Clinical and psychological features distinguishing obsessive-compulsive and chronic tic disorders

Shame in the obsessive compulsive related disorders: a conceptual review

BACKGROUND

Theoretical and anecdotal support for the role of shame in obsessive compulsive related disorders (OCRDs) is prominent. Developing our understanding of shame׳s role in OCRDs is important to building knowledge about this new diagnostic category. This review aims to consolidate our understanding of shame in each OCRD, through summarizing existing clinical, conceptual, and empirical work.

METHODS

We provide an overview of shame, its measurement considerations, and a full review of 110 articles addressing shame in OCRDs.

RESULTS

General shame and shame about having a mental illness are the broadest types of shame relevant to OCRDs; symptom-based shame and body shame may be more specific to OCRDs. In OCD, violent, sexual, or blasphemous obsessions may trigger symptom-based shame. In trichotillomania (TTM) and skin picking (SP), symptom-based shame may be related to pulling, picking, and post-pulling/picking behaviors. In hoarding disorder, symptom-based shame may accompany beliefs about being defective due to living with clutter. Body shame appears inherent to body dysmorphic disorder, while in TTM and SP it may arise as a secondary response to damage resulting from body focused repetitive behaviors.

LIMITATIONS

Much of the current knowledge on shame in OCRDs comes from anecdotal, case, and conceptual work. Empirical studies do not always assess specific types of shame, instead assessing shame as a general construct.

CONCLUSIONS

Shame is closely related to OCRDs. Clinical and research recommendations drawing from the literature are provided.

Tic disorders and obsessive compulsive disorder: where is the link?

Over the last years evidence on the overlap between tic-disorders (TD) and obsessive compulsive behavior/disorder (OCB/OCD) has increased. The main focus of research have been the phenomenological and epidemiological similarities and differences in samples of different age, primary diagnosis (TD vs. OCD) including the co-occurrence of both. Unfortunately, only a minority of studies included all three groups (TD, TD + OCD, OCD). Nevertheless, new insight concerning possible subtypes for both TD and OCD has been gained. While some authors concentrated on OCD with/without tics we will summarize the field of TD and OCB/OCD from the viewpoint of tics, since OCB plays an important role in patients with TD. Thereby we will not only sharpen the clinicans' awareness of known differences in phenomenology, epidemiology, genetics and neurobiology, aimed to improve their diagnoses and treatment but also highlight the gaps of knowledge and discuss possibilities for further research in this field.

Tic or compulsion?: it's Tourettic OCD

A subgroup of individuals suffering from obsessive-compulsive disorder (OCD) frequently present to treatment with an atypical yet distinguishable array of symptoms akin to both Tourette's disorder (TD) and OCD. These individuals often receive standard treatments for OCD (or less likely, TD) that fail to address the blended features of their presentation. It is argued that these individuals would be better served, both psychotherapeutically and pharmacologically, by the adoption of a Tourettic OCD (TOCD) conceptual framework.

Screening for Obsessive and Compulsive Symptoms: Validation of the Clark-Beck Obsessive-Compulsive Inventory

The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria and current cognitive-behavioral formulations. Revisions were made to the CBOCI on the basis of psychometric and item analyses of an initial pilot study of clinical and nonclinical participants. The construct validity of the revised CBOCI was supported in a subsequent validation study involving OCD, nonobsessional clinical, and nonclinical samples. A principal-factor analysis of the 25 items found 2 highly correlated factors of Obsessions and Compulsions. OCD patients scored significantly higher on the measure than nonobsessional anxious, depressed, and nonclinical samples. The questionnaire had strong convergent validity with other OCD symptom measures but more modest discriminant validity.

Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder

In this study, we sought to characterize obsessive-compulsive disorder (OCD) patients with impulsive features, and to determine whether they constitute a distinct subtype of OCD. Therefore we systematically assessed impulse control disorders and other impulsive conditions categorized as obsessive-compulsive spectrum disorders (OCSDs) in 153 Japanese adult patients with OCD. Forty-five subjects (29%) had concurrent impulsive disorders, and they were differentiated from other OCD patients on a range of demographic features (e.g., younger age at onset), and clinical features (e.g., pervasive and severe psychopathology, and poor treatment outcome). However, on logistic regression, none of these variables predicted comorbid impulsivity. The findings appear to support the argument that OCD patients with impulsive features constitute a subtype of OCD. However, further research is necessary to determine whether impulsivity should be conceptualized as lying on a spectrum with compulsivity or as a dimension that is orthogonal to compulsivity.

A cognitive-behavioral/psychophysiological model of tic disorders

This article discusses current cognitive behavioral, as well as neurophysiological, accounts of the development and maintenance of tic behavior in chronic (simple or complex) tic disorders. A cognitive psychophysiological model is further elaborated, highlighting the reciprocal interplay of background cognitive and physiological factors preceding tic onset. According to the model, cognitive factors such as perfectionist concerns and heightened sensory awareness and self-attention, as well as physiological factors such as a high level of motor activation and accompanying elevated muscle tension, play a role in tic habits. Negative appraisals of tics and counter-productive coping strategies developed by clients as a means to suppress or to disguise the tic behavior may also locally reinforce tic onset. Neurochemical factors are viewed largely as concomitants of behavioral adaptations or compensations to the tic problem rather than as independent markers or precursors of tic onset. Clinically, the model emphasizes the role of cognitive-behavioral factors in tic onset, and suggests that tic management is best accomplished through cognitive behavioral interventions designed to prevent build up of both tension and pre-monitory urge in tic-affected muscles, rather than reverse the tic at the onset of the premonitory urge. The clinical validity of parts of the model is supported by recent experimental, psychometric and clinical studies. Other parts of the model remain speculative but at least yield testable predictions. A strength of the model is its ability to account for findings over diverse psychological and biological domains.