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Wairauch Y, Siev J, Hasdai U, Dar R. Compulsive rituals in Obsessive-Compulsive Disorder - A qualitative exploration of thoughts, feelings and behavioral patterns. J Behav Ther Exp Psychiatry 2024; 84:101960. [PMID: 38513433 DOI: 10.1016/j.jbtep.2024.101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Rituals are common among healthy individuals and across cultures and often serve adaptive purposes. In individuals with obsessive-compulsive disorder (OCD), rituals become compulsive, time-consuming and distressing, and may lead to functional impairment. Previous research has examined the functions and characteristics of compulsive rituals, but there is paucity of in-depth, first-person reports about this topic. METHOD We used a qualitative approach to explore thoughts, feelings, and behavioral patterns that characterize OCD rituals. Ten individuals with OCD participated in a semi-structured interview that focused on their most prominent compulsive ritual. The interviews were subjected to a thematic analysis. RESULTS Eight themes emerged from the analysis and were organized in two main categories: Micro Level perspective, comprising triggers, attention, emotional changes, and stopping criteria; and Macro Level perspective, comprising feelings and perceptions, change over time, motives, and inhibitors. The findings shed light on the role of fixed rules and feelings of "completeness" in OCD rituals, the nature of emotional and attentional characteristics during rituals performance, and the evolution of compulsive rituals over time. LIMITATIONS This study used a qualitative approach based on a small number of participants, which limits the generalizability of the findings. CONCLUSION Our results, if replicated, may have clinical implications. The reported patterns of anxiety reduction during ritual performance may contribute to the fine-tuning of CBT for OCD. The findings concerning the nature of attention during ritual performance and the development of rituals over time may be important for understanding the mechanisms that maintain compulsive rituals.
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Affiliation(s)
- Yair Wairauch
- School of Psychological Sciences, Tel Aviv University, Israel
| | | | - Udi Hasdai
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Israel.
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Korka B, Will M, Avci I, Dukagjini F, Stenner MP. Strategy-based motor learning decreases the post-movement β power. Cortex 2023; 166:43-58. [PMID: 37295237 DOI: 10.1016/j.cortex.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023]
Abstract
Motor learning depends on the joint contribution of several processes including cognitive strategies aiming at goal achievement and prediction error-driven implicit adaptation. Understanding this functional interplay and its clinical implications requires insight into the individual learning processes, including at a neural level. Here, we set out to examine the impact of learning a cognitive strategy, over and above implicit adaptation, on the oscillatory post-movement β rebound (PMBR), which typically decreases in power following (visuo)motor perturbations. Healthy participants performed reaching movements towards a target, with online visual feedback replacing the view of their moving hand. The feedback was sometimes rotated, either relative to their movements (visuomotor rotation) or invariant to their movements (and relative to the target; clamped feedback), always for two consecutive trials interspersed between non-rotated trials. In both conditions, the first trial with a rotation was unpredictable. On the second trial, the task was either to re-aim, and thereby compensate for the rotation experienced in the first trial (visuomotor rotation; Compensate condition), or to ignore the rotation and keep on aiming at the target (clamped feedback; Ignore condition). After-effects did not differ between conditions, indicating that the amount of implicit learning was similar, while large differences in movement direction in the second rotated trial between conditions indicated that participants successfully acquired re-aiming strategies. Importantly, PMBR power following the first rotated trial was modulated differently in the two conditions. Specifically, it decreased in both conditions, but this effect was larger when participants had to acquire a cognitive strategy and prepare to re-aim. Our results therefore suggest that the PMBR is modulated by cognitive demands of motor learning, possibly reflecting the evaluation of a behaviourally significant goal achievement error.
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Affiliation(s)
- Betina Korka
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany.
| | - Matthias Will
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Izel Avci
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | | | - Max-Philipp Stenner
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany
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Ferrante D, D'Olimpio F. Who guards over obsessive fear of guilt? The case of Not Just Right Experiences and disgust. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zaccari V, Rogier G, Pulsinelli D, Mancini F, D’Olimpio F. Explaining Interaction of Guilt and Obsessive-Compulsive Symptoms in Not Just Right Experiences. CLINICAL NEUROPSYCHIATRY 2022; 19:39-44. [PMID: 35360469 PMCID: PMC8951168 DOI: 10.36131/cnfioritieditore20220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective "Not Just Right Experiences" (NJREs) are currently considered a characteristic of Obsessive-Compulsive Disorder (OCD). Significant associations have been found between NJREs and Obsessive-Compulsive (OC) symptoms in nonclinical and clinical populations. Literature support a significant relationship between NJREs, feelings of guilt and OC features. This study aims to clarify the role of the potential interplay between guilt and OC symptomatology in NJREs and verify if high levels of guilt will predict NJREs and OC symptoms and trait guilt levels will positively interact in their prediction of NJREs. Method One hundred and eighty-nine adults recruited from normal population were assessed with questionnaires of NJREs and OC symptoms and proneness to experience guilt. Results All the variables involved in the study (NJREs severity, guilt and OCI-R scores) were positively and significantly correlated and showed that guilt and OCI-R scores significantly and positively interact in the prediction of NJREs levels. Guilt predicted NJREs only when levels of OCI-R were high. Conclusions These results support the association between guilt sensitivity or OC symptoms and NJREs in clinical and nonclinical participants and that a disposition toward high levels of guilt and OC symptoms have a particular sensitivity to NJREs corroborating centrality of guilt in OC symptoms.
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Affiliation(s)
- Vittoria Zaccari
- School of Cognitive Psychotherapy, Rome, Italy, Department of Psychology, University Guglielmo Marconi, Rome, Italy,Corresponding author Vittoria Zaccari E-mail:
| | - Guyonne Rogier
- Educational Sciences Unit, University of Genoa, Genova, Italy
| | - Daniela Pulsinelli
- School of Cognitive Psychotherapy, Rome, Italy, Department of Psychology, University Guglielmo Marconi, Rome, Italy
| | - Francesco Mancini
- School of Cognitive Psychotherapy, Rome, Italy, Department of Psychology, University Guglielmo Marconi, Rome, Italy
| | - Francesca D’Olimpio
- Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy
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Are “not just-right experiences” trait and/or state marker for obsessive-compulsive disorder? THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Cerea S, Lovetere G, Bottesi G, Sica C, Ghisi M. The relationship between body dysmorphic disorder symptoms and 'not just right' experiences in a sample of individuals seeking cosmetic surgery and aesthetic medicine procedures. Clin Psychol Psychother 2021; 29:1034-1049. [PMID: 34723408 DOI: 10.1002/cpp.2683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is characterized by concerns for perceived defects in physical appearance that appear to others as mild or unobservable. Individuals with BDD frequently refer concerns with their physical appearance being 'not right' (not just right experiences; NJREs), and BDD-related behaviours may be performed until their appearance is perceived as 'right'. The aim of the study was to explore the relationship between BDD and NJREs in cosmetic surgery and aesthetic medicine settings. METHODS Individuals requesting cosmetic procedures with BDD symptoms (BDD-symptoms group; n = 24), without BDD symptoms (cosmetic intervention [CI] group; n = 45), and individuals that have never required these procedures (no cosmetic intervention [NCI] group; n = 53) entered the study. RESULTS Results showed a greater number of past-month NJREs, higher NJREs severity, higher drive for thinness, and greater general distress in the BDD-symptoms group. Pertaining to features associated with NJREs (perfectionism and obsessive-compulsive disorder symptoms) and ED core features, the BDD-symptoms group scored higher only with respect to NCI. Regression analyses showed that BDD symptoms were predicted by age, NJREs severity, and drive for thinness above and beyond general distress, perfectionism, obsessive-compulsive disorder symptoms, bulimia, and body dissatisfaction related to weight and shape in the BDD-Symptoms group (in comparison with the CI and NCI groups). CONCLUSIONS NJREs may represent a potential vulnerability factor for BDD symptoms in cosmetic settings.
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Affiliation(s)
- Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Claudio Sica
- Department of Health Sciences, Psychology Section, University of Firenze, Firenze, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy.,U.O.C. Hospital Psychology, University-Hospital of Padova, Padova, Italy
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Bragdon LB, Eng GK, Belanger A, Collins KA, Stern ER. Interoception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions. Front Psychiatry 2021; 12:686482. [PMID: 34512412 PMCID: PMC8424053 DOI: 10.3389/fpsyt.2021.686482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoceptive processes are present in a range of psychiatric conditions, and there is a small but growing body of research on the role of interoception in obsessive-compulsive disorder (OCD). In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD. Investigations in OCD utilizing objective measures of interoception are limited and results mixed, however, the subjective experience of internal bodily sensations appears to be atypical and relate to specific patterns of symptom dimensions. Further, neuroimaging investigations suggest that interoception is related to core features of OCD, particularly sensory phenomena and disgust. Interoception is discussed in the context of treatment by presenting an overview of existing interventions and suggesting how modifications aimed at better targeting interoceptive processes could serve to optimize outcomes. Interoception represents a promising direction for multi-method research in OCD, which we expect, will prove useful for improving current interventions and identifying new treatment targets.
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Affiliation(s)
- Laura B. Bragdon
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Goi Khia Eng
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Amanda Belanger
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Katherine A. Collins
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily R. Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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Mancusi L, McKay D. Behavioral avoidance tasks for eliciting disgust and anxiety in contamination fear: An examination of a test for a combined disgust and fear reaction. J Anxiety Disord 2021; 78:102366. [PMID: 33578215 DOI: 10.1016/j.janxdis.2021.102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
While research supports the role of disgust in contamination OCD, there is also an overlap with fear in motivating avoidance. The "heebie-jeebies" is an emotional response associated with fear and disgust that motivates avoidance of contact with skin-transmitted pathogens (e.g., parasites). This motivation aligns with characteristics of contamination OCD. From a screening of undergraduate students (N = 188), contamination fearful (n = 14), high trait-anxious (n = 14), and low trait-anxious (n = 18) groups were created. Participants engaged in disgust, fear, and "heebie-jeebies" behavioral avoidance tasks. Participants rated "heebie-jeebies" emotion, physical sensations, and behavioral urges. Duration or refusal of task was recorded. A significant interaction effect was found for disgust and anxiety. Participants with higher disgust reported higher "heebie-jeebies" emotion at high, but not low, levels of anxiety. Exploratory analyses revealed that many contamination fearful and high trait-anxious participants refused to complete the task. The interaction of disgust and anxiety significantly predicted the probability of refusal. Participants with higher disgust and anxiety were more likely to refuse to complete the task. Results suggest that the "heebie-jeebies" motivates avoidance of skin-transmitted pathogens. Future research is warranted to further investigate the "heebie-jeebies" and how it relates to contamination concerns.
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Schmidt S, Wagner G, Walter M, Stenner MP. A Psychophysical Window onto the Subjective Experience of Compulsion. Brain Sci 2021; 11:brainsci11020182. [PMID: 33540916 PMCID: PMC7913241 DOI: 10.3390/brainsci11020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
In this perspective, we follow the idea that an integration of cognitive models with sensorimotor theories of compulsion is required to understand the subjective experience of compulsive action. We argue that cognitive biases in obsessive-compulsive disorder may obscure an altered momentary, pre-reflective experience of sensorimotor control, whose detection thus requires an implicit experimental operationalization. We propose that a classic psychophysical test exists that provides this implicit operationalization, i.e., the intentional binding paradigm. We show how intentional binding can pit two ideas against each other that are fundamental to current sensorimotor theories of compulsion, i.e., the idea of excessive conscious monitoring of action, and the idea that patients with obsessive-compulsive disorder compensate for diminished conscious access to "internal states", including states of the body, by relying on more readily observable proxies. Following these ideas, we develop concrete, testable hypotheses on how intentional binding changes under the assumption of different sensorimotor theories of compulsion. Furthermore, we demonstrate how intentional binding provides a touchstone for predictive coding accounts of obsessive-compulsive disorder. A thorough empirical test of the hypotheses developed in this perspective could help explain the puzzling, disabling phenomenon of compulsion, with implications for the normal subjective experience of human action.
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Affiliation(s)
- Stefan Schmidt
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany; (S.S.); (G.W.); (M.W.)
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany; (S.S.); (G.W.); (M.W.)
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany; (S.S.); (G.W.); (M.W.)
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
| | - Max-Philipp Stenner
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-391-626392301; Fax: +49-391-6715233
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Dominke C, Graham-Schmidt K, Gentsch A, Schütz-Bosbach S. Action inhibition in individuals with high obsessive-compulsive trait of incompleteness: An ERP study. Biol Psychol 2021; 159:108019. [PMID: 33460785 DOI: 10.1016/j.biopsycho.2021.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/01/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Missing action completion signals are assumed to trigger repetitive behavior and feelings of the action "not being right". This proposal is based mostly on individual's self-reports. Here, we investigated the influence of experimentally manipulated action completion experience and the obsessive-compulsive (OC) trait of incompleteness on behavioral and neurophysiological measures of action inhibition. METHODS Action completion was manipulated in an adapted Go/NoGo task, and OC trait incompleteness was assessed in healthy participants. More commission errors and faster responses were expected after missing action completion, especially for individuals with high OC trait incompleteness. The inhibition-related event-related potentials (ERPs) N200 and P300 were also measured. RESULTS High OC trait incompleteness led to more errors following omitted- and faster responses during commission errors following incongruent outcomes. Furthermore, lower N200 was associated with worse response inhibition, and high OC trait incompleteness was associated with reduced N200, but not reduced P300 amplitude. These findings provide evidence that trait-like feelings of incompleteness may underlie maladaptive action repetition and impaired inhibitory control as observed in OCD.
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Affiliation(s)
- Clara Dominke
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany.
| | - Kyran Graham-Schmidt
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany
| | - Antje Gentsch
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany
| | - Simone Schütz-Bosbach
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany
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Ricketts EJ, Snorrason Í, Mathew AS, Sigurvinsdottir E, Ólafsson RP, Woods DW, Lee HJ. Heightened Sense of Incompleteness in Excoriation (Skin-Picking) Disorder. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10201-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cervin M, Perrin S, Olsson E, Claesdotter-Knutsson E, Lindvall M. Involvement of fear, incompleteness, and disgust during symptoms of pediatric obsessive-compulsive disorder. Eur Child Adolesc Psychiatry 2021; 30:271-281. [PMID: 32211970 PMCID: PMC7932948 DOI: 10.1007/s00787-020-01514-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 03/16/2020] [Indexed: 12/24/2022]
Abstract
Fear has been assigned a central role in models of obsessive-compulsive disorder (OCD), but empirical investigations into the emotions that underpin OCD symptoms are few, especially in pediatric samples. Using validated, clinician-led structured interviews, 124 youth with OCD reported on the presence and severity of symptoms across the main symptom dimensions of OCD (aggressive, symmetry, contamination) and the degree to which fear, incompleteness, and disgust accompanied these symptoms. For comparison purposes, the degree of fear, incompleteness, and disgust during symptoms was obtained also from youth with social anxiety disorder (SAD; n = 27) and generalized anxiety disorder (GAD; n = 28). Participants with OCD reported that all three emotions were involved in their symptoms; however, fear was most strongly linked to aggressive symptoms, incompleteness to symmetry symptoms, and disgust to contamination symptoms. Incompleteness differentiated youth with OCD from those with SAD and GAD. No differences for these emotions were found for youth with OCD with versus without the tic-disorder subtype or comorbid autism. A positive association between incompleteness and self-reported hoarding emerged among youth with OCD. Further studies of the emotional architecture of pediatric OCD, and its relationship to etiology and treatment, are warranted.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden.
- Skåne Child and Adolescent Psychiatry, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Elin Olsson
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Magnus Lindvall
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
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Cervin M, Perrin S. Incompleteness and Disgust Predict Treatment Outcome in Pediatric Obsessive-Compulsive Disorder. Behav Ther 2021; 52:53-63. [PMID: 33483124 DOI: 10.1016/j.beth.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 01/09/2023]
Abstract
Increasing evidence suggests that pediatric obsessive-compulsive disorder (OCD) is motivated not only by fear but also by feelings of incompleteness and disgust. However, it is currently unclear whether emotion involvement in OCD symptoms is associated with treatment response in youth with OCD. The present study examined whether treatment outcome for youth with OCD was predicted by the degree to which fear, disgust, and incompleteness were involved in baseline OCD symptoms. Children and adolescents with OCD entering treatment for this condition (N = 111) were administered standardized OCD symptom measures and an interview designed to assess the degree of fear, incompleteness, and disgust experienced during current OCD symptoms. Follow-up assessments occurred on average 13 months after baseline with each participant coded for outcome according to internationally acknowledged change criteria for pediatric OCD. Higher levels of incompleteness and disgust as part of baseline OCD symptoms predicted poorer outcome. The degree of fear during baseline OCD symptoms did not predict outcome. If replicated under controlled conditions, these results suggest that incompleteness and disgust may act as barriers to improvement in pediatric OCD and that treatment modifications that target these emotion-related motivators may improve outcome for a subset of youth.
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Affiliation(s)
- Matti Cervin
- Lund University and Skåne Child and Adolescent Psychiatry.
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Taboas W, McKay D. Inducing and manipulating sensations of incompleteness. Bull Menninger Clin 2020; 84:237-263. [PMID: 33000964 DOI: 10.1521/bumc.2020.84.3.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Incompleteness (INC) and Harm Avoidance (HA) are known core dimensions of obsessive-compulsive disorder (OCD). Emotional processing and inhibitory learning (IL) have both been proposed as viable mechanisms of exposure for the alleviation of HA, yet the relationship with INC remains unclear. This study evaluated differential manipulation responses to induced INC. The authors specifically tested whether targeting the key component of IL, expectancy violation generated by the discrepancy between an articulated prediction and the actual exposure experience, would lead to improved outcomes. A sample of undergraduates (N = 68) completed a series of behavioral tasks to induce INC, followed by manipulations (exposure with or without articulated predictions) to reduce INC reactions. Results show that modest changes were observed following reduction manipulations following INC induction. Furthermore, heightened HA predicted the changes of induced sensations. Mediation tests showed that articulation of predicted sensations mediated pre- to postreduction ratings. Clinical and research implications are discussed.
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Affiliation(s)
- William Taboas
- Postdoctoral Research Fellow at the Center for Understanding and Treating Anxiety (CUTA), San Diego State University, San Diego, California
| | - Dean McKay
- Professor and Fordham-Columbia Research Fellow in the Department of Psychology, Fordham University, Bronx, New York
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Summers BJ, Wilver NL, Garratt GH, Cougle JR. A Multimethod Analysis of Incompleteness and Visual "Not Just Right" Experiences in Body Dysmorphic Disorder. Behav Ther 2020; 51:764-773. [PMID: 32800304 DOI: 10.1016/j.beth.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/26/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) often report engaging in repetitive behaviors aimed at reducing feelings of imperfection anchored to their appearance. "Not just right" experiences (NJREs) and incompleteness (INC) are constructs related to perfectionism that have traditionally been studied in obsessive-compulsive disorder, though recent research has also linked these phenomena to BDD. We sought to replicate and extend this research via two studies. Study 1 examined BDD symptoms, INC, as well as harm avoidance (HA) in an unselected sample (N = 179); moderate associations were observed between symptoms and both INC and HA. Participants also completed a novel visual NJRE task in which they were shown appearance-related and non-appearance-related images meant to evoke an NJRE response (i.e., discomfort and urge to "fix" stimuli). BDD symptoms predicted reactivity to appearance-related NJRE stimuli above negative affect. Study 2 compared INC, HA, and task reactivity in a BDD sample (N = 50) to nonpsychiatric controls (N = 44). The BDD group evidenced greater INC, HA, and reactivity to both appearance and nonappearance NJRE stimuli, relative to controls; however, group differences did not remain after controlling for age and negative affect. These studies broadly corroborate previous research highlighting NJREs and INC as potential vulnerability factors relevant to BDD, though these phenomena may not be specific to BDD symptoms.
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Affiliation(s)
- Berta J Summers
- Massachusetts General Hospital/Harvard Medical School; Florida State University.
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Melli G, Moulding R, Puccetti C, Pinto A, Caccico L, Drabik MJ, Sica C. Assessing beliefs about the consequences of not just right experiences: Psychometric properties of the Not Just Right Experience-Sensitivity Scale (NJRE-SS). Clin Psychol Psychother 2020; 27:847-857. [PMID: 32378795 DOI: 10.1002/cpp.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/20/2020] [Accepted: 05/03/2020] [Indexed: 11/07/2022]
Abstract
Although current cognitive conceptualizations of obsessive-compulsive disorder (OCD) emphasize that rituals are performed in order to avoid overtly threatening outcomes, it has also been noted that there are individuals for whom the attempt to correct "not just right experiences" (NJREs) rather than dangerous outcomes per se appear important. This article examines the idea that individuals have differing tolerances for-or sensitivity to-NJREs, in a similar manner as occurs regarding for other experience such as the distinction between disgust propensity and disgust sensitivity. In Study 1, using a nonclinical Italian sample, the NJRE-Sensitivity Scale (NJRE-SS) was created and refined. Its final version consisted of eight items loading on two subscales-an intolerance of NJREs due to their perceived interference with cognitive tasks and due to their interference with enjoyment of life. In Study 2, the factor structured was confirmed in a separate sample. The measure was found to have convergent validity with related measures including a separate measure assessing the severity and frequency of NJREs themselves. However, the NJRE-SS predicted OCD symptoms over-and-above the general NJRE measure, with particularly the interference with cognitive tasks subscale being of importance. Clinical implications are discussed.
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Affiliation(s)
- Gabriele Melli
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence, Florence, Italy
| | - Richard Moulding
- Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Australia
| | - Camilla Puccetti
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence, Florence, Italy
| | - Antonio Pinto
- Cognitive and Behavioral Psychotherapy Center, Naples, Italy
| | - Laura Caccico
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence, Florence, Italy
| | - Marta Joanna Drabik
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence, Florence, Italy
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Mathew AS, Davine TP, Snorrason I, Houghton DC, Woods DW, Lee HJ. Body-focused repetitive behaviors and non-suicidal self-injury: A comparison of clinical characteristics and symptom features. J Psychiatr Res 2020; 124:115-122. [PMID: 32135390 DOI: 10.1016/j.jpsychires.2020.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
Body-focused repetitive behaviors (BFRBs) and non-suicidal self-injury (NSSI) are recognized as distinct categories in the DSM-5. However, definitions and assessment of NSSI sometimes encompasses behaviors similar to BFRBs, and little data exist about their clinical differences. The current study examined clinical characteristics and symptom features associated with NSSI vs. BFRBs. The current sample included 1523 individuals who endorsed moderate to severe NSSI (n = 165) or BFRBs: hair pulling group (n = 102), skin picking group (n = 216), nail picking group (n = 253), nail biting group (n = 487), and cheek biting group (n = 300). Responders were asked to complete questionnaires on clinical features relevant for BFRBs and NSSI. NSSI and BFRBs had significant differences on several clinical features. Individuals in the NSSI group were more likely than individuals with BFRBs to report engaging in the behavior for social-affective reasons (i.e., to get out of doing something, or receive attention from others). Individuals in the NSSI group were also more likely to engage in the behavior to regulate tension and feelings of emptiness, and to experience relief during the act. In contrast, individuals in the BFRB groups were more likely to engage in the behavior automatically without reflective awareness, to reduce boredom, or to fix appearance. The NSSI group obtained significantly higher scores on questionnaires assessing stress, anxiety, depression, and harm avoidance. Overall, the results showed several notable differences between NSSI and BFRBs that are consistent with clinical literature and definitions of these problems in the DSM-5.
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Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Taylor P Davine
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - David C Houghton
- Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
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Cervin M, Perrin S, Olsson E, Claesdotter-Knutsson E, Lindvall M. Incompleteness, harm avoidance, and disgust: A comparison of youth with OCD, anxiety disorders, and no psychiatric disorder. J Anxiety Disord 2020; 69:102175. [PMID: 31896022 DOI: 10.1016/j.janxdis.2019.102175] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 11/12/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022]
Abstract
Psychological models of pediatric obsessive-compulsive disorder (OCD) place a heavy emphasis on harm avoidance as a maintaining factor and target for treatment. Incompleteness and disgust may also play a role in pediatric OCD but remain understudied. Youth with OCD (n = 100), anxiety disorders (n = 96), and no impairing psychiatric symptoms (n = 25) completed self-report measures of trait-level incompleteness, harm avoidance, and disgust and current symptoms of OCD, anxiety, and depression. Group differences and associations between emotions, symptoms, and pre- to post-treatment change in overall OCD severity were examined. Youth with OCD and anxiety disorders scored higher on harm avoidance and disgust than youth with no psychiatric disorder. Youth with OCD scored higher on incompleteness than youth with anxiety disorders and youth with no psychiatric disorder. Harm avoidance showed unique associations to self-reported symptoms of OCD, anxiety, and depression while incompleteness was uniquely related to OCD and disgust to anxiety. Within the OCD sample, incompleteness and harm avoidance were differentially related to the major OCD symptom dimensions, and change in incompleteness was uniquely related to pre- to post-treatment change in OCD severity. Trait-level incompleteness appears to play a central role in pediatric OCD and studies investigating its direct involvement in symptoms and associations with treatment outcome are needed. The role of disgust in relation to pediatric OCD remains unclear.
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Affiliation(s)
- Matti Cervin
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden.
| | - Sean Perrin
- Lund University, Department of Psychology, Lund, Sweden
| | - Elin Olsson
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Magnus Lindvall
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden
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21
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Sica C, Caudek C, Belloch A, Bottesi G, Ghisi M, Melli G, García-Soriano G, Olatunji BO. Not Just Right Experiences, Disgust Proneness and Their Associations to Obsessive–Compulsive Symptoms: A Stringent Test with Structural Equation Modeling Analysis. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10029-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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22
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Takagishi Y. Factor Structure, Validity, and Reliability of the Japanese Version of the Balanced Index of Psychological Mindedness (BIPM). JAPANESE PSYCHOLOGICAL RESEARCH 2018. [DOI: 10.1111/jpr.12245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Development of a Picture-Based Measure for “Not Just Right” Experiences Associated with Compulsive Sorting, Ordering, and Arranging. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9969-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bragdon LB, Gibb BE, Coles ME. Does neuropsychological performance in OCD relate to different symptoms? A meta-analysis comparing the symmetry and obsessing dimensions. Depress Anxiety 2018; 35:761-774. [PMID: 29920848 DOI: 10.1002/da.22785] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 04/05/2018] [Accepted: 05/29/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Investigations of neuropsychological functioning in obsessive-compulsive disorder (OCD) have produced mixed results for deficits in executive functioning (EF), attention, and memory. One potential explanation for varied findings may relate to the heterogeneity of symptom presentations, and different clinical or neurobiological characteristics may underlie these different symptoms. METHODS We investigated differences in neuropsychological functioning between two symptoms groups, obsessing/checking (O/C) and symmetry/ordering (S/O), based on data suggesting an association with different motivations: harm avoidance and incompleteness, respectively. Ten studies (with 628 patients) were included and each investigation assessed at least one of 14 neuropsychological domains. RESULTS The S/O domain demonstrated small, negative correlations with overall neuropsychological functioning, performance in EF, memory, visuospatial ability, cognitive flexibility, and verbal working memory. O/C symptoms demonstrated small, negative correlations with memory and verbal memory performance. A comparison of functioning between symptom groups identified large effect sizes showing that the S/O dimension was more strongly related to poorer neuropsychological performance overall, and in the domains of attention, visuospatial ability, and the subdomain of verbal working memory. CONCLUSIONS Findings support existing evidence suggesting that different OCD symptoms, and their associated core motivations, relate to unique patterns of neuropsychological functioning, and, potentially dysfunction in different neural circuits.
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Affiliation(s)
- Laura B Bragdon
- Department of Psychology, Binghamton University, Binghamton, NY
| | - Brandon E Gibb
- Department of Psychology, Binghamton University, Binghamton, NY
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Cepeda SL, McKay D, Schneider SC, La Buissonnière-Ariza V, Egberts JTNE, McIngvale E, Goodman WK, Storch EA. Politically-focused intrusive thoughts and associated ritualistic behaviors in a community sample. J Anxiety Disord 2018; 56:35-42. [PMID: 29631796 DOI: 10.1016/j.janxdis.2018.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 01/04/2023]
Abstract
A significant proportion of the U.S. population report increased stress attributed to the political climate following the controversial 2016 United States (U.S.) Presidential election. The political stressors paired with the growth in news consumption and social media-use could be a potential trigger for obsessive-compulsive-like symptoms specific to politics in some individuals. This study aimed to elucidate the rate of Politically-focused Intrusive Thoughts and associated Ritualistic Behaviors (PITRB), their demographic and clinical correlates, and the degree of association with political ideology. Survey data were collected using the crowdsourcing platform Mechanical Turk. A total of N = 484 individuals completed the survey. Measures of politically-focused intrusive thoughts and ritualistic behaviors, general obsessive-compulsive symptoms, depression, anxiety, anxiety control, worry, and disability were administered, as well as a measure of social and economic conservative affiliation. Results showed that a quarter of the sample (25.2%) had at least one PITRB more than once a day. PITRB was associated with all measures of psychopathology and disability. Finally, anxiety control moderated the relationship between PITRB and both anxiety and depression. No differences in psychopathology were found between major party affiliations. The findings suggest that politically-focused intrusive thoughts and ritualistic behaviors are associated with psychopathology domains in a manner comparable to general obsessive-compulsive symptoms.
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Affiliation(s)
- Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, United States
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | | | | | - Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.
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McKay D, Kim SK, Mancusi L, Storch EA, Spankovich C. Profile Analysis of Psychological Symptoms Associated With Misophonia: A Community Sample. Behav Ther 2018. [PMID: 29530266 DOI: 10.1016/j.beth.2017.07.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Misophonia is characterized by extreme aversive reactions to certain classes of sounds. It has recently been recognized as a condition associated with significant disability. Research has begun to evaluate psychopathological correlates of misophonia. This study sought to identify profiles of psychopathology that characterize misophonia in a large community sample. A total of N = 628 adult participants completed a battery of measures assessing anxiety and anxiety sensitivity, depression, stress responses, anger, dissociative experiences, obsessive-compulsive symptoms and beliefs, distress tolerance, bodily perceptions, as well as misophonia severity. Profile Analysis via Multidimensional Scaling (PAMS) was employed to evaluate profiles associated with elevated misophonia and those without symptoms. Three profiles were extracted. The first two accounted for 70% total variance and did not show distinctions between groups. The third profile accounted for 11% total variance, and showed that misophonia is associated with lower obsessive-compulsive symptoms for neutralizing, obsessions generally, and washing compared to those not endorsing misophonia, and higher levels of obsessive-compulsive symptoms associated with ordering and harm avoidance. This third profile extracted also showed significant differences between those with and without misophonia on the scale assessing physical concerns (that is, sensitivity to interoceptive sensations) as assessed with the ASI-3. Further research is called for involving diagnostic interviewing and experimental methods to clarify these putative mechanisms associated with misophonia.
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Affiliation(s)
| | | | | | - Eric A Storch
- University of South Florida; Rogers Behavioral Health-Tampa; Johns Hopkins All Children's Hospital
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Is the first cut really the deepest? Frequency and recency of nonsuicidal self-injury in relation to psychopathology and dysregulation. Psychiatry Res 2018; 259:392-397. [PMID: 29120848 PMCID: PMC5767158 DOI: 10.1016/j.psychres.2017.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/10/2017] [Accepted: 10/21/2017] [Indexed: 01/27/2023]
Abstract
Research on nonsuicidal self-injury (NSSI) has moved beyond examination of factors that associate with the mere presence or absence of the behavior, and into more nuanced examination of which discrete features of NSSI behavior relate to pathology. This study examined two features of NSSI, frequency of occurrence and recency, as cross-sectional predictors of psychopathology in a large community sample of adults with a history of NSSI (N = 315). Results of 2 × 2 factorial ANOVAs testing the interactive effects of NSSI frequency (clinical, subclinical) and recency (current, past) revealed that current NSSI was consistently associated with poorer emotional and behavioral health (e.g., greater symptoms of depression, panic, and anxiety, worse emotion regulation, greater alcohol misuse). Results for NSSI frequency were more variable, though preliminary evidence suggested significant interactions of current NSSI and clinical frequency on emotion dysregulation, general anxiety, and panic. Possible clinical and empirical implications of the NSSI disorder frequency criteria proposed in DSM-5 are discussed.
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Boisseau CL, Sibrava NJ, Garnaat SL, Mancebo MC, Eisen JL, Rasmussen SA. The Brown Incompleteness Scale (BINCS): Measure development and initial evaluation. J Obsessive Compuls Relat Disord 2018; 16:66-71. [PMID: 29750139 PMCID: PMC5937536 DOI: 10.1016/j.jocrd.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, incompleteness has received increased clinical attention as a core motivation underlying obsessive-compulsive spectrum disorders. Yet, assessment of incompleteness has relied almost exclusively on self-report and has assumed a unitary conceptualization of this phenomenon. Therefore, we sought to develop and validate a new multi-faceted clinician-administered measure of incompleteness. The Brown Incompleteness Scale (BINCS) consists of 21 items; each rated on a 5-point scale, with higher scores indicating a greater degree of incompleteness. The current study describes the measure's development and preliminary validation. METHODS The scale was administered to 100 consecutive participants who were part of a longitudinal follow-up study of OCD. The reliability, validity, and factor analytic structure of the scale were evaluated. RESULTS Exploratory factor analysis supported a two-factor solution, which can best be described as representing both behavioral and sensory manifestations of incompleteness. CONCLUSIONS The BINCS demonstrated strong internal consistency as well as convergent and divergent validity. This clinician-administered scale will provide a more comprehensive clinical assessment of patients with incompleteness.
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Affiliation(s)
- Christina L. Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Nicholas J. Sibrava
- Department of Psychology, Baruch College – The City University of New York, NY, United States
| | - Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Maria C. Mancebo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
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Fornés-Romero G, Belloch A. Induced not just right and incompleteness experiences in OCD patients and non-clinical individuals: An in vivo study. J Behav Ther Exp Psychiatry 2017; 57:103-112. [PMID: 28500953 DOI: 10.1016/j.jbtep.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/06/2017] [Accepted: 05/02/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Research on incompleteness and not-just right experiences, (INC/NJREs) indicate that some OCD symptom dimensions are motivated by these experiences rather than by anxiety. Most published data are correlational, using non-clinical individuals. This study sought to examine INC/NJREs in vivo in non-clinical and OCD individuals. METHODS Study 1: Ninety-three undergraduates were randomly assigned to a INC/NJREs induction (n=44) or non-induction task (n=47). Scores on self-reports assessing INC, NJREs, OCD, Anxiety, and Depression were also recorded. Study 2: Twenty adults with OCD performed the induction task and completed the same questionnaire-packet as the non-clinical participants. RESULTS Study 1: The induction-group scored higher on several DVs of the experimental task, as INC/NJREs and uncomfortable physical sensations predicted impulses/urges to do something. All the DVs correlated with INC, NJREs, and OCD symptoms. Anxiety was only related to suppressing difficulties of the most intense sensation. Study 2: Results were comparable to those found in non-clinical people. Induced INC/NJREs correlated with compulsions severity and were associated with ordering, washing, and hoarding symptoms. OCDs did not differ from non-clinical subjects in the number of induced INC/NJREs, but they were more disturbing, difficult to suppress, and instigated more urges to do in OCDs. LIMITATIONS The small group of OCDs and the lack of a non-OCD clinical group kept us from drawing conclusions about the specificity of INC/NJREs to some OCD symptoms. CONCLUSIONS Findings support the role of INC/NJREs as stimuli triggering urges and/impulses to do and their impact on OCD severity.
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Affiliation(s)
- Gertrudis Fornés-Romero
- Department of Personality Psychology, Faculty of Psychology, Research and Treatment Unit for Obsessive-Compulsive and Related Disorders, I'TOC. University of Valencia, Spain.
| | - Amparo Belloch
- Department of Personality Psychology, Faculty of Psychology, Research and Treatment Unit for Obsessive-Compulsive and Related Disorders, I'TOC. University of Valencia, Spain.
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The Relationship Between Obsessive-Compulsive Symptoms, Perfectionism, and Anxiety Sensitivity for Not Just Right Experiences. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The obsessive-compulsive core dimensions model posits that compulsions are driven by harm avoidance, or to counteract a sense of incompleteness, known as ‘not just right experiences’ (NJREs). Evidence suggests NJREs are associated with obsessive-compulsive disorder (OCD) symptoms and maladaptive perfectionism. However, manipulations of NJREs have focused on the visual system, and have not been examined in the context of arousal fears associated with anxiety sensitivity (AS). This study examined the relationship between OC symptoms, perfectionism, and AS using in vivo manipulations of NJREs across visual, auditory, and tactile sensory modalities. Using a 2 (NJRE vs. JRE) × 2 (AS vs. no AS) between-subjects design, participants (N = 132) completed behavioural tasks designed to elicit NJREs and assess task discomfort and urge to counteract sensory-specific stimuli. Strong relationships were observed between task ratings and self-report measures of NJREs, incompleteness, OCD symptoms, maladaptive perfectionism, and AS. Those in the NJRE conditions gave significantly higher task ratings compared to JRE conditions; however, there was no main effect for AS. While maladaptive perfectionism and AS were significant predictors of task performance, there was no interaction between the two. The results confirm and extend research suggesting a strong association between NJREs and incompleteness motivations, as well as sensory-affective disturbance in OCD.
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Ben-Sasson A, Dickstein N, Lazarovich L, Ayalon N. Not Just Right Experiences: Association with Obsessive Compulsive Symptoms and Sensory Over-Responsivity. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/0164212x.2017.1303418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Noam Dickstein
- Occupational Therapy Department, University of Haifa, Haifa, Israel
| | - Liraz Lazarovich
- Occupational Therapy Department, University of Haifa, Haifa, Israel
| | - Noga Ayalon
- Occupational Therapy Department, University of Haifa, Haifa, Israel
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Anxiety sensitivity and obsessive-compulsive symptom dimensions: Further evidence of specific relationships in a clinical sample. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bottesi G, Ghisi M, Sica C, Freeston MH. Intolerance of uncertainty, not just right experiences, and compulsive checking: Test of a moderated mediation model on a non-clinical sample. Compr Psychiatry 2017; 73:111-119. [PMID: 27939647 DOI: 10.1016/j.comppsych.2016.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Intolerance of uncertainty (IU) and not just right experiences (NJREs) have been claimed putative vulnerability factors for obsessive-compulsive disorder (OCD). The aim of the present study was to test whether IU could represent a trans-diagnostic construct accountable for OC checking behaviors and whether NJREs could embody an OCD-specific criterion through which IU operates. METHOD One hundred and eighty-eight Italian community individuals completed self-report measures of IU, NJREs, OC symptoms, worry, anxiety, and depression. Mediation and moderated mediation models were tested using a bootstrapping approach, wherein IU was included as the independent variable as well as the moderator; checking behaviors were entered as the dependent variable; and NJRE severity was included as a mediator. RESULTS The main findings highlighted that NJREs were a mediator of the relationship between IU and checking behaviors; nonetheless, in connection with medium levels of IU, NJREs no longer mediated the path. Furthermore, IU did not emerge to moderate the mediation. CONCLUSION Despite their preliminary nature, the present results might be a hint for future research, as theoretical integration may represent a way to go for better understanding OCD etiology and phenomenology.
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Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy.
| | - Marta Ghisi
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy.
| | - Claudio Sica
- Department of Health Sciences, University of Firenze, via di San Salvi 12, Complesso di San Salvi Padiglione 26, 50135 Firenze, Italy.
| | - Mark H Freeston
- Institute of Neuroscience, (Ridley Building, 4th Floor), Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, Tyne and Wear NE1 7RU, United Kingdom.
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Abstract
OBJECTIVE Harm avoidance (HA) and "not just right experience" (NJRE) have been proposed to be 2 core motivational processes underlying obsessive-compulsive disorder (OCD). The objective of this study was to explore whether NJRE demarcates a neurodevelopmental OCD subgroup distinct from HA related to autistic traits and/or to a broader phenotype of cognitive rigidity and sensory processing difficulties associated with an earlier age of OCD onset. METHODS A correlational design investigated whether NJRE and HA are distinct entities in OCD and explored their relationship to autism spectrum disorder (ASD) traits measured by the Autism Quotient (AQ), sensory processing, set-shifting, and age of OCD onset in an OCD sample (N=25). RESULTS NJRE was only moderately (r=.34) correlated to HA and not significant in this study. Consistent with predictions, NJRE was associated with sensory processing difficulties and an earlier age of OCD onset. No significant relationships were found between NJRE and ASD traits as measured by the AQ or set-shifting difficulties. CONCLUSIONS These preliminary findings suggest a lack of evidence demonstrating NJRE as a manifestation of core autistic traits as measured by the AQ. However, NJRE was associated with sensory abnormalities and an earlier age of OCD onset. The role of NJRE as a developmental, and possibly neurodevelopmental, risk factor for OCD possibly warrants further investigation.
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Sokol Y, Serper M. Temporal self appraisal and continuous identity: Associations with depression and hopelessness. J Affect Disord 2017; 208:503-511. [PMID: 27832930 DOI: 10.1016/j.jad.2016.10.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/17/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND While depression is associated with decreased self-worth, less is known about how depression relates to the degree of perceived unity of the self over time (CI; continuous identity) and appraisal of past and future selves (temporal self-appraisal). In Study 1, we examined the relationship between depression severity and temporal self-appraisal. In Study 2, we examined depression and hopelessness severity as it relates to temporal self-appraisal and continuous identity. It was hypothesized that individuals with significant levels of depressed mood would report lower self appraisals of current and future selves and that hopelessness about the future would be associated with disturbances in perception of self over time (CI; continuous identity) and temporal self-appraisal. METHODS Study 1 examined depressed mood (n=75) and non-depressed mood (n=144) individuals to determine their self-rated personal attributes for their past, present and future selves using a validated task of temporal self-appraisal. Study 2 examined an independent sample of subjects. Based on cutoff scores for clinically significant depression and hopelessness, Depressed/Hopeless (n=63) and Non-Depressed /Non-Hopeless (n=168) subjects were asked complete the validated task of temporal self-appraisal and also complete a validated task to assess their continuous identity. RESULTS In Study 1, a significant difference was found between the depressed mood group and the non-depressed mood group in how they see themselves changing over time. The non-depressed group perceived themselves increasing in positive personal attributes from past, to present, to future self. The depressed mood group perceived themselves as deteriorating from the past to the present in terms of positive attributes about their self-identity. However, contrary to expectations, the depressed group perceived their future self as improved from their present self. Subjects' past and future selves were at a similar level and both were significantly higher than perception of their present self-worth. Study 2 replicated these findings and also found severity of depression was significantly related to lower levels of CI. Additionally, it was found that the severity of hopelessness was minimally associated with continuous identity and temporal self-appraisal ratings. CONCLUSION These results suggests that even people with depressed mood have an instinctive grasp of the possibility to an improved future self-worth despite the negative cognitions associated with present self-worth and hopeless expectations about the future. While depressed and hopeless individuals may view the world negatively and feel hopeless about their general future, these results suggest that depressed individuals distinguish between hopelessness about future external success and future self-improvement. Despite perceiving their past and future selves to be more positive, depression severity was associated with less continuous identity. Since depressed individuals perceive a future self as a return to or a recovery of a past self, therapeutic strategies may focus on improving a sense of continuous identity with past and future selves and focusing on deriving meaning from current life difficulties to improve beyond a past self, growing to a superior future self. LIMITATIONS AND FUTURE RESEARCH Limitations include using self-report measures of depression and hopelessness. Future studies may wish to use individuals who were diagnosed with depression to explore further how depressed people see themselves changing from the present to the future. Additionally, future studies could determine if depressed individuals who do not perceive their future self to be improved are at higher risk for adverse outcomes.
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Affiliation(s)
- Yosef Sokol
- Department of Psychology, Hofstra University, United States
| | - Mark Serper
- Department of Psychology, Hofstra University, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States.
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Summers BJ, Matheny NL, Cougle JR. 'Not just right' experiences and incompleteness in body dysmorphic disorder. Psychiatry Res 2017; 247:200-207. [PMID: 27918970 DOI: 10.1016/j.psychres.2016.11.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/30/2016] [Accepted: 11/26/2016] [Indexed: 10/20/2022]
Abstract
The current studies examined the role of 'not just right' experiences (NJREs) and incompleteness (INC) in body dysmorphic disorder (BDD). In Study 1, a clinical BDD sample endorsed more severe NJREs than healthy controls, when controlling co-occurring symptoms of depression and anxiety. In Study 2, INC predicted reactivity to an in vivo task designed to evoke BDD-related concerns in an unselected sample. Study 3 demonstrated a positive relationship between INC and BDD symptom severity in a community sample. Study 4 examined in vivo sensory NJRE tasks and INC in a sample high and low in BDD symptoms. The high symptom group reported greater INC and reactivity to a visual NJRE task than their low symptom counterparts, when controlling for co-occurring symptoms of depression, anxiety, and OC symptoms. No group differences were observed for tasks assessing auditory and tactile NJREs. These studies demonstrate a unique relationship between INC/NJREs and BDD.
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Affiliation(s)
- Berta J Summers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Natalie L Matheny
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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Bragdon LB, Coles ME. Examining heterogeneity of obsessive-compulsive disorder: Evidence for subgroups based on motivations. J Anxiety Disord 2017; 45:64-71. [PMID: 27960103 DOI: 10.1016/j.janxdis.2016.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a heterogeneous illness and evidence suggests that different clinical characteristics may relate to varying treatment outcomes. This study was designed to identify subgroups based on core motivational domains in a clinical sample of individuals with OCD, and to compare groups on clinical characteristics. Cluster analyses identified four subgroups including groups with relatively high or low levels of both harm avoidance (HA) and incompleteness (INC) motivations. A subgroup was identified that demonstrated a "traditional profile" marked by high motivation to avoid harm, and elevated levels of beliefs about responsibility/overestimation of threat. The model also contained a subgroup characterized by high incompleteness, low motivation to avoid harm, and higher levels of perfectionistic beliefs and intolerance of uncertainty. Findings reemphasize that current cognitive and behavioral models of OCD may be enhanced by integrating incompleteness/NJREs.
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Affiliation(s)
- Laura B Bragdon
- Binghamton Anxiety Clinic, Department of Psychology, Binghamton University, United States.
| | - Meredith E Coles
- Binghamton Anxiety Clinic, Department of Psychology, Binghamton University, United States
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Sica C, Bottesi G, Caudek C, Orsucci A, Ghisi M. "Not Just Right Experiences" as a psychological endophenotype for obsessive-compulsive disorder: Evidence from an Italian family study. Psychiatry Res 2016; 245:27-35. [PMID: 27526314 DOI: 10.1016/j.psychres.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 01/01/2023]
Abstract
The heart of the obsessional process may be considered the subject's underlying impression that "something is wrong" or "that something is not just as it should be". This phenomenon, labeled "not just right experiences" (NJREs), has increasingly been receiving attention as a possible marker of obsessive-compulsive disorder (OCD). The present study sought to add to the evidence that NJREs may be a putative endophenotype of obsessional symptoms. To this aim, measures of NJREs, obsessive-compulsive (OC) symptoms and psychological distress were compared in offspring of parents with and without OC symptoms. The offspring of parents with OC symptoms (N=120) reported higher frequency and severity of NJREs compared to offspring of parents without OC symptoms (N=106). Such differences remained significant for NJREs frequency and close to significance for NJREs severity, when general distress (i.e., anxiety and depression) was controlled. The possible role of NJREs as an endophenotype for OCD is discussed in reference to Gottesman and Gould criteria and the National Institute of Mental Health RDoC initiative.
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Affiliation(s)
- Claudio Sica
- Department of Health Sciences, University of Firenze, Italy.
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Italy
| | - Corrado Caudek
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Firenze, Italy
| | | | - Marta Ghisi
- Department of General Psychology, University of Padova, Italy
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Sibrava NJ, Boisseau CL, Eisen JL, Mancebo MC, Rasmussen SA. An empirical investigation of incompleteness in a large clinical sample of obsessive compulsive disorder. J Anxiety Disord 2016; 42:45-51. [PMID: 27268401 PMCID: PMC5003676 DOI: 10.1016/j.janxdis.2016.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 03/17/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
Obsessive Compulsive Disorder (OCD) is a disorder with heterogeneous clinical presentations. To advance our understanding of this heterogeneity we investigated the prevalence and clinical features associated with incompleteness (INC), a putative underlying core feature of OCD. We predicted INC would be prominent in individuals with OCD and associated with greater severity and impairment. We examined the impact of INC in 307 adults with primary OCD. Participants with clinically significant INC (22.8% of the sample) had significantly greater OCD severity, greater rates of comorbidity, poorer ratings of functioning, lower quality of life, and higher rates of unemployment and disability. Participants with clinically significant INC were also more likely to be diagnosed with OCPD and to endorse symmetry/exactness obsessions and ordering/arranging compulsions than those who reported low INC. Our findings provide evidence that INC is associated with greater severity, comorbidity, and impairment, highlighting the need for improved assessment and treatment of INC in OCD.
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Affiliation(s)
- Nicholas J. Sibrava
- Baruch College – The City University of New York, New York, NY,Alpert Medical School of Brown University, Providence, RI
| | - Christina L. Boisseau
- Alpert Medical School of Brown University, Providence, RI,Butler Hospital, Providence, RI
| | - Jane L. Eisen
- Alpert Medical School of Brown University, Providence, RI
| | - Maria C. Mancebo
- Alpert Medical School of Brown University, Providence, RI,Butler Hospital, Providence, RI
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Summers BJ, Sarawgi S, Fitch KE, Dillon KH, Cougle JR. Six In Vivo Assessments of Compulsive Behavior: A Validation Study Using the Obsessive-Compulsive Inventory-Revised. Assessment 2016; 25:483-497. [PMID: 27305930 DOI: 10.1177/1073191116654759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to the complex and heterogeneous nature of obsessive-compulsive disorder (OCD), movement toward multimodal assessment has become necessary to more precisely understand the nature of the disorder and interrelations between symptom clusters. Thus, the present study utilized large undergraduate samples (total N = 800) to test the validity of six in vivo assessments of OC symptoms (i.e., one ordering/arranging task, two contamination fear/washing tasks, and three checking tasks). Associations between task-specific variables and self-reported symptom scores (as measured by the Obsessive-Compulsive Inventory-Revised [OCI-R]) were examined. The majority of the in vivo task variables (those presented in Studies 1-4) exhibited significant relationships with the corresponding OCI-R symptom subscale (i.e., ordering, washing, checking). However, many of the task variables demonstrated relationships with other OCI-R symptom subscales, as well. Some evidence for discriminant validity was found, as task variables were generally unrelated to past-week symptoms of depression or anxiety. While continued research is necessary to further establish the validity and utility of the tasks discussed in the current article, findings have implications for improving future empirical examination of OC symptoms.
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41
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42
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Incompleteness and not just right experiences in the explanation of Obsessive-Compulsive Disorder. Psychiatry Res 2016; 236:1-8. [PMID: 26795870 DOI: 10.1016/j.psychres.2016.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/28/2015] [Accepted: 01/07/2016] [Indexed: 11/22/2022]
Abstract
In the past decade, not just right experiences (NJRE) and incompleteness (INC) have attracted renewed interest as putative motivators of symptoms in obsessive-compulsive disorder (OCD), beyond harm avoidance (HA). This study examines, in 267 non-clinical undergraduates and 47 OCD patients, the differential contributions of HA, INC, and NJRE to the different OCD symptom dimensions and the propensity to have the disorder. The results indicate that although both the NJRE and INC range from normality to OCD, their number and intensity significantly increase as the obsessional tendencies increase, which suggests that they are vulnerability markers for OCD. Although they cannot be considered fully specific to OCD, they are more important in explaining OCD symptoms than general distress and harm-related beliefs, and they are also better indicators of OCD severity than HA. In light of the operationalization of both NJRE and INC across the items on their respective questionnaires, the two constructs seem to capture different aspects of the same complex underlying construct: whereas INC might refer to a relatively stable disposition or trait of engaging in compulsive rituals, NJRE resemble obsessions more, and the appraisals that individuals ascribe to the experience would motivate the compulsions.
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43
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Sokol Y, Eisenheim E. The Relationship Between Continuous Identity Disturbances, Negative Mood, and Suicidal Ideation. Prim Care Companion CNS Disord 2016; 18:15m01824. [PMID: 27247841 DOI: 10.4088/pcc.15m01824] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/20/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To examine the relationship between continuous identity and a measure of depression, anxiety, and stress as well as suicidal ideation using 2 validated measures of continuous identity. METHOD A total of 246 subjects recruited from the Amazon Mechanical Turk subject pool who completed a full survey in November 2014 were included in the analyses. Stress, anxiety, and depression severity were measured using the Depression, Anxiety, and Stress Scale. Continuous identity was measured with the Venn continuous identity task and the me/not me continuous identity task. RESULTS Multiple regression analyses revealed continuous identity disturbances were significantly associated with depressed mood (R (2) = 0.37, P < .01). Continuous identity also predicted suicide severity, even after controlling for demographic factors, negative life events, and depressed mood. Additionally, predictive discriminant analysis revealed continuous identity, depression severity, and negative life events correctly classified 74.1% of participants into high and low suicide risk groups. CONCLUSION Lack of continuous identity predicted both depression and suicidality severity. Integration of perceived identities may be a worthwhile goal for behavioral interventions aimed at reducing depressed mood and suicidality.
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Affiliation(s)
- Yosef Sokol
- Department of Psychology, Hofstra University, Hempstead, New York
| | - Edouard Eisenheim
- Department of Psychology, Hofstra University, Hempstead, New York; Department of Psychiatry, Mount Sinai School of Medicine, New York, New York
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Van Schalkwyk GI, Bhalla IP, Griepp M, Kelmendi B, Davidson L, Pittenger C. Toward Understanding the Heterogeneity in OCD: Evidence from narratives in adult patients. Aust N Z J Psychiatry 2016; 50:74-81. [PMID: 25855685 PMCID: PMC4598276 DOI: 10.1177/0004867415579919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current attempts at understanding the heterogeneity in obsessive-compulsive disorder have relied on quantitative methods. The results of such work point toward a dimensional structure for obsessive-compulsive disorder. Existing qualitative work in obsessive-compulsive disorder has focused on understanding specific aspects of the obsessive-compulsive disorder experience in greater depth. However, qualitative methods are also of potential value in furthering our understanding of obsessive-compulsive disorder heterogeneity by allowing for open-ended exploration of the obsessive-compulsive disorder experience and correlating identified subtypes with patient narratives. OBJECTIVE We explored variations in patients' experience prior to, during and immediately after performing their compulsions. METHOD Semi-structured interviews were conducted with 20 adults with obsessive-compulsive disorder, followed by inductive thematic analysis. Participant responses were not analyzed within the context of an existing theoretical framework, and themes were labeled descriptively. RESULTS The previous dichotomy of 'anxiety' vs 'incompleteness' emerged organically during narrative analysis. In addition, we found that some individuals with obsessive-compulsive disorder utilized their behaviors as a way to cope with stress and anxiety more generally. Other participants did not share this experience and denied finding any comfort in their obsessive-compulsive behaviors. The consequences of attentional difficulties were highlighted, with some participants describing how difficulty focusing on a task could influence the need for it to be repeated multiple times. CONCLUSIONS The extent to which patients use obsessive-compulsive disorder as a coping mechanism is a relevant distinction with potential implications for treatment engagement. Patients may experience ambivalence about suppressing behaviors that they have come to rely upon for management of stress and anxiety, even if these behaviors represent symptoms of a psychiatric illness.
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Affiliation(s)
| | | | | | | | - Larry Davidson
- Department of Psychiatry, Yale University,Yale Program for Recovery and Community Health, Yale University
| | - Christopher Pittenger
- Department of Psychiatry, Yale University,Department of Psychology, Yale University,Child Study Center, Yale University,Interdepartmental Neuroscience Program, Yale University,Correspondence: 34 Park Street, W315, New Haven, CT 06519, 203-974-7675,
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Sica C, Bottesi G, Orsucci A, Pieraccioli C, Sighinolfi C, Ghisi M. "Not Just Right Experiences" are specific to obsessive-compulsive disorder: further evidence from Italian clinical samples. J Anxiety Disord 2015; 31:73-83. [PMID: 25743760 DOI: 10.1016/j.janxdis.2015.02.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 01/31/2015] [Accepted: 02/01/2015] [Indexed: 12/18/2022]
Abstract
Not Just Right Experiences (NJREs) are considered to be a perceptually tinged phenomenon mainly related to obsessive-compulsive disorder (OCD). The evidence of an association between NJREs and OCD or OC symptoms have been accumulating in the last few years, whereas there is a paucity of studies about the role of this construct in other clinical conditions considered part of the "OCD spectrum". In the current study, the NJRE-Q-R Severity scale (a well-validated measure of NJREs) was administered to 41 patients with OCD, 53 with hair-pulling disorder (HPD), 38 with gambling disorder (GD) and 43 with eating disorders (ED) along with measures of OC symptoms and general distress. In each group, NJREs were consistently associated with OC symptoms; moreover, the pattern of associations appeared coherent with the main clinical features of each disorder. The OCD group reported higher levels of NJREs severity than GD and ED, whereas there were no differences between the OCD and HPD groups. However, HPD patients did not have higher scores of NJREs severity than GD and ED counterparts. NJREs appear to be specific to OCD, but further study is needed to establish the role of this construct in OCD-related disorders.
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Affiliation(s)
- Claudio Sica
- Department of Health Sciences, University of Firenze, Italy.
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Italy
| | | | | | - Cecilia Sighinolfi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Italy
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Visual, tactile, and auditory "not just right" experiences: associations with obsessive-compulsive symptoms and perfectionism. Behav Ther 2014; 45:678-89. [PMID: 25022778 DOI: 10.1016/j.beth.2014.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/14/2014] [Accepted: 03/17/2014] [Indexed: 12/31/2022]
Abstract
"Not just right" experiences (NJREs), or uncomfortable sensations associated with the immediate environment not feeling "right," are thought to contribute to obsessive-compulsive disorder (OCD) symptomatology. The literature suggests that NJREs are experienced across sensory modalities; however, existing in vivo measures have been restricted to visual inductions (e.g., viewing and/or rearranging a cluttered table). The present study used a large undergraduate sample (N=284) to examine 4 in vivo tasks designed to elicit and assess NJREs across separate sensory modalities (i.e., visual, tactile, and auditory). Task ratings (discomfort evoked, and urge to counteract task-specific stimuli) were uniquely associated with self-report measures of NJREs, OC symptoms (ordering/arranging, checking, and washing), and certain maladaptive domains of perfectionism (doubts about actions, and organization). Findings have implications for experimental research and clinical work targeting NJREs specific to particular senses.
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Taylor S, Conelea CA, McKay D, Crowe KB, Abramowitz JS. Sensory intolerance: latent structure and psychopathologic correlates. Compr Psychiatry 2014; 55:1279-84. [PMID: 24703593 PMCID: PMC4060532 DOI: 10.1016/j.comppsych.2014.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Sensory intolerance refers to high levels of distress evoked by everyday sounds (e.g., sounds of people chewing) or commonplace tactile sensations (e.g., sticky or greasy substances). Sensory intolerance may be associated with obsessive-compulsive (OC) symptoms, OC-related phenomena, and other forms of psychopathology. Sensory intolerance is not included as a syndrome in current diagnostic systems, although preliminary research suggests that it might be a distinct syndrome. OBJECTIVES First, to investigate the latent structure of sensory intolerance in adults; that is, to investigate whether it is syndrome-like in nature, in which auditory and tactile sensory intolerance co-occur and are associated with impaired functioning. Second, to investigate the psychopathologic correlates of sensory intolerance. In particular, to investigate whether sensory intolerance is associated with OC-related phenomena, as suggested by previous research. METHOD A sample of 534 community-based participants were recruited via Amazon.com's Mechanical Turk program. Participants completed measures of sensory intolerance, OC-related phenomena, and general psychopathology. RESULTS Latent class analysis revealed two classes of individuals: those who were intolerant of both auditory and tactile stimuli (n=150), and those who were relatively undisturbed by auditory or tactile stimuli (n=384). Sensory-intolerant individuals, compared to those who were comparatively sensory tolerant, had greater scores on indices of general psychopathology, more severe OC symptoms, a higher likelihood of meeting caseness criteria for OC disorder, elevated scores on measures of OC-related dysfunctional beliefs, a greater tendency to report OC-related phenomena (e.g., a greater frequency of tics), and more impairment on indices of social and occupational functioning. Sensory-intolerant individuals had significantly higher scores on OC symptoms even after controlling for general psychopathology. CONCLUSIONS Consistent with recent research, these findings provide further evidence for a sensory intolerance syndrome. The findings provide a rationale for conducting future research for determining whether a sensory intolerance syndrome should be included in the diagnostic nomenclature.
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Affiliation(s)
- Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | | | - Dean McKay
- Department of Psychology, Fordham University, New York, NY, USA
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Abramowitz JS, Fabricant LE, Taylor S, Deacon BJ, McKay D, Storch EA. The relevance of analogue studies for understanding obsessions and compulsions. Clin Psychol Rev 2014; 34:206-17. [DOI: 10.1016/j.cpr.2014.01.004] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/18/2013] [Accepted: 01/13/2014] [Indexed: 11/16/2022]
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