Obsessive-compulsive Disorder Symptoms Research Articles

'Autism is the Arena and OCD is the Lion': Autistic adults' experiences of co-occurring obsessive-compulsive disorder and repetitive restricted behaviours and interests.

Repetitive behaviours and interests are a hallmark feature of autism. It is very common for autistic people to experience mental health difficulties, such as obsessive-compulsive disorder. Previous research has investigated similarities and differences between obsessive-compulsive disorder symptoms and repetitive behaviours in autism through questionnaires and observation studies. This is the first study to interview autistic adults about their personal experiences of differentiating between obsessive-compulsive disorder symptoms and repetitive behaviours related to autism. We interviewed 15 autistic adults who experience obsessive-compulsive disorder symptoms. We recorded these interviews and carefully analysed these to find themes. We found some differences between repetitive behaviours and obsessive-compulsive disorder. Participants said repetitive behaviours are part of who they are and what they want to be doing, whereas obsessive-compulsive disorder symptoms conflicted with how they view themselves. Obsessive-compulsive disorder was said to cause negative emotions, while participants said they experience lots of different emotions when doing repetitive behaviours. A similarity participants reported was trying to stop themselves from doing obsessive-compulsive disorder symptoms and repetitive behaviours that other people can see. There was also overlap between obsessive-compulsive disorder and repetitive behaviours. Participants talked about experiences when obsessive-compulsive disorder would take over routines and make them feel more intense and negative. Also, participants' special interests were sometimes connected to the obsessions they experienced. We conclude that clinicians can use these findings to support conversations with autistic clients in differentiating between repetitive behaviours and obsessive-compulsive disorder symptoms. We also think that further research investigating how obsessive-compulsive disorder symptoms might be hidden by autistic and typically developing people is needed.

Psychometric Evaluation of the Chinese Version of the Family Accommodation Scale for Obsessive–Compulsive Disorder Patient Version

This study aimed to examine the psychometric properties of the Chinese version of the family accommodation scale for obsessive–compulsive disorder (OCD) patient version (FAS-PV). A total of 171 adult OCD patients and 145 family members were enrolled in the present study. The majority of the adult OCD patients (89.5%) reported engaging in at least one accommodating behavior in the past week. The FAS-PV comprised three components that included (a) direct participation and facilitation, (b) provision of reassurance and assumption, and (c) modification of routines and avoidance. The FAS-PV demonstrated excellent internal consistency. The correlation between the total FAS-PV score and the criteria measure demonstrated excellent convergent validity when assessing the OCD symptom severity, global functioning, family functioning, and functioning impairment. The findings supported that the FAS-PV could be used widely in evaluating and identifying the accommodating behavior both in clinical and in research settings, especially in adult OCD patients who usually present to the clinic alone.

Sensory over-responsivity and orbitofrontal cortex connectivity in obsessive-compulsive disorder

BackgroundSensory over-responsivity (SOR) in obsessive-compulsive disorder (OCD) is associated with illness severity and functional impairment. However, the neural substrates of SOR in OCD have not yet been directly probed. MethodsWe examined resting-state global functional connectivity markers of SOR in 119 adults with OCD utilizing the CONN-fMRI Functional Connectivity Toolbox for SPM (v21a). We quantified SOR with the sensory sensitivity and sensory avoiding subscales of the Adult and Adolescent Sensory Profile (AASP). We also measured: OCD severity, with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Obsessive-Compulsive Inventory-Revised (OCI-R); sensory phenomena with the Sensory Phenomena Scale (SPS); general anxiety, with the Beck Anxiety Inventory (BAI); and depressive symptomatology, with Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR). ResultsThere was a significant positive relationship of SOR with global connectivity in anterior and medial OFC (Brodmann's area 11, k = 154, x = 14, y = 62, z = −18, whole-brain corrected at FWE p < 0.05). LimitationsFuture investigations should explore neural responses to sensory stimulation tasks in OCD and compare findings with those obtained in other conditions also characterized by high SOR, such as autism spectrum disorder. ConclusionsThis study implicates OFC functional connectivity as a neurobiological mechanism of SOR in OCD and suggests that the substrates of SOR in OCD may be dissociable from both that of other symptoms in OCD, and SOR in other disorders. With replication and extension, the finding may be leveraged to develop and refine treatments for OCD and investigate the pathophysiology of SOR in other conditions.

Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder

BackgroundExposure and response prevention (ERP) is considered the first-line psychotherapy for obsessive-compulsive disorder (OCD). Substantial research supports the effectiveness of ERP, yet a notable portion of patients do not fully respond while others experience relapse. Understanding poor outcomes such as these necessitates further research. This study investigated the role of patient adherence to ERP tasks in concentrated exposure treatment (cET) in a sample who had previously not responded to treatment or relapsed.MethodThe present study included 163 adults with difficult-to-treat OCD. All patients received cET delivered during four consecutive days. Patients’ treatment adherence was assessed using the Patient EX/RP Adherence Scale (PEAS-P) after the second and third day of treatment. OCD severity was evaluated at post-treatment, 3-month follow-up, and 1-year follow-up by independent evaluators.ResultsPEAS-P scores during concentrated treatment were associated with OCD-severity at post-treatment, 3-month follow-up, and 1-year follow-up. Moreover, PEAS-P scores predicted 12-month OCD severity adjusting for relevant covariates. Adherence also predicted work- and social functioning at 1-year follow-up.ConclusionsThese results indicate that ERP adherence during the brief period of cET robustly relates to improvement in OCD symptoms and functioning in both the short and long term. Assessing adherence might identify patients at risk of poor outcomes, while improving adherence may enhance ERP for treatment resistant patients.Trial RegistrationClinicalTrials.gov identifier: NCT02656342.

Obsessive Compulsive Disorder (OCD) During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic, present in Indonesia for 17 months, has significantly impacted mental health, especially in individuals with obsessive-compulsive disorder (OCD). Studies in Europe reported a 17.9% to 60.3% increase in OCD symptom severity. Notably, no research in Indonesia has explored the pandemic’s effects on OCD patients. Lockdown measures in Indonesia may exacerbate symptoms, but some OCD patients benefit, finding relief from societal stigmatization and the opportunity to advise others on infection prevention. This review aims to examine the impact of the COVID-19 pandemic on OCD patients in Indonesia and discuss potential management strategies. Methods: We conducted a comprehensive literature search, identifying studies, articles, and reports relevant to the effects of the COVID-19 pandemic on OCD patients in Indonesia. These sources were critically evaluated to provide a comprehensive overview. Results: This review reveals that the pandemic poses unique challenges to OCD patients in Indonesia. Lockdown measures may worsen symptoms, although some patients find relief from societal stigmatization. OCD patients can play a valuable role in advising others on infection prevention. Telemedicine, especially CBT, and medication adherence tools are crucial for effective management. Conclusion: The COVID-19 pandemic affects OCD patients in Indonesia in various ways. It is essential to recognize how lockdown measures impact symptom severity and the opportunities for patients to contribute positively to society. Telemedicine and medication adherence tools are valuable for managing OCD during the pandemic. Addressing the needs of OCD patients and implementing effective strategies for their care during COVID-19 is essential in Indonesia.

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.

Lose yourself: feared self, emotion regulation, and obsessive-compulsive and eating disorder symptomatology

ABSTRACT Objectives Feared self refers to an individual’s “possible” self that has undesired qualities or characteristics and has been linked to obsessive compulsive symptoms. However, feared self may also relate to eating disorder pathology, given the importance of views of self in the disorder. Method This questionnaire-based study in a non-clinical sample (N = 238) examined whether a feared self would independently predict the symptom severity of obsessive-compulsive disorder (OCD) and eating disorders (ED), while controlling for potential comorbidity of the respective symptoms. A secondary aim was to examine whether emotion regulation moderated the relationship between a feared self and OCD symptoms and a feared self and ED symptoms. Results Feared self was a significant unique predictor of symptoms of both disorders. Emotion regulation was not found to significantly moderate the relationship between feared self and either OCD or ED symptoms, although emotion regulation was a significant independent predictor of the respective symptoms. Conclusions The study is one of the first to show that a feared self uniquely predicts ED symptoms, over-and-above coexisting OCD symptoms. As such, the results provide support for feared self as a potential transdiagnostic factor. Implications and limitations are discussed.

Obsessive compulsive disorder: overview of the condition and its nursing management.

Obsessive compulsive disorder (OCD) is a complex condition characterised by intrusive and distressing thoughts (obsessions) and repetitive behaviours or mental acts (compulsions). The symptoms of OCD cause significant distress and anxiety and can have a debilitating effect on a person's daily functioning. This article gives an overview of OCD, including its prevalence, aetiology, symptoms and treatment strategies, with the aim of enhancing nurses' understanding of the condition and its adverse effects on a person's life. The author also discusses some of the ways in which nurses in any setting can support a person with OCD.

Inferential confusion in the worldview of individuals with Obsessive Compulsive Disorder (OCD): a qualitative approach

Introduction. The Inference-based Approach (IBA) is an etiologic, therapeutic research paradigm regarding inferential confusion (IC) as an exclusive metacognitive process of obsessive compulsive disorder (OCD). IC is the rational tendency of individuals with OCD to underrate abstract data and personal experiences and overrate hypothetical possibilities. IC therefore fosters uncertainty and facilitates the justification of obsessive constructs. IBA has noted that qualitative research on IC and the exploration of IC in non-OCD cognitive constructs are required to refine cognitive and therapeutic OCD models. This could help clarify whether OCD treatment by IBA is overlooking non-obsessive IC habits which, if left untreated, could compromise treatment success. Objective. To identify the possible influence of IC on non-obsessive, cognitive worldview constructs of individuals with OCD and to compare these constructs with those of individuals without OCD. Method. Twenty-five semi-structured, in-depth interviews were conducted, 15 with individuals with OCD and 10 with a comparison group without OCD or OCD symptoms. Data were collected and analyzed using Grounded Theory methodology. Results. IC was identified in the non-obsessive cognitive worldview constructs of every participant with OCD. IC was not identified in the comparative group. Discussion and conclusion. The results suggest that IC affects the rational composition of non-obsessive cognitive worldview constructs of individuals with OCD. The implications this could have for the cognitive and therapeutic models of OCD are discussed.

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.

State-dependent effects of repetitive transcranial magnetic stimulation on symptom dimensions of obsessive-compulsive disorder: A case report

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation procedure that is FDA-cleared for treating obsessive-compulsive disorder (OCD). Evidence suggests that controlling brain state during rTMS treatment can influence treatment outcomes. We present the case of a patient with refractory OCD who received symptom provocation immediately preceding rTMS treatment sessions. The patient experienced more subjective and objective improvement in OCD symptoms targeted by provocations than in other symptom domains. These results suggest the importance of brain state during rTMS and could be used to guide and optimize neuromodulation treatment for OCD.

Neurological soft signs as trait markers of a subset of patients with obsessive-compulsive disorder with low insight and altered cognitive abilities

Neurological soft signs (NSS) are subtle motor control impairments that include involuntary movements and abnormalities of motor coordination, sensory integration and lateralization. They engage different brain networks, including the prefrontal networks that support the higher cognitive functions that are dysfunctional in obsessive-compulsive disorder (OCD). This study investigated the relationships between the presence of NSS and patients’ severity of OCD symptoms, insight, and treatment resistance in a sample of 63 patients. Treatment-resistance was assessed considering all the treatments the patients received during the course of their disease. The four dimensions of OCD defined in the dimensional obsessive-compulsive scale were considered. Links between the patients’ cognitive abilities and NSS were assessed using tests targeting specifically the core components of executive functions.As expected, OCD patients displayed more NSS than individually matched control participants. In OCD patients, high NSS scores were associated with poor insight and lower cognitive abilities. Multiple regression analysis identified worse visuospatial working memory, attentional control, and verbal fluency as predictive factors of high NSS scores among cognitive functions. Unexpectedly, the patients displaying symptoms in the contamination/washing dimension displayed less NSS than the other patients. In contrast, neither the severity of OCD symptoms nor long-range treatment resistance was significantly related to patients’ NSS scores. Altogether, our findings suggest that high NSS scores may be a trait marker of a subset of OCD patients with low insight and particularly altered cognitive abilities who would not express the contamination/washing dimension of the pathology.

Investigating Parenting Styles and Relationship Obsessive-compulsive Disorder Symptoms: The Mediating Role of Alexithymia

Investigating Parenting Styles and Relationship Obsessive-compulsive Disorder Symptoms: The Mediating Role of Alexithymia

Impact of Benzodiazepines and Illness Duration on Obsessive-Compulsive Disorder during COVID-19 in Italy: Exploring Symptoms' Evolutionary Benefits.

Obsessive-compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insights of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas the severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need for additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and an extraordinary supply of essential resources.

Reductions in Anxiety are Associated with Decreased Expressive Suppression and Increased Cognitive Reappraisal After Cognitive-Behavioral Treatment: A Naturalistic Study in Youth.

Broad deficits in emotion regulation skills have been observed in children with anxiety-related disorders. These deficits typically improve during cognitive-behavioral therapy (CBT), but few studies have examined changes in expressive suppression and cognitive reappraisal in youth with anxiety disorders and/or obsessive-compulsive disorder (OCD) during CBT, especially in real-world settings. In a naturalistic treatment-seeking sample, 123 youth completed measures of anxiety, depression, and emotion regulation strategy use before and after 15 sessions of CBT. For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD. Thus, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction; improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT.

Increases in functional connectivity between the default mode network and sensorimotor network correlate with symptomatic improvement after transcranial direct current stimulation for obsessive-compulsive disorder

BackgroundNon-invasive neuromodulation is a promising intervention for obsessive-compulsive disorder (OCD), although its neurobiological mechanisms of action are still poorly understood. Recent evidence suggests that abnormalities in the connectivity of the default mode network (DMN) and the supplementary motor area (SMA) with other brain regions and networks are involved in OCD pathophysiology. We examined if transcranial direct current stimulation (tDCS) alters these connectivity patterns and if they correlate with symptom improvement in treatment-resistant OCD. MethodsIn 23 patients from a larger clinical trial (comparing active tDCS to sham) who underwent pre- and post-treatment MRI scans, we assessed resting-state functional MRI (rs-fMRI) data. The treatment involved 30-minute daily tDCS sessions for four weeks (weekdays only), with the cathode over the SMA and the anode over the left deltoid. We conducted whole-brain connectivity analysis comparing active tDCS-treated to sham-treated patients. ResultsWe found that active tDCS, but not sham, led to connectivity increasing between the DMN and the bilateral pre/postcentral gyri (p = 0.004, FDR corrected) and temporal-auditory areas plus the SMA (p = 0.028, FDR corrected). Also, symptom improvement was directly associated with connectivity increasing between the left lateral sensorimotor network and the left precuneus (r = 0.589, p = 0.034). LimitationsLimited sample size (23 participants with resting-state neuroimaging), inability to analyze specific OCD symptom dimensions (e.g., harm, sexual/religious, symmetry/checking, cleaning/contamination). ConclusionsThese data offer novel information concerning functional connectivity changes associated with non-invasive neuromodulation interventions in OCD and can guide new brain stimulation interventions in the framework of personalized interventions.

Testing an Imagery Rescripting Exercise Targeting Fear of Self

A feared possible self refers to the unwanted characteristics that a person may possess or develop. We tested an experimental paradigm to target fear of possible self using imagery rescripting. A student sample (n= 91), with moderate obsessive–compulsive disorder symptoms, engaged in written and audio-guided exercises to evoke episodic future mental imagery that represented their feared possible self. Participants were then randomized between imagery rescripting or neutral imagery control tasks. The results revealed no difference between conditions in fear of self or general obsessional beliefs following the manipulation. State anxiety and the urge to neutralize the imagery reduced more in the control condition than in the rescripting condition. These findings suggest that the current paradigm is emotionally engaging but not effective at addressing fear of self as measured. Methodological improvements such as removing a written component of the rescripting task and idiosyncratic measuring of fear of self are proposed.

Better treatment response in people with obsessive-compulsive disorder is associated with more use of a planning-focused coping style

Background Obsessive-compulsive disorder (OCD) is a common and highly disabling mental health condition. Although effective treatments such as cognitive behavioural therapy are available, a substantial minority of patients do not respond to treatment, and those who do often experience relapse. There is an urgent need to understand more about the psychological factors involved in response to OCD treatment. Prior literature suggests that poorer treatment response may be related to higher levels of early life stress and experiential avoidance, while better treatment response may be related to positive coping styles (planning; active coping). Methods Individuals with OCD (n = 202) took part in an online survey in which they reported what OCD treatment they had received, and how their OCD symptoms at the time of the survey compared to their OCD symptoms before they had received any treatment. They also completed measures of OCD severity, early life stress, experiential avoidance, planning and active coping. Depression and anxiety were measured as control variables. Results It was found that more severe OCD symptoms were associated with higher levels of early life stress and more use of experiential avoidance, but were unrelated to planning or active coping. On the other hand, a better self-reported response to OCD treatment was associated with more use of the planning style of coping, but was not associated with early life stress, experiential avoidance or active coping. Conclusions The present study highlights planning-focused coping as a possible modifiable factor in maximising treatment response in people with OCD. Given that sustained recovery from OCD is relatively rare, research that focuses on how to maximise the benefit of existing treatments could have a significant impact on individuals living with the condition.

Psychometric Properties of Thai Version of Obsessive Belief Questionnaire (OBQ-T)

Background: Obsessive Beliefs Questionnaire (OBQ) is a valid measure for assessing obsessional beliefs, which are the main symptoms of obsessive-compulsive disorder (OCD). It is translated and assessed psychometric properties in many languages, however, no valid questionnaire for assessing the beliefs related to OCD is established in Thailand. Objective: To assess the psychometric properties of the Thai version of the Obsessive Belief Questionnaire (OBQ-T). Materials and Methods: Participants include ninety-two OCD patients who were duly informed of the details of the present study. Written consent was obtained. The Obsessive Beliefs Questionnaire-44 (OBQ-44) was translated into Thai (OBQ-T) after receiving permission. Data regarding the characteristics of the participants, the OBQ-T, the Thai self-report version of the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCSII-SR-T) severity scale, the Thai Florida Obsessive Compulsive Inventory (FOCI-T), the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL), were collected and analyzed. Psychometric properties of the OBQ-T were tested. Results: The OBQ-T has excellent reliability with a Cronbach’s coefficient of 0.945. It has a positive correlation with the Y-BOCS II-SR-T severity scale and the FOCI, which indicates the concurrent validity of the OBQ-T. The content validity index shows acceptable content validity. The confirmatory factor analysis (CFA) and the exploratory factor analysis (EFA) were examined, and the three-factor model is most similar to the original OBQ-44, which is composed of three factors reflecting responsibility and threat estimation, perfectionism and intolerance for uncertainty, and importance and control of thought. Conclusion: The OBQ-T has an acceptable reliability and validity for the measurement of beliefs and appraisals, which are related to the pathogenesis of obsessions. Keywords: Obsessive Compulsive Disorder, Psychometric properties, Thai, Obsessional belief questionnaire

Alone together: the role of existential concerns in symptoms of relationship obsessive-compulsive disorder

ABSTRACT Objective Emerging research has identified the relevance of existential concerns in various subtypes and dimensions of obsessive-compulsive disorder (OCD). However, at present, no studies have examined these concerns in relation to relationship OCD (ROCD). Method The current study examined the association between ROCD symptoms and all five existential concerns (i.e., isolation, identity, meaninglessness, guilt, and death). Data was obtained from a sample of undergraduate university students in Sydney, Australia (N = 353), Mage = 20.95 years. Participants completed a number of scales including measures of ROCD symptoms, attitudes to relationships, and existential concerns. Results The results revealed significant positive correlations between all five existential concerns and ROCD symptoms. In particular, the correlations found for Isolation and Identity concerns were significantly larger than those found for Meaninglessness, Guilt, and Death. Notably, the relationships between ROCD symptoms and all five existential concerns remained significant after controlling for quality of current relationship, catastrophic beliefs about relationships, and neuroticism. Conclusions The current findings highlight the need to consider existential issues in conceptualising ROCD. Clinical implications are discussed.