In search of specificity: "not just right experiences" and obsessive-compulsive symptoms in non-clinical and clinical Italian individuals

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.

The relationship between body dysmorphic disorder symptoms and 'not just right' experiences in a sample of individuals seeking cosmetic surgery and aesthetic medicine procedures

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.

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.

The Short Forms of the Hewitt and Flett's Multidimensional Perfectionism Scale: Which Factor Structure Better Fits Italian Data?

One of the most used instruments to assess perfectionism is Hewitt and Flett's Multidimensional Perfectionism Scale (HFMPS). This article reports result of two studies aimed at evaluating and comparing two short HFMPS versions provided by literature in Italian samples. In Study 1, two previously proposed short forms-Cox and colleagues' and Hewitt and colleagues'-were compared in terms of factor structure and concurrent validity in a community sample of 324 participants. In Study 2, validity and reliability of the two short scales in 102 university students and 58 patients with a primary diagnosis of Obsessive-Compulsive Disorder were examined. Results revealed mixed findings concerning which of the two short form should be preferred.

Reaching reliable change using short, daily, cognitive training exercises delivered on a mobile application: The case of Relationship Obsessive Compulsive Disorder (ROCD) symptoms and cognitions in a subclinical cohort

BACKGROUND

Relationship Obsessive Compulsive Disorder (ROCD) is a presentation of OCD centering on interpersonal relationships. The aim of this Randomized Control Trial (RCT) was to assess the efficacy of short, game like, daily cognitive interventions delivered via mobile application in reducing subclinical ROCD symptoms and associated phenomena.

METHODS

Fifty university students identified as having subclinical levels of ROCD symptoms (using the Structured Clinical Interview for DSM-5 Clinical Version) were randomized into: immediate-use group (iApp group; n = 25) and delayed-use group (dApp group; n = 25). The iApp group started using the evaluated cognitive-behavioral training application at baseline for 15 days (T0 to T1). The dApp group commenced using the application at T1 for 15 days (T1 to T2). All participants completed questionnaires at baseline (T0), 15 days from baseline (T1), and 30 days from baseline (T2).

RESULTS

Repeated measure MANOVAs showed significant Group (iApp vs. dApp) × Time (T0 vs. T1) interactions. These interactions indicated greater decrease in ROCD symptoms, OCD beliefs and social anxiety symptoms, as well as a greater increase in self-esteem in the iApp group compared to dApp group at T1. Moreover, the Reliable Change Index (RCI) indicated reliable change on ROCD symptoms for a significant portion of participants (42-52%).

LIMITATIONS

Sample size and the use of self-report measures limits the generalizability of the results.

CONCLUSIONS

Short, daily cognitive training interventions delivered via mobile applications may be useful in reducing subclinical ROCD symptoms and associated features. Further testing is needed for clinical populations.

Operational method of reliability and content-validity analysis: Taking "trait-symptoms" screening of individuals at high-risk for OCD as an example

A well-designed self-reported scale is highly applicable to current clinical and research practices. However, the problems with the scale method, such as quantitative analysis of content validity and test-retest reliability analysis of state-like variables are yet to be resolved. The main purpose of this paper is to propose an operational method for solving these problems. Additionally, it aims to enhance understanding of the research paradigm for the scale method (excluding criterion-related validity). This paper used a study that involved screening of high-risk groups for OCD (Obsessive-Compulsive Disorder), conducted 5 rounds of tests, and developed scales, reliability, and validity analysis (using sample sizes of 496, 610, 600, 600 and 990). The operational method we propose is practical, feasible, and can be used to develop and validate a scale.

Assessing beliefs about the consequences of not just right experiences: Psychometric properties of the Not Just Right Experience-Sensitivity Scale (NJRE-SS)

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.

Incompleteness, harm avoidance, and disgust: A comparison of youth with OCD, anxiety disorders, and no psychiatric disorder

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.

Perfectionism in Italy and the USA

Abstract. Perfectionism research has been recently extending its scope internationally. The short forms of the Almost Perfect Scale-Revised (APS-R; Slaney, Rice, Mobley, Trippi, & Ashby, 2001 ; Rice, Richardson, & Tueller, 2014 ) and the Multidimensional Perfectionism Scale (MPS; Cox, Enns, & Clara, 2002 ; Hewitt & Flett, 1990 ), originally validated with North American samples, have been translated for use on Italian samples. However, these tests have yet to be evaluated for measurement equivalence between the respective countries. Both scales were administered to undergraduate students in the USA ( N = 336) and Italy ( N = 201). Multiple group confirmatory factor analyses supported partial scalar invariance for both scales, indicating functional equivalence across cultures. Italian students reported lower levels of perfectionistic strivings. No meaningful differences in perfectionistic concerns were found between countries. Further study is needed to assess why some items and factors may differ between Italians and Americans.

From self-induced to perceived errors - A generalized over-monitoring activity in obsessive-compulsive disorder

Well-functioning error monitoring of the inner and outer environments is essential for adaptively altering behavior, while malfunction characterizes conditions such as obsessive-compulsive disorder (OCD). The underlying brain processing is manifested as Error-Related Negativity (ERN) signal elicited following error comission, and Perceived Error Related Theta Activity (PERTA) signal elicited following detection of discrepancy in the environment. Yet, while enhanced ERN was repeatedly demonstrated in OCD patients and was found to be potentiated among their unaffected first degree relatives, no comparable observations were reported with regard to PERTA. We recorded EEG activity while OCD patients, OCD patients' siblings (Family), and healthy controls (HC) performed computerized tasks. For the examination of ERN we used the Stroop task and for the examination of PERTA we presented correct and incorrect mathematical equations. Increased ERN (0-120 ms post response) was observed in both the OCD and Family groups, but only the OCD patients' signal significantly differed from that of HC's. Similarly, modified PERTA activity was observed in both the OCD and Family groups in the N1 peak (65-125 ms post perceived error), but only for the OCD group this activity significantly differed from that of HC. Both ERN and PERTA's N1 are fast occurring peaks, which suggests that OCD is associate with a constantly over-activated detection system that monitors the inner and outer environment and reacts promptly following detection of a mistake. Furthermore, the modified but non-significantly different activity of the Family group suggests that the pathological condition evolves in vulnerable individuals with neuronal predisposition.

Perfectionism and Academic Performance in Italian College Students

This study analyzed the psychometric properties of the Italian translation of both the Short Almost Perfect Scale (SAPS) and the Short Multidimensional Perfectionism Scale (SMPS), and the academic implications of perfectionism on 414 Italian college students aged between 18 and 58 years. Results revealed some limitations with the SAPS factor structure that, once addressed, yielded scores with good internal consistency and convergent validity. The SMPS had adequate psychometric properties. Higher perfectionistic strivings scores were associated with better academic performance and with higher rates of studying. This study provides support for the usefulness of both the SAPS and the SMPS in understanding relationships between different perfectionism dimensions and academic outcomes for Italian students.

Body dysmorphic disorder and its associated psychological and psychopathological features in an Italian community sample

OBJECTIVE

Body Dysmorphic Disorder (BDD) is a psychiatric condition characterized by preoccupation with perceived defects in physical appearance that are not observable or appear slight to others, along with low self-esteem, high perfectionism, and high comorbidity. Little is known about BDD prevalence and phenomenology in the Italian context, and no data are currently available on BDD prevalence using DSM-5 criteria in the Italian context. The aims of the current study were to explore the prevalence and the phenomenology of BDD and its associated psychological and psychopathological features such as self-esteem, perfectionistic traits, social anxiety, depressive, and obsessive-compulsive symptoms in a community sample.

METHODS

Six hundred and fifteen community individuals completed a battery of self-report questionnaires.

RESULTS

10 (1.63%) individuals met DSM-5 diagnostic criteria for BDD; hair, nose and teeth were the most common areas of concern. Individuals with BDD reported also lower levels of self-esteem, more severe social anxiety symptomatology, general distress, depression and obsessive-compulsive features than people without BDD.

CONCLUSIONS

BDD is not a rare condition in the Italian context and it emerged to be associated with significant morbidity.

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.

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.

Intolerance of uncertainty, not just right experiences, and compulsive checking: Test of a moderated mediation model on a non-clinical sample

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.

'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 and not just right experiences in the explanation of Obsessive-Compulsive Disorder

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.

Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample

Trichotillomania (TTM) is still a scarcely known and often inadequately treated disorder in Italian clinical settings, despite growing evidence about its severe and disabling consequences. The current study investigated the phenomenology of TTM in Italian individuals; in addition, we sought to examine patterns of self-esteem, anxiety, depression, and OCD-related symptoms in individuals with TTM compared to healthy participants. The current study represents the first attempt to investigate the phenomenological and psychopathological features of TTM in Italian hair pullers. One hundred and twenty-two individuals with TTM were enrolled: 24 were assessed face-to-face (face-to-face group) and 98 were recruited online (online group). An additional group of 22 face-to-face assessed healthy controls (HC group) was included in the study. The overall female to male ratio was 14:1, which is slightly higher favoring female than findings reported in literature. Main results revealed that a higher percentage of individuals in the online group reported pulling from the pubic region than did face-to-face participants; furthermore, the former engaged in examining the bulb and running the hair across the lips and reported pulling while lying in bed at higher frequencies than the latter. Interestingly, the online TTM group showed greater functional and psychological impairment, as well as more severe psychopathological characteristics (self-esteem, physiological and social anxiety, perfectionism, overestimation of threat, and control of thoughts), than the face-to-face one. Differences between the two TTM groups may be explained by the anonymity nature of the online group, which may have led to successful recruitment of more serious TTM cases, or fostered more open answers to questions. Overall, results revealed that many of the phenomenological features of Italian TTM participants matched those found in U.S. clinical settings, even though some notable differences were observed; therefore, cross-cultural invariance might represent a characteristic of OCD-related disorders.

The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples

OBJECTIVE

The Depression Anxiety Stress Scales-21 (DASS-21) is the short version of a self-report measure that was originally developed to provide maximum differentiation between depressive and anxious symptoms. Despite encouraging evidence, the factor structure and other features of the DASS-21 are yet to be firmly established.

METHOD

A community sample of 417 participants and two clinical groups (32 depressive patients and 25 anxious patients) completed the Italian version of the DASS-21 along with several measures of psychopathology.

RESULTS

Confirmatory factor analyses suggested that the DASS-21 is a measure of general distress plus three additional orthogonal dimensions (anxiety, depression, and stress). The internal consistency and temporal stability of the measure were good; each DASS-21 scale correlated more strongly with a measure of a similar construct, demonstrating good convergent and divergent validity. Lastly, the DASS-21 demonstrated good criterion-oriented validity.

CONCLUSION

The validity of the Italian DASS-21 and its utility, both for community and clinical individuals, are supported.

"Not Just Right Experiences" in adolescents: phenomenology and associated characteristics

Efforts to understand the nature of "Not Just Right Experiences" (NJREs) have expanded the scientific understanding of obsessive-compulsive (OC) behavior. Approximately 80% of unselected adults report experiencing NJREs and these experiences have been found to highly correlate with OC behavior. The purpose of this study was to assess NJREs in an unselected sample of adolescents (ages 14-17; N = 152), to compare their experience with adults (N = 237), and to assess the relation between NJREs and OC symptoms. Findings from questionnaires completed on the Internet were consistent with previous findings in adults, 81% of adolescents endorsed recently having an NJRE. Some reactions differed according to age: adults reported NJREs as more frequent and adolescents endorsed feeling more compelled to respond. Surprisingly, OC symptoms were not significantly related to NJREs in the adolescents. Implications, limitations, and future directions for the study of NJREs in youth are discussed.

"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.

Hoarding and emotional reactivity: the link between negative emotional reactions and hoarding symptomatology

Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD's etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious hoarding difficulties to examine how hoarding symptoms related to both general and hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict hoarding symptoms. These findings provide support for cognitive-behavioral models of hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for hoarding.

From socially prescribed perfectionism to problematic use of internet communicative services: the mediating roles of perceived social support and the fear of negative evaluation

BACKGROUND

The present study developed and tested a model that explains how people who believe that others have unrealistically high standards and exert pressure on them to be perfect (that is, people high in socially prescribed perfectionism) develop a problematic use of internet communicative services (GPIU). Following the perfectionism social disconnection model and previous evidence about the role that the online environment might play in the development of problematic internet use, low reported social support and the fear of negative evaluations in face to face interactions were hypothesized to mediate the association between socially prescribed perfectionism and GPIU.

METHODS

A sample of 465 undergraduate students was recruited (240 F; mean age 21.91+2.23years), and the hypotheses were tested through structural equation modeling separately for men and women.

RESULTS

Among men, the association between SPP and GPIU was fully mediated by the fear of being negatively evaluated and the perception of low social support. For women, we found a partially mediated model in which SPP affected GPIU indirectly through the fear of negative evaluations. The presence of a direct effect of SPP on GPIU was also found. Moreover, perceived social support was not found to be a significant mediator among women.

CONCLUSIONS

The findings suggest that problematic use of internet communicative services might be, at least in part, a defensive response to extreme social evaluation pressures.

The sense of incompleteness as a motivator of obsessive-compulsive symptoms: an empirical analysis of concepts and correlates

Contemporary models of obsessive-compulsive disorder emphasize the importance of harm avoidance (HA) and related dysfunctional beliefs as motivators of obsessive-compulsive (OC) symptoms. Recently, there has been a resurgence of interest in Janet's (1908) concept of incompleteness (INC) as another potentially important motivator. Contemporary investigators define INC as the sense that one's actions, intentions, or experiences have not been properly achieved. Janet defined INC more broadly to include alexithymia, depersonalization, derealization, and impaired psychological mindedness. We conducted two studies to address four issues: (a) the clinical correlates of INC; (b) whether INC and HA are distinguishable constructs; (c) whether INC predicts OC symptoms after controlling for HA; and (d) the relative merits of broad versus narrow conceptualizations of INC. Study 1 was a meta-analysis of the clinical correlates of narrowly defined INC (16 studies, N=5,940). INC was correlated with all types of OC symptoms, and was more strongly correlated with OC symptoms than with general distress. Study 2 (N=534 nonclinical participants) showed that (a) INC and HA were strongly correlated but factor analytically distinguishable; (b) INC statistically predicted all types of OC symptoms even after controlling for HA; and (c) narrow INC was most strongly correlated with OC symptoms whereas broad INC was most strongly correlated with general distress. Although the findings are limited by being correlational in nature, they support the hypothesis that INC, especially in its narrow form, is a motivator of OC symptoms.

"Not just right experiences" in patients with Tourette syndrome: complex motor tics or compulsions?

Tourette syndrome (TS) is a chronic tic disorder often accompanied by specific obsessive-compulsive symptoms (OCS) or full-blown obsessive-compulsive disorder (OCD). Repetitive behaviours are commonly reported by patients with TS, who experience the urge to perform an action until it has been done "just right". This study investigated the clinical correlates of "not just right experiences" (NJREs) in this clinical population. A standardised battery of self-report psychometric measures was administered to 71 adult patients with TS recruited from a specialist TS clinic. NJREs were systematically screened for using the Not Just Right Experiences-Questionnaire Revised (NJRE-QR). The vast majority of patients in our clinical sample (n=57, 80%) reported at least one NJRE. Patients diagnosed with TS and co-morbid OCD/OCS (n=42, 59%) reported a significantly higher number of NJREs compared to TS patients without OCD/OCS. The strongest correlation was found between NJRE-QR scores and self-report measures of compulsivity. NJREs appear to be intrinsic to the clinical phenomenology of patients with TS and can present with higher frequency in the context of co-morbid OCD/OCS, suggesting they are more related to compulsions than tics.

Symptom dimensions in obsessive-compulsive disorder: phenomenology and treatment outcomes with exposure and ritual prevention

BACKGROUND

Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. Currently, the cognitive-behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP); however, clinical impression and some empirical data suggest that certain OCD symptoms are more responsive to treatment than others.

METHODS

Prior work identifying symptom dimensions within OCD is discussed, including epidemiological findings, factor analytic studies, and biological findings. Symptom dimensions most reliably identified include contamination/cleaning, doubt about harm/checking, symmetry/ordering, and unacceptable thoughts/mental rituals. The phenomenology of each of these subtypes is described and research literature is summarized, emphasizing the differential effects of EX/RP and its variants on each of these primary symptom dimensions.

RESULTS

To date it appears that EX/RP is an effective treatment for the various OCD dimensions, although not all dimensions have been adequately studied (i.e. symmetry and ordering).

CONCLUSIONS

Modifications to treatment may be warranted for some types of symptoms. Clinical implications and directions for future research are discussed.

Should nonsuicidal self-injury be a putative obsessive-compulsive-related condition? A critical appraisal

Nonsuicidal self-injury (NSSI) has many behavioral and cognitive features that would make it appear to be closely tied to obsessive-compulsive disorder (OCD). Obsessive-compulsive-related disorders (OCRDs) have been described in the literature as conditions that share a common phenomenology, neurobiology, and treatment response. The authors reviewed the literature describing the degree that NSSI is similar to, and distinct from, OCRDs based on these hypothesized common areas. They conclude with recommendations for conceptualization that draws partly from the OCRD literature and from cognitive-behavioral models of rumination.

Functions of compulsions in obsessive-compulsive disorder

OBJECTIVES

The key function of compulsions in obsessive-compulsive disorder (OCD) is to alleviate anxiety or distress caused by the obsessions, but compulsions may also have other functions. The main aim of this study was to systematically ascertain what motivates individuals with OCD to perform compulsions.

METHOD

A total of 108 adults with OCD were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Functions of Compulsions Interview. The latter instrument elicits the functions of identified compulsions.

RESULTS

The functions of 218 compulsions were identified. The mean number of functions per compulsion in the whole sample was 2.94 and the vast majority of compulsions (85.3%) were performed for more than one reason. The total number of functions of compulsions endorsed for the three main compulsions correlated with Y-BOCS total scores (r = 0.37, p < 0.001). Compulsions were most frequently performed automatically and to decrease distress or anxiety, but there was substantial variation, depending on the type of compulsion. Hoarding was often performed for reasons not related to any other compulsion (involving a perceived need for collected objects), whereas ordering/symmetry/repeating compulsions were frequently performed to achieve a 'just right' feeling. Checking was frequently performed because of the belief that something bad or unpleasant would happen if one failed to check; washing/cleaning compulsions were most frequently performed to decrease distress or anxiety and automatically, and mental compulsions were performed automatically far more often than for other reasons.

CONCLUSIONS

The majority of compulsions have more than one function and they are often performed automatically. The finding of different functions of compulsions in different types of compulsions provides some support to the subtyping of OCD on the basis of obsessions and compulsions. Identifying functions of compulsions allows better understanding of the functional relationship between obsessions and compulsions, which may have implications for cognitive-behavioural therapy of OCD.