Obsessive-compulsive Related Disorders Research Articles

The genetics of trichotillomania and excoriation disorder: A systematic review

BackgroundTrichotillomania (TTM) and excoriation disorder (ED) are impairing obsessive-compulsive related disorders that are common in the general population and for which there are no clear first-line medications, highlighting the need to better understand the underlying biology of these disorders to inform treatments. Given the importance of genetics in obsessive-compulsive disorder (OCD), evaluating genetic factors underlying TTM and ED may advance knowledge about the pathophysiology of these body-focused repetitive behaviors. AimIn this systematic review, we summarize the available evidence on the genetics of TTM and ED and highlight gaps in the field warranting further research. MethodWe systematically searched Embase, PsycInfo, PubMed, Medline, Scopus, and Web of Science for original studies in genetic epidemiology (family or twin studies) and molecular genetics (candidate gene and genome-wide) published up to June 2023. ResultsOf the 3536 records identified, 109 studies were included in this review. These studies indicated that genetic factors play an important role in the development of TTM and ED, some of which may be shared across the OCD spectrum, but there are no known high-confidence specific genetic risk factors for either TTM or ED. ConclusionsOur review underscores the need for additional genome-wide research conducted on the genetics of TTM and ED, for instance, genome-wide association and whole-genome/whole-exome DNA sequencing studies. Recent advances in genomics have led to the discovery of risk genes in several psychiatric disorders, including related conditions such as OCD, but to date, TTM and ED have remained understudied.

Demographics, psychiatric comorbidities, and hospital outcomes across eating disorder types in adolescents and youth: insights from US hospitals data

ObjectiveThe aim of our study was to delineate the differences in demographics, comorbidities, and hospital outcomes by eating disorder types in adolescents and transitional-age youth (15–26 years), and measure the association with psychiatric comorbidities.MethodsWe conducted a cross-sectional study using the nationwide inpatient sample (2018–2019) and included 7,435 inpatients (age 12–24 years) with a primary diagnosis of eating disorders: anorexia nervosa (AN, 71.7%), bulimia nervosa (BN, 4.7%), avoidant/restrictive food intake disorder (ARFID, 9.5%), and other. We used independent logistic regression models controlled for demographics to evaluate the adjusted odds ratio association of comorbidities with eating disorder types.ResultsThe mean age of BN inpatients was 17.5 years, which was significantly higher compared to the total number of inpatients with eating disorders (15.9 years). Approximately four-fifths of the inpatients with AN and BN were female patients whereas ARFID was seen in a higher proportion of male patients (32.6% vs. 13.7% overall). Anxiety (57.5%) and depressive (47.3%) disorders were prevalent in the total number of inpatients with eating disorders, with suicidal behaviors seen significantly higher in BN (25.7% vs. 12.9% overall). The likelihood of obsessive compulsive–related disorder was higher in all eating disorder types, i.e., AN (OR 2.14), BN (OR 1.79), and ARFID (OR 1.74); however, anxiety (OR 1.52) and neurodevelopmental (OR 1.70) disorders were significantly higher in ARFID. In terms of hospital outcomes, inpatients with ARFID had a longer mean length of stay (13.7 days vs. 8.4 days in BN) and higher mean total charges ($87,747 vs. $44,882 in BN).ConclusionOur findings identify notable demographic and clinical distinctions within inpatients diagnosed with AN, BN, and ARFID. Specifically, inpatients with BN belonging to older age brackets manifest elevated occurrences of depressive disorders and suicidal tendencies. ARFID is linked to prolonged hospitalization and increased costs, underscoring distinctive complexities in care. This highlights the significance of personalized interventions that account for demographic variations and psychiatric comorbidities, aiming to improve outcomes for diverse populations affected by eating disorders.

Structured clinical interview for diagnosing obsessive-compulsive spectrum disorders.

BackgroundThere are several established structured diagnostic interviews that cover common mental disorders seen in general psychiatry clinics. The administration of more focused diagnostic interviews may be useful in specialty clinics, such as OCD clinics. A semi-structured clinician-administered interview for obsessive-compulsive spectrum disorders (SCID-OCSD) was developed and adapted for DSM-5/ICD-11 obsessive-compulsive and related disorders as well as other putative obsessive-compulsive spectrum conditions. ObjectiveTo introduce a semi-structured diagnostic interview for in-depth assessment of obsessive-compulsive spectrum disorders (OCSDs), and to report on its implementation in adults with primary OCD attending an OCD-specialized unit. MethodsPatients with primary OCD were interviewed using the SCID-OCSD. The SCID-OCSD assesses disorders drawn from several diagnostic categories that share some core features of obsessive-compulsive phenomenology and that are often comorbid in OCD (e.g., obsessive-compulsive related disorders, impulse-control disorders, and a spectrum of compulsive-impulsive conditions such as tics, eating disorders, non-suicidal self-injury, and behavioral addictions. Participants had to be at least moderately symptomatic on the Yale-Brown Obsessive-Compulsive Severity scale (YBOCS, i.e., a total score ≥ 14) to be included in the current study. ResultsOne hundred and one adult patients with current OCD (n = 101, 37 men and 64 women), took part in the study. Forty-two participants (n = 42) had OCD and one or more current or past comorbid OCSDs, with excoriation (skin-picking) disorder (n = 16) and body dysmorphic disorder (n = 14) being the most common. Nine (n = 9) participants reported a history of non-suicidal self-injury, and 6 participants reported a history of comorbid tics. ConclusionsIn OCD clinics, the SCID-OCSD may help diagnose the full range of putative OCSDs, and so facilitate treatment planning and research on these conditions.

A Systematic Review of the Inter-individual Differences in Avoidance Learning

Avoidance is typically adaptive given it prevents threat. However, avoidance becomes maladaptive when it is executed out of proportion of threat (i.e., excessive or insufficient avoidance), persists in the absence of threat, or excessively generalizes to other innocuous situations. Although there has been an increase in research in these different processes of maladaptive avoidance, the role of inter-individual differences in these avoidance processes receives less research attention, despite its theoretical and clinical importance. In this systematic review, we summarized the role of inter-individual traits that relate to risk or resilient factors for anxiety-related disorders, trauma-and stressor-related disorders, obsessive-compulsive related disorders, pain related disorders, eating-related disorders, and affective disorders. A majority of the inter-individual differences had an apparent mixed or null effect on the different processes of avoidance. We discussed this lack of evidence of inter-individual differences on avoidance due to a lack of methodological and/or analytical consensus in the field, in addition to a lack of integration of recent findings into existing theories. Recommendations for future research are discussed, with a focus on examining the conditions or experimental parameters for certain inter-individual traits to manifest their effects on avoidance, identifying the nuances of methodological and/or inter-individual differences in avoidance, and a call for integrating recent preliminary findings into existing theories.

Relationship of Obsessive Compulsive Disorder with Social Anxiety and Psychological Resilience in Adults

Objective: Obsessive-compulsive disorder (OCD) is a mental illness characterized by permanent obsessions and compulsions that cause severe distress and disrupting one's functionality. The obsession is defined as a pattern of intortion, intortion and improper thought, idea, imagination and impulses. In this context, the aim of the study is to determine the relationship of obsessive compulsive disorder in adults with social anxiety and psychological durability. The group of this study was composed of individuals who were treated or still seeing in the hospitals and private psychological counseling center in İzmir region in 2022-2023. Method: The sample of the study was composed of 400 participants who have been diagnosed with obsessive compulsive age of 18 years and more selected by the purposeful sampling method. Maudsley Obsessive Compulsive Question list to collect data in the study, Liebowitz was used as a scale of social anxiety and short psychological stability. Results: In the finding of the research, it is moderately positive (p<0.05); Slowness, doubt, strong level between ruminating levels at strong level (p<0,01 *p<0,05); Maudsley is very strongly positive between obsessive compulsive levels(p<0.05); weak levels of anxiety, avoidance and social anxiety levels (p<0,17, p<0,11); The levels of psychological strength were found to be weakly negative and significant relations between the levels. Conclusion: obsessions and compulsions were significant in the results of the research results in the results of the tested variables. However, there were no significant results in the anticipated psychological endurance level. Therefore, the relationship between obsessive-compulsive scores and another variable may be examined.

Structural brain network connectivity in trichotillomania (hair-pulling disorder)

Neuroimaging studies suggest involvement of frontal, striatal, limbic and cerebellar regions in trichotillomania, an obsessive-compulsive related disorder. However, findings regarding the underlying neural circuitry remains limited and inconsistent. Graph theoretical analysis offers a way to identify structural brain networks in trichotillomania. T1-weighted MRI scans were acquired in adult females with trichotillomania (n = 23) and healthy controls (n = 16). Graph theoretical analysis was used to investigate structural networks as derived from cortical thickness and volumetric FreeSurfer output. Hubs, brain regions with highest connectivity in the global network, were identified, and group differences were determined. Regions with highest connectivity on a regional level were also determined. There were no differences in small-worldness or other network measures between groups. Hubs in the global network of trichotillomania patients included temporal, parietal, and occipital regions (at 2SD above mean network connectivity), as well as frontal and striatal regions (at 1SD above mean network connectivity). In contrast, in healthy controls hubs at 2SD represented different frontal, parietal and temporal regions, while at 1SD hubs were widespread. The inferior temporal gyrus, involved in object recognition as part of the ventral visual pathway, had significantly higher connectivity on a global and regional level in trichotillomania. The study included women only and sample size was limited. This study adds to the trichotillomania literature on structural brain network connectivity. Our study findings are consistent with previous studies that have implicated somatosensory, sensorimotor and frontal-striatal circuitry in trichotillomania, and partially overlap with structural connectivity findings in obsessive-compulsive disorder.

Cyberchondria: a Growing Concern During the COVID-19 Pandemic and a Possible Addictive Disorder?

The main purpose of this narrative review is to provide a brief overview of the current empirical evidence regarding the conceptualization, assessment, and treatment of cyberchondria, with a focus on the potential classification of cyberchondria as a behavioral addiction. Although cyberchondria has been widely associated with anxiety, it has also been suggested that it may be linked to obsessive-compulsive features. A less explored proposal is the categorization of cyberchondria as a behavioral addiction. The present review explores the existing literature with respect to the possible classification of cyberchondria as a behavioral addiction by considering cyberchondria with respect to components of the interaction of person, affect, cognition and execution model. There is a lack of consensus regarding the definition and conceptualization of cyberchondria. The empirical evidence available to date suggests that cyberchondria is a multifactorial construct that operates transdiagnostically, particularly with respect to obsessive-compulsive-related disorders and health-related anxiety. The extent to which the condition may reflect a behavioral addiction as a form of problematic use of the internet also warrants consideration. Cyberchondria may have become more prevalent during the COVID-19 pandemic, with particular populations prone to health-related anxiety likely having greater vulnerability. Existing data in part support the potential classification of cyberchondria as a behavioral addiction, although many gaps in understanding currently exist. Cyberchondria appears to be a growing concern. However, there is not yet enough empirical evidence to determine whether this clinical condition has enough similarities with behavioral addictions to be considered as one. Likewise, psychometric instruments that exist to date have not been designed from the theoretical framework of behavioral addictions, so most of the factors that they evaluate may be preferentially related to anxiety. Finally, there is still no consensus on whether cyberchondria should be addressed in the context of health anxiety interventions, OCRD, or behavioral addictions; thus, more empirical evidence is needed.

RTMS investigation of resistant Obsessive-Compulsive Related Disorders: Efficacy of targeting the reward system.

Repetitive Transcranial Magnetic Stimulation (rTMS) is not only a therapeutic option but also an investigational tool to explore circuits and subjective dimensions in pathological conditions. Obsessive-Compulsive Related Disorders (OCRDs) shared similarities with Substance Use Disorder (SUD), suggesting the involvement of the reward system. This study aimed to verify the efficacy of targeting the reward system with rTMS in OCRDs. Patients with trichotillomania, hoarding disorder and skin picking disorder were treated with rTMS over the left DorsoLateral PreFrontal Cortex (DLPFC) at 15 Hz, targeting the reward system via the connection with the nucleus accumbens and the ventral tegmental area. All patients were administered with psychometric scales assessing depression symptoms and severity of OCRDs symptoms at the baseline, at the end of the treatment and a 1-month follow-up. Analysis of the results showed a reduction in symptom severity at the end of the treatment in all three groups (p < 0.0001) as well as a reduction in depression symptoms (p < 0.01). Improvements at 1-month follow-up were maintained only in younger patients. Indeed, when changes in scores at the follow-up were analyzed separately for younger (<30 years) and older patients (>60 years), the elderly showed again an increase in symptoms severity, suggesting that the stability of TMS effects over time reduces with age, possibly as an effect of age-related reduction in brain plasticity. This study adopted with promising results a protocol (15 Hz over the left DLPFC) targeting the reward system, typically employed in addictions. These results can be in line with the view of OCRDs as behavioral addictions, suggesting the implication of common circuits, such as the reward system, in the mechanisms at the basis of these disorders.

Heavy Study Investment in Pre-adolescence and Adolescence: Psychometric Properties of the Studyholism Inventory (SI-10)

The Studyholism Inventory (SI-10) allows evaluating two types of Heavy Study Investment (Studyholism – or obsession toward study – and Study Engagement), and four kinds of student (engaged studyholics, disengaged studyholics, engaged students, detached students). We analyzed its psychometric properties in Italian pre-adolescents (n = 451) and adolescents (n = 446) and proposed its cut-off scores. Moreover, we investigated some demographic and study-related differences in studyholism and study engagement. The results supported the use of the SI-10 in pre-adolescents and adolescents. The fit indices are similar in the two samples (for adolescents, GFI = .98, RMSEA = .059). Moreover, we found a high prevalence of studyholism, especially in pre-adolescence (18.6&percnt;), and a decrease in study engagement in both genders from pre-adolescence to adolescence. In conclusion, the SI-10 might be used from pre-adolescence for research, preventive, and clinical purposes. Also, demographic-related results supported the definition of studyholism as an obsessive-compulsive related disorder.

A review of psychocutaneous disorders from a psychotherapeutic perspective-Toolkit for the dermatologist.

The study of psychocutaneous disorders requires a multidisciplinary approach. It is of paramount importance that dermatologists understand the psychiatric premise for these disorders. Mental health professionals can also benefit from a better understanding of the dermatologic manifestations of psychiatric disorders they may encounter in their practice. The aim of this study is to elevate the level of understanding regarding psychotherapeutic treatment of psychocutaneous disorders. We performed a literature review using the major databases. Four researchers reviewed English, full text, peer-reviewed articles that were published after 2000 using our specific search terms and inclusion/exclusion criteria. The majority of psychocutaneous disorders seem to be clustered among three DSM-5 disorders: depressive disorders, anxiety disorders, and obsessive-compulsive related disorders. Better recognition of the underlying psychiatric comorbidities may lead to improved patient outcomes.

Use of Lamotrigine in the pharmacological management of a lady with longstanding history of Trichotillomania

IntroductionTrichotillomania is characterized by recurrent pulling of one’s hair despite attempts of stopping, resulting in hair loss. Previously classified as impulse control disorder, it is now considered an obsessive-compulsive related disorder in DSM-5. First-line therapy is cognitive behavioural therapy (CBT), with strong support for habit reversal training. For pharmacological therapy, selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed. Clomipramine has been used but is limited by its side effect profile. Many patients continue to experience distressing symptoms despite current treatment methods.ObjectivesLamotrigine, an anticonvulsant medication, is frequently utilized by psychiatrists to treat conditions like Bipolar Disorder. However, its utility in treating Trichotillomania has not been explored. We are interested to find out if it could benefit patients who have not responded adequately to current available treatment.MethodsWe report a case of a lady suffering from Trichotillomania for many years with limited improvement despite active treatment. We follow her progress after being started on Lamotrigine for six months.ResultsIn our case, a lady with longstanding Trichotillomania has previously been treated with SSRIs and Chlomipramine with limited response. An incidental trial of Lamotrigine after stopping her other medications has led to sustained improvement and stabilization of her condition. A possible hypothesis on how Lamotrigine’s mode of action could have led to this improvement will explored in this paper.ConclusionsThis case illustrates the potential of Lamotrigine to treat Trichotillomania in someone who has not responded adequately to usual treatment and could be an area worth looking into for future research.DisclosureNo significant relationships.

The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders.

N-acetyl-L-cysteine (NAC) is a compound of increasing interest in the treatment of psychiatric disorders. Primarily through its antioxidant, anti-inflammatory, and glutamate modulation activity, NAC has been investigated in the treatment of neurodevelopmental disorders, schizophrenia spectrum disorders, bipolar-related disorders, depressive disorders, anxiety disorders, obsessive compulsive-related disorders, substance-use disorders, neurocognitive disorders, and chronic pain. Whilst there is ample preclinical evidence and theoretical justification for the use of NAC in the treatment of multiple psychiatric disorders, clinical trials in most disorders have yielded mixed results. However, most studies have been underpowered and perhaps too brief, with some evidence of benefit only after months of treatment with NAC. Currently NAC has the most evidence of having a beneficial effect as an adjuvant agent in the negative symptoms of schizophrenia, severe autism, depression, and obsessive compulsive and related disorders. Future research with well-powered studies that are of sufficient length will be critical to better understand the utility of NAC in the treatment of psychiatric disorders.

Neurocircuit dynamics of arbitration between decision-making strategies across obsessive-compulsive and related disorders

Obsessions and compulsions are central components of obsessive–compulsive disorder (OCD) and obsessive–compulsive related disorders such as body dysmorphic disorder (BDD). Compulsive behaviours may result from an imbalance of habitual and goal-directed decision-making strategies. The relationship between these symptoms and the neural circuitry underlying habitual and goal-directed decision-making, and the arbitration between these strategies, remains unknown. This study examined resting state effective connectivity between nodes of these systems in two cohorts with obsessions and compulsions, each compared with their own corresponding healthy controls: OCD (nOCD = 43; nhealthy = 24) and BDD (nBDD = 21; nhealthy = 16). In individuals with OCD, the left ventrolateral prefrontal cortex, a node of the arbitration system, exhibited more inhibitory causal influence over the left posterolateral putamen, a node of the habitual system, compared with controls. Inhibitory causal influence in this connection showed a trend for a similar pattern in individuals with BDD compared with controls. Those with stronger negative connectivity had lower obsession and compulsion severity in both those with OCD and those with BDD. These relationships were not evident within the habitual or goal-directed circuits, nor were they associated with depressive or anxious symptomatology. These results suggest that abnormalities in the arbitration system may represent a shared neural phenotype across these two related disorders that is specific to obsessive–compulsive symptoms. In addition to nosological implications, these results identify potential targets for novel, circuit-specific treatments.

The transdiagnostic nature of disgust propensity: An examination of its associations with anxiety and obsessive compulsive-related disorder symptoms

Significant research highlights the role of disgust propensity in obsessive-compulsive disorder (OCD) and other anxiety-based diagnoses and suggests that heightened disgust propensity may be a transdiagnostic risk factor for these disorders. However, OCD was reclassified from an anxiety to an obsessive-compulsive and related disorder (OCRD), due in part to OCD being associated with a range of non-anxiety affective experiences, including disgust. A fair amount of work has examined the relationship between disgust, OCD, and anxiety disorders; less information is available on its relation to the OCRDs. The present study examined associations between specific domains of disgust propensity and self-reported symptoms of several anxiety disorders, OCD, body dysmorphic disorder (BDD), and hoarding in two non-clinical samples. Results showed that specific phobia, OCD, and BDD symptoms were consistently and strongly correlated with disgust domains. Results of multivariate regression analyses indicated replicable relationships between animal-reminder disgust and specific phobia symptoms, core disgust and animal phobia symptoms, and contamination disgust and cleaning symptoms, controlling for negative affect, anxiety sensitivity, and experiential avoidance. Results were inconsistent for panic, BDD, and hoarding symptoms. These results partially support the argument that the OCRDs are more distinct than similar and that OCD and some anxiety disorders are defined by common psychological processes.

Animal Models of Psychiatric Disorders: A Literature Review

Introduction: Animal models have been used in many areas of research to provide insights into mechanisms and treatments for various disorders and diseases. For example, animals are often used in other areas of psychology, such as learning, with examples such as Pavlov’s dogs and Skinner’s rats. Further, animals have also been noted to exhibit psychiatric disorders that are frequently observed in humans, such as depression and anxiety. However, the use of animal models in other less studied fields of psychiatric research is unclear. This poses the questions: is the use of animals effective in studies of common mental health disorders? If so, what aspects of common mental health disorders do current studies focus on? Further, can disorders that have lower prevalence rates also be studied with the use of animals? This paper reviews the use of animals in the study of obsessive-compulsive related disorders of addiction, eating disorders, and trichotillomania (a disorder of compulsive hair-pulling) to answer these questions. Methods: Addiction, eating disorders, and trichotillomania were examined based on ease of study in non-human animals, and sufficient available literature. Nine articles for each disorder were examined to determine types of animals used, and the purpose of animal models in the study. Results: Research shows animal models are often used to study the etiology, genetics, mechanisms, and neurochemistry of psychiatric disorders. Animal models have high validity and translate well to humans. However, treatments of psychiatric disorders are less studied using animal models. Discussion: The review of the current literature suggests animal models are effective in studies of addiction, eating disorders, and trichotillomania. Animal models can be developed to inform various aspects of psychiatric disorders and should be expanded to include studies examining treatments as well. Further, food addiction also should be further assessed using animal models. Conclusion: Overall, animal models are useful in studying various aspects of psychiatric disorders and should continue to be used for those less commonly studied. Future studies with animal models should focus on psychiatric disorders that involve compulsive, repetitive behaviours.

Identification of Body Dysmorphic Disorder in Patients Seeking Corrective Procedures From Oral and Maxillofacial Surgeons.

Body dysmorphic disorder (BDD) is an obsessive-compulsive related disorder characterized by an individual's preoccupation with the appearance of at least 1 perceived physical flaw. The bodily concerns held by individuals with BDD are largely unnoticeable, if at all, to other individuals. Those living with BDD are compelled to engage in repetitive behaviors or cognitive acts that interfere with daily function and activities. Despite the high prevalence of BDD in patients who seek cosmetic procedures (ie, as high as 1 in 5 such patients) and the availability of validated screening tools for this disorder, implementing a protocol of regularly screening for BDD is only rarely practiced by surgeons. Few studies have investigated its prevalence in the setting of elective dentoalveolar and orthognathic procedures. With the scope of practice of maxillofacial surgeons expanding in recent years to include facial cosmetic procedures, it is becoming increasingly important to screen for such disorders so that patients and physicians can appropriately weigh the risks and benefits of surgical intervention. We conducted a cross-sectional cohort study (n = 46) consisting of 3 groups of patients, who were seeking either facial cosmetic, orthognathic, or dentoalveolar procedures. All patients in the study were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ) and assessed for severity of disorder using the BDDQ severity scale. Additional patient variables included age, sex, history of psychiatric diagnosis, primary diagnosis, and type of operation/procedure being sought. Among the 3 groups, patients seeking dentoalveolar surgery were the most represented (67%) in this sample, followed by cosmetic surgery (27%) and orthognathic surgery (6%). Twenty-six female participants and 20 male participants were included, with an overall mean age of 38 years. Two percent of participants carried a previous psychiatric diagnosis and 10.8% of the sample were classified as high-risk for BDD. The group containing the highest proportion of patients at high-risk for BDD were those seeking facial cosmetic procedures (16.7%), followed by those seeking dentoalveolar procedures (10%); none of the patients seeking orthognathic procedures were found to be at high-risk for BDD (0%). The BDDQ is an efficient way to screen for BDD in patients who are seeking orthognathic or facial cosmetic surgery. In our sample, patients presenting to maxillofacial surgeons for facial cosmetic surgery were found to score significantly higher on the BDDQ than those presenting for dentoalveolar surgery. In contrast to results of previous literature, patients seeking orthognathic surgery in our sample demonstrated no elevated risk for BDD, a finding which may be attributable to our small sample size. Ultimately, the data obtained from this study can aid surgeons in identifying patients with BDD in their own surgical practice, so that they may appropriately triage patients who may, or may not, benefit from surgical intervention.

The Future of Obsessive-Compulsive Spectrum Disorders: A Research Perspective.

Obsessive-compulsive disorder (OCD) sits at the epicenter of a spectrum of related conditions (often referred to as obsessive-compulsive related disorders (OCRD) or obsessive-compulsive spectrum disorders (OCSD)) that can be as disabling as they are varied in presentation. Research in the field now encompasses diverse disciplines ranging from inflammatory mechanisms to computational psychiatry, to neurocognitive endophenotypes to functional imaging to pharmacogenomics to brain stimulation approaches. As these disorders become more clearly elucidated, there is a need to continually re-evaluate the implications of research findings and to incorporate these findings into new treatment approaches that benefit both patients and clinicians. Even the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) is intended to be flexible and to incorporate validated and reliable biomarkers and neuroscience findings as they become available. This concluding chapter highlights just a few areas of study that promise to influence our understanding of the pathophysiology and clinical practice of OCRD. These include patient-centered outcomes research, the study of developmental brain trajectories in spectrum conditions, robot models of OCRDs, goal-directed versus habit-based behaviors, pharmacogenomics, problematic use of the Internet, and digital interventions. For example, digital medicine may become increasingly useful by identifying patients early on in the course of their illness; providing biomarkers to subtype patients; predicting treatment response; serving as a more proximal outcome measure of treatment response; or providing easily accessible and less costly forms of care. In order to address unmet clinical needs in OCRD, it is helpful to take an interdisciplinary perspective, and the work described in this collection of articles is likely to be invaluable in shaping the future of the field.

Cognitive Inflexibility in OCD and Related Disorders.

Cognitive inflexibility is suggested by the hallmark symptoms of obsessive-compulsive disorder (OCD), namely the occurrence of repetitive thoughts and/or behaviours that persist despite being functionally impairing and egodystonic to the individual. As well as being implied by the top-level symptoms, cognitive inflexibility in OCD, and some related conditions, has also been objectively quantified in case-control studies using computerised cognitive tasks. This chapter begins by considering the objective measurement of different aspects of cognitive flexibility using neuropsychological paradigms, with a focus on neural and neurochemical substrates. It moves on to conduct a systematic review and meta-analysis of findings from a widely deployed flexibility task: the Intra-Dimensional/Extra-Dimensional Set-Shift Task (IDED). By pooling data from 11 studies (335 OCD patients and 311 controls), we show that Extra-Dimensional (ED) shift deficits are a robust and reproducible finding (effect size medium-large) in OCD across the literature, and that this deficit is not attributable to group differences in age or IQ. The OCD ED deficit is then discussed in terms of dysfunction of fronto-striatal pathways (as exemplified, for example, by functional connectivity data), and the putative role of different neurotransmitters. We consider evidence that impaired ED shifting constitutes a candidate vulnerability marker (or 'endophenotype') for OCD. Theavailable literature is then surveyed as to ED findings in other obsessive-compulsive (OC) related disorders (e.g. hoarding, body-dysmorphic disorder, and trichotillomania), as well as in non-OC disorders (schizophrenia and anxiety symptoms in general). Lastly, we consider more recent, emerging developments in the quantification of compulsivity using cognitive tasks and questionnaires, as well as key directions for future research, including the need to refine compulsivity and its composite cognitive processes.

Social Media Peer Support Groups for Obsessive-Compulsive and Related Disorders: Understanding the Predictors of Negative Experiences

IntroductionAs social media platforms become commonplace in daily life, online peer support groups have become an increasingly popular resource for people living with physical and mental health issues. Although the benefits of using online peer support groups have been well documented, there can be also be significant risks associated with groups hosted on social media platforms. People living with obsessive-compulsive related disorders may be particularly vulnerable to negative experiences in such groups. MethodUsing a mixed-methods approach, the aim of the current study was to identify the predictors of negative experiences among people who used social media peer support groups for obsessive-compulsive and related disorders. ResultsResults indicated that barriers to treatment and quality of “offline” interpersonal support predicted users’ negative experiences in social media peer support groups for obsessive-compulsive and related disorders. Thematic analysis suggested that the contributing factors towards participants’ negative experiences included: (1) confronting content; (2) misinformation; (3) preoccupation with symptoms; (4) social comparison; and (5) hopelessness about recovery prospects. DiscussionIt was concluded that using social media peer support groups for obsessive-compulsive and related disorders, without adequate support structures in place, can pose users at the risk of negative experiences. Further research is necessary to gain a deeper understanding of how to enhance positive experiences and protect against the possible risks for users of unmoderated online peer support groups.

A CROSS SECTIONAL DESCRIPTIVE STUDY OF OCD IN CHILDREN AND ADOLESCENTS

This study was a part of a bigger multicentric study to examine the socio-demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD. Our sample comprised 30 subjects with OCD. Socio-demographic data was collected on a proforma specifically designed for this study. Clinical information was obtained on Structured clinical interview for Diagnostic and Statistical Manual, 5th edition Research Version (SCID), Children’s Yale Brown Obsessive Compulsive Scale (CYBOCS), the Children’s Depression Rating Scale–Revised (CDRS) and the Family Interview for Genetic Studies (FIGS). In our sample 70% of participants were male and 67.7% had onset of symptoms before 14 years of age. Most common obsessions in our participants were of doubts about contamination and magical thinking/superstitious while the most common compulsions were those involving checking, washing and rituals involving other persons. Comorbid psychiatric disorders were seen in 63.3% patients with most common being depression, Obsessive Compulsive Related Disorders (OCRDs), intermittent explosive disorder and anxiety disorder. The associated OCD symptoms on CYBOCS including lack of insight, avoidance and indecisiveness were on a spectrum. 46.6% had positive family history of OCD in first degree relative.