C. Alec Pollard

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

Four Types of Social Phobia in a Community Sample

Point prevalence rates and demographic characteristics associated with four specific forms of social phobia (public speaking/performing, writing in front of others, eating in restaurants, and use of public restrooms) were examined in a sample of adult residents of the greater St. Louis area. Diagnoses were determined by structured interview in accordance with DSM-III criteria. An unadjusted prevalence rate of 22.6% was found for all four social phobias combined. Application of DSM-III significant distress criteria resulted in a prevalence rate of 2.0%. Public speaking/performing phobias were by far the most common (20.6%). Prevalence rates of 2.8%, 1.2%, and 0.2% were found for phobias related to writing, eating, and use of public restrooms, respectively. Social phobias were more common among women than men. No other demographic differences were found between social phobics and the rest of the sample. Results of this study suggest a higher prevalence of social phobia than has been indicated by prior research. Explanations for and implications of these findings are discussed.

Three types of obsessive compulsive disorder in a community sample

Until recently, prior estimates of the prevalence of obsessive compulsive disorder (OCD) have been based on clinical data. The present investigation studied point prevalence and demographic data that pertain to three ritual-based forms of OCD in a sample of the adult general population of the greater St. Louis area. Two hundred fifty male and 247 female subjects were administered a structured interview designed to identify the presence of symptoms associated with OCD according to DSM-III criteria. The overall prevalence rate of OCD was 2.8%. The most prevalent form of OCD involved checking (1.6%), followed by a miscellaneous category that included repeating, counting and collecting rituals (1.0%) and, finally, washing compulsions (.8%). Subjects with OCD did not differ demographically from the rest of the sample except that they were more likely to live in the city. Results indicate that OCD is more prevalent than previously supposed and that checking compulsions may be the most common form of ritual in nonclinical samples.

Perceived parental characteristics of patients with obsessive compulsive disorder, depression, and panic disorder.

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.

Help-seeking patterns of community residents with depressive symptoms

From a community sample, fifty-five individuals identified as having three or more symptoms of depression were asked if and where they had sought help and how they found or would find treatment. Only 20 subjects (33.9%) reported having sought professional help. No demographic differences were found between help-seekers and non-help-seekers. Eighty percent of the help-seekers had seen a mental health professional while 20% had seen a non-psychiatric physician. However, non-psychiatric physicians and friends or personal acquaintances were most frequently cited as the first point of contact for locating treatment. Results suggest that most individuals with a moderate number of depressive symptoms do not seek professional assistance but that, among those who do, a majority is eventually seen by a mental health professional. Virtually all utilize intermediaries other than mental health professionals, however, to locate assistance. The non-psychiatric physician plays a prominent role in locating help for depressed individuals, which suggests the need to educate physicians about appropriate treatment referral.

Help-seeking patterns of anxiety-disordered individuals in the general population

Abstract From a sample of the general population, 142 individuals who had been diagnosed by structured interview as having agoraphobia, social phobia, or obsessive compulsive disorder according to DSM-III criteria were asked if and where they sought help and how they found or would find treatment. Only 40% of the agoraphobics, 28% of those with obsessive compulsive disorder, and 8% of the social phobics reported having sought professional assistance. No demographic differences were found between help-seekers and non-help-seekers, except an equivocal finding suggesting that help-seekers were more likely to live in the city. Almost half of the help-seekers had not seen a mental health professional. Nonpsychiatric physicians and members of the clergy were most frequently cited as the first point of contact for locating treatment. Results suggest that most anxiety disordered individuals do not receive help from professionals with appropriate expertise. Greater involvement of physicians and the clergy may facilitate future attempts to increase public awareness of and access to effective treatments currently available for anxiety disorders.

Sexual history and quality of current relationships in patients with obsessive compulsive disorder: A comparison with two other psychiatric samples

It has been hypothesized that sexual conflict is a causal factor in the development of obsessive compulsive disorder. This study investigated the relationship between obsessive compulsive disorder and variables related to the individuals sexual history, present life, sexual satisfaction, and marital adjustment. Of inpatient admissions, 363 who met criteria for obsessive compulsive disorder, panic disorder, and depressive disorder completed a standard history questionnaire and the Marital Adjustment Test. Findings showed that obsessive compulsive individuals cannot be distinguished from either depressive or panic disordered groups by a particular sexual history. Future studies should use measures that do not rely on patient self-report.

Comprehensive Behavioral Management of Complex Tinnitus: A Case Illustration

This paper describes a comprehensive program for behavioral management of complex tinnitus. The clinical characteristics and typical treatment of tinnitus are reviewed. Psychosocial sequelae are discussed in terms of their exacerbation of the symptom and their potential as foci of treatment. The management problems of tinnitus are considered analogous to those of chronic pain. A case illustration is provided with a description of the treatment process. The comprehensive behavioral program discussed in the present paper included biofeedback therapy, pain management training, social skills training, assertion training, in vivo exposure to being alone, cognitive treatment of depression, and marital therapy. Outcomes were monitored multidimensionally. Self-report of tinnitus severity decreased after the 6th treatment day and stabilized at a “mild” rating after the 9th day. Skin temperature readings at baseline increased and stabilized after the 8th day, and the patient was able to reliably increase skin temperature on request. Scores on the Beck Depression Inventory and the Willoughby Personality Schedule, and a self-rating of Fear of Being Alone dropped markedly by the end of treatment. Follow-up data at 3 months indicated maintenance of gains.

Treatment of Refractory Obsessive-Compulsive Disorder: The St. Louis Model.

In this article, we describe a cognitive behavioral treatment approach to cases of obsessive-compulsive disorder (OCD) that have not responded to standard outpatient evidence-based treatment. The approach begins with an assessment of the reasons why patients have not responded to treatment, which can be grouped into two categories: (a) inadequacies in the level of OCD treatment the patient has received; and (b) The presence of treatment-interfering behaviors that have obstructed the patients ability to participate adequately in treatment. Treatment is then assigned according to category. Patients in Category 1 receive a more intensive level of evidence-based OCD treatment. Patients in Category 2 receive readiness treatment, a cognitive behavioral treatment designed to help patients get ready for OCD treatment by modifying treatment-interfering behaviors. Case examples are provided to illustrate this treatment approach.

Prevalence of Various Depressive Symptoms in a Sample of the General Population

Data on prevalence of and demographics associated with various symptoms of depression are reported for a sample of the general population. Of the nine symptoms assessed, the most frequently occurring were dysphoric mood (17.8%), increased sleep (15%), and loss of interest in other people or activities previously enjoyed (11 8%) 39% of subjects reported one or more symptoms of depression. 8% of subjects reported wondering if life is worth living, a symptom that in and of itself is suggestive of clinically significant depression. The number of depressive symptoms reported was related to income, education, age, and residence (city versus county), but not to sex. The findings provide evidence that various symptoms of depression may be more common in the general population than previously suspected.