Later Bedtimes Predict Prospective Increases in Symptom Severity in Individuals with Obsessive Compulsive Disorder (OCD): An Initial Study

Sleep quality and its clinical associations in trichotillomania and skin picking disorder

BACKGROUND

Trichotillomania (TTM) is characterized by recurrent hair pulling and associated hair loss. Skin picking disorder (SPD) is characterized by recurrent skin picking and associated scarring or tissue damage. Both disorders are also accompanied by psychological distress and poor sleep. Very little, however, is known about lifestyle variables that may contribute to symptom severity in these disorders.

METHODS

We recruited 87 adults as part of a cross-sectional study of 3 groups (TTM, SPD, and non-affected). Clinical subjects (n=69) were compared with controls (n=18) on sleep quality as measured by Pittsburgh Sleep Quality Index (PSQI). We used partial least squares regression to identify which variables were significantly associated with poor sleep quality among those participants with TTM or SPD.

RESULTS

Clinical subjects had significantly poorer sleep quality than controls. Sleep quality was significantly related to older age, worse perceived stress, lower distress tolerance and greater impulsivity in adults with BFRBs. Poor sleep quality was associated with worse hair pulling symptom severity but not skin picking severity. Higher levels of comorbid mental disorders was also associated with worse sleep, above and beyond the impact of these other variables.

CONCLSUIONS

Poor sleep quality appears to be related to multiple variables. Further research is needed to determine causality and to tailor treatment to specific patient needs.

Does Concentrated Exposure Treatment for Obsessive-Compulsive Disorder Improve Insomnia Symptoms? Results From a Randomized Controlled Trial

Insomnia is a substantial problem in patients with obsessive-compulsive disorder (OCD). There is, however, a lack of studies investigating changes in concurrent symptoms of insomnia in OCD after concentrated treatment. A recent randomized controlled trial randomized participants to the Bergen 4-day treatment (B4DT, n = 16), or 12 weeks of unguided self-help (SH, n = 16), or waitlist (WL, n = 16). Patients from the SH- and WL-group who wanted further treatment after the 12 weeks were then offered the B4DT (total of 42 patients treated with the B4DT). There were no significant differences in symptoms of insomnia between the conditions at post-treatment, but a significant moderate improvement at 3-month follow-up for patients who received the B4DT. Insomnia was not associated with OCD-treatment outcome, and change in symptoms of insomnia was mainly related to changes in depressive symptoms. The main conclusion is that concentrated exposure treatment is effective irrespective of comorbid insomnia, and that insomnia problems are moderately reduced following treatment.

A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations

Cross-sectional and experimental research have shown that task-unrelated thoughts (i.e., mind wandering) relate to sleep disturbances, but there is little research on whether this association generalizes to the day-level and other kinds of task-unrelated mentation. We employed a longitudinal daily diary design to examine the within-person and between-person associations between three self-report instruments measuring mind wandering, maladaptive daydreaming (a condition characterized by having elaborate fantasy daydreams so insistent that they interfere with daily functioning) and sleep disturbances. A final sample of 126 participants self-identified as experiencing maladaptive daydreaming completed up to 8 consecutive daily reports (in total 869 daily observations). The scales showed acceptable-to-excellent within-person reliability (i.e., systematic day-to-day change) and excellent between-person reliability. The proportion of between-person variance was 36% for sleep disturbances, 57% for mind wandering, and 75% for maladaptive daydreaming, respectively (the remaining being stochastic and systematic within-person variance). Contrary to our pre-registered hypothesis, maladaptive daydreaming did not significantly predict sleep disturbances the following night, B = -0.00 (SE = 0.04), p = .956. Exploratory analyses indicated that while nightly sleep disturbances predicted mind wandering the following day, B = 0.20 (SE = 0.04), p < .001, it did not significantly predict maladaptive daydreaming the following day, B = -0.04 (SE = 0.05), p = .452. Moreover, daily mind wandering did not significantly predict sleep disturbances the following night, B = 0.02 (SE = 0.05), p = .731. All variables correlated at the between-person level. We discuss the implications concerning the differences between maladaptive daydreaming and mind wandering and the possibility of targeting sleep for mind wandering interventions.