Obsessional Intrusive Thoughts Research Articles

Homosexual Obsessive–compulsive Disorder Comorbid with Bipolar Disorder: A Rare Case report

IntroductionWhile bipolar disorder–obsessive compulsive disorder overlap is quite common, sexuality remains a largely unexplored area of this clinical entity.ObjectivesIllustrate through a clinical vignette the case of a patient with diagnosed homosexual obsessive –compulsive disorder (OCD) comorbid with bipolar disorder (BD).MethodsThe clinical case report was prepared through the review of the patient´s clinical record.ResultsWe report a rare case of a 22 year-old man who was diagnosed with Homosexual Obsessive–compulsive Disorder comorbid with Bipolar Disorder, admitted to our department for a suicide attempt. He came from a religious and conservative background and suffered from intrusive, unwanted mental images of homosexual behaviour since the age of 17. He presented periods of remission from his obsessive thoughts, while showing signs of elevated mood, talkativeness, restlessness, agitation and hyperactivity that would last for a few days, with recrudescence of obsessive and depressive symptoms again afterwards. The present case showed a significant reduction in depressive symptoms and in the impact of his obsessive intrusive thoughts after prescription of Risperidone and Sodium Valproate along with Exposure and Response Prevention Therapy conducted over a period of 6 weeks.ConclusionsThe homosexual OCD comorbid with bipolar disorder can cause important distress and impairment and severely impact a person’s life in multifaceted ways. Correct diagnosis, adequate medication and psychotherapy provide the effective treatment.Disclosure of InterestNone Declared

Obsessional intrusive thoughts in children: An interview based study.

We aimed to investigate the experience of obsessional intrusive thoughts (OITs) in a sample of children aged 8 to 10 years old and to test the main tenets of the cognitive model of OCD. Specifically, we assessed: (1) the prevalence of OITs experienced by young children; (2) their frequency and content; (3) the emotions they evoke; (4) the reasons why they are upsetting; (5) how they are appraised (6) and what control strategies they use. Forty-nine children (28 girls, 21 boys; mean age 9.1 years) from the community completed two self-report questionnaires assessing anxiety and obsessive-compulsive symptoms. Children were interviewed using the Children's Anxious Thoughts Interview, which assessed their experiences of OITs. From the 49 participants, 71.43% reported having experienced at least one OIT. The most frequent contents related to harm and doubt. Of the total sample, 28.6% reported having experienced one OIT recently with at least moderate frequency; these participants reported higher anxiety and obsessive-compulsive interference, described feeling nervous and anxious when experiencing their OIT, and rated their OIT as highly important and distracting. The most frequently reported control strategies were cognitive - suppression, distraction and thought replacement. Almost two thirds of community children reported experiencing OITs. The findings from this study provide preliminary support for the application of the cognitive model of OCD in children. Subtle differences from previous research with adults are discussed.

Are failures to suppress obsessive-intrusive thoughts associated with working memory?

Background and objectivesObsessive compulsive disorder (OCD) is characterised by repeated attempts to suppress obsessive-intrusive thoughts (OITs). Nonclinical individuals also regularly engage in thought suppression. Attempts to suppress OITs are often unsuccessful and there is wide variation in suppression abilities across nonclinical and clinical samples. Understanding the mechanisms that explain variations in suppression abilities could enhance our understanding of OCD. This study aimed to investigate one potential mechanism – working memory – using a comprehensive thought suppression task. MethodsEighty-three nonclinical participants completed a computerized thought dismissibility task (in which they replaced an obsessive-intrusive thought with a neutral thought), and a computerized working memory task. Participants also completed measures of OCD and negative mood. ResultsNone of the suppression variables (OIT frequency, mean OIT duration, mean latency to return, total OIT duration) were correlated with working memory capacity. Obsessive-compulsive symptoms were correlated with total OIT duration, but the relationship was not significant after controlling for negative mood. LimitationsThe thought dismissibility task does not account for differences in motivation to suppress OITs. The sample was non-clinical and mostly female. ConclusionAn individual's ability to suppress OITs is not associated with their working memory capacity, suggesting poor working memory does not explain persistent OITs in individuals with OCD.

The Frequency and Factor Structure of Obsessional Intrusive Thoughts in College Students Group

The Frequency and Factor Structure of Obsessional Intrusive Thoughts in College Students Group

The Frequency and Factor Structure of Obsessional Intrusive Thoughts in College Students Group

The Frequency and Factor Structure of Obsessional Intrusive Thoughts in College Students Group

Which Facets of Mindfulness Protect Individuals from the Negative Experiences of Obsessive Intrusive Thoughts?

Obsessive intrusive thoughts (OITs) are experienced by the majority of the general population, and in their more extreme forms are characteristic of obsessive–compulsive disorder (OCD). These cognitions are said to exist on a continuum that includes differences in their frequency and associated distress. The key factors that contribute to an increased frequency and distress are how the individual appraises and responds to the OIT. Facets of mindfulness, such as nonjudgment and nonreactivity, offer an alternative approach to OITs than the negative appraisals and commonly utilised control strategies that often contribute to distress. Clarifying the role of facets of mindfulness in relation to these cognitions offers a means to elucidate individual characteristics that may offer protection from distress associated with OITs. A sample of nonclinical individuals (n = 583) completed an online survey that assessed their experiences of OITs, including frequency, emotional reaction and appraisals, and trait mindfulness. The findings from a series of multiple regression analyses confirmed that specific facets of mindfulness relating to acting with awareness and acceptance (nonjudgment and nonreactivity) consistently predicted less frequent and distressing experiences of OITs. In contrast, the observe facet emerged as a consistent predictor of negative experiences of OITs. These findings suggest that acting with awareness and acceptance may confer protective characteristics in relation to OITs, but that the observe facet may reflect a hypervigilance to OITs. Mindfulness-based prevention and intervention for OCD should be tailored to take account of the potential differential effects of increasing specific facets of mindfulness.

Psychometric Properties of a Short Korean Version of the Revised Obsessive Intrusion Inventory.

ObjectiveThe Revised Obsessive Intrusion Inventory (ROII) is a 52-item scale that evaluates obsessional intrusive thoughts. The aim of the present study was to validate a short, 20-item Korean version of the ROII (ROII-20).MethodsOf the 1125 participants who completed the ROII-20, 895 participants completed the scale to examine the factor structure of the scale. A subgroup of these participants (n=53) completed the scale twice to determine test-retest reliability. To establish external validity, 230 participants completed the scale and other questionnaires.ResultsExploratory factor analyses suggested a hierarchical model comprising two higher order factors of autogenous obsessions (resulting from aggressive thoughts and sexual thoughts) and reactive obsessions (resulting from thoughts about contamination, thoughts about accidents, and thoughts about dirt). Confirmatory factor analyses supported this model. The results indicated good internal consistency and test-retest reliability. External validity was supported by relationships with obsessive-compulsive symptoms and general distress.ConclusionThe ROII-20 presents good psychometric properties and may be considered as a promising instrument for measuring obsessional intrusions.

Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities

Cognitive models of Obsessive Compulsive Disorder (OCD) purport that obsessions are normal intrusive thoughts that are misappraised as significant, leading to negative emotional responses and maladaptive attempts to control the thoughts and related emotions. This paper utilised a large multi-national dataset of interview data regarding intrusive thoughts, to investigate three questions related to the cognitive model of OCD and to its stability across cultures. First, the paper aimed to investigate the implicit yet-hitherto-untested assumption of cognitive models that misappraisals and control strategies for intrusive thoughts relate similarly across cultures. Second, this study aimed to build upon recent studies categorising intrusive thoughts into repugnant and non-repugnant categories, by investigating whether the content of intrusive thought moderates the relationship between the thoughts and appraisals and control strategies. Finally, this study aimed to provide further evidence regarding whether general beliefs implicated in cognitive models of OCD (e.g., responsibility, importance of thoughts) influence the occurrence of intrusions via maladaptive appraisals and control strategies. Overall, it was found that while overall intrusive thought frequency, distress, ease and importance of dismissal all varied significantly by site, their relationship with appraisals and control strategies did not. Generally, appraisals and action taken to confront the thought were the more consistent predictors, with the notably caveat that the relationship between thought frequency and appraisals was not strong. Second, repugnant vs. non-repugnant thought-content differed only with respect to thought frequency, but thought-content did not moderate the relationship between intrusive thoughts and control strategies and appraisals. Finally, appraisals and control strategies generally partially mediated the relationship between general OCD-related beliefs and the occurrence of, and distress associated with, intrusive thoughts. The results are taken to add credence to cognitive models of OCD and their validity across cultures.

Symptom dimensions in obsessive-compulsive disorder: Differences in distress, interference, appraisals and neutralizing strategies

Background and objectivesCognitive proposals about the mediating role of misinterpretations, emotional reactions, and control strategies in the escalation of obsessional intrusive thoughts (OIT) to clinical obsessions have received only partial support. This study aims to examine these variables, taking into account the obsession/OIT contents and the severity of the Obsessive-Compulsive Disorder (OCD). MethodsAfter identifying their most upsetting OIT/obsession, 61 OCD patients and 61 non-clinical individuals assessed the associated distress, interference and appraisals, and the strategies used to control the obsession/OIT. ResultsCompared with the nonclinical subjects, OCD individuals scored higher on all variables. The obsession's severity was associated with high disturbance, interference and dysfunctional appraisals, whereas the compulsion's severity was related to specific control strategies. Different obsessional contents produced similar emotional disturbance and interference. However, obsessional contents influence the amount of adscription to different dysfunctional appraisals and the frequency of use of several control strategies. LimitationsOur conclusions are limited by the scarce number of patients representing the various obsessive contents, specially order. ConclusionsOverall, superstitious obsessions were more dysfunctionally appraised than the other obsessional contents, inducing both covert and overt neutralizing strategies, whereas contamination obsessions were less dysfunctionally appraised.

Symptom dimensions in obsessive–compulsive disorder: From normal cognitive intrusions to clinical obsessions

Cognitive behavioral models of obsessive–compulsive disorder (OCD) assume continuity between normal obsessional intrusive thoughts (OITs) and obsessions. However, this assumption has recently been criticized. This article examines this issue using a new instrument (the Obsessional Intrusive Thoughts Inventory, INPIOS) specifically designed to assess the frequency and content of 48 OITs, which was completed by 734 community subjects and 55 OCD patients. Confirmatory factor analysis suggests six first-order factors included in two second-order factors, one containing aggressive, sexual, religious, immoral and repugnant OITs, and the other containing contamination, doubts and checking, symmetry and order, and superstition OITs. This structure integrates the research on OC symptoms and OITs. The INPIOS showed excellent known-groups validity, and it adequately represented obsessions as well as OITs. OCD and community subjects experience OITs representative of all types of obsessional contents. The dimensional structure is discussed in terms of OIT/obsessive–compulsive symptom structures currently proposed.

Are the dysfunctional beliefs that predict worry different from those that predict obsessions?

AbstractChronic worry present in Generalized Anxiety Disorder (GAD) and obsessions characteristic of the Obsessive–Compulsive Disorder (OCD) are cognitive phenomena that share some features, but they also differ on others. Based on current cognitive approaches, dysfunctional meta‐cognitive beliefs underlie the development and/or maintenance of both GAD and OCD. However, to date, there has been little empirical evidence about the differences between the beliefs that predict the occurrence of obsessions and those that predict worry. This study focuses on the search for these differences and examines to what extent worry and obsessions are associated with a similar or different pattern of dysfunctional cognitive contents. One hundred and seventy‐five community subjects completed measures of worry and obsessional intrusive thoughts, as well as questionnaires assessing obsession‐related and worry‐related meta‐cognitive beliefs. Results showed that beliefs about uncontrollability and danger, as well as cognitive self‐consciousness, play a central role in predicting worry, whereas the beliefs concerning the importance of thoughts and Thought–Action Fusion probability are relevant in accounting for the frequency of obsessive intrusive thoughts. Copyright © 2007 John Wiley & Sons, Ltd.

Postpartum onset obsessive-compulsive disorder: diagnosis and management.

The postpartum period is associated with an increased risk of developing obsessive-compulsive disorder (OCD) in women. Postpartum onset OCD is often undiagnosed and untreated resulting in serious consequences for the patient, her family and the newborn. The symptoms of postpartum onset OCD may consist of obsessional intrusive thoughts about harming the newborn without compulsions or with both obsessions and compulsions. In this review, the phenomenology of postpartum onset OCD is described as well as strategies for screening and diagnosis. The review also characterizes the differences between postpartum onset OCD and postpartum depression and postpartum psychosis and explores strategies for managing postpartum onset OCD patients. Issues regarding pharmacologic treatment of OCD in breastfeeding mothers are also reviewed.

Obsessional thoughts in postpartum females and their partners: Content, severity, and relationship with depression

Only a few studies have examined the development or exacerbation of obsessive–compulsive disorder (OCD) during pregnancy and the postpartum. Although the available literature suggests that OCD symptoms, particularly obsessional problems, develop at higher than expected rates among postpartum females, the overall prevalence of such symptoms in the postpartum remains unknown. Previous findings also suggest that intrusive distressing thoughts related to situational stressors are common in the general population. Therefore, the present study was designed to assess the presence and phenomenology of postpartum obsessive-like intrusive thoughts, images, and impulses in a large sample of parents with very young infants. Surveys were mailed to 300 childbearing women and their partners. Results were obtained from approximately one fifth of the sample; and 65% of respondents indicated the presence of obsessional intrusive thoughts. Intrusions were similar to “normal obsessions” as reported in previous research. Results are discussed in terms of the content of intrusive thoughts, their relationship to depression, and implications for etiological models of OCD and perinatal education.

Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 2

Differences between obsessions and worry have been clearly demonstrated on several variables [Langlois, F., Freeston, M. H., & Ladouceur, R. (2000). Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1. Behaviour Research and Therapy, 38, 157–173.]. Previous factor analysis of obsessions or worries have typically been used in developing measures for OCD and GAD symptoms. These studies generally support the distinctiveness of obsessions and worries but there have been no direct comparisons of the factor structure of obsession and worry on the same measure. This study aimed to compare the general structure of worry and obsessional intrusions. It also attempted to identify the relations between the respective factors identified in the appraisals of intrusions and the factor structures of coping strategies used in reaction to the thoughts. 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Different factor structures were obtained for worry and obsessive intrusive thoughts. However, the factor structure for the strategies used to counter the thoughts were highly similar for both types of thought. Furthermore, regression analysis identified interesting relationships between the strategies, the thought characteristics and appraisal. Thus, despite the ability to find differences between obsessive intrusive thoughts and worry, and even to accurately categorize them based on these differences, there may in fact exist common processes that are shared over much of a continuum. Sharp differences in the processes involved may only become clear in prototypical cases. The implications for models of cognitive intrusion are discussed.

Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1

Worry is the central characteristic of Generalized Anxiety Disorder (GAD) and obsessions are a central feature of Obsessive–Compulsive Disorder (OCD). There are strong similarities between these disorders: repetitive cognitive intrusions, negative emotions, difficulty dismissing the intrusion and finally, loss of mental control. Direct comparisons between obsessions and worries are almost non-existent in the literature but key distinctions have been proposed. The study attempted to specify the differences between obsessive intrusive thoughts and worry in a nonclinical population across a series of variables drawn from current models (appraisal, general descriptors and emotional reactions). 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Within-subject comparisons demonstrated significant differences on several variables: frequency, duration, percentage of verbal and image content, interference, egodystonic nature, stimuli awareness, emotions, etc. Most of these differences remained significant after controlling for frequency of thought. Discriminant analysis demonstrated a low classification error rate when using nine variables to categorize thoughts as obsessions or worries. Results generally support the differences postulated in the literature with the exception that obsessive intrusive thoughts are better controlled. The egodystonic/egosyntonic dimention emerged as an important variable in understanding obsessions and worry.

Process characteristics of worry and obsessive intrusive thoughts

One hundred and twenty-five university students were administered a battery of self-report measures to assess worry disposition and content, frequency of obsessive intrusive thoughts, and 10 conceptually derived appraisal dimensions of worry and obsessional intrusions. Process ratings indicated that the worrisome thoughts were considered more disturbing than the ego-dystonic intrusive thoughts. Worry was also distinguished by a focus on the possible consequences of negative events, whereas concern about the personal meaning of the thought was a unique process dimension for obsessive intrusive thoughts. Both content and process variables are important in differentiating worry and obsessive-like intrusive thoughts in a nonclinical population.

Process characteristics of worry and obsessive intrusive thoughts

Process characteristics of worry and obsessive intrusive thoughts

Perceived Control and Appraisal of Obsessional Intrusive Thoughts: A Replication and Extension

The present study had two purposes: 1) to examine the relationship between tendency to experience obsessional intrusive thoughts and tendency to worry; 2) to replicate and extend earlier findings (Purdon and Clark, 1993, 1994) on appraisal and thought suppression strategies in the persistence and control of obsessional intrusive thoughts. A sample of 160 college students were administered the Revised Obsessional Intrusions Inventory (ROII), the Penn State Worry Questionnaire (PSWQ), the Beck Depression Inventory (BDI), and the White Bear Suppression Inventory (WBSI). The ROII total score had minimal association with worry, trait thought suppression, or depressive symptoms, thereby supporting the distinctiveness of obsessional intrusive thoughts. Hierarchical multiple regression analyses revealed that cognitive appraisal, especially worries that the intrusion might come true in real life, accounted for a significant amount of variance in thought frequency and controllability. Thought suppression strategies accounted for substantially less variance in both frequency and control of intrusive thoughts. The results are discussed in terms of their support for Rachman's (1993) and Salkovskis' (1985, 1989) theories regarding the role of personal responsibility in the persistence of obsession-like intrusive thoughts.

Obsessive intrusive thoughts in nonclinical subjects. Part II. Cognitive appraisal, emotional response and thought control strategies

This second part of the study reports on the appraisal and thought control responses of 270 students to their most upsetting intrusive thought. Multiple regression analysis revealed that belief that one could act on the intrusive thought and perceived uncontrollability of the thought were the two most important predictors of the frequency, or persistence of the distressing intrusion. Intrusions rated as very difficult to control were also associated with increased belief that one could act on the intrusion, avoidance of situations that may trigger the intrusion, reduced success with one's most typical thought control strategy and higher thought frequency. Based on the Padua Inventory Total score, high and low obsessional Ss were selected. Highly obsessional individuals reported more unwanted obsessive intrusive thoughts and rated their thoughts as significantly more frequent and believable than low obsessive individuals. The type of thought control strategy typically used was not a factor in thought frequency and controllability, nor did it differentiate between high and low obsessional groups. The results are discussed in terms of Salkovskis' cognitive model of obsessions and intrusive thoughts.

Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms

The present study reports on the development and preliminary validation of a 52 item self-report instrument designed to assess intrusive thoughts, images and impulses that are similar to the aggressive, sexual and disease-related thinking characteristic of clinical obsessions. Two hundred and ninety-three students completed the Obsessive Intrusions Inventory (OII) as well as standard self-report measures of negative cognitions and obsessive, anxious and depressive symptoms. Regression analysis revealed that intrusive thinking was a significant and unique predictor of obsessional but not anxious or depressive symptoms. Furthermore, intrusive thinking showed a moderate correlation with anxious but not depressive cognitions. The results indicate that the intrusive thoughts assessed by the OII are distinct from other forms of negative thinking and may, in fact, constitute an analogue form of clinical obsessions in nonclinical populations.