance on the task was positively correlated with both self-reported symptoms and interviewer-rated measures associated with OCD. Conclusions This study provides preliminary data to support the use of this task as a new possible behavioral measure of compulsive checking behavior in OCD. If we merge the traditional behavioral research with this novel and ecologically valid method, it could improve the assessment of OCD in both clinical and research setting.

Anxiety Provocation and Measurement Using Virtual Reality in Patients with Obsessive-Compulsive Disorder

The current study is a preliminary test of a virtual reality (VR) anxiety-provoking tool using a sample of participants with obsessive-compulsive disorder (OCD). The tasks were administrated to 33 participants with OCD and 30 healthy control participants. In the VR task, participants navigated through a virtual environment using a joystick and head-mounted display. The virtual environment consisted of three phases: training, distraction, and the main task. After the training and distraction phases, participants were allowed to check (a common OCD behavior) freely, as they would in the real world, and a visual analogy scale of anxiety was recorded during VR. Participants' anxiety in the virtual environment was measured with a validated measure of psychiatric symptoms and functions and analyzed with a VR questionnaire. Results revealed that those with OCD had significantly higher anxiety in the virtual environment than did healthy controls, and the decreased ratio of anxiety in participants with OCD was also higher than that of healthy controls. Moreover, the degree of anxiety of an individual with OCD was positively correlated with a his or her symptom score and immersive tendency score. These results suggest the possibility that VR technology has a value as an anxiety-provoking or treatment tool for OCD.

Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

A dysfunction of the fronto-striatal loop has been associated with obsessive-compulsive disorder (OCD). Functional imaging studies suggest that reversal learning is affected by deficits in fronto-striatal brain areas and thus should be impaired in patients with OCD. The authors compared patients with OCD and healthy comparison subjects on a reversal learning task. Correlation analyses and group comparisons showing prolonged reaction times of different response parameters are associated with increasing severity of compulsions. The reversal learning task has been shown to be associated with ventral fronto-striatal brain activation by functional magnetic resonance imaging (fMRI) in healthy comparison subjects. The purpose of this article is to suggest that the reversal learning task can be used as a neuropsychiatric measurement of the ventral fronto-striatal dysfunction in OCD.

Naltrexone augmentation in OCD: A double-blind placebo-controlled cross-over study

Current treatments for Obsessive Compulsive Disorder (OCD) rely primarily on serotonergic mechanisms. However, approximately 30% of patients do not respond to serotonin reuptake inhibitors and remain chronically ill. Given the behavioral similarities between some of the compulsive behaviors in OCD and addiction, we hypothesized that the opioid antagonist naltrexone might attenuate compulsions in OCD as well. The effect of naltrexone augmentation to SRI was compared to placebo in 10 OCD outpatients who had not responded to an adequate dose of SSRI or clomipramine for at least 2 months. Participants underwent 5 weeks of treatment with naltrexone or placebo (and 1 week of tapering) in a randomized, double-blind, cross-over design. Patients were evaluated weekly using the Y-BOCS, CGI, HAM-A, and MADRS scales. A two-way repeated measures MANOVA revealed no significant effect for Y-BOCS. However, while receiving naltrexone, patients had significantly higher scores on CGI, MADRS and HAM-A as compared to placebo. The lack of significant findings on OC symptoms could be due to either ceiling effect or alternatively, due to a non-specific exacerbation on anxiety and depression but not on OC symptoms.