Obsessive-compulsive Disorder Symptom Severity Research Articles

Low psychosocial functioning in obsessive–compulsive disorder and its clinical implications

Patients with obsessive–compulsive disorder (OCD) seem to be impaired in multiple domains of psychosocial functioning, but this is still insufficiently objectively measured. The Personal and Social Performance Scale (PSP) offers a validated, reliable and operational tool to assess the psychosocial functioning of patients. Using the PSP scale, examination of psychosocial functioning in a larger sample of outpatients with OCD (n=89) as well as its relationship to their specific psychopathology was conducted. Patients with severe OCD symptoms had low PSP total scores, especially in the sub-items of socially useful activities, personal and social relationships and disturbing and aggressive behaviors. Significant correlation coefficients were found between the PSP total score and the Y-BOCS as well as the Hamilton-Depression score. However, social parameters such as educational and occupational status were only related to PSP and Y-BOCS and not to HAM-D. Patients with OCD show similarly low psychosocial functioning values on the PSP scale to other patients with severe psychiatric diseases, e.g. schizophrenia, as reported in the literature, which was underestimated up to now. This relationship seems to be mainly mediated by comorbid depression. Psychosocial interventions specifically adapted for OCD patients should now be developed more and applied broadly.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Moderators

The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for obsessive–compulsive disorder (OCD) as well as potential moderators that may be associated with outcome. A literature search revealed sixteen randomized-controlled trials (RCTs) with a total sample size of 756 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges’s g = 1.39) and at follow-up (Hedges’s g = 0.43). Subsequent analyses revealed few moderators of CBT efficacy. Neither higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was significantly associated with a decrease in CBT effect size. Similarly, effect size did not vary as a function of ‘type’ of CBT, treatment format, treatment integrity assessment, blind assessment, age of onset, duration of symptoms, percentage of females, number of sessions, or percent comorbidity. However, active treatments showed small...

Characteristics of Young Children with Obsessive-Compulsive Disorder: Baseline Features from the POTS Jr. Sample.

Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that can emerge early in childhood and persist into adulthood. The primary aim of this paper is to examine the characteristics of a large sample of young children with OCD (age range from 5 to 8). The sample will be described with regard to: demographics, OCD symptoms/severity, family history and parental psychopathology, comorbidity, and global and family functioning. The sample includes 127 youth with a primary diagnosis of OCD who participated in a multi-site, randomized control clinical trial of family-based exposure with response prevention. Key findings include moderate to severe OCD symptoms, high rates of impairment, and significant comorbidity, despite the participants' young age. Discussion focuses on how the characteristics of young children compare with older youth and with the few other samples of young children with OCD. Considerations regarding generalizability of the sample and limitations of the study are discussed.

Validation of the Italian version of the Yale–Brown Obsessive Compulsive Scale–Second Edition (Y-BOCS-II) in a clinical sample

ObjectiveThe Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is the most widely accepted measure of obsessive–compulsive disorder (OCD) symptom severity. Recently, the scale has been revised into a second edition (Y-BOCS-II) in order to improve its measurement properties. The present study aimed to evaluate the psychometric properties of the Italian version of the Y-BOCS-II Severity Scale (SS) in a large clinical sample. MethodThe original version of the Y-BOCS-II was translated into Italian, which involved forward and back-translation procedures. The Italian Y-BOCS-II-SS was administered to one hundred twenty-five treatment-seeking adults with OCD, together with the original Y-BOCS-SS and a battery of self-report measures assessing OCD symptom severity and depressive and anxious symptomology. The factor structure, internal consistency, temporal stability, and construct validity were investigated on the whole sample, while inter-rater and test–retest reliability were assessed on a subsample of participants. ResultsFactor analyses revealed a two-factor structure different from those of the original scale, comprising (1) symptom severity; and (2) interference from symptoms. Internal consistency, test–retest reliability over a 2-week period and inter-rater reliability were satisfactory. The Y-BOCS-II-SS also showed excellent construct validity (and better than the Y-BOCS-SS), with good convergent and discriminant validity when assessed against other OCD symptom measures and measures of depression, anxiety and worry. ConclusionsThese findings suggest that the Italian version of the Y-BOCS-II-SS retains the adequate psychometric properties of the original and that it can be confidently used as an assessment tool of OCD symptoms in both clinical and research settings.

Neuropsychological dysfunction in adults with early-onset obsessive-compulsive disorder: the search for a cognitive endophenotype.

Evidence suggests that early-onset obsessive-compulsive disorder (OCD) is an etiologically distinct subtype of OCD. The objective of the present work was to search for neurocognitive endophenotypes of early-onset OCD based on assessments of attention, memory, and executive function in patients with the disorder and their unaffected siblings. We compared the performance of 40 adult patients with early-onset OCD, 40 of their unaffected siblings, and 40 unrelated healthy controls on a neuropsychological battery designed for this study. We searched for associations among test performance, demographic variables (age, sex and years of education) and clinical symptoms of early-onset OCD. Patients performed significantly worse than healthy controls on the Tower of Hanoi, and the Stroop and Wisconsin tests, indicating impairments in planning, mental flexibility and inhibitory control. The performance of the unaffected first-degree siblings of patients with early-onset OCD on the Stroop and Wisconsin tests also differed from that of healthy controls. Symptom severity in early-onset OCD was strongly correlated with performance on the Tower of Hanoi. Our findings support the existence of specific executive function deficits in patients with early-onset OCD. Relatives presented an intermediate phenotype between patients and controls, suggesting that executive functions such as mental flexibility and response inhibition may be considered candidate endophenotypes of early-onset OCD.

Outcomes of cognitive behaviour therapy for obsessive–compulsive disorder in young people with and without autism spectrum disorders: A case controlled study

Obsessive–compulsive disorder (OCD) and autism spectrum disorders (ASD) are highly co-morbid. It is suggested that youth with ASD will respond less well to cognitive behaviour therapy (CBT), as compared to their typically developing counterparts. To date there is no empirical evidence to support this view. The current study sought to compare CBT for OCD outcomes among youth with and without ASD. 22 young people with ICD-10 diagnoses of OCD and ASD (OCD+ASD) were matched with 22 youth with OCD, but no ASD (OCD+NoASD) according to base line OCD symptom severity, age, and gender. Outcomes were assessed for the two groups following a course of individually tailored, but protocol-driven CBT for OCD. While both groups responded to treatment the OCD+ASD group׳s outcomes were inferior to the OCD+NoASD group, as indicated by a significantly smaller decrease in symptoms over treatment (38.31% vs. 48.20%) and lower remission rates at post-treatment (9% vs. 46%). Overall, young people experiencing OCD in the context of ASD benefitted from CBT, but to a lesser extent than typically developing children. Recent efforts to modifying standard CBT protocols for OCD in ASD should continue in order to optimise outcomes among youth with this particular dual psychopathology.

Treatment expectancy for anxiety change and response to cognitive behavioral therapy for OCD

Although research investigating the role of treatment expectancy in treatment response showed positive associations for various anxiety disorder diagnoses, among individuals with obsessive-compulsive disorder (OCD) the results have been mixed. The purpose of the present study was to investigate the extent to which pre-treatment expectancy for anxiety change, as well as early changes in expectancy for anxiety change, are associated with response to 12 weeks of group cognitive behavioral therapy for OCD. Although pre-treatment expectancy for anxiety change did not significantly predict treatment response, increases in expectancy for anxiety change from pre-treatment to session four were significantly associated with reductions in OCD symptom severity at the end of treatment. Negative associations were observed between pre-treatment expectancy for anxiety change and pre-treatment OCD symptom severity, depression, anxiety, and stress symptom severity, and intolerance of uncertainty. The results support a role of treatment expectancy in OCD, and highlight the importance of assessing expectancy for anxiety change multiple times throughout treatment.

Reliability and validity of the Thai version of the Florida Obsessive-Compulsive Inventory.

This study aimed to examine the reliability and validity of the Thai version of the FOCI (FOCI-T), which is a brief self-report questionnaire to assess the symptoms and severity of obsessive-compulsive disorder (OCD). Forty-seven OCD patients completed the FOCI-T, the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL). They were then interviewed to determine the OCD symptom severity by the Yale-Brown Obsessive-Compulsive Scale-Second Edition (YBOCS-II) and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D), together with the Global Assessment of Functioning (GAF) and the Clinical Global Impression-Severity Scales (CGI-S). The result showed that the FOCI-T had satisfactory internal consistency reliability on both the Symptom Checklist (KR-20 = 0.86) and the Severity Scale (α = 0.92). Regarding validity analyses, the FOCI-T Severity Scale had stronger correlations with the YBOCS-II and CGI-S than the FOCI-T Symptom Checklist. This implied the independence between the FOCI-T Symptom Checklist and the Severity Scale and good concurrent validity of the FOCI-T Severity Scale. Our results suggested that the FOCI-T was found to be a reliable and valid self-report measure to assess obsessive-compulsive symptoms and severity.

Brain white matter integrity and association with age at onset in pediatric obsessive-compulsive disorder.

BackgroundObsessive-compulsive disorder (OCD) is a common and debilitating neuropsychiatric illness thought to involve abnormal connectivity of widespread brain networks, including frontal-striatal-thalamic circuits. At least half of OCD cases arise in childhood and their underlying neuropathology may differ at least in part from that of adult-onset OCD. Yet, only a few studies have examined brain white matter (WM) integrity in childhood-onset OCD using diffusion tensor imaging (DTI), and none have examined potential associations with age at onset.ResultsIn this study, 17 youth with OCD and 19 healthy control subjects, ages 10 to 19 years, underwent DTI on a 3T Siemens scanner. DSM-IV diagnoses were established with standardized interviews, and OCD symptom severity was evaluated using the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Voxel-wise analyses were conducted on data processed with tract-based spatial statistics (TBSS) to derive measures of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). OCD patients had significantly lower FA in seven WM clusters, with over 80% of significant voxels in bilateral frontal cortex and corpus callosum (CC). There were no regions of significantly higher FA in patients compared with controls. Patients also had significantly higher RD in right frontal cortex and right body of the CC. Earlier age at onset of OCD correlated significantly with lower FA in the right thalamus and with higher RD in the right CC. FA and RD were not significantly associated with symptom severity.ConclusionsThese findings point to compromised WM integrity and reduced myelination in some brain regions of children with OCD, particularly the CC and fiber tracts that connect the frontal lobes to widespread cortical and subcortical targets. They also suggest that age at onset may be a moderator of some of the WM changes in pediatric OCD.

Secondary Psychometric Examination of the Dimensional Obsessive-Compulsive Scale: Classical Testing, Item Response Theory, and Differential Item Functioning.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a promising measure of obsessive-compulsive disorder (OCD) symptoms but has received minimal psychometric attention. We evaluated the utility and reliability of DOCS scores. The study included 832 students and 300 patients with OCD. Confirmatory factor analysis supported the originally proposed four-factor structure. DOCS total and subscale scores exhibited good to excellent internal consistency in both samples (α = .82 to α = .96). Patient DOCS total scores reduced substantially during treatment (t = 16.01, d = 1.02). DOCS total scores discriminated between students and patients (sensitivity = 0.76, 1 - specificity = 0.23). The measure did not exhibit gender-based differential item functioning as tested by Mantel-Haenszel chi-square tests. Expected response options for each item were plotted as a function of item response theory and demonstrated that DOCS scores incrementally discriminate OCD symptoms ranging from low to extremely high severity. Incremental differences in DOCS scores appear to represent unbiased and reliable differences in true OCD symptom severity.

Extinction retention and fear renewal in a lifetime obsessive–compulsive disorder sample

Obsessive–compulsive disorder (OCD), like other illnesses with prominent anxiety, may involve abnormal fear regulation and consolidation of safety memories. Impaired fear extinction memory (extinction recall, ER) has been shown in individuals with current symptoms of OCD [1]. However, contrary to expectations, the only previous study investigating this phenomenon showed a positive correlation between extinction recall abilities and OCD symptomology (i.e., as OCD symptoms worsened, extinction memory improved). The purpose of the current study was to determine if patients with a lifetime diagnosis of OCD (not necessarily currently symptomatic) also demonstrate impairments in extinction memory, and the relationship between OCD symptomology and extinction memory in this type of sample. In addition, we also examined fear renewal, which has never been investigated in an OCD sample. We enrolled 37 patients with OCD, the majority of whom were on serotonin reuptake inhibitors, and 18 healthy control participants in a 2-day paradigm assessing fear conditioning and extinction (Day 1) and extinction retention and renewal (Day 2). Skin conductance responses (SCRs) were the dependent measure. Results, as in the prior study, indicated that the only between-group difference was impaired ER in OCD patients relative to controls. Contrary to our prediction, OCD symptom severity was not correlated with the magnitude of extinction recall. There were no differences in fear renewal between OCD patients and controls.

Clinical and Family Correlates of Coercive–Disruptive Behavior in Children and Adolescents with Obsessive–Compulsive Disorder

Obsessive–compulsive disorder (OCD) in youth is frequently associated with disruptive behaviors such as attacks of rage or temper. A common but insufficiently understood form of disruptive behavior in OCD is forceful attempts to impose symptom accommodation on family members. This study examined: (a) the phenomenology of coercive–disruptive behaviors in pediatric OCD, (b) child and family correlates of coercive–disruptive behavior; and (c) indirect effects of coercive–disruptive behavior on OCD symptom severity, mediated by family accommodation. We addressed these aims by evaluating the families of 61 treatment-seeking youth diagnosed with OCD, using structured interviews and maternal report scales. Most mothers reported coercive–disruptive behavior. Coercive–disruptive behavior was associated with severity of OCD symptoms, but not with particular symptom dimensions. Coercive–disruptive behavior was associated with anxiety, oppositionality and hyperactivity, but not with depression or inattentiveness. At the family level, coercive–disruptive behavior was associated with family accommodation and related parental distress but not with dimensions of family style. Hierarchical regression indicated that the family-level variable of accommodation contributed to predicting coercive–disruptive behavior, above and beyond child-level variables. The indirect pathway through family accommodation accounted for 97.13 % of the total effect of coercive–disruptive behaviors on OCD severity, supporting the mediational model. Overall, the data suggest that coercive–disruptive behaviors are common in youth with OCD and are more strongly linked to youth clinical features than to family style. Coercive–disruptive behaviors are a cause for concern and may lead to increased family accommodation, which has frequently been found to predict worse clinical outcomes.

Predictors and moderators of Internet-based cognitive behavior therapy for obsessive–compulsive disorder: Results from a randomized trial

Internet-based cognitive behavior therapy (ICBT) for obsessive–compulsive disorder (OCD) has shown efficacy in randomized trials but many patients do not respond to the treatment, we therefore need to find predictors and moderators of treatment response. In this study, we analyzed predictors of ICBT response using both post-treatment as well as 24-month outcome data. As half of the participants were randomized to receive an Internet-based booster program as an adjunct to ICBT, we also investigated moderators of ICBT with or without booster. Results showed that more severe baseline OCD symptoms predicted worse end state outcome but also higher degree of change. Furthermore, high degree of working alliance predicted better outcome but patients with primary disgust emotions had worse treatment effects. The moderator analysis also indicated that scoring high on the obsessing subscale on the Obsessive–Compulsive Inventory-Revised predicted worse treatment outcome in the booster group. In conclusion, there are some possible predictors and moderators of ICBT for OCD but more research is needed with larger and clinically representative samples.

Self-reported psychotic-like experiences in individuals with obsessive-compulsive disorder versus schizophrenia patients: Characteristics and moderation role of trait anxiety

Psychotic-like experiences (PLEs) have been found to manifest themselves on a continuum spanning both the general and clinical populations. Despite robust evidence that anxiety disorders are associated with increased risk of PLEs, little is known about their characteristics in obsessive compulsive disorder (OCD). Therefore, this study aimed to explore the phenomenological similarities and differences of PLEs in OCD versus schizophrenia patients and healthy controls, and to test the impact of distress symptomatology on PLEs in OCD patients. The survey included the Peter et al. Delusion Inventory, the Launay–Slade Hallucinations Scale, the Beck Depression Inventory II, the Spielberger State-Trait Anxiety Inventory, and measures of severity of OCD and schizophrenia symptoms. Considering the clinical groups as a whole, few differences were found for both delusions and hallucination-like experiences. Nevertheless, after controlling for emotional distress differences between OCD and schizophrenia patients in some PLEs became significant. Moreover, obsessive symptoms moderated by anxiety trait predicted levels of delusion-like experiences in OCD patients. This study highlights PLEs are also present in OCD patients, in particularly in presence of higher emotional distress and that anxiety trait plays a relevant role in the development and maintenance of delusion-like experiences in OCD patients.

Paediatric Obsessive-Compulsive Disorder and Depressive Symptoms: Clinical Correlates and CBT Treatment Outcomes

Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 – 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 – 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms.Electronic supplementary materialThe online version of this article (doi:10.1007/s10802-014-9943-0) contains supplementary material, which is available to authorized users.

Moderators of Impairment Agreement among Parent-Child Dyads in Pediatric Obsessive-Compulsive Disorder.

Inter-rater agreement for symptom impairment associated with obsessive-compulsive disorder (OCD) varies between parents and children. However, extraneous variables that may influence these agreement differences have scarcely been examined. Therefore, the purpose of this paper was to examine moderators of parent and child agreement on ratings of overall OCD-related impairment and impairment across three domains (i.e., school, social, home) as measured by the Children's OCD Impact Scale - Child and Parent versions (COIS-C/P). One hundred sixty-six children with OCD and their parents completed ratings of symptom severity, impairment, and demographics, among other measures, prior to psychosocial treatment initiation. Overall parent-child agreement of impairment was in the moderate range. Age, OCD symptom severity, resistance and control, obsession and compulsion severity, and insight emerged as moderator variables, with the direction of moderation varying by domain. Results, implications, and study limitations are discussed.

Association of Metacognitive Beliefs, Obsessive Beliefs and Symptom Severity With Quality of Life in Obsessive–Compulsive Patients

The aim of this study was to evaluate the association of obsessive beliefs, obsessive–compulsive disorder severity and metacognitive beliefs to the quality of life in patients with obsessive–compulsive disorder (OCD). Sixty one adults with a principal diagnosis of OCD were recruited for the study. Participants were assessed by trained clinicians using an unstructured clinical interview, the Obsessive Beliefs Questionnaire, the Yale–Brown Obsessive–Compulsive Scale, the Metacognitive Beliefs Questionnaire and the WHO Quality of Life Questionnaire. Data were analyzed using Pearson's of correlation coefficients and multiple regression analyses. Findings indicate that obsessive beliefs, severity total OCD and metacognitive beliefs were associated with total quality of life scores. Regression analysis revealed that while OCD total severity explained 40.1% of the variance in total quality of life, obsessive beliefs (perfectionism/certainty domain) and metacognitions (cognitive self-consciousness and negative beliefs about thoughts in general) explained an additional 13.7%, 7.7% and 5.4% of the variance in QoL. Findings indicate that the metacognitive beliefs associated with OCD symptom severity are different from that associated with quality of life. The implications are that metacognitive therapy aimed at symptom reduction may not necessarily result in improved QoL in OCD patients.

Hoarding in children and adolescents with obsessive–compulsive disorder

Compared to studies in adults, there have been few studies of hoarding in children and adolescents with obsessive–compulsive disorder (OCD). In the current study, we evaluated OCD clinical features, Axis I disorders, and social reciprocity scores in 641 children and adolescents with OCD, of whom 163 (25%) had hoarding compulsions and 478 did not. We found that, as a group, youth with hoarding had an earlier age at onset and more severe lifetime OCD symptoms, poorer insight, more difficulty making decisions and completing tasks, and more overall impairment. The hoarding group also had a greater lifetime prevalence of panic disorder, specific phobia, Tourette disorder, and tics. As measured with the Social Reciprocity Scale, the hoarding group had more severe deficits in parent-rated domains of social communication, social motivation, and restricted interests and repetitive behavior. In a multivariable model, the overall social reciprocity score, age at onset of OCD symptoms, symmetry obsessions, and indecision were independently related to hoarding in these children and adolescents with OCD. These features should be considered as candidate risk factors for the development of hoarding behavior in pediatric OCD.

Personality and symptom severity in Obsessive–Compulsive Disorder: The mediating role of depression

Elevated levels of Neuroticism and lower levels of Extraversion have been reliably shown in patients with anxiety and depressive disorders and some studies have demonstrated these patterns amongst patients diagnosed with Obsessive–Compulsive Disorder (OCD). However, because comorbid anxiety and depression is common in OCD, it is unclear whether the previously observed relationships are due to comorbid anxiety and depression or are more specifically related to the presence of OCD. This study sought to disentangle the relationship between personality and OCD by investigating the relationship between Extraversion, Neuroticism and OCD symptom severity and illness duration. Additionally, we explored the relationship between these variables and the additional variable of depression. Specifically, we tested whether depression mediated these relationships amongst a sample of 322 outpatients diagnosed with OCD. We found that depression fully mediated the relationship between personality and OCD symptom severity but not duration. Indeed, neither personality nor depression could explain illness duration. The results suggest that depression is an important variable to consider when understanding OCD symptom severity and trumps personality variables in terms of its explanatory power. The results also suggest that further work is needed to identify the variables that best explain illness duration in OCD.

The treatment of obsessive‐compulsive checking: A randomised trial comparing danger ideation reduction therapy with exposure and response prevention

Standard psychological treatment of obsessive‐compulsive disorder (OCD) typically involves the behavioural‐based therapy exposure and response prevention (ERP). This study compared the effectiveness of ERP with the recently developed cognitive therapy‐based treatment package, Danger Ideation Reduction Therapy for obsessive‐compulsive checkers (DIRT‐C) (Vaccaro, Jones, Menzies, and St Clare). Both treatments were delivered in 14 1‐hr individual weekly sessions. Post‐treatment intention‐to‐treat analysis revealed large statistically significant improvements for participants in both ERP (n = 22) and DIRT‐C (n = 28) conditions. However, treatment effect sizes for change in OCD symptom severity at post‐treatment were greater for DIRT‐C than for ERP (3.74 versus 2.89). In addition, at post‐treatment assessment, significantly more participants who received DIRT‐C were recovered compared with those who received ERP (43% versus 14%). Similarly, at 6‐month follow‐up, treatment effect sizes for change in OCD symptom severity were greater for DIRT‐C than for ERP (3.9 versus 2.76). This study provides further evidence of the usefulness of the DIRT‐C package for people with OCD checking subtype. Future research investigating DIRT‐C is warranted.