Role In Obsessive-compulsive Disorder Research Articles

Beliefs about losing control and other OCD-related cognitions: An experimental investigation

Background and objectivesCognitive theories of obsessive-compulsive disorder (OCD) suggest that dysfunctional beliefs influence symptoms. However, well-established belief domains do not fully explain OCD symptomatology, suggesting other cognitive mechanisms may be involved. An additional belief domain which may play a role in OCD is beliefs about losing control. Indeed, these beliefs have been found to be associated with OCD symptoms. However, the relationships between beliefs about losing control and other OCD phenomena, including other relevant dysfunctional beliefs, is unclear. The aim of this study was to examine the relationships between beliefs about losing control and appraisals hypothesized to be relevant to OCD. MethodsA total of 163 participants completed the experimental protocol, wherein they received false (positive or negative) feedback regarding the likelihood they may lose control and completed a vignette task asking them to read hypothetical scenarios relevant to OCD concerns (checking, and aggressive thoughts). Vignettes were followed by questions and prompts used to measure OCD-relevant appraisals. ResultsBased on MANOVAs, beliefs about losing control had a significant impact on appraisals in the checking, F (151) = 5.55, p = .001, and aggressive thoughts, F (151) = 2.898, p = .037, vignettes. However, planned comparison indicated that in the aggressive thoughts vignettes, this effect was in the opposite direction than was hypothesized. LimitationsThe losing control induction may have inadvertently influenced participants’ beliefs about the utility of thought control. ConclusionsFindings provide preliminary evidence for an association between beliefs about losing control and OCD-relevant appraisals.

Childhood emotional maltreatment, maladaptive coping and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder.

Previous studies have reported childhood emotional maltreatment (CEM) to be associated with specific obsessive-compulsive (OC) symptoms, but maladaptive coping, which may be the underlying mechanism in this relationship, has not been evaluated yet. Thus, the present study aimed to examine the effects of CEM on the OC symptoms of responsibility for harm and unacceptable thoughts, as well as obsessive-compulsive disorder (OCD) severity, through maladaptive coping, including cognitive avoidance, experiential avoidance and emotional suppression in OCD patients (n = 360). The results showed that CEM had direct effects, as well as indirect effects via cognitive and experiential avoidance and emotional suppression, on responsibility for harm and unacceptable thoughts. In addition, the indirect effect of CEM on OCD severity was significantly mediated by the roles of cognitive avoidance and experiential avoidance. The present study adds new literature to evidence indicating the role of early childhood events in developing and maintaining OCD in which adverse maladaptive coping related to unpleasant childhood abuse plays an important role in OCD. More precisely, OCD patients who experience a history of CEM may further use maladaptive coping to cope with their distress and subsequently experience responsibility for harm, unacceptable thoughts and severe OCD.

Changes in the psychological defense mechanism and clinical features of patients with OCD – A four-year follow-up study

ObjectiveThe present study aims to (1) follow up with 4-year changes in the efficacy outcome, defense style questionnaire (DSQ) score, and clinical features of patients with obsessive-compulsive disorder (OCD) and (2) analyze the relationship between different levels of efficacy and changes in the patients' psychological defense mechanisms. MethodsThe following data collection and 4-year follow-up were completed for 153 patients with OCD: (1) the treatment process, efficacy outcome, course of disease, and clinical features of OCD were collected using a self-made general information questionnaire and (2) the control method was used to analyze the changes in clinical symptoms (Yale–Brown obsessive compulsive scale [YBOCS], Hamilton anxiety score [HAMA], and Hamilton depression scale [HAMD]) in patients with OCD. Moreover, the changes in the psychological defense mechanism (measured by DSQ) and the relation between the prognosis and DSQ score were investigated. Results(1) The HAMA score (8.7 ± 4.8 points), HAMD score (12.0 ± 6.6 points) and YBOCS score (16.4 ± 8.4 points) were significantly lower during the follow-up than at the time of enrollment (p < 0.01). In the two DSQ evaluations, there were no significant differences in the factors, with the exception of a significant decrease in the use of “reaction formation” (t = 2.533, p = 0.015). The changes of mature defense factors in the significant efficacy group significantly increased (p < 0.01). Which was mainly manifested in the significant increase in the score of “sublimation” item, and the difference was extremely significant (t = −3.093, p = 0.006). ConclusionAn abnormal psychological defense mechanism plays an important role in OCD, and the use of a mature defense mechanism is significantly related to the treatment efficacy.

Are there differences in oxidative stress and inflammatory processes between the autogenous and reactive subtypes of obsessive-compulsive disorder? A controlled cross-sectional study.

Objective:To date, no study has investigated whether autogenous and reactive obsessive-compulsive disorder (OCD) types are different entities in terms of oxidative stress and inflammatory processes. The aim of this study is to compare them in terms of these features.Methods:The study was conducted in subjects with reactive OCD (n=19), autogenous OCD (n=14), and a control group (n=17). All participants were non-smokers. Sociodemographic data were collected and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Obsessive Beliefs Questionnaire (OBQ), and Overvalued Ideas Scale (OVIS) were administered. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), paraoxonase (PON1), total oxidant status (TOS), and total antioxidant status (TAS) were measured.Results:There were no significant differences in TAS, TOS, or oxidative stress index (OSI) between the OCD and control groups. PON1 and hs-CRP levels were higher in the OCD group, whereas IL-6 and IL-10 levels were lower. Comparison across the three groups revealed no differences in TAS, TOS, OSI, or PON1 levels; however, hs-CRP was significantly higher while IL-6 and IL-10 were significantly lower in the reactive group compared to controls.Conclusion:Our results show that, although inflammatory processes may play a role in OCD, the autogenous and reactive subtypes do not differ from each other in these respects. The classification of OCD into autogenous and reactive subtypes should be reevaluated.

Left Amygdala Functional Connectivity Decreased after Fear of Negative Events was Disregarded in Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental disorder that affects patients throughout their lives, leading to a diminished quality of life for patients and families, reduced productivity, and higher health care costs. It is of clinical and theoretical importance to investigate a more efficacious therapeutic approach for OCD and the neurophysiological mechanism underlying the efficacy of treatment, potentially associated with the etiology of OCD. Recently, a novel psychotherapy designated cognitive-coping therapy (CCT) has been reported to have a large effect size in OCD treatment. CCT hypothesizes that fear of negative events plays a crucial role in OCD. The study entitled “Decreased left amygdala functional connectivity by cognitive-coping therapy in obsessive-compulsive disorder” attempted to investigate the potential neurophysiological mechanism underlying the efficacy of CCT for OCD. The study provides crystal evidence showing that 4-week pharmacotherapy plus CCT decreases the left amygdala seed-based functional connectivity (LA-FC) with the right anterior cingulate gyrus and the left paracentral lobule/the left superior parietal/left inferior parietal, and 4-week CCT decreases the LA-FC with the left middle occipital gyrus/the left superior parietal. The alteration of the LA-FC with the right anterior cingulate gyrus positively correlates to the reduction of the Yale-Brown obsessive-compulsive scale (Y-BOCS) score. Therefore, it provides new insights into understanding the neurophysiology and neuropsychology behind the onset and treatment of OCD.

Antiglutamatergic agents for obsessive-compulsive disorder: Where are we now and what are possible future prospects?

Recent data suggest that obsessive-compulsive disorder (OCD) is driven by an imbalance among the habit learning system and the goal-directed system. The frontostriatal loop termed cortico-striatal-thalamo-cortical (CSTC) circuitry loop is involved in habits and their dysfunction plays an important role in OCD. Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD. Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABAergic transmission, and could represent the pathophysiology of OCD. Moreover, the dysregulation of glutamate levels can lead to neurotoxicity, acting as a neuronal excitotoxin. The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients. Indeed, some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission. Although robust data supporting a progression of such brain changes are not available so far, an early intervention could help interrupt damage from neurotoxicity. Moreover, agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients.

Obsessive-Compulsive Disorder and Decision Making under Ambiguity: A Systematic Review with Meta-Analysis.

In the last decade, decision-making has been proposed to have a central role in obsessive-compulsive disorder (OCD) aetiology, since patients show pathological doubt and an apparent inability to make decisions. Here, we aimed to comprehensively review decision making under ambiguity, as measured by the Iowa Gambling Task (IGT), in OCD, using a meta-analytic approach. According to PRISMA Guidelines, we selected 26 studies for a systematic review and, amongst them, 16 studies were included in a meta-analysis, comprising a total of 846 OCD patients and 763 healthy controls (HC). Our results show that OCD patients perform significantly lower than HC at the IGT, pointing towards the direction of a decision making impairment. In particular, this deficit seems to emerge mainly in the last three blocks of the IGT. IGT scores in OCD patients under the age of 18 were still significantly lower than in HC. Finally, no difference emerged between medicated and unmedicated patients, since they both scored significantly lower at the IGT compared to HC. In conclusion, our results are in line with the hypothesis according to which decision making impairment might represent a potential endophenotype lying between the clinical manifestation of OCD and its neurobiological aetiology.

Imagery Rescripting on Guilt-Inducing Memories in OCD: A Single Case Series Study.

Background and objectivesCriticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results.MethodsAfter monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to 3 months. Indexes of OCD, depression, anxiety, disgust, and fear of guilt were collected.ResultsPatients reported a significant decrease in OCD symptoms. The mean value on the Yale−Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the 3-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety.ConclusionsOur findings suggest that after ImRs intervention focusing on patients’ early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD.

Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions.

Cognitive fusion (CF) involves the tendency to "buy in" to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive-compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional cognitive-behavioural constructs (i.e., obsessive beliefs such as inflated responsibility), predict OCD symptoms. Fifty-two treatment-seeking adults with OCD completed self-report measures of CF, obsessive beliefs, OCD symptoms, and general distress. Domains of CF were differentially associated with the responsibility for harm, symmetry, and unacceptable thoughts of OCD dimensions; yet after accounting for obsessive beliefs, only the negative evaluation domain of CF significantly predicted symmetry OCD symptoms. Obsessive beliefs significantly predicted all OCD dimensions except for contamination. These findings provide additional support for existing cognitive-behavioural models of OCD across symptom dimensions, with the exception of contamination symptoms, and suggest that the believability of thoughts and feelings about negative evaluation adds to the explanation of symmetry symptoms. Conceptual and treatment implications, study limitations, and future directions are discussed.

The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?

Introduction: Obsessive-compulsive disorder (OCD) is a disabling illness that is associated with significant functional impairment. Although evidence-based pharmacotherapies exist, currently available medications are ineffective in some patients and may cause intolerable side effects in others. There is an urgent need for new treatments. Discussion: A growing body of basic and clinical research has showed that the endocannabinoid system (ECS) plays a role in anxiety, fear, and repetitive behaviors. At the same time, some patients with OCD who smoke cannabis anecdotally report that it relieves their symptoms and mitigates anxiety, and several case reports describe patients whose OCD symptoms improved after they were treated with cannabinoids. Taken together, these findings suggest that the ECS could be a potential target for novel medications for OCD. In this study, we review evidence from both animal and human studies that suggests that the ECS may play a role in OCD and related disorders. We also describe findings from studies in which cannabinoid drugs were shown to impact symptoms of these conditions. Conclusions: An emerging body of evidence suggests that the ECS plays a role in OCD symptoms and may be a target for the development of novel medications. Further exploration of this topic through well-designed human trials is warranted.

Later Bedtimes Predict Prospective Increases in Symptom Severity in Individuals with Obsessive Compulsive Disorder (OCD): An Initial Study

ABSTRACT Prior studies of sleep in individuals with OCD have often focused on sleep duration. Several studies have found that individuals with OCD sleep less than healthy controls while others have failed to find significant group differences. Addressing sleep timing has been much more rare, but have consistently shown that many individuals with severe OCD in inpatient facilities had markedly elevated rates of disruptions in sleep timing. We extend prior work by testing prospective relations between sleep and OC symptoms in individuals representing a range of OC symptom severity. Twenty-six individuals diagnosed with OCD, 18 healthy controls, and 10 with subthreshold OC symptoms, completed seven days of sleep diaries and OCD symptom ratings. Results showed that sleep timing (later bedtimes) predicted prospective increases in both obsessions and compulsions in individuals with OCD but not the other two groups. In contrast, there were no significant effects of sleep duration. The significant effects of sleep timing in the OCD group were maintained controlling for depressive symptoms and OCD symptoms did not predict prospective changes in sleep timing. In conclusion, there is increasing evidence that sleep timing may play an important role in OCD and additional work in this area is encouraged.

Consider Role of Glutamatergic Habenula-projecting Globus Pallidus in OCD.

Recently, in a review article in this journal, Vlček and colleagues described the putative role played by the glutamatergic system in obsessive-compulsive disorder (OCD) and how this might explain the effects of certain treatments. They describe a neuroanatomical model, which includes a specific role of the amygdala-hippocampus complex (AHC) and would complete the classic cortico-striatal-thalamo-cortical (CSTC) mechanism of OCD. The role of the AHC can perhaps be better understood when considering its ancient relationship to the rest of the forebrain of mammals. This leads to distinguishing between primary (lamprey-like), secondary (amphibian-like) and tertiary (mammal-like) parts of the forebrain including amygdaloid, ventral extrapyramidal and dorsal extrapyramidal systems, respectively. A specific role in OCD may be played by the habenula-projecting part of the pallidum, which evaluated the result of behaviour in human's earliest vertebrate ancestors. The addition of these primary relationship to the authors' description could be fruitful when planning the future research, as suggested by them.

Cognitive Errors and Psychological Resilience in Patients With Social Anxiety and Obsessive-Compulsive Disorder: A Cross-Sectional Study

Background: Cognitive errors have been presented as effective factors in the creation and continuation of obsessive– compulsive disorder and social anxiety disorder. Psychological resilience is an important factor in the tolerance of cognitive errors. Objective: The present study aimed to compare cognitive errors and the psychological resilience of patients with social anxiety disorder and those with obsessive–compulsive disorder. Methods: This cross-sectional study investigated a total of 60 patients, 30 with social anxiety disorder and 30 with obsessivecompulsive disorder (OCD), seen at a hospital in Zanjan city, Iran, in 2017. Participants were aged between 15 and 50 years. Participants were chosen using convenience sampling and on the basis of psychiatrist diagnosis and structured diagnostic interviews (SCID-I, II) according to the inclusion and exclusion criteria. The Cognitive Errors Questionnaire (CET) and the Connor-Davidson Resilience Scale (CD-RISC) were used to assess the variables. Results: A significant difference was observed between the two patient groups in the cognitive errors components (P≤0.05). In patients with OCD, the highest average rate of cognitive errors was related to catastrophizing and splitting error. In patients with SAD, the highest mean rate of cognitive errors was related to catastrophizing. There was no significant difference in psychological resilience between the two groups. Conclusion: Cognitive errors play an important role in OCD and social anxiety disorder (SAD). OCD patients were observed to make more cognitive errors than SAD patients. However, psychological resilience was equal between both groups.

Smoking Prevalence, Nicotine Dependence, and Impulsivity in Obsessive-Compulsive Disorder

This study compared obsessive-compulsive disorder (OCD) and control participants in terms of smoking prevalence, nicotine dependence, and impulsivity. Data derived from 314 OCD patients and 319 control participants revealed that smoking prevalence did not differ between the two groups yet the severity of nicotine dependence was higher among OCD patients. OCD group also exhibited greater total, cognitive, and non-planning impulsivity than controls, and this pattern of differences was also evidenced in OCD and control current and never smokers. In both OCD and control group, modest positive associations were found between impulsivity and nicotine dependence, yet the relationships were relatively stronger for the OCD group. Results are discussed in terms of how smoking, dependence, and impulsivity might articulate to play a role in obsessive-compulsive disorder.

I obsessively clean because deontological guilt makes me feel physiologically disgusted!

The emotions of guilt and disgust play a pivotal role in obsessive-compulsive disorder (OCD). The present study hypothesized the existence of a distinctive relation between deontological (but not altruistic) guilt and subjective and physiological correlates of disgust. Moreover, we aimed at testing whether the evoked emotion of disgust may activate OCD-like washing behaviors. Gender-matched healthy participants were randomly assigned to altruistic (n = 31) or deontological guilt (n = 30) inductions followed by a cleaning task, while their electrocardiogram was continuously recorded to derive vagally-mediated heart rate variability (HRV). At baseline and after each experimental condition, participants’ momentary emotional state was assessed by visual analog scales (VAS). Compared to altruistic guilt, deontological guilt had the effect of: a) enhancing the physiological correlate of disgust (i.e. augmented HRV); b) increasing OCD-like washing behaviors (e.g. checking). In both groups, washing behaviors had the effect to reduce the physiological correlate of disgust. These effects were stronger in participants with higher OC tendencies, as indicated by scores on the dispositional questionnaires. Results support previous reports on a distinctive relation between deontological guilt and both disgust and OCD symptoms.

What you see is what you do: Imagery and the moral judgements of individuals with OCD

BackgroundIt has been suggested that differences in moral judgements play a role in Obsessive Compulsive Disorder (OCD). Specifically, it has been proposed that individuals with OCD make moral judgements using more deontological rather than utilitarian principles. Visualising an image has also been linked to making deontological judgements in non-clinical populations; however, this has not yet been tested in individuals with OCD, who often experience intrusive imagery. MethodOne hundred and forty-five participants (including 30 with OCD and 27 in a comparison group) answered questions on moral dilemmas that required them to choose between deontological and utilitarian options. The mediational role of imagery in the relationship between OCD and deontological moral judgements was tested. ResultsA greater presence of OCD symptomatology was associated with making more deontological judgements. However, when compared by group, individuals with OCD did not make significantly more deontological judgements. Whilst imagery was found to have a relationship with moral judgements, this did not mediate the relationship between OCD and moral judgements. ConclusionsThe results suggest an association between moral judgements and OCD, not mediated by imagery.

Emotion regulation difficulties in obsessive-compulsive disorder.

Emotion regulation difficulties are implicated in psychological disorders but their role in obsessive-compulsive disorder (OCD) is unclear. Two studies examining these difficulties in OCD are presented. A community sample (Study 1; n=306) and a clinical OCD sample (Study 2; n=59) completed the Difficulties in Emotion Regulation Scale (DERS) and measures of depression, anxiety, and OCD. In Study 2, the OCD sample was compared to a matched control group (n=59, selected from Study 1). In Study 1, OCD was positively correlated with DERS total and subscale scores, and the DERS significantly predicted OCD severity even after accounting for age, gender, depression, and anxiety. In Study 2, emotion regulation difficulties were significantly higher in the clinical sample compared to the matched control group, even after accounting for depression and anxiety. Results showed that emotion regulation difficulties in OCD cannot simply be attributed to mood difficulties. Theoretical and treatment implications are discussed.

Manipulating beliefs about losing control causes checking behaviour

Cognitive theories of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs lead to the development of symptoms. However, psychometric studies have provided mixed evidence regarding whether beliefs about control over thoughts predict OCD symptoms above and beyond other obsessive beliefs. Clinical reports have documented concerns among those diagnosed with OCD regarding a potential loss of control over their thoughts and behaviour, indicating that broadening the scope of beliefs about control by integrating aspects of losing control may better explain their role in OCD. In this study, 133 undergraduate participants underwent a bogus EEG session and received (positive or negative) false feedback about the possibility that they may lose control over their thoughts and behaviour, and completed a task asking them to control the pace of pictures. As hypothesized, participants in the high (versus low) beliefs about losing control condition checked significantly more often which keys they should use to control the pictures, t(106.95) = 2.28, p = .02, d = .44, demonstrating that manipulating beliefs about control can impact checking behaviour when a potential loss of control is emphasized. Also, checking behaviour predicted a lower desire for control, such that compulsions may be seen as opportunities to re-establish disrupted control cognitions.

Is the concept of compulsion useful in the explanation or description of addictive behaviour and experience?

The concept of compulsion, in which addictive behaviour is said to be carried out against the will, is central to the disease theory of addiction and ubiquitous in modern definitions. The aims of this article are: (i) to describe various meanings of compulsion in the literature; (ii) to compare the part thought to be played by compulsion in addiction with its suggested role in obsessive-compulsive disorder; (iii) to critically examine the place of compulsion in influential neurobiological accounts of addiction; (iv) to summarise the empirical evidence bearing on the usefulness of the compulsion concept, evidence that seems at first sight incompatible with the notion of compulsion. This is followed by a discussion of which possible meanings of compulsion can survive an empirical test and what role they might play in understanding addiction, paying particular attention to a distinction between strong and weak senses of compulsion. A conclusion is that addictive behaviour cannot be considered compulsive at the time it is carried out, though other possible meanings of compulsion as an explanation or description of addictive behaviour and experience are discussed. Among other conclusions, it is suggested that, although in some senses of the term it may seem arbitrary whether or not ‘compulsion’ should be retained, its use has important consequences for the public understanding of addiction, and is likely to deter people's attempts to overcome their addictions and their chances of success.

Disgust proneness predicts obsessive-compulsive disorder symptom severity in a clinical sample of youth: Distinctions from negative affect

BackgroundAlthough studies have linked disgust proneness to the etiology and maintenance of obsessive-compulsive disorder (OCD) in adults, there remains a paucity of research examining the specificity of this association among youth. MethodThe present study employed structural equation modeling to examine the association between disgust proneness, negative affect, and OCD symptom severity in a clinical sample of youth admitted to a residential treatment facility (N =471). ResultsResults indicate that disgust proneness and negative affect latent factors independently predicted an OCD symptom severity latent factor. However, when both variables were modeled as predictors simultaneously, latent disgust proneness remained significantly associated with OCD symptom severity, whereas the association between latent negative affect and OCD symptom severity became nonsignificant. Tests of mediation converged in support of disgust proneness as a significant intervening variable between negative affect and OCD symptom severity. Subsequent analysis showed that the path from disgust proneness to OCD symptom severity in the structural model was significantly stronger among those without a primary diagnosis of OCD compared to those with a primary diagnosis of OCD. LimitationsGiven the cross-sectional design, the causal inferences that can be made are limited. The present study is also limited by the exclusive reliance on self-report measures. ConclusionsDisgust proneness may play a uniquely important role in OCD among youth.