Ayelet Meron Ruscio

The Epidemiology of Obsessive-Compulsive Disorder in the National Comorbidity Survey Replication

Despite significant advances in the study of obsessive-compulsive disorder (OCD), important questions remain about the disorders public health significance, appropriate diagnostic classification, and clinical heterogeneity. These issues were explored using data from the National Comorbidity Survey Replication, a nationally representative survey of US adults. A subsample of 2073 respondents was assessed for lifetime Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) OCD. More than one quarter of respondents reported experiencing obsessions or compulsions at some time in their lives. While conditional probability of OCD was strongly associated with the number of obsessions and compulsions reported, only small proportions of respondents met full DSM-IV criteria for lifetime (2.3%) or 12-month (1.2%) OCD. OCD is associated with substantial comorbidity, not only with anxiety and mood disorders but also with impulse-control and substance use disorders. Severity of OCD, assessed by an adapted version of the Yale–Brown Obsessive Compulsive Scale, is associated with poor insight, high comorbidity, high role impairment, and high probability of seeking treatment. The high prevalence of subthreshold OCD symptoms may help explain past inconsistencies in prevalence estimates across surveys and suggests that the public health burden of OCD may be greater than its low prevalence implies. Evidence of a preponderance of early onset cases in men, high comorbidity with a wide range of disorders, and reliable associations between disorder severity and key outcomes may have implications for how OCD is classified in DSM-V.

Psychometric Properties of Nine Scoring Rules for the Clinician- Administered Posttraumatic Stress Disorder Scale

The use of structured interviews that yield continuous measures of symptom severity has become increasingly widespread in the assessment of posttraumatic stress disorder (PTSD). To date, however, few scoring rules have been developed for converting continuous severity scores into dichotomous PTSD diagnoses. In this article, we describe and evaluate 9 such rules for the Clinician-Administered PTSD Scale (CAPS). Overall, these rules demonstrated good to excellent reliability and good correspondence with a PTSD diagnosis based on the Structured Clinical Interview for Diagnostic and Statistical Manual ofMental Disorders (3rd ed., rev.; DSM-III-R; American Psychiatric Association, 1987). However, the rules yielded widely varying prevalence estimates in 2 samples of male Vietnam veterans. Also, the use of DSM-III-R versus DSM-IV criteria had negligible impact on PTSD diagnostic status. The selection of CAPS scoring rules for different assessment tasks is discussed.

A Meta-Analysis of the Effect of Cognitive Bias Modification on Anxiety and Depression.

Cognitive biases have been theorized to play a critical role in the onset and maintenance of anxiety and depression. Cognitive bias modification (CBM), an experimental paradigm that uses training to induce maladaptive or adaptive cognitive biases, was developed to test these causal models. Although CBM has generated considerable interest in the past decade, both as an experimental paradigm and as a form of treatment, there have been no quantitative reviews of the effect of CBM on anxiety and depression. This meta-analysis of 45 studies (2,591 participants) assessed the effect of CBM on cognitive biases and on anxiety and depression. CBM had a medium effect on biases (g = 0.49) that was stronger for interpretation (g = 0.81) than for attention (g = 0.29) biases. CBM further had a small effect on anxiety and depression (g = 0.13), although this effect was reliable only when symptoms were assessed after participants experienced a stressor (g = 0.23). When anxiety and depression were examined separately, CBM significantly modified anxiety but not depression. There was a nonsignificant trend toward a larger effect for studies including multiple training sessions. These findings are broadly consistent with cognitive theories of anxiety and depression that propose an interactive effect of cognitive biases and stressors on these symptoms. However, the small effect sizes observed here suggest that this effect may be more modest than previously believed.

Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication

BACKGROUND Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R). METHOD The NCS-R is a nationally representative household survey fielded in 2001-2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia. RESULTS The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose-response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment. CONCLUSIONS Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.

Epidemiology of Anxiety Disorders

This chapter presents an overview of the descriptive epidemiology of anxiety disorders based on recently completed surveys of the general population. The overall prevalence of anxiety disorders is shown to be quite high, but with considerable variation from the most prevalent (specific phobias) to the least prevalent (agoraphobia without a history of panic disorder) disorders. Age-of-onset (AOO) of anxiety disorders is typically in childhood or adolescence and the course is often chronic-recurrent. Anxiety disorders are highly comorbid with each other and with other mental disorders. Because of their early AOO, they are often the temporally primary disorders in comorbid profiles, raising the question whether early interventions to treat anxiety disorders might have a positive effect on the onset, persistence, or severity of secondary disorders such as mood and substance use disorders. This possibility has not yet been extensively explored but warrants further study given the high societal costs of anxiety disorders.

Informing the continuity controversy: a taxometric analysis of depression.

Researchers and practitioners have long debated the structural nature of mental disorders. Until recently, arguments favoring categorical or dimensional conceptualizations have been based primarily on theoretical speculation and indirect empirical evidence. Within the depression literature, methodological limitations of past studies have hindered their capacity to inform this important controversy. Two studies were conducted using MAXCOV and MAMBAC, taxometric procedures expressly designed to assess the underlying structure of a psychological construct. Analyses were performed in large clinical samples with high base rates of major depression and a broad range of depressive symptom severity. Results of both studies, drawing on 3 widely used measures of depression, corroborated the dimensionality of depression. Implications for the conceptualization, investigation, and assessment of depression are discussed.

A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorder.

Intolerance of uncertainty (IU) has been suggested to reflect a specific risk factor for generalized anxiety disorder (GAD), but there have been no systematic attempts to evaluate the specificity of IU to GAD. This meta-analysis examined the cross-sectional association of IU with symptoms of GAD, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). Random effects analyses were conducted for two common definitions of IU, one that has predominated in studies of GAD (56 effect sizes) and another that has been favored in studies of OCD (29 effect sizes). Using the definition of IU developed for GAD, IU shared a mean correlation of .57 with GAD, .53 with MDD, and .50 with OCD. Using the alternate definition developed for OCD, IU shared a mean correlation of .46 with MDD and .42 with OCD, with no studies available for GAD. Post-hoc significance tests revealed that IU was more strongly related to GAD than to OCD when the GAD-specific definition of IU was used. No other differences were found in the magnitude of associations between IU and the three syndromes. We discuss implications of these findings for models of shared and specific features of emotional disorders and for future research efforts.

A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)

BACKGROUND Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators. METHOD The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, sociodemographics, parental psychopathology and 12-month DSM-IV disorders. RESULTS Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2.6, 0.7 and 0.4% respectively. Although ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators [area under the receiver operator characteristic curve (AUC)=0.88]. The distribution (conditional probability of attempt) of the risk index is: 19.0% very low (0.0%), 51.1% low (3.5%), 16.2% intermediate (21.3%), and 13.7% high (78.1%). Two-thirds (67.1%) of attempts were made by ideators in the high-risk category. CONCLUSIONS A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.

A Taxometric Investigation of the Latent Structure of Worry

Researchers have described 2 types of worriers, normal and pathological, who differ in the frequency, intensity, and controllability of their worry experiences. Although normal and pathological worry are generally treated as separate though related phenomena, no study has tested for separateness against the alternative hypothesis that all worry exists along a single dimension. In the present study, worry ratings of 1,588 college students were submitted to taxometric procedures designed to evaluate latent structure. Results provided evidence for the dimensionality of worry. These findings suggest that generalized anxiety disorder (GAD), whose central feature is worry, may also be quantitatively rather than qualitatively different from normal functioning. The authors argue that a focus on normal and pathological extremes has constrained the study of worry phenomena and that dimensional conceptualization of worry may significantly enhance understanding of both worry and GAD.

Generalized worry disorder : a review of DSM-IV generalized anxiety disorder and options for DSM-V

Background: Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM‐III. The majority of these revisions have been in response to its poor inter‐rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM‐IV GAD criteria for DSM‐V. Method: First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM‐III‐R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM‐IV criteria for GAD was examined. Conclusions: The review presents a number of options to be considered for DSM‐V. One option is for GAD to be re‐labeled in DSM‐V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM‐V validity tests and field trials. Depression and Anxiety, 2010.