Unacceptable Thoughts Research Articles

The Emotional Schemas and Obsessive-Compulsive Symptom Dimensions in People with Obsessive-Compulsive Disorder

Growing research shows an association between emotional schemas and psychopathology. Therefore, the study of emotional schemas in psychiatric disorders is an important issue regarding psychopathology. Also, emotional processes are important factors in relation to obsessive-compulsive disorder (OCD), but experimentally no study has examined the relations of emotional schemas to obsessive-compulsive (OC) symptom dimensions in people with OCD. The aims of this study were to compare emotional schemas between people with OCD and non-clinical control participants and to investigate the relationships between emotional schemas and OC symptom dimensions in OCD. Eighty individuals with OCD completed the Leahy Emotional Schema Scale (LESS) and measures of clinical characteristics. Results showed that people with OCD had higher scores on the maladaptive emotional schemas of guilt and uncontrollability than non-clinical control group. Non-clinical control participants had higher scores on the adaptive emotional schema of higher values than people with OCD. Guilt significantly predicted the OC symptom dimensions of responsibility for harm and symmetry after controlling for clinical characteristics. Uncontrollability was a significant predictor of the OC dimensions of unacceptable thoughts. These findings indicate that specific dimensions of maladaptive emotional schemas such as guilt and uncontrollability may be associated with some specific OC symptom dimensions in people with OCD. This study provided more evidence for Leahy’s emotional schema model in people with OCD.

MOSES’ ANXIETY AND DEFENSE MECHANISM IN EXODUS: GODS AND KINGS MOVIE

Anxiety is part of the defense mechanism. Defense mechanisms are psychological strategies unconsciously used to defend a person from anxiety arising from unacceptable thoughts or feelings. This study found the types of Moses’ anxiety and investigate the defense mechanism that Moses employed in reducing his anxiety by employing Freud’s concept as the main theory. The design of this research was qualitative research with content analysis as its approach. As the data, this study employed words including narrations and dialogues that were taken from Exodus Gods and Kings’ movie script. This study showed that Moses character experienced three types of anxieties covering neurotic anxiety, moral anxiety, and realistic anxiety. Furthermore, Moses employed five types of the defense mechanism covering repression, formation, isolation, denial, and aggression. The conclusion of this research considered Moses character experienced neurotic anxiety when he identified a boy that represented as the authority figure who was punishing him. The moral anxiety experienced in four times, overall happened when he felt guilty and realistic anxiety experienced three times because he managed some threats from the outer world. Moreover, all these features of the defense mechanism used to cope with Moses’s anxious feeling. The implication of this research provided another point of view in seeing Exodus: Gods and Kings' movie as the portrayal of the way how people can't suffer anxiety easily because anxious feeling happened from many factors and how people tried to use the defense mechanism to reduce anxiety.

The role of disgust propensity and sensitivity on sexual excitations and inhibition in obsessive-compulsive disorder.

Sexuality is understudied in Obsessive-Compulsive Disorder (OCD). According to the Dual Control Model, low sexual excitation (SE) and high sexual inhibition (SI) are indicative of a higher probability of experiencing a sexual dysfunction. The present study investigated SE and SI in OCD patients compared with controls. It was hypothesized that OCD patients report lower SE and higher SI than controls. Given their potential role as inhibitors of sexual response, it was hypothesized that in the OCD group higher disgust propensity/sensitivity, contamination/washing symptoms, unacceptable thoughts, and obsessive beliefs predicted lower SE, higher SI due to Threat of Performance Failure, and higher SI due to Threat of Performance Consequences. Seventy-two OCD patients and 72 controls matched on gender/age completed the Disgust Propensity and Sensitivity Scale-Revised, Obsessive Beliefs Questionnaire-46, Obsessive Compulsive Inventory- Revised, and Sexual Inhibition/Sexual Excitation Scales. OCD patients had higher SE, SI due to Threat of Performance Failure, and SI due to Threat of Performance Consequences than controls. In the OCD group, higher disgust sensitivity, SI due to Threat of Performance Consequences, and perfectionism predicted higher SI due to Threat of Performance Failure. Higher SI due to Threat of Performance Failure and contamination/washing symptoms predicted higher SI due to Threat of Performance Consequences. These findings highlight the presence of sexual difficulties in OCD patients, particularly a higher SE and SI. The latter is especially relevant in those patients with higher disgust sensitivity, contamination/washing symptoms and perfectionism. Psychotherapists should assess and target sexuality during clinicalpractice with OCD patients.

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.

OLIG2 gene polymorphisms are associated with nasty, unpleasant and uncontrollable thoughts in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is one of 10 major debilitating neuropsychiatric disorders, according to the World Health Organization (WHO), affecting around 2.3% of people worldwide. Obsessive-compulsive symptoms are caused by shared or distinct genetic or environmental influences. Several imaging studies have detected white-matter alterations in OCD, and recent studies have demonstrated thatOCD is associated with variations in the OLIG2 gene. The aim of this study was to investigate whether OLIG2 gene is associated with OCD and its clinical features in a Brazilian sample. We genotyped three variants in OLIG2 gene, rs762178, rs1059004, and rs9653711 in 205 OCD patients and 202 healthy controls by Taqman® methodology. Genotypes and alleles distributions were analyzed by χ2 or Fisher exact tests. The rs762178 and rs9653711 polymorphisms were significantly associated with OCD (P = 0.048 and 0.029, respectively). We also observed an association of rs1059004 and rs9653711 with the presence of Obsessive-Compulsive Inventory-Revised (OCI-R) obsessing (unacceptable thoughts) subscore (P = 0.031 and 0.034, respectively). Moreover, the pair of loci consisting of rs762178 and rs9653711 A-G haplotype was associated with OCD (P < 0.0001). The OLIG2 gene may be involved in OCD, particularly in patients showing nasty, unpleasant and uncontrollable thoughts. However, more studies in larger samples are needed to replicate these findings.

The Mediating Role of Emotion Regulation Difficulties in the Relationship Between Self-Compassion and OCD Severity in a Non-Referred Sample.

Self-compassion involves extending kindness and understanding to one's self. Research has demonstrated inverse relationships between self-compassion and maladaptive constructs associated with obsessive-compulsive disorder (OCD), including emotion regulation (ER) difficulties. The current study sought to explore associations between self-compassion, ER difficulties, and OCD severity. Data were collected at the International Obsessive-Compulsive Disorder Foundation convention from 62 attendees who reported having a diagnosis of OCD (51% male, mean age 35.9 years). Findings demonstrated that self-compassion and ER difficulties were associated with overall OCD severity. Results also indicated that ER difficulties mediated relationships between self-compassion and overall OCD severity, as well as the severity of two OCD symptom dimensions, responsibility for harm and unacceptable thoughts. These findings suggest that self-compassion and ER difficulties may be involved in the maintenance and severity of OCD.

Psychometric properties of the highly sensitive person scale and its relation to symptom dimensions in patients with obsessive-compulsive disorder

This study aimed to evaluate psychometric properties of the Persian version of the 25-item Highly Sensitive Person Scale (HSPS) with a three-factor structure including ease of excitation (EOE), low sensory threshold (LST), and aesthetic sensitivity (AES) (study 1) and to assess the relations of the HSPS factors to obsessive-compulsive (OC) symptom dimensions in patients with obsessive-compulsive disorder (OCD) by controlling for depression, anxiety, and OCD severity (study 2). Two hundred OCD outpatients and 100 healthy subjects were included in this study. Participants completed the Highly Sensitive Person Scale (HSPS), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS), and the Depression Anxiety Stress Scales (DASS-21). The results showed that the 20-item HSPS with three factors had an acceptable fit and good internal consistency, after removing five items. OCD patients scored higher on EOE and LST than healthy subjects. The results showed that LST significantly predicted responsibility for harm after controlling for OCD severity, depression, and anxiety. LST and AES were significant predictors of unacceptable thoughts. EOE significantly predicted symmetry. These findings suggest that the modified HSPS is a valid scale among Iranian OCD patients. In addition, the HSPS factors may be related to heterogeneous OC symptom dimensions.

Sharing Violent Thoughts on the Internet.

The anonymity of the Internet enables people to explore and share certain thoughts they may not feel comfortable sharing through traditional means. This is true for socially unacceptable thoughts, including violent and sexually sadistic fantasies. Despite one's relative freedom to explore virtually any subject anonymously, some Internet activities can attract unwanted attention from the media and law enforcement authorities. The case of former New York City police officer Gilberto Valle is illustrative of the problems that can be generated by online activities. This article discusses the case of United States v. Valle, 807 F.3d 508 (2nd Cir. 2015) and the tension between First Amendment protections and criminal activity. Forensic mental health experts may be well suited to educate the trier of fact about violent fantasies and their associated risks.

Examining the Relationships Between Perfectionism and Obsessive-Compulsive Symptom Dimensions Among Rural Veterans.

Perfectionism, a trait-like individual difference variable reflecting the tendency to set extremely high standards along with critical evaluations of one's own behavior, has long been regarded as a risk and maintenance factor for obsessive-compulsive disorder (OCD). However, research exploring the relationship between these constructs is mixed. One explanation for these equivocal findings is the heterogeneous nature of OCD. Indeed, there is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. The current study examined the associations between self-reported perfectionism and OCD symptom dimensions controlling for probable depression status. The sample included 67 rural veterans. Results revealed a unique association between perfectionism and the unacceptable thoughts dimension of OCD. These findings are consistent with a growing body of literature demonstrating that OCD symptom dimensions have unique underlying dysfunctional beliefs.

Validation of The Dimensional Obsessive‐Compulsive Scale for Mexican population

The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report instrument that addresses significant limitations of previous obsessive-compulsive (OC) symptom measures by separately assessing the severity of four OC symptom dimensions: contamination, responsibility for harm, unacceptable thoughts, and symmetry. Notably, no research has culturally adapted or validated the DOCS for the Mexican population (DOCS-M), and the current study seeks to bridge that gap. We recruited 457 adults, the majority of whom were college students, to evaluate the factor structure, internal consistency and convergent validity of the DOCS-M. A confirmatory factor analysis supported the four-factor structure. Moreover, excellent internal consistency was obtained for the subscale and total scores. Convergent validity was also supported through strong positive and significant correlations with the OBQ-SV and III-31-M. In sum, study findings suggest that the DOCS-M is a valid instrument for assessing OCD symptom dimensions and severity in a Mexican population.

Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions

Cognitive models of obsessive-compulsive disorder (OCD), although widely-supported, do not fully explain obsessive-compulsive (OC) symptoms. Mid-level constructs from acceptance and commitment therapy (ACT; e.g., experiential avoidance, cognitive fusion) may advance our understanding of OCD symptoms by adding explanatory power to existing conceptual models. The current study examined the extent to which mid-level ACT constructs account for unique variability in OCD symptom dimensions within a large treatment-seeking sample of individuals with OCD. In line with previous research in analogue samples, regression analyses revealed that although experiential avoidance and cognitive fusion showed associations with OCD symptoms, these constructs did not generally add to the prediction of OCD symptoms once general distress and obsessive beliefs were accounted for. An exception was that cognitive fusion was a unique predictor of unacceptable obsessional thoughts along with beliefs about importance of and need to control thoughts. These findings provide further support for the cognitive model of OCD as well as the notion that mid-level ACT constructs best relates to the unacceptable thoughts dimension of OCD. Conceptual and treatment implications, study limitations, and future directions are discussed.

Emotion Regulation in Patients with Obsessive Compulsive Disorder: Unique Effects for Those with “Taboo Thoughts”

Emotion regulation (ER) is a modifiable and transdiagnostic construct that has been widely studied across the affective disorders; however, little research has evaluated the relationship between ER and obsessive–compulsive (OC) features (e.g., OC symptom dimensions, OC symptom severity, and obsessive beliefs). The current study therefore evaluates the relationship between ER difficulties and OC features in the largest sample of adults with OCD to date. Participants (N = 57) completed a clinician-administered diagnostic and OC symptom assessment, as well as self-report questionnaires. Results revealed a specific relationship between ER difficulties, the unacceptable thoughts dimension, and obsessive beliefs, even after controlling for co-occurring depressive symptomology. Specifically, patients with “taboo thoughts” and elevated obsessive beliefs experienced greater difficulties accepting unwanted emotions, engaging in goal-directed behaviors when upset, accessing ER strategies, and clarifying emotions. Pending replication with a longitudinal framework, results highlight the utility of integrating emotion regulation modules into typical behavior therapy protocols for patients with unacceptable thoughts. Additional clinical implications, limitations and future directions are discussed.

Mental contamination obsessions: An examination across the obsessive-compulsive symptom dimensions

Mental contamination (MC) is an experience in which individuals feel dirty or impure even though they have not come into direct contact with a contaminated object (e.g., merely thinking about something immoral or disgusting). Although limited research has examined MC in relation to contact contamination-relevant cognitions and symptoms, no studies to date have investigated the extent to which this construct is associated with the “unacceptable thoughts” obsessive-compulsive (OC) subtype. In our sample of unselected participants (n = 304) who completed a self-report battery we found: (a) as in previous studies, MC was related to contact contamination OC symptoms and relevant cognitive distortions (i.e., threat overestimation and contamination thought action fusion), and (b) as hypothesized, MC was also associated with unacceptable thoughts symptoms and relevant cognitive distortions (intolerance of uncertainty and experiential avoidance). However, contrary to hypotheses, MC was also related to the responsibility for harm and symmetry/incompleteness OC symptom dimensions. Accordingly, rather than being uniquely tied to specific dimensions, it appears that MC may be associated with more general latent vulnerability factors associated with OCD. Additional implications for the way MC is conceptualized and treated and directions for further study are also discussed.

Early maladaptive schemas and suicidal risk in an Iranian sample of patients with obsessive-compulsive disorder

There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.

The relation of childhood trauma to suicide ideation in patients suffering from obsessive-compulsive disorder with lifetime suicide attempts

The aim of this study was to evaluate the relations of childhood trauma (CT) and obsessive-compulsive (OC) symptom dimensions to suicide ideation in patients with obsessive-compulsive disorder (OCD). Seventy OCD outpatients with lifetime suicide attempts and 60 controls were included. Participants completed the Scale for Suicide Ideation (SSI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). Among OCD patients, 97.1% had current suicide ideation. OCD patients revealed higher scores on CT, suicide ideation, depression and anxiety than controls. The CT history of sexual abuse (SA) and OC symptom dimension of unacceptable thoughts explained suicide ideation. It was concluded that SA and unacceptable thoughts may contribute to high suicidality and have important implications for the assessment and treatment of suicide risk in OCD patients with lifetime suicide attempts.

Anxiety sensitivity and obsessive-compulsive symptom dimensions: Further evidence of specific relationships in a clinical sample

The relationship between anxiety sensitivity (AS) and obsessive-compulsive disorder (OCD) has been widely recognized. The specific relationships between AS dimensions and OCD symptom dimensions are less often investigated and the existing studies have shown several limitations and have reported inconsistent results. The present study analyzed the role of AS dimensions in OCD, focusing on different types of OCD symptoms. Dimensional self-report measures of AS and OCD were administered to a clinical sample (86 OCD patients), together with measures of depression, anxiety, and obsessive beliefs. At a bivariate level, the symmetry dimension of OCD was strongly correlated with the social dimension of AS and moderately with the physical and cognitive dimensions. The other OCD and AS dimensions were weakly correlated or uncorrelated. Hierarchical regression analyses revealed that the symmetry dimension was mainly predicted by the social AS dimension and, to a lesser extent, by obsessive beliefs, while the responsibility for harm and mistakes dimension was predicted by obsessive beliefs, but not by the AS dimensions. Unexpectedly, the unacceptable thoughts and contamination OCD symptom dimensions were not predicted by any of the considered variables. Theoretical and clinical implications for the results pertaining to symmetry-related OCD symptoms are discussed.

Uncertain and Fused: Cognitive Fusion, Thought-Action Fusion, and the Intolerance of Uncertainty as Predictors of Obsessive-Compulsive Symptom Dimensions.

Cognitive-behavioral models of obsessions, although widely accepted, do not entirely explain obsessive-compulsive (OC) symptoms. Constructs from relational frame theory (RFT; e.g., cognitive fusion-the tendency for behavior to be overly regulated and influenced by cognition) may improve our understanding of OC symptoms above and beyond cognitive-behavioral constructs (e.g., intolerance of uncertainty [IU]). This study examined the extent to which cognitive fusion accounts for unique variability in four OC symptom dimensions: contamination, responsibility for harm, unacceptable thoughts, and order/symmetry. Participants completed measures of cognitive fusion, general distress, thought action fusion, IU, and OC symptoms. Regression analyses showed that IU and thought-action fusion (TAF) were significant predictors across the OC symptom dimensions; however, cognitive fusion was only a unique predictor of the unacceptable thoughts symptom dimension. Results support the notion that RFT may best relate to the unacceptable thoughts domain of OCD. Study findings, limitations, and future directions are discussed.

Dimensional Approach to Obsessive-Compulsive Disorder: Dimensional Obsessive-Compulsive Scale with Turkish Psychometric Properties

The Dimensional Obsessive Compulsive Scale (DOCS) is a measurement tool that examines the severity of thematically distinct symptom domains of obsessive compulsive disorder (OCD). In this study we assess psychometric properties of the Turkish version of DOCS. Ninety-six patients who presented consecutively to the Dışkapı Yıldırım Beyazıt Teaching and Research Hospital outpatient unit and who were diagnosed with OCD according to the DSM-IV-TR criteria were enrolled in the study. The DOCS, Yale-Brown Obsessive Compulsive Scale (YBOCS), and Padua Inventory (PI) were completed by the participants. Internal consistency was estimated using Cronbach’s Alpha values and item-total correlations. Principal component analyses with Varimax rotation were used to assess latent factor structure . Explanatory Factor Analyses (EFA) revealed a 4-factor solution for the DOCS. Chronbach’s alpha values for the whole scale, “contamination” sub-scale, “responsibility” sub-scale, “unacceptable thoughts”, and “symmetry” sub-scales were 0.874, 0.932, 0.933, 0.948, 0.921, respectively. There was a high correlation between both total scores and sub-scales scores of DOCS, YBOCS and PI. Internal consistencies were good for the total scale and excellent for the sub-scales. The factor structure and the contents of the factors were perfectly in line with the original scale (i.e. 4 factor). Positive correlations between DOCS, its sub-scales, and similar OCD scales suggest that the DOCS accurately measures the structures it claims to assess. Thus the DOCS Turkish version can measure dimensional obsessive compulsive symptoms among the Turkish speaking OCD population.

Cognitive Fusion, Experiential Avoidance, and Obsessive Beliefs as Predictors of Obsessive-Compulsive Symptom Dimensions

Cognitive-behavioral models of obsessions, which posit that such symptoms arise from the misinterpretation of intrusive thoughts, have empirical support. Yet, these models do not entirely explain obsessive-compulsive (OC) symptoms. Cognitive fusion, derived from relational frame theory (RFT), refers to the tendency for behavior to be overly regulated and influenced by cognition, and may incrementally improve our understanding of OC symptoms. The current study examined the extent to which constructs within these theoretical approaches predict various OC symptom dimensions. Participants completed measures of cognitive fusion, psychological flexibility, and obsessive beliefs, as well as OC symptoms. Regression analyses revealed that constructs from cognitive-behavioral and RFT models were associated with certain OC symptom dimensions. Moreover, RFT-related constructs uniquely predicted the unacceptable thoughts OC dimension over and above variance explained by cognitive-behavioral constructs. Results suggest...

Violent obsessions are associated with suicidality in an OCD analog sample of college students

The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.