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Lee EB, Wetterneck CT, McIngvale E, Williams MT, Björgvinsson T. Rethinking Unacceptable Thoughts: Validation of an Expanded Version of the Dimensional Obsessive-Compulsive Scale. Behav Ther 2024; 55:786-800. [PMID: 38937050 DOI: 10.1016/j.beth.2023.11.003] [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: 05/04/2023] [Revised: 09/29/2023] [Accepted: 11/24/2023] [Indexed: 06/29/2024]
Abstract
The Dimensional Obsessive-Compulsive Scale (DOCS) is widely used to measure obsessive-compulsive disorder (OCD) severity across four broad symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, symmetry). Despite its proven utility, there is reason to suspect that the unacceptable thoughts subscale conflates different types of unacceptable thoughts that are meaningfully distinct from one another. In the current study, we first evaluated the psychometric properties of a newly developed DOCS violent and/or aggressive thoughts subscale. We then examined the factor structure, psychometric properties, and diagnostic sensitivity of a seven-factor version of the DOCS that includes the four original DOCS subscales and three more-specific versions of the unacceptable thoughts scale (i.e., sexually intrusive thoughts, violent and/or aggressive thoughts, and scrupulous or religious thoughts). The sample included 329 residential and intensive outpatients, the majority of which had a diagnosis of OCD (75.2%). The new unacceptable thoughts subscales demonstrated convergent and discriminant validity with unique associations between the subscales and depression, suicide, and perceived threat from emotions that were not present in the broader unacceptable thoughts subscale. The seven-factor version of the DOCS demonstrated slightly lower levels of diagnostic sensitivity than the original DOCS. Thus, the four-factor version of the DOCS is recommended for screening purposes. A score of 40 or higher on the seven-factor version of the DOCS best predicted a diagnosis of OCD. Overall, the three additional unacceptable thoughts subscales appear to be distinct factors that have potential value in research and clinical settings.
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Ong CW, Sheehan KG, Xu J, Falkenstein MJ, Kuckertz JM. A network analysis of mechanisms of change during exposures over the course of intensive OCD treatment. J Affect Disord 2024; 354:385-396. [PMID: 38508457 DOI: 10.1016/j.jad.2024.03.089] [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: 09/27/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Exposure and response prevention (ERP) is an evidence-based treatment for obsessive-compulsive disorder (OCD). Theories for how it works vary in their emphasis on active mechanisms of change. The current study aimed to clarify mechanisms of change in ERP for OCD using network analysis, comparing ERP networks at the start and end of intensive treatment (partial hospital and residential). In our sample of 182 patients, the most central node in both networks was engagement with exposure, which was consistently related to greater understanding of ERP rationale, higher willingness, and less ritualization, accounting for all other variables in the network. There were no significant differences in networks between the start and end of treatment. These results suggest that nonspecific parameters like facilitating engagement in exposures without ritualizing and providing a clear rationale to clients may be key to effective treatment. As such, it may be useful for clinicians to spend adequate time underscoring the need to eliminate rituals to fully engage in exposure tasks and explaining the rationale for ERP prior to doing exposures, regardless of theoretical orientation. Nonetheless, findings represent group-level statistics and more fine-grained idiographic analyses may reveal individual-level differences with respect to central mechanisms of change. Other limitations include demographic homogeneity of our sample.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, University of Toledo, United States.
| | - Kate G Sheehan
- Department of Psychology, University of Toledo, United States
| | - Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
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3
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Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.
Key learning aims
(1)
To gain knowledge needed for working with clients with OCD across race, ethnicity and culture.
(2)
To understand how race, ethnicity and culture affect the assessment and treatment of OCD.
(3)
To increase awareness of critical skills needed to implement CBT effectively for OCD in ethnoracially diverse clients.
(4)
To acknowledge potential barriers experienced by minoritized clients and assist in creating accessible spaces for services.
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Williams MT, Taylor RJ, George JR, Schlaudt VA, Ifatunji MA, Chatters LM. Correlates of Obsessive-Compulsive Symptoms Among Black Caribbean Americans. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020; 50:53-77. [PMID: 33840831 PMCID: PMC8034584 DOI: 10.1080/00207411.2020.1826261] [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: 10/23/2022]
Abstract
Despite the rapid growth of the Black Caribbean population in the United States, we know little about the presentation and prevalence of obsessive-compulsive disorder (OCD) among these groups. This study examines the demographic correlates and the effect of racial discrimination on OCD symptoms among a nationally-representative sample of Black Caribbean and African American adults (n = 5,191). Drawing on the Composite International Diagnostic Interview Short Form (CIDI-SF) for OCD, we examine two types of obsessions (harm and contamination) and four types of compulsions (repeating, washing, ordering, and counting). There we no significant differences between Black Caribbeans and African Americans in obsessions and compulsions. Analysis among Black Caribbeans found that compared with Jamaican and Trinidadian Americans, Haitian American individuals reported the fewest number of obsessions and compulsions. We show that Black Caribbean Americans with lower income, lower self-rated physical and mental health, and more experiences with racial discrimination report higher levels of OCD. More specifically, racial discrimination was associated with contamination and harm obsessions, as well as washing and repeating compulsions. Our findings highlight the need to consider specific domains of OCD relative to Black Caribbeans, and the relationship between social and demographic variables on symptomology.
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Affiliation(s)
| | | | - Jamilah R. George
- University of Connecticut, Department of Psychological Sciences, Storrs, CT
| | | | - Mosi Adesina Ifatunji
- University of Wisconsin at Madison, Department of Afro American Studies, Madison, WI
| | - Linda M. Chatters
- University of Michigan, School of Social Work, Ann Arbor, MI
- University of Michigan, School of Public Health, Ann Arbor, MI
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5
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Ching TH, Jelinek L, Hauschildt M, Williams MT. Association Splitting for Obsessive-Compulsive Disorder: A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2352096512666190912143311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Association splitting is a cognitive technique that targets obsessions in
obsessive-compulsive disorder (OCD) by weakening biased semantic associations among OCDrelevant
concepts.
Objective:
In this systematic review, we examine studies on the efficacy of association splitting for
reducing OCD symptoms.
Methods:
Following PRISMA guidelines, six studies were included, with diversity in sample characteristics,
mode of administration (i.e., self-help vs therapist-assisted), language of administration,
comparator groups, etc.
Results:
Results indicated that association splitting, as a self-help intervention, was efficacious in
reducing overall OCD symptom severity, specific OCD symptoms (i.e., sexual obsessions), subclinical
unwanted intrusions, and thought suppression, with small-to-large effect sizes (e.g., across
relevant studies, ds = .28-1.07). Findings were less clear when association splitting was administered
on a therapist-assisted basis as an add-on to standard cognitive-behavior therapy (CBT). Nonetheless,
across studies, the majority of participants reported high acceptability, ease of comprehension,
and adherence to daily association splitting practice.
Conclusion:
Although association splitting is an efficacious and acceptable self-help intervention
for OCD symptoms, future studies should include appropriate comparison groups, conduct longitudinal
assessments, examine efficacy for different symptom dimensions, and assess changes in semantic
networks as proof of mechanistic change. There should also be greater representation of
marginalized groups in future studies to assess association splitting’s utility in circumventing barriers
to face-to-face CBT. Ethical considerations are also discussed.
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Affiliation(s)
- Terence H.W. Ching
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269- 1020, United States
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marit Hauschildt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Monnica T. Williams
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269- 1020, United States
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6
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Zhou Y, Cao X, Wang J, Gao R, Chen Y, Liu Y, Zhang Z, Wang Z, Storch EA, Fan Q. Association between miscellaneous symptoms and primary symptom dimensions among chinese adults with obsessive-compulsive disorder. Psychiatry Res 2019; 274:274-279. [PMID: 30825727 DOI: 10.1016/j.psychres.2019.02.042] [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] [Received: 07/08/2018] [Revised: 02/02/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
Obsessive compulsive-disorder (OCD) is a common mental illness characterized by the presence of obsessions and/or compulsions. Symptom presence and severity is typically evaluated through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). However, miscellaneous symptoms embedded within the Y-BOCS Symptom Checklist have often been overlooked despite being associated with certain dimensions. In this study, we used exploratory factor analysis and logistic regression to explore the relationship between various miscellaneous symptoms and OCD symptom dimensions among 123 Chinese adults with OCD. A four-dimensional model was factorially derived: Obsessions, Symmetry/Ritual, Contamination/Cleaning and Contamination/Cleaning. In general, 11 out of 17 miscellaneous symptoms were associated with one or more of the symptom dimensions. Among them, the Obsessions dimension was significantly associated with seven miscellaneous symptoms: "Fear of not saying just the right thing," "Intrusive (non-violent) images," "Intrusive nonsense sounds, words", etc. The Symmetry/Ritual dimension was significantly associated with "Need to tell, ask, or confess." The Contamination/Cleaning dimension was related to "Need to know or remember". The Hoarding/Religion dimension was related to "Fear of losing things," and "Superstitious fears". Results contribute to the clinical assessment, diagnosis and treatment of Chinese patients with OCD by understanding the extent to which certain miscellaneous symptoms are associated with primary symptom dimensions.
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Affiliation(s)
- Yuxin Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xuan Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jianyu Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Rui Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yongjun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Ying Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zongfeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China.
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7
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Ching TH, Williams MT. The role of ethnic identity in OC symptom dimensions among Asian Americans. J Obsessive Compuls Relat Disord 2019; 21:112-120. [PMID: 32377506 PMCID: PMC7201378 DOI: 10.1016/j.jocrd.2019.03.005] [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: 10/27/2022]
Abstract
Little is known about obsessive-compulsive (OC) symptoms in Asian Americans. Past research has shown elevations in certain symptom dimensions when compared with White Americans, but there have not been any studies on cultural mechanisms for these differences. In this study, we examined whether ethnic identity mediated differences in severity of various OC symptom dimensions between Asian and White Americans. A total of 453 participants (79 Asian American, 374 non-Hispanic White) completed measures of ethnic identity and OC symptoms. Separate boostrapped mediation analyses were conducted to determine the indirect (i.e., mediation) effect of ethnoracial group membership on different OC symptom dimensions, via ethnic identity. There was significant evidence of mediation across the majority of OC subscales examined. Asian Americans reported stronger ethnic identity than their White counterparts, which in turn predicted more severe contamination obsessions and washing compulsions, harm-related intrusions, checking, neutralizing, as well as symmetry/ordering symptoms. This study is the first to demonstrate an exacerbating function of ethnic identity for OC symptoms among Asian Americans, contrary to some previous evidence of its protective role for overall mental health among ethnoracial minorities. More research is needed to test and validate hypotheses about why ethnic identity mediated group differences in OC symptoms.
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Affiliation(s)
- Terence H.W. Ching
- Corresponding author. University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA. (T.H.W. Ching)
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8
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du Mortier JAM, Visser HAD, van Balkom AJLM, van Megen HJGM, Hoogendoorn AW, Glas G, van Oppen P. Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist. Psychiatry Res 2019; 271:299-305. [PMID: 30521999 DOI: 10.1016/j.psychres.2018.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 10/18/2018] [Accepted: 11/18/2018] [Indexed: 12/20/2022]
Abstract
Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.
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Affiliation(s)
| | - Henny A D Visser
- GGz Centraal, Innova Postbus 3051, 3800 DB Amersfoort, The Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | | | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Gerrit Glas
- Dimence Groep, Postbus 473, 8000 AL Zwolle, The Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
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9
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George JR, Pittenger C, Kelmendi B, Lohr JM, Adams TG. Disgust sensitivity mediates the effects of race on contamination aversion. J Obsessive Compuls Relat Disord 2018; 19:72-76. [PMID: 31341759 PMCID: PMC6656395 DOI: 10.1016/j.jocrd.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
African Americans report greater contamination aversion than European Americans. Few studies have attempted to identify potential causes for this elevated contamination aversion, though existing research and theory suggests this may be partly due to concomitant heightened disgust sensitivity. The present study examined the relations between race, disgust sensitivity, and contamination aversion among African and European Americans. A convenience sample of fourhundred and twenty-nine participants completed the Disgust Scale - Revised (DS-R) and the Padua Inventory - Revised (PI-R). African Americans endorsed greater disgust sensitivity (DS-R total) - particularly on the core and contamination subscales of the DS-R - and scored higher on the contamination subscale of the PI-R (but not on other subscales) than European Americans. Mediational analyses revealed a significant total effect of race on contamination aversion and a significant indirect effect of race on contamination aversion through disgust sensitivity; the direct effect of race on contamination aversion remained significant even after controlling for race. These findings suggest that elevated contamination aversions among African Americans may be partly due to elevated disgust sensitivity. If confirmed with larger and clinical samples, and more robust experimental methods, this relationship may prove to have implications for the treatment of contamination-based obsessive-compulsive disorder (OCD) among African Americans.
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Affiliation(s)
| | | | - Benjamin Kelmendi
- Yale University School of Medicine, Department of Psychiatry
- Clinical Neuroscience Division of the VA National Center for PTSD, West Haven VACHS
| | | | - Thomas G. Adams
- Yale University School of Medicine, Department of Psychiatry
- University of Arkansas at Fayetteville
- Clinical Neuroscience Division of the VA National Center for PTSD, West Haven VACHS
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10
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Hong JH, Lee EB, Wetterneck CT, Hart JM. Need to screen for clinical levels of OCD? Four questions are the key. Bull Menninger Clin 2017; 81:247-263. [DOI: 10.1521/bumc_2017_81_03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Judy H. Hong
- Doctoral student at the University of Houston, Houston, Texas
| | - Eric B. Lee
- Doctoral student at Utah State University, Logan, Utah
| | - Chad T. Wetterneck
- Cognitive behavior specialist and clinical supervisor at Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - John M. Hart
- Cognitive and therapy specialist at The Menninger Clinic, Houston, Texas
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11
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Williams MT, Taylor RJ, Mouzon DM, Oshin LA, Himle JA, Chatters LM. Discrimination and symptoms of obsessive-compulsive disorder among African Americans. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2017; 87:636-645. [PMID: 28816492 DOI: 10.1037/ort0000285] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study examined symptoms of obsessive-compulsive disorder (OCD) in a nationally representative sample of African American adults (n = 3,570) and correlations between OCD symptom dimensions and experiences of discrimination. Two categories of discrimination were examined, everyday racial discrimination and everyday nonracial discrimination (e.g., because of gender, age, and weight), to determine if racial discrimination had a unique impact on OCD symptoms. Results indicated that everyday racial discrimination was related to both categories of obsessions and all 4 categories of compulsions. Everyday nonracial discrimination, however, was not related to any of the categories of obsessions or compulsions. This indicates that racial discrimination is uniquely related to obsessions and compulsions for African Americans. The implications of these findings are discussed. (PsycINFO Database Record
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Affiliation(s)
- Monnica T Williams
- Department of Psychological Sciences, College of Liberal Arts and Sciences, University of Connecticut
| | - Robert Joseph Taylor
- School of Social Work, Program for Research on Black Americans, Institute for Social Research, University of Michigan
| | - Dawne M Mouzon
- Edward J. Bloustein School of Planning and Public Policy, Institute for Health, Health Care Policy, and Aging Research, Rutgers University
| | - Linda A Oshin
- Department of Psychological Sciences, College of Liberal Arts and Sciences, University of Connecticut
| | - Joseph A Himle
- Department of Psychiatry, School of Social Work, University of Michigan
| | - Linda M Chatters
- Schools of Social Work and Public Health, Program for Research on Black Americans, Institute for Social Research, University of Michigan
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12
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Chasson GS, Williams MT, Davis DM, Combs JY. Missed diagnoses in African Americans with obsessive-compulsive disorder: the structured clinical interview for DSM-IV Axis I disorders (SCID-I). BMC Psychiatry 2017; 17:258. [PMID: 28716021 PMCID: PMC5514479 DOI: 10.1186/s12888-017-1422-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 07/05/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Research on the utility of structured interviews in assessing OCD is scarce, and even more so, in its use for OCD in African Americans. The purpose of this study was to examine the utility of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) in detecting OCD in African Americans when used by well-trained, culturally competent clinicians. METHODS Seventy-four African American adults with OCD were assessed with the SCID-I and additional measures of OCD. RESULTS Results revealed the poor diagnostic utility of the SCID OCD section (SCID-OCD), with 66.2% (N = 49) correctly identified and 33.8% (N = 25) incorrectly diagnosed. Participants receiving the correct diagnosis were more likely to endorse compulsive behaviors, specifically ordering compulsions, and experience greater symptom severity. CONCLUSION The lack of sensitivity for identification of OCD is discussed as the SCID-OCD seems to often miss a true diagnosis of OCD in African Americans.
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Affiliation(s)
- Gregory S. Chasson
- 0000 0004 1936 7806grid.62813.3eDepartment of Psychology, Illinois Institute of Technology, 3105 S. Dearborn, Chicago, IL 60616 USA
| | - Monnica T. Williams
- 0000 0001 0860 4915grid.63054.34Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020 USA
| | - Darlene M. Davis
- 0000 0001 2113 1622grid.266623.5Center for Mental Health Disparities, Department of Psychological & Brain Sciences, University of Louisville, 2301 South Third Street, Louisville, KY 40292 USA
| | - Jessica Y. Combs
- 0000 0001 2107 308Xgrid.412724.6Department of Psychology, Spalding University, Louisville, KY USA
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13
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Williams MT, Taylor RJ, Himle JA, Chatters LM. Demographic and health-related correlates of obsessive-compulsive symptoms among African Americans. J Obsessive Compuls Relat Disord 2017; 14:119-126. [PMID: 30079297 PMCID: PMC6072272 DOI: 10.1016/j.jocrd.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the correlates of the symptoms of obsessive-compulsive disorder (OCD) among a nationally-representative sample of African American adults (n = 3,570). Demographic and several self-rated health variables were examined. Although only 1.6% of the sample met DSM-IV diagnostic criteria for OCD, a sizeable proportion of the sample reported compulsions (12.5%) and obsessions (15.3%). Material hardship was positively associated with nearly all measured symptoms of OCD and fewer years of educational attainment was related to greater compulsive symptoms. Self-rated mental health was related to both compulsions and obsessions, and self-rated physical health was associated with counting and repeating compulsions. Implications and areas for further research with African Americans are discussed, including improving access to care for those most in need of services.
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Affiliation(s)
- Monnica T Williams
- College of Liberal Arts & Sciences, Department of Psychological Sciences School of Medicine, Department of Psychiatry, University of Connecticut
| | - Robert Joseph Taylor
- School of Social Work, Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor
| | - Joseph A Himle
- School of Social Work, Department of Psychiatry, University of Michigan, Ann Arbor
| | - Linda M Chatters
- School of Social Work, School of Public Health, Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor
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14
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Asadi S, Daraeian A, Rahmani B, Kargari A, Ahmadiani A, Shams J. Exploring yale-brown obsessive-compulsive scale symptom structure in Iranian OCD patients using item-based factor analysis. Psychiatry Res 2016; 245:416-422. [PMID: 27620324 DOI: 10.1016/j.psychres.2016.08.028] [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] [Received: 01/20/2016] [Revised: 07/29/2016] [Accepted: 08/07/2016] [Indexed: 11/25/2022]
Abstract
Obsessive compulsive disorder (OCD) is a heterogeneous psychiatric disorder. This study aimed to reach a comprehensive perspective of OCD symptoms in Iranian patients. Item-based factor analysis of Y-BOCS checklist from 216 outpatients resulted in five factors including aggression/checking, contamination/cleaning, symmetry/ordering/repeating/counting/hoarding, sexual and somatic. Regression analyses showed that miscellaneous items can be predicted by these factors. Results showed that OCD subtypes in Iranian patients resemble to those of other nations except the aggressive, sexual and religious obsessions; demonstrating the influence of the culture on obsession manifestation. The correlation analyses of factors and clinical characteristics demonstrated that aggression/checking was associated with high obsession scores and more avoidance. Contamination/cleaning was correlated with higher compulsion score. Patients with higher scores on symmetry/ordering/counting/repeating/hoarding had familial OCD pattern with earlier age of onset, lower age at assessment, higher obsession and more avoidance. Sexual factor was associated with less compulsion scores and somatic factor was associated with higher obsessions and compulsions as well as less familial history and more avoidance. These findings provide a comprehensive view of OCD symptom structure in Iranian OCD patients and will be of value to studies using symptom factor to lead investigation of its causes, correlates and treatment strategies considering cross-cultural differences.
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Affiliation(s)
- Sareh Asadi
- NeuroBiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azin Daraeian
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Rahmani
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Section of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Atiye Kargari
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolhassan Ahmadiani
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamal Shams
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ching THW, Williams M, Siev J. Violent obsessions are associated with suicidality in an OCD analog sample of college students. Cogn Behav Ther 2016; 46:129-140. [PMID: 27659199 DOI: 10.1080/16506073.2016.1228084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.
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Affiliation(s)
- Terence H W Ching
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Monnica Williams
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Jedidiah Siev
- b Psychology Department , Swarthmore College , Swarthmore , PA , USA
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Differences in duration of untreated illness, duration, and severity of illness among clinical phenotypes of obsessive-compulsive disorder. CNS Spectr 2015; 20:474-8. [PMID: 24967664 DOI: 10.1017/s1092852914000339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a prevalent, disabling, and comorbid condition that is frequently under-recognized and poorly treated. OCD phenotypes may differ in terms of clinical presentation and severity. However, few studies have investigated whether clinical phenotypes differ in terms of latency to treatment (ie, duration of untreated illness[DUI]), duration, and severity of illness. The present study was aimed to quantify the aforementioned variables in a sample of OCD patients. METHODS One hundred fourteen outpatients with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnosis of OCD were recruited, and their main clinical features were collected. Severity of illness was assessed through the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and the main phenotypes were identified through the Y-BOCS Symptom Checklist. A one-way analysis of variance (ANOVA) test, followed by a Bonferroni post-hoc test, were performed to compare DUI, duration, and severity of illness across subgroups. RESULTS In the whole sample, the mean DUI exceeded 7 years (87.35±11.75 months), accounting for approximately half of the mean duration of illness (172.2±13.36 months). When subjects were categorized into 4 main clinical phenotypes, respectively, aggressive/checking (n=31), contamination/cleaning (n=37), symmetry/ordering (n=32), and multiple phenotypes (n=14), DUI, duration, and severity of illness resulted significantly higher in the aggressive/checking subgroup, compared to other subgroups (F=3.58, p<0.01; F=3.07, p<0.01; F=4.390, p<0.01). DISCUSSION In a sample of OCD patients, along with a mean latency to treatment of approximately 7 years, regardless of the phenotype, patients had spent half of their duration of illness (DI) without being treated. DUI, duration, and severity of illness resulted significantly higher in the aggressive/checking subgroup.
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Wetterneck CT, Siev J, Adams TG, Slimowicz JC, Smith AH. Assessing Sexually Intrusive Thoughts: Parsing Unacceptable Thoughts on the Dimensional Obsessive-Compulsive Scale. Behav Ther 2015; 46:544-56. [PMID: 26163717 PMCID: PMC4809189 DOI: 10.1016/j.beth.2015.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 05/08/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD), often classified in a broader symptom dimension that includes aggressive and religious obsessions, as well. Indeed, the Dimensional Obsessive-Compulsive Scale (DOCS) Unacceptable Thoughts Scale includes obsessional content relating to sexual, violent, and religious themes associated with rituals that are often covert. However, there is reason to suspect that sexual obsessions differ meaningfully from other types of unacceptable thoughts. We conducted two studies to evaluate the factor structure, initial psychometric characteristics, and associated clinical features of a new DOCS scale for sexually intrusive thoughts (SIT). In the first study, nonclinical participants (N=475) completed the standard DOCS with additional SIT questions and we conducted an exploratory factor analysis on all items and examined clinical and cognitive correlates of the different scales, as well as test-retest reliability. The SIT Scale was distinct from the Unacceptable Thoughts Scale and was predicted by different obsessional cognitions. It had good internal consistency and there was evidence for convergent and divergent validity. In the second study, we examined the relationships among the standard DOCS and SIT scales, as well as types of obsessional cognitions and symptom severity, in a clinical sample of individuals with OCD (N=54). There were indications of both convergence and divergence between the Unacceptable Thoughts and SIT scales, which were strongly correlated with each other. Together, the studies demonstrate the potential utility of assessing sexually intrusive thoughts separately from the broader category of unacceptable thoughts.
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The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive-compulsive disorder. J Anxiety Disord 2014; 28:553-8. [PMID: 24983796 PMCID: PMC4151097 DOI: 10.1016/j.janxdis.2014.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/02/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients. METHOD The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n=87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. RESULTS The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β=.27, p=.02) and hoarding dimensions (β=.23, p=.04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. CONCLUSIONS EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.
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Olatunji BO, Tomarken A, Zhao M. Effects of Exposure to Stereotype Cues on Contamination Aversion and Avoidance in African Americans. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2014. [DOI: 10.1521/jscp.2014.33.3.229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Williams MT, Wetterneck CT, Thibodeau MA, Duque G. Validation of the Yale-Brown Obsessive-Compulsive Severity Scale in African Americans with obsessive-compulsive disorder. Psychiatry Res 2013; 209:214-21. [PMID: 23664665 DOI: 10.1016/j.psychres.2013.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/02/2013] [Accepted: 04/09/2013] [Indexed: 12/16/2022]
Abstract
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is widely used in the assessment of obsessive-compulsive disorder (OCD), but the psychometric properties of the instrument have not been examined in African Americans with OCD. Therefore, the purpose of this study is to explore the properties of the Y-BOCS severity scale in this population. Participants were 75 African American adults with a lifetime diagnosis of OCD. They completed the Y-BOCS, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II), and the Multigroup Ethnic Identity Measure (MEIM). Evaluators rated OCD severity using the Clinical Global Impression Scale (CGI) and their global assessment of functioning (GAF). The Y-BOCS was significantly correlated with both the CGI and GAF, indicating convergent validity. It also demonstrated good internal consistency (α=0.83) and divergent validity when compared to the BAI and BDI-II. Confirmatory factor analyses tested five previously reported models and supported a three-factor solution, although no model exhibited excellent fit. An exploratory factor analysis was conducted, supporting a three-factor solution. A linear regression was conducted, predicting CGI from the three factors of the Y-BOCS and the MEIM, and the model was significant. The Y-BOCS appears to be a valid measure for African American populations.
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Affiliation(s)
- Monnica T Williams
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
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