Presentation Of Obsessive-compulsive Disorder Research Articles

Obsessive-Compulsive Disorder Presenting With Psychotic Features in the Setting of Polysubstance Abuse

Obsessive-Compulsive Disorder Presenting With Psychotic Features in the Setting of Polysubstance Abuse

Stereotypes and OCD-Symptom Presentations: A Mixed-Methods Evaluation Using Male-Character Vignettes

Stereotypes toward symptom presentations of obsessive compulsive disorder (OCD) are poorly understood. A mixed-methods, multistudy analysis of OCD stigma was conducted. In Study 1 ( N = 60), participants read one of five vignettes (symmetry/just right, contamination, sexual, harm/aggression, scrupulous OCD) before responding to open-ended questions. Inductive content analyses revealed anxiety-relevant stereotypes (e.g., trivialization) for symmetry/just right and contamination and serious mental-illness stereotypes (e.g., dangerous) for harm/aggression and sexual vignettes. In Study 2 ( N = 698), participants read one of seven vignettes (OCD-symptom presentations, generalized anxiety disorder, schizophrenia) before responding to stigma measures. The sexual, harm/aggression, and schizophrenia vignettes were strongly associated with serious mental-illness stigma. The scrupulous vignette was associated with the most anxiety-relevant stigma. Together, these studies detail stereotype endorsement across OCD-symptom presentations. Stigma-reduction interventions should include psychoeducation and address macro-level stereotypes (i.e., stereotypes that exist across symptom presentations) while enhancing opportunities for contact to mitigate stigma.

Clinical presentation of obsessive compulsive disorder in albanians youth

Clinical presentation of obsessive compulsive disorder in albanians youth

Sexual dysfunction in relationship obsessive compulsive disorder

Relationship obsessive compulsive disorder (ROCD) is a disabling presentation of obsessive compulsive disorder (OCD) that has recently received increased research attention. ROCD refers to obsessive preoccupation, doubts, and compulsive behaviors focusing on one’s relationship and relationship partner’s qualities and attributes). In this paper, we present ROCD through a case study, describe its phenomenology and evaluate the impact of ROCD symptoms on sexual functioning. We then describe processes that may underlie dysfunctional sexual behavior in ROCD drawing on cognitive-behavioral models of ROCD and contemporary theories of sexual response. Conceptual links between ROCD and related constructs to various propensities of sexual behavior are discussed and treatment suggestions are outlined.

Schizo-obsessive presentation in a young girl with DiGeorge syndrome

DiGeorge syndrome (DGS), linked with the deletion of a gene located in chromosome 22-band 22q11, commonly presents with a triad of conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia. DGS is associated with cognitive deficits, neurodevelopmental disorders, and high rates of schizophrenia and anxiety disorders; hence, psychiatrists have an important role in the diagnosis and timely treatment of the disorder. Comorbid Schizophrenia with Obsessive Compulsive Disorder presentation is one of the uncommon ways in which patients might present. The aim of this report is to raise awareness of picking up early sub-threshold features, the need for long term follow up, rational use of medications in atypical presentations, and multi-faceted approach to intervention.

Scrupulosity, Religious Affiliation and Symptom Presentation in Obsessive Compulsive Disorder.

Scrupulosity is a common yet understudied presentation of obsessive compulsive disorder (OCD) that is characterized by obsessions and compulsions focused on religion. Despite the clinical relevance of scrupulosity to some presentations of OCD, little is known about the association between scrupulosity and symptom severity across religious groups. The present study examined the relationship between (a) religious affiliation and OCD symptoms, (b) religious affiliation and scrupulosity, and (c) scrupulosity and OCD symptoms across religious affiliations. One-way ANOVAs, Pearson correlations and regression-based moderation analyses were conducted to evaluate these relationships in 180 treatment-seeking adults with OCD who completed measures of scrupulosity and OCD symptom severity. Scrupulosity, but not OCD symptoms in general, differed across religious affiliations. Individuals who identified as Catholic reported the highest level of scrupulosity relative to individuals who identified as Protestant, Jewish or having no religion. Scrupulosity was associated with OCD symptom severity globally and across symptom dimensions, and the magnitude of these relationships differed by religious affiliation. Findings are discussed in terms of the dimensionality of scrupulosity, need for further assessment instruments, implications for assessment and intervention, and the consideration of religious identity in treatment.

Variation in obsessive-compulsive symptoms between children and adults

The complexity and diversity of clinical manifestations of obsessive-compulsive disorder have intrigued psychiatrists for a long time. Various differences have been noted in the presentation of obsessive-compulsive disorder of different age group. It was aimed to assess the variations of presentation of symptoms in children and adults in a tertiary level hospital. This study was done in an outpatient department from May 2015 to April 2017. Four hundred patients were included in the study consecutively after considering the inclusion and exclusion criteria. Respondents were interviewed with a semi-structured questionnaire which includes demographic variables, psychiatric diagnoses (DSM-IV-TR) and Y-BOCS symptom checklist. Obsessive-compulsive disorder started before adulthood in 41.5% of patients and onset after 18 years was found to be 58.5%. In this study, cases of obsessions, dirt and contamination was seen to predominate in both early- and late-onset obsessive compulsive disorder (68.3 and 71.4% respectively) and among the cases of compulsions, cleaning variety was found to be highest in both early- and late-onset (65.8 and 73.3% respectively). Age should be taken into account when evaluating obsessive compulsive disorder patients. The results suggest that more studies are necessary to determine whether in fact, it defines a homogeneous and particular group in obsessive-compulsive disorder.

“I can’t stop thinking about my child's flaws”: An investigation of parental preoccupation with their children's perceived flaws

Parent-child obsessive-compulsive (OC) symptoms involve obsessive preoccupation on perceived flaws in one's child. Such preoccupation is often accompanied by compulsive behaviors aimed at alleviating the resulting distress. Parent-child OC symptoms can be construed as an additional presentation of Relationship Obsessive Compulsive Disorder (ROCD), a presentation of obsessive compulsive disorder (OCD) in which symptoms are centered on a significant other. In this study, a self-report scale for assessing parent-child ROCD symptoms (the PROCSI-PC) was created on the bases of an existing partner-focused ROCD scale. Confirmatory Factor Analysis conducted on a sample of 350 parents supported a five factor solution of the PROCSI-PC corresponding to five perceived-flaw domains: appearance, intelligence, competence, morality, and sociability-stability. The PROCSI-PC total score was associated with parental OCD and mood symptoms, and with parental stress. Moreover, the PROCSI-PC was associated with greater depression above and beyond the effect of parental OCD symptoms, and with greater parental stress above and beyond the effects of OCD symptoms and depression. Finally, the PROCSI-PC was linked to self-reported disability resulting from obsessive preoccupation of parents on their child's perceived flaws. The results indicate the parent-child OC symptoms may be a prevalent source of unique distress that is especially challenging for parents.

Familial occurrence of tic disorder, anxiety and depression is associated with the clinical presentation of obsessive compulsive disorder (OCD) in children and adolescents

Obsessive compulsive disorder (OCD) is a neuropsychiatric entity. The aim was to explore the association of familial OCD, tics, anxiety, and depression with the presentation of OCD in offspring. To our knowledge, this is the first study examining the association of other familial psychiatric disorders with OCD in offspring.A total of 198 families recruited to a Scandinavian multicenter treatment study participated. Characteristics of the child were assessed with standard measures. Family psychiatric disorders were assessed with two methods: a parent interview with open questions and a parent interview with specific questions concerning tics, depression, anxiety, and OCD.A family history of OCD was described in 6% of the probands. No differences were observed between children who had relatives with OCD and children without familial occurrence of OCD. Familial tic disorder was associated with comorbid tics, externalizing disorders, repeating compulsions, and hoarding in the child proband. Familial anxiety was associated with internalizing disorders and comorbid tics, whereas familial depression was associated with somatic obsessions and hoarding in the proband.Our study shows that familial occurrence of other psychiatric disorders is associated with differences in the clinical presentation. Identifying subtypes may have implications for our understanding of the etiology of OCD.

Validation of the Penn Inventory of Scrupulosity (PIOS) in scrupulous and nonscrupulous patients: Revision of factor structure and psychometrics.

Scrupulosity, or obsessive-compulsive symptoms related to religiosity or religion, is a common presentation of obsessive compulsive disorder (OCD), and it is important to elucidate its phenomenology and measurement. Today, the most widespread questionnaire for the assessment of scrupulosity is the Penn Inventory of Scrupulosity (PIOS). The current study examines the psychometric properties of the PIOS in outpatient, treatment-seeking patients. Results of a confirmatory factor analysis suggested an unsatisfactory fit for previously suggested factor structures. A follow-up exploratory factor analysis suggested that a bifactor model was the most suitable solution. In addition, the scores of the PIOS and its revised subscales were found to have moderate-good concurrent validity; however, its scores discriminated poorly between patients with scrupulous obsessions and patients with OCD and other repugnant obsessions. Group differences and receiver operating characteristics (ROC) analyses both indicated that the PIOS is more suitable in discriminating scrupulous obsessions in Christian patients but not in other religious groups (i.e., Jews, nonreligious patients). Additional analyses revealed that the co-occurrence of scrupulous and other repugnant obsessions is also moderated by religious affiliation. These results raise questions in terms of grouping scrupulosity with other repugnant obsessions and suggest for the need of culturally sensitive instruments of scrupulosity. (PsycINFO Database Record

Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review

ABSTRACT Objective: With the intensified public awareness and media coverage of issues concerning gender identity and gender incongruence, distinguishing true gender dysphoria or incongruence from the sexual obsessions of obsessive-compulsive disorder (OCD) is especially important. Although intrusive sexual obsessions are not uncommon in OCD, obsessions concerning sexual content are more difficult for clinicians to identify as OCD than other types of obsessions (e.g., obsessions concerning contamination). Making the correct diagnosis helps ensure that appropriate clinical treatment can be offered. Methods: We present a case report of a homosexual, single, young male with new-onset intrusive repetitive obsessive thoughts that he was transgender. The case report is accompanied by a review of the pertinent endocrine and psychiatric literature. Results: A Yale-Brown Obsessive Compulsive Scale indicated a significant negative impact of the patient's symptoms. Conclusion: To our knowledge, this is the first cas...

Uncertainty, god, and scrupulosity: Uncertainty salience and priming god concepts interact to cause greater fears of sin

Background and objectivesDifficulties tolerating uncertainty are considered central to scrupulosity, a moral/religious presentation of obsessive-compulsive disorder (OCD). We examined whether uncertainty salience (i.e., exposure to a state of uncertainty) caused fears of sin and fears of God, as well as whether priming God concepts affected the impact of uncertainty salience on those fears. MethodAn internet sample of community adults (N = 120) who endorsed holding a belief in God or a higher power were randomly assigned to an experimental manipulation of (1) salience (uncertainty or insecurity) and (2) prime (God concepts or neutral). ResultsAs predicted, participants who received the uncertainty salience and God concept priming reported the greatest fears of sin. There were no mean-level differences in the other conditions. The effect was not attributable to religiosity and the manipulations did not cause negative affect. LimitationsWe used a nonclinical sample recruited from the internet. ConclusionsThese results support cognitive-behavioral models suggesting that religious uncertainty is important to scrupulosity. Implications of these results for future research are discussed.

Scrupulosity: A cognitive–behavioral analysis and implications for treatment

Scrupulosity involves obsessive religious doubts and fears, unwanted blasphemous thoughts and images, as well as compulsive religious rituals, reassurance seeking, and avoidance. This article provides a comprehensive review of the nature of scrupulosity, including (a) a detailed clinical description, (b) information about how to differentiate scrupulosity from normal religious practice, (c) cross cultural aspects of scrupulosity, and (d) the relationships between scrupulosity and religiosity. Next, evidence is presented in support of scrupulosity as a presentation of obsessive compulsive disorder (OCD), and a cognitive–behavioral model of scrupulosity extending current models of OCD is outlined. In this model, the influence of religion on the misinterpretation of unacceptable intrusive thoughts, the ways in which symptom content depends on one׳s religious identification, and the role of intolerance of uncertainty are emphasized. Finally treatment implications are discussed for applying exposure and response prevention and cognitive techniques to the specific concerns relevant to scrupulosity.

Predictors of mental pollution: The contribution of religion, parenting strategies, and childhood trauma

One presentation of obsessive-compulsive disorder that has begun to receive research attention is mental pollution, a sense of inward contamination that persists regardless of the presence of external contaminants. Given the need to better understand this phenomenon, we sought to identify predictor variables that could inform theory, treatment, and prevention. A large number of undergraduate students completed a battery of self-report questionnaires assessing personal experiences, religious variables, parenting strategies, and childhood trauma, that appear theoretically relevant to mental pollution. Results indicated that mental pollution was not associated with degree of religiosity, yet positively associated with exposure to childhood trauma and maladaptive guilt induction strategies by one's parents. Implications for the assessment and cognitive-behavioral treatment of mental pollution, as well as limitations of the study, are discussed.

A Case of Obsessive-Compulsive Disorder Presenting as Dissociative Disorder

To the Editor: Dissociative experiences have often been reported in obsessive-compulsive disorder (OCD)1,2 without overt dissociative disorder. Patients with OCD and high dissociation are more likely to be checkers and arrangers than those with low dissociation.2,3 Conversely, both obsessive and compulsive symptoms4,5 have also been reported in dissociative disorders. We report the case of a young lady who presented with dissociative motor disorder and mutism and who was later diagnosed with OCD after a drug-assisted interview. Case report. Ms A, a 24-year-old woman from a middle-class socioeconomic urban background, who premorbidly had a well-adjusted personality and had no past or family history of mental disorders, was brought to our hospital in 2009 with a 3-month history of frequent attacks of repeated nodding of the head and blinking of the eyes with absent speech lasting about 15–20 minutes each time, but with complete responsiveness and consciousness during the attack. Such attacks were noted to be occurring 3–4 times a week, with the patient denying existence of the attacks. A detailed history revealed that Ms A had been recently married (over a year before) and was having difficulties in interpersonal relationships with her in-laws. A complete physical and neurologic examination revealed no abnormalities, routine hemogram and biochemical investigations were negative for any findings outside normal limits, and electroencephalogram was uneventful. During serial interviews, Ms A avoided eye-to-eye contact and would deny the existence of any problem. She also had frequent episodes of rapid head nodding and blinking of the eyes, during which she would become completely mute and refuse to answer any questions. Initially, a diagnosis of mixed dissociative disorder (ICD-10 Diagnostic Criteria for Research) was made, largely comprising dissociative motor disorder and dissociative mutism. An attempt at individual psychotherapy was made consisting of removal of secondary gain and symptom reduction. However, Ms A continued to have attacks in spite of repeated therapist attempts, and therapy was declared largely unsuccessful. Since no more information was forthcoming from the patient at this time, a sodium thiopental interview was planned in order to delve into her conflict areas. After informed consent was obtained from the patient and caregivers, the interview was carried out. During the interview, the patient revealed that she had been having repeated blasphemous and homicidal thoughts about her in-laws with an obsessive quality. These were accompanied by compensatory mental compulsions of trying to abort such thoughts by forcible “amnesia,” which led to her dissociative symptoms. After this information was obtained, Ms A was diagnosed as suffering from OCD, mixed type, with a Yale-Brown Obsessive Compulsive Scale (YBOCS)6 score of 27/40. The patient was then started on sertraline treatment at a dosage maintained at 200 mg/d, and cognitive-behavioral therapy (CBT) was added later at the end of 4 weeks. At follow-up, Ms A showed substantial improvement of both dissociative symptoms and OCD (YBOCS score of 6/40). A number of previous studies have observed a link between OCD and dissociative symptoms, but this patient demonstrated a rare example of OCD presenting as dissociative disorder. The value of the drug-assisted interview in reformulating the diagnosis cannot be overappreciated, as it led to a paradigm shift in the management plan. Little evidence exists as to causation, but some authors have suggested that disruptions of reality monitoring due to attempts at forcible “amnesia” by the patient7 and the consequent distress may lead to dissociative symptoms. Further, sociocultural taboos of revealing the blasphemous and homicidal nature of her thoughts may explain why these obsessions were kept so secret. In addition to pharmacotherapy, to which the patient showed marked response, CBT may be tried in such cases despite reports of poor outcome.2 To conclude, patients with OCD may present as having dissociative disorder due to the high levels of distress associated with the nature of the thoughts. A high index of suspicion may be essential to managing such a patient appropriately.

Intermittent abdominal pain in a 6-year-old child: the psycho-social-cultural evaluation

The dramatic surge in diversity in the western world requires a commitment by pediatric providers to understand unique psychosocial presentations of distress, as well as to have an understanding of normative cultural values and health-seeking behaviors. We report a case of apparent recurrent abdominal pain that evolved into a unique culturally salient presentation of obsessive compulsive disorder in a 6-year-old young girl. Access to integrated mental health professionals assisted in the identification of this disorder, if not success in referral and treatment.

An Atypical Presentation of Obsessive Compulsive Disorder with Difficulty in Hearing

Obsessive compulsive disorder (OCD) is a common psychiatric disorder which is easily recognized. However, sometimes patients of OCD present in such an atypical or bizarre way that their problem comes to notice as being a psychiatric disorder after multiple consultations in different specialties. We are reporting a case of a man who had first sought opinion in the Department of Ear, Nose and Throat (ENT) for hearing impairment. He was then referred to a neurologist and a general physician for evaluation of neurological cause of his symptom. As no pathology related to ENT or neurology could be detected, he was referred to the Department of Psychiatry. The patient's chief complaints were difficulty in hearing and inability to understand at once. He could be diagnosed as a case of OCD after meticulous evaluation and studying his response to treatment. There was significant improvement in all the presenting symptoms over a period of 6 weeks on 60 mg of fluoxetine.

Compulsive prayer and its management

Religious symptoms have been recognized as a presentation of obsessive-compulsive disorder (OCD) for centuries. The two main treatment strategies for OCD, cognitive behavior therapy (exposure and response prevention [ERP]), and SSRIs have been shown to be effective in religious OCD. The presentation of religious OCD within formal prayer, reported in Judaism and Islam, poses special challenges of inaccessibility of personal prayer, sanctity of the symptom, and the status of the therapist. A method of guided-prayer repetition, a variant of ERP, is described, and its successful application is reported in three cases of ultra-orthodox Jewish men with prayer as the main symptom of their religious OCD.

Starvation in obsessive-compulsive disorder due to scrupulosity

This report describes an unusual presentation of obsessive–compulsive disorder (OCD) with predominant religious obsessions and compulsions (scrupulosity) in which the patient starved himself by keeping fast excessively to the extent of emaciation and extreme weakness even in walking and became bedridden.