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Aggarwal A, Qiao S, O'Leary SD, Schlekat KN, Li X. Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties. AIDS Behav 2024; 28:2054-2077. [PMID: 38441698 DOI: 10.1007/s10461-024-04305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 06/13/2024]
Abstract
Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA.
| | - Shannon D O'Leary
- College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Katrina N Schlekat
- Arnold School of Public Health, University of South Carolina Honors College, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
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2
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Petersen JM, Twohig MP. Sexual Orientation Intrusive Thoughts and Well-Being: The Mediating Role of Psychological Inflexibility. J Cogn Psychother 2023; 37:142-155. [PMID: 37258302 DOI: 10.1891/jcp-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sexual orientation intrusive thoughts are a debilitating form of obsessive-compulsive disorder. The present study aimed to elucidate how psychological inflexibility and dysfunctional beliefs may impact the relationships of sexual orientation intrusive thoughts and obsessive-compulsive (OC) symptoms with well-being. A total of 181 undergraduate students completed measures of sexual orientation intrusive thoughts, OC symptoms, psychological inflexibility, dysfunctional beliefs, and well-being. Results indicated positive correlations between psychological inflexibility, sexual orientation intrusive thoughts, dysfunctional beliefs, and OC symptoms, along with negative correlations between well-being and sexual orientation intrusive thoughts, OC symptoms, dysfunctional beliefs, and psychological inflexibility. Psychological inflexibility acted as a mediator between sexual orientation intrusive thoughts and well-being and between OC symptoms and well-being. Dysfunctional beliefs were not a significant mediator. These results suggest that psychological inflexibility may partially explain the association between OC symptoms and well-being, pointing toward the need for future research on the impact of psychological inflexibility on well-being in the context of OC symptoms.
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3
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Pinciotti CM, Smith Z, Singh S, Wetterneck CT, Williams MT. Call to Action: Recommendations for Justice-Based Treatment of Obsessive-Compulsive Disorder With Sexual Orientation and Gender Themes. Behav Ther 2022; 53:153-169. [PMID: 35227395 DOI: 10.1016/j.beth.2021.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/02/2022]
Abstract
Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance; identity concealment and discomfort; and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behavioral treatment of sexual orientation (SO) and gender-themed obsessive-compulsive disorder (OCD) has inadvertently reinforced anti-lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) stigma and contributed to minority stress in clients, treatment providers, and society at large. We present updated recommendations for treatment of SO- and gender-themed OCD through a more equitable, justice-based lens, primarily through eliminating exposures that contribute to minority stress and replacing them with psychoeducation about LGBTQ+ identities, and exposures to neutral and positive stimuli, uncertainty, and core fears. We also present recommendations for equitable research on SO- and gender-themed OCD.
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Affiliation(s)
| | | | - Sonia Singh
- South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences
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4
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Visvalingam S, Crone C, Street S, Oar EL, Gilchrist P, Norberg MM. The causes and consequences of shame in obsessive-compulsive disorder. Behav Res Ther 2022; 151:104064. [DOI: 10.1016/j.brat.2022.104064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
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Pittenger C, Brennan BP, Koran L, Mathews CA, Nestadt G, Pato M, Phillips KA, Rodriguez CI, Simpson HB, Skapinakis P, Stein DJ, Storch EA. Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 300:113853. [PMID: 33975093 PMCID: PMC8536398 DOI: 10.1016/j.psychres.2021.113853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry and Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.
| | - Brian P Brennan
- Biological Psychiatry Laboratory and Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Lorrin Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michele Pato
- Institute for Genomic Health and Department of Psychiatry, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, and Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Office of Mental Health, Research Foundation for Mental Hygiene, New York Psychiatric Institute, New York, NY, United States
| | - Petros Skapinakis
- Department of Psychiatry, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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6
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Ching THW, Rouleau TM, Turner E, Williams MT. Disgust sensitivity mediates the link between homophobia and sexual orientation obsessive-compulsive symptoms. Cogn Behav Ther 2021; 50:452-465. [PMID: 33475018 DOI: 10.1080/16506073.2020.1861083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous research has shown that intrusive thoughts in obsessive-compulsive disorder (OCD) often focus on emotionally significant aspects of individuals' lives (e.g., values and beliefs). The current study sought to expand our understanding of OC symptoms related to sexual orientation (SO-OC symptoms) by investigating the roles of homophobia (i.e., negative attitudes, affect, and behaviors toward individuals with a same-gender orientation) and disgust propensity and sensitivity. A total of 592 self-identified heterosexual college students were recruited to complete measures of homophobia, disgust propensity and sensitivity, and SO-OC symptoms. Results of separate parallel mediation analyses indicated that the relationships between homophobic affect/attitudes and avoidance/aggression on one hand, and SO-OC symptoms on the other, were partially mediated specifically by disgust sensitivity, after controlling for gender. Theoretical and clinical implications are discussed, including how homophobia can be conceptualized as a disgust response in the treatment of SO-OC symptoms, as well as how other constructs of potential interest (sexual and moral disgust, religiosity, conservative sexual ideology) can be examined in future research.
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Affiliation(s)
- Terence H W Ching
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Emma Turner
- Department of Trauma Research, Baylor Scott and White Research Institute, Dallas, TX, USA
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Aboujaoude E, Starcevic V. Case Report: Doubts and Pre-occupations About Being Transgender: Questioning One's Gender Identity or a Case of Obsessive-Compulsive Disorder? Front Psychiatry 2021; 12:644114. [PMID: 33859583 PMCID: PMC8042142 DOI: 10.3389/fpsyt.2021.644114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
We report the case of a biological female with gender identity-related doubts that were misconstrued as suggesting obsessive-compulsive disorder (OCD). The patient's parent seemed to favor an OCD explanation for the gender-based self-questioning over acceptance of possible transgender identity. We discuss what OCD is and what it is not in the context of gender identity-based doubt; analogy with the better studied sexual orientation-related OCD; cultural flashpoints around sex and gender that can become the object of OCD; how confusion about biological sex, assigned gender and gender identity can lead to clinical harm; and the role of mental health professionals in fighting the stigma faced by gender minorities.
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Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Psychiatry, Nepean Hospital, Penrith, NSW, Australia
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8
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Wetterneck CT, Pinciotti CM, Knott L, Kinnear K, Storch EA. Development and validation of the Adult OCD Impact Scale (AOIS): A measure of psychosocial functioning for adults with obsessive-compulsive disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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9
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Chentsova‐Dutton YE, Ryder AG. Cultural models of normalcy and deviancy. ASIAN JOURNAL OF SOCIAL PSYCHOLOGY 2020. [DOI: 10.1111/ajsp.12413] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Andrew G. Ryder
- Concordia University Montreal Quebec Canada
- Jewish General Hospital Montreal Quebec Canada
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Ching TH, Jelinek L, Hauschildt M, Williams MT. Association Splitting for Obsessive-Compulsive Disorder: A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2352096512666190912143311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Association splitting is a cognitive technique that targets obsessions in
obsessive-compulsive disorder (OCD) by weakening biased semantic associations among OCDrelevant
concepts.
Objective:
In this systematic review, we examine studies on the efficacy of association splitting for
reducing OCD symptoms.
Methods:
Following PRISMA guidelines, six studies were included, with diversity in sample characteristics,
mode of administration (i.e., self-help vs therapist-assisted), language of administration,
comparator groups, etc.
Results:
Results indicated that association splitting, as a self-help intervention, was efficacious in
reducing overall OCD symptom severity, specific OCD symptoms (i.e., sexual obsessions), subclinical
unwanted intrusions, and thought suppression, with small-to-large effect sizes (e.g., across
relevant studies, ds = .28-1.07). Findings were less clear when association splitting was administered
on a therapist-assisted basis as an add-on to standard cognitive-behavior therapy (CBT). Nonetheless,
across studies, the majority of participants reported high acceptability, ease of comprehension,
and adherence to daily association splitting practice.
Conclusion:
Although association splitting is an efficacious and acceptable self-help intervention
for OCD symptoms, future studies should include appropriate comparison groups, conduct longitudinal
assessments, examine efficacy for different symptom dimensions, and assess changes in semantic
networks as proof of mechanistic change. There should also be greater representation of
marginalized groups in future studies to assess association splitting’s utility in circumventing barriers
to face-to-face CBT. Ethical considerations are also discussed.
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Affiliation(s)
- Terence H.W. Ching
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269- 1020, United States
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marit Hauschildt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Monnica T. Williams
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269- 1020, United States
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Williams MT, Ching THW, Tellawi G, Siev J, Dowell J, Schlaudt V, Slimowicz JC, Wetterneck CT. Assessing Sexual Orientation Symptoms in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT). Behav Ther 2018; 49:715-729. [PMID: 30146139 DOI: 10.1016/j.beth.2017.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/09/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one's sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current paper details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure's 12 items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears; Factor 2: Somatic Checking) and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.
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Affiliation(s)
- Monnica T Williams
- University of Connecticut; Behavioral Wellness Clinic and Louisville OCD Clinic, Louisville, KY.
| | | | - Ghazel Tellawi
- Behavioral Wellness Clinic and Louisville OCD Clinic, Louisville, KY; University of Louisville
| | | | - Jessica Dowell
- Behavioral Wellness Clinic and Louisville OCD Clinic, Louisville, KY; University of Louisville
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12
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Ching THW, Williams MT, Siev J, Olatunji BO. Responsibility/Threat Overestimation Moderates the Relationship Between Contamination-Based Disgust and Obsessive-Compulsive Concerns About Sexual Orientation. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1109-1117. [PMID: 29476409 DOI: 10.1007/s10508-018-1165-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/03/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Disgust has been shown to perform a "disease-avoidance" function in contamination fears. However, no studies have examined the relevance of disgust to obsessive-compulsive (OC) concerns about sexual orientation (e.g., fear of one's sexual orientation transforming against one's will, and compulsive avoidance of same-sex and/or gay or lesbian individuals to prevent that from happening). Therefore, we investigated whether the specific domain of contamination-based disgust (i.e., evoked by the perceived threat of transmission of essences between individuals) predicted OC concerns about sexual orientation, and whether this effect was moderated/amplified by obsessive beliefs, in evaluation of a "sexual orientation transformation-avoidance" function. We recruited 283 self-identified heterosexual college students (152 females, 131 males; mean age = 20.88 years, SD = 3.19) who completed three measures assessing disgust, obsessive beliefs, and OC concerns about sexual orientation. Results showed that contamination-based disgust (β = .17), responsibility/threat overestimation beliefs (β = .15), and their interaction (β = .17) each uniquely predicted OC concerns about sexual orientation, ts = 2.22, 2.50, and 2.90, ps < .05. Post hoc probing indicated that high contamination-based disgust accompanied by strong responsibility/threat overestimation beliefs predicted more severe OC concerns about sexual orientation, β = .48, t = 3.24, p < .001. The present study, therefore, provided preliminary evidence for a "sexual orientation transformation-avoidance" process underlying OC concerns about sexual orientation in heterosexual college students, which is facilitated by contamination-based disgust, and exacerbated by responsibility/threat overestimation beliefs. Treatment for OC concerns about sexual orientation should target such beliefs.
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Affiliation(s)
- Terence H W Ching
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA.
| | - Monnica T Williams
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Jedidiah Siev
- Department of Psychology, Swarthmore College, Swarthmore, PA, USA
| | - Bunmi O Olatunji
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA
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Ching THW, Williams MT. Association splitting of the sexual orientation-OCD-relevant semantic network. Cogn Behav Ther 2017; 47:229-245. [DOI: 10.1080/16506073.2017.1343380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Terence H. W. Ching
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, USA
| | - Monnica T. Williams
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, USA
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Ching THW, Williams M, Siev J. Violent obsessions are associated with suicidality in an OCD analog sample of college students. Cogn Behav Ther 2016; 46:129-140. [PMID: 27659199 DOI: 10.1080/16506073.2016.1228084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Terence H W Ching
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Monnica Williams
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Jedidiah Siev
- b Psychology Department , Swarthmore College , Swarthmore , PA , USA
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Melli G, Moulding R, Gelli S, Chiorri C, Pinto A. Assessing Sexual Orientation-Related Obsessions and Compulsions in Italian Heterosexual Individuals: Development and Validation of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS). Behav Ther 2016; 47:431-43. [PMID: 27423161 DOI: 10.1016/j.beth.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/24/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022]
Abstract
Sexual Orientation-Obsessive-Compulsive Disorder (SO-OCD) is characterized by intrusive thoughts, images, and urges related to one's sexual orientation, and by consequent avoidance, reassurance seeking, and overt and covert compulsions. Currently there is no short self-report measure that assesses SO-OCD symptoms. The current article describes two studies that develop and evaluate the first version of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS), a 14-item Italian self-report measure targeted towards heterosexual individuals. In Study 1, the SO-OCS was developed and refined through item analysis and exploratory factor analysis from an initial pool of 33 items administered to 732 Italian nonclinical participants. The SO-OCS showed a unidimensional structure and an acceptable internal consistency. In Study 2, the factor structure, internal consistency, temporal stability, construct and criterion validity, and diagnostic sensitivity of the SO-OCS were investigated in three samples of Italian participants (294 from the general population, 52 OCD patients who reported sexual orientation-related symptoms or concerns as a primary complaint, and 51 OCD patients who did not report these symptoms as primary complaint). The SO-OCS was again found to have a unidimensional structure and good internal consistency, as well as to exhibit strong construct validity. Specifically, the SO-OCS showed an excellent criterion validity and diagnostic sensitivity, as it successfully discriminated between those with SO-OCD and all other groups of participants. Finally, evidence of temporal stability of the SO-OCS in a nonclinical subsample was found. The SO-OCS holds promise as a measure of SO-OCD symptoms in heterosexual individuals.
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Affiliation(s)
- Gabriele Melli
- University of Pisa; Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO).
| | | | - Simona Gelli
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO)
| | | | - Antonio Pinto
- Cognitive and Behavioral Psychotherapy Center, Naples
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Safer DL, Bullock KD, Safer JD. Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review. AACE Clin Case Rep 2016. [DOI: 10.4158/ep161223.cr] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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