Visual, tactile, and auditory "not just right" experiences: associations with obsessive-compulsive symptoms and perfectionism

A comparison of 'not just right experiences' in obsessive-compulsive disorder, anxiety and depressive disorders and non-clinical controls in China

OBJECTIVE

The aim of this study is to investigate the characteristics of 'not just right experiences' (NJREs) in patients with obsessive-compulsive disorder (OCD), anxiety disorders (ADs) or major depressive disorder (MDD), compared with those of healthy controls (HCs).

METHOD

One hundred adults with OCD, 86 adults with ADs, 57 adults with MDD and 60 HCs were enrolled in the study. The Not Just Right Experiences Questionnaire Revised (NJRE-QR), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate clinical symptoms in patients with OCD, ADs or MDD. The Obsessive Belief Questionnaire-44 (OBQ-44) was used to evaluate OC beliefs in the OCD patients. The HCs only received assessment using the NJRE-QR. Analysis of variance (ANOVA) and covariance (ANCOVA) were performed to compare the NJREs scores across the groups, while Pearson correlation and partial correlation analyses were used to examine the association between NJREs and other clinical features. The contribution of NJREs to predict OC symptoms was determined by multiple stratified linear regression.

RESULTS

Individuals with OCD had significantly higher scores for the number of NJREs than ADs, but not MDD. The severity of NJREs was also significantly higher in patients with OCD than those with MDD or ADs (F = 5.23 and F = 19.79, respectively, P < 0.01). All the clinical scores in the NJRE-QR were significantly higher than those in the HC group. The number and severity of NJREs correlated significantly with the Y-BOCS total score (r = 0.29 and r = 0.39, respectively, P < 0.01). NJREs showed an independent contribution to OC symptoms, which alone explained 8% of the variation (F = 16.49, ΔR2  = 0.08; P < 0.01).

CONCLUSION

NJREs are related closely to OC symptoms, with their severity discriminating between OCD patients and those with ADs or MDD. NJREs were more specific for OCD in the Chinese population and are therefore worthy of further study in the future.

Sensory over-responsivity and symptoms across the obsessive-compulsive spectrum: a web-based study (Preprint)

BACKGROUND

Sensory overresponsivity (SOR) has emerged as a potential endophenotype in obsessive-compulsive disorder (OCD), but few studies have examined SOR in relation to the major symptom dimensions of OCD and to symptoms across the full obsessive-compulsive (OC) symptom spectrum.

OBJECTIVE

This study had 2 main objectives. First, we examined the psychometric properties of the SOR Scales in a community-based sample of Spanish adolescents and adults. Second, we identified how SOR difficulties are related to symptoms across the full OC spectrum (eg, OC, body dysmorphic, hoarding, skin-picking, and hair-pulling symptoms), including the heterogeneity of OC symptoms.

METHODS

We translated the SOR Scales into Spanish-a measure that assesses SOR across the 5 sensory modalities-and created a web-based version of the measure. A sample of 1454 adolescents and adults (mean age 23.84, SD 8.46 years) participated in the study, and 388 (26.69%) participants completed the survey twice (approximately 8 months apart). The survey also contained a web-based measure that assesses symptoms across the full OC spectrum: harm and checking, taboo obsessions, contamination or cleaning, symmetry and ordering, body dysmorphic, hoarding, hair-pulling, and skin-picking symptoms.

RESULTS

The psychometric properties of the SOR Scales were excellent, and the test-retest reliability was adequate. All types of SOR were related to all major symptom dimensions of OCD and to all OC spectrum symptoms.

CONCLUSIONS

SOR across the sensory modalities can be validly assessed using a web-based measure. SOR emerged as a pure transdiagnostic phenomenon in relation to symptoms across the OC spectrum, with no specific sensory modality being more strongly related to OC symptoms. SOR can shed much needed light on basic mechanisms that are important for the onset and maintenance of OC spectrum symptoms, and this study shows that large-scale web-based studies can aid in this endeavor. Future studies should examine whether SOR precedes or emerges alongside OC symptoms.

Core Motivations of Childhood Obsessive-Compulsive Disorder: The Role of Harm Avoidance and Incompleteness

In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the associations between these two forms of OCD classification. Participant topographical symptoms were self-reported using the Obsessive-Compulsive Inventory-Child Version (OCI-CV). Clinicians assessed whether participant symptoms were motivated by harm avoidance and/or incompleteness. Structural equation modeling was employed to explore the associations between harm avoidance and incompleteness and symptom dimensions in youth with OCD. Results showed that harm avoidance was significantly associated with doubting/checking, obsessing, and neutralizing symptoms, whereas incompleteness was associated with doubting/checking, ordering, and neutralizing symptoms. Findings are consistent with child and adult literature and highlight the importance of assessing the underlying function of OC behaviors.

Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.

Action inhibition in individuals with high obsessive-compulsive trait of incompleteness: An ERP study

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.

Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates

Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.

A Multimethod Analysis of Incompleteness and Visual "Not Just Right" Experiences in Body Dysmorphic Disorder

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.

A multi-method analysis of incompleteness in behavioral treatment of contamination-based OCD

Contamination fear and washing compulsions are among the most common symptoms of obsessive compulsive disorder (OCD). Though these symptoms have traditionally been viewed as being driven by a desire to avoid harm, recent research has highlighted the importance of feelings of incompleteness (INC) or not-just right experiences (NJREs) in this symptom dimension. However, no study to date has examined the extent to which INC/NJREs may be associated with treatment response for contamination symptoms. The current study used a multi-method approach to examine the role of INC/NJREs in treatment of contamination symptoms. Participants (n = 88) with elevated contamination symptoms, half of whom met for an OCD diagnosis, engaged in three sessions of exposure and response prevention (ERP) targeting contamination fears, and completed self-report and in vivo measures of INC/NJRES and contamination symptoms. ERP was associated with significant reductions in INC/NJREs. Further, changes in INC were associated with changes in contamination symptoms, independent of changes in harm avoidance. Greater discomfort in response to an in vivo NJRE task at pre-treatment predicted poor treatment response, though a self-report measure of INC did not predict response. These findings provide novel evidence for the importance of INC/NJREs in contamination-based OCD and its treatment.

"Not just right" experiences account for unique variance in eating pathology

"Not just right" experiences (NJREs) are uncomfortable sensations of incompleteness linked to obsessive-compulsive disorder; however, NJREs may be transdiagnostic and play a role in eating pathology. The current study examined relations between NJREs and eating pathology in undergraduate students. Participants (n = 248) completed self-report and behavioral assessments. Controlling for obsessive-compulsive symptoms, negative affect, and perfectionism, NJRE frequency was associated with greater drive for thinness, body dissatisfaction, and bulimic symptoms. Discomfort in response to a visual in vivo NJRE task was positively associated with drive for thinness and body dissatisfaction. The present study provides initial evidence for NJREs in eating pathology. Theoretical implications are discussed.

Sensory over-responsivity in trichotillomania (hair-pulling disorder)

OBJECTIVE

This study was an initial investigation of sensory-over responsivity (SOR) to external sensations among individuals with trichotillomania (TTM).

METHODS

Adults endorsing DSM-5 TTM criteria (N = 609) and a non-affected comparison sample (N = 268) completed a self-report survey.

RESULTS

The majority of the TTM group endorsed SOR symptoms; three-quarters endorsed at least mild tactile and auditory SOR. About 15% endorsed SOR symptoms in the severe to extreme range. TTM participants had significantly higher mean scores in both auditory (t (652.89) = -6.51, p < .001, d = .45) and tactile (t (655.24) = -8.38, p < .001, d = .58) modalities than comparison participants, with medium effect sizes. Greater levels of SOR were related to greater levels of perfectionism and by-proxy pulling urges. SOR was significantly and positively correlated with functional impairment when controlling for TTM severity.

CONCLUSION

This study expands prior work in obsessive-compulsive related disorders by contributing the first data about associations between TTM and over-responsivity to external sensations. Findings collectively suggest SOR may be related to maladaptive emotion regulation processes in TTM. A novel measure of SOR was developed and administered in this study.

The Brown Incompleteness Scale (BINCS): Measure development and initial evaluation

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.

Restricted, Repetitive Behaviors in Autism Spectrum Disorder and Obsessive-Compulsive Disorder: A Comparative Review

This review paper critically examines literature regarding restricted and repetitive behaviors (RRBs) in Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD). The similar behavioral profiles of these disorders presents the potential for confusion regarding diagnoses and intervention efforts. As such, this review highlights the similarities and differences between RRBs in ASD and OCD. The developmental trajectories of RRBs are presented, followed by an exploration of three constructs implicated in RRB manifestation: anxiety, executive functioning, and sensory phenomena. While RRBs tend to develop with some similarity in both disorders, the differing role of anxiety highlights important distinctions between ASD and OCD. We urge researchers and clinicians to think critically about the dimensions that affect RRB presentation. Future research should use this review as a starting point to further elucidate the differences between RRBs in these two populations.

Induced not just right and incompleteness experiences in OCD patients and non-clinical individuals: An in vivo study

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.

Psychometric Properties of the Frost Multidimensional Perfectionism Scale in Spanish Children and Adolescents

The Frost Multidimensional Perfectionism Scale (FMPS) is one of the most used instruments to assess perfectionism. The FMPS assesses six dimensions: Concern over Mistakes (CM), Parental Expectations (EP), Parental Criticism (PC), Doubts about Actions (DA), Organization (OR), and Personal Standards (PS). CM, PE, PC, and DA are facets of a more general dimension considered Maladaptive Perfectionism. PS is frequently considered Adaptive Perfectionism. FMPS psychometric properties have been studied in adults but scarcely in children. We adapted the FMPS for Spanish children and adolescents and studied these properties in a sample of 1,648 Spanish young people (mean age = 13.36; SD = 2.28). Multigroup confirmatory factor analyses were used to test whether the FMPS dimensions found in adults are applicable to children. Results supported this hypothesis. The FMPS dimensional structure was invariant across gender and age. FMPS subscales showed good internal consistency (Cronbach’s α: .71-.92) and test–retest reliability (intraclass correlations: .70-.85). Moderate and high correlations with measures of dysfunctional beliefs, anxiety, and depression supported the validity of the FMPS scores. Results from regression equations showed that the relationship of perfectionism with anxiety and depression is mostly due to Maladaptive Perfectionism.

The Relationship Between Obsessive-Compulsive Symptoms, Perfectionism, and Anxiety Sensitivity for Not Just Right Experiences

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.

Sensory over responsivity and obsessive compulsive symptoms: A cluster analysis

BACKGROUND

Several studies have examined the sensory component in Obsesseive Compulsive Disorder (OCD) and described an OCD subtype which has a unique profile, and that Sensory Phenomena (SP) is a significant component of this subtype. SP has some commonalities with Sensory Over Responsivity (SOR) and might be in part a characteristic of this subtype. Although there are some studies that have examined SOR and its relation to Obsessive Compulsive Symptoms (OCS), literature lacks sufficient data on this interplay.

OBJECTIVES

First to further examine the correlations between OCS and SOR, and to explore the correlations between SOR modalities (i.e. smell, touch, etc.) and OCS subscales (i.e. washing, ordering, etc.). Second, to investigate the cluster analysis of SOR and OCS dimensions in adults, that is, to classify the sample using the sensory scores to find whether a sensory OCD subtype can be specified. Our third goal was to explore the psychometric features of a new sensory questionnaire: the Sensory Perception Quotient (SPQ).

METHOD

A sample of non clinical adults (n=350) was recruited via e-mail, social media and social networks. Participants completed questionnaires for measuring SOR, OCS, and anxiety.

RESULTS

SOR and OCI-F scores were moderately significantly correlated (n=274), significant correlations between all SOR modalities and OCS subscales were found with no specific higher correlation between one modality to one OCS subscale. Cluster analysis revealed four distinct clusters: (1) No OC and SOR symptoms (NONE; n=100), (2) High OC and SOR symptoms (BOTH; n=28), (3) Moderate OC symptoms (OCS; n=63), (4) Moderate SOR symptoms (SOR; n=83). The BOTH cluster had significantly higher anxiety levels than the other clusters, and shared OC subscales scores with the OCS cluster. The BOTH cluster also reported higher SOR scores across tactile, vision, taste and olfactory modalities. The SPQ was found reliable and suitable to detect SOR, the sample SPQ scores was normally distributed (n=350).

CONCLUSIONS

SOR is a dimensional feature that can influence the severity of OCS and may characterize a unique sensory OCD subtype.

'Not just right' experiences and incompleteness in body dysmorphic disorder

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.

"Not Just Right Experiences" as a psychological endophenotype for obsessive-compulsive disorder: Evidence from an Italian family study

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.

An empirical investigation of incompleteness in a large clinical sample of obsessive compulsive disorder

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.

Incompleteness, aesthetic sensitivity, and the obsessive-compulsive need for symmetry

BACKGROUND AND OBJECTIVES

The "need for symmetry" is a well recognized yet little understood feature of obsessive-compulsive (OC) experience. In light of the strong associations between the OC-related trait of incompleteness and symmetry-related behaviors and symptoms, and between perceptual symmetry and aesthetic judgments, this study examined whether trait incompleteness is associated with enhanced natural aesthetic skill and/or aesthetic sensitivity, particularly as they pertain to visual symmetry.

METHODS

A quasi-experimental design was used to compare the responses of nonclinical individuals with high versus average levels of trait incompleteness on self-report measures and two performance measures of aesthetic judgment.

RESULTS

Compared to controls, participants high in incompleteness reported higher levels of self-perceived symmetry-related concerns and behaviors, and displayed greater aesthetic sensitivity in the form of substantially heightened preferences for symmetry in images. Contrary to the hypothesis relating to aesthetic skill, however, the two groups did not differ in their capacity to estimate accurately the objective aesthetic value of images. Nor did they differ in self-reported aesthetics interests and background.

LIMITATIONS

A clinical sample was not included.

CONCLUSIONS

Findings provide evidence that high trait incompleteness is associated not just with symptomatic symmetry-related concerns but with a nonspecific heightened preference for visual symmetry. Conceptual implications are discussed, particularly the potential value of the perceptual fluency theory of symmetry and aesthetic response for explaining the association between incompleteness and symmetry preferences and symptoms.

"Not Just Right Experiences" are specific to obsessive-compulsive disorder: further evidence from Italian clinical samples

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.