David Veale

Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessive–compulsive disorder

Forty patients with obsessive-compulsive disorder (OCD) were compared to matched healthy controls on neuropsychological tests which are sensitive to frontal lobe dysfunction. On a computerized version of the Tower of London test of planning, the patients were no different from healthy controls in the accuracy of their solutions. However, when they made a mistake, they spent more time than the controls in generating alternative solutions or checking that the next move would be correct. The results suggest that OCD patients have a selective deficit in generating alternative strategies when they make a mistake. In a separate attentional set-shifting task, OCD patients were impaired in a simple discrimination learning task and showed a continuous cumulative increase in the number who failed at each stage of the task, including the crucial extradimensional set shifting stage. This suggests that OCD patients show deficits in both acquiring and maintaining cognitive sets. The cognitive deficits in OCD may be summarized as: (i) being easily distracted by other competing stimuli; (ii) excessive monitoring and checking of the response to ensure a mistake does not occur; and (iii) when a mistake does occur, being more rigid at setting aside the main goal and planning the necessary subgoals. Both studies support the evidence of fronto-striatal dysfunction in OCD and the results are discussed in terms of an impaired Supervisory Attentional System.

Advances in a cognitive behavioural model of body dysmorphic disorder

Body dysmorphic disorder (BDD) is the most distressing and handicapping of all the body image disorders. A cognitive behavioural model of BDD is discussed which incorporates evidence from recent studies and advances in the authors 1996 conceptual model. The model aims to understand the maintenance of symptoms in BDD, to assist in the process of engagement of therapy and to guide the strategies to use. At the core of BDD is an excessive self-focussed attention on a distorted body image, the negative appraisal of such images leading to rumination, changes in mood and the use of safety behaviours. Evidence for possible risk factors in the development of BDD is also discussed.

Executive function in Tourette's syndrome and obsessive-compulsive disorder

BACKGROUND Cognitive performance was compared in the genetically and neurobiologically related disorders of Tourettes syndrome (TS) and obsessive-compulsive disorder (OCD), in three domains of executive function: planning, decision-making and inhibitory response control. METHOD Twenty TS patients, twenty OCD patients and a group of age- and IQ-matched normal controls completed psychometric and computerized cognitive tests and psychiatric rating scales. The cognitive tests were well-characterized in terms of their sensitivity to other fronto-striatal disorders, and included pattern and spatial recognition memory, attentional set-shifting, and a Go/No-go set-shifting task, planning, and decision-making. RESULTS Compared to controls, OCD patients showed selective deficits in pattern recognition memory and slower responding in both pattern and spatial recognition, impaired extra-dimensional shifting on the set-shifting test and impaired reversal of response set on the Go/No-go test. In contrast, TS patients were impaired in spatial recognition memory, extra-dimensional set-shifting, and decision-making. Neither group was impaired in planning. Direct comparisons between the TS and OCD groups revealed significantly different greater deficits for recognition memory latency and Go/No-go reversal for the OCD group, and quality of decision-making for the TS group. CONCLUSIONS TS and OCD show both differences (recognition memory, decision-making) and similarities (set-shifting) in selective profiles of cognitive function. Specific set-shifting deficits in the OCD group contrasted with their intact performance on other tests of executive function, such as planning and decision-making, and suggested only limited involvement of frontal lobe dysfunction, possibly consistent with OCD symptomatology.

Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: A multisite study☆

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n=35), bulimia nervosa (BN; n=26), or BDD (n=56), relative to female (n=34) and male (n=36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The studys empirical and clinical implications are considered.

The Development and Validation of the Exercise Dependence Questionnaire.

The aim of the present study was to develop and validate the Exercise Dependence Questionnaire (EDQ). 86 statements, derived from semi structured questionnaires, were used to develop a self report rating scale which was completed by 449 subjects who exercised for more than 4 hours a week. Factor analysis was used and items not loading onto any factors (<0.6), that loaded onto more than one factor or intercorrelated greater than 0.6 were rejected from the analysis. The final EDQ consisted of 29 items and eight factors; interference with social / family / work life, positive reward, withdrawal symptoms, exercise for weight control, insight into problem, exercise for social reasons, exercise for health reasons and stereotyped behaviour. These factors were shown to have good internal reliability. The questionnaire was then partially validated against the Eating Attitudes Test, the Profile of Mood States factors; depression, anxiety, fatigue and vigour, perceptions of control over behaviour and characteristics...

Spontaneously occurring images and early memories in people with body dysmorphic disorder

A semi‐structured interview assessing the presence and characteristics of spontaneous appearance‐related images was designed and administered. A total of 18 patients with body dysmorphic disorder (BDD) and 18 normal controls took part. The BDD patients were found to have spontaneously occurring appearance‐related images that were significantly more negative, recurrent, and viewed from an observer perspective than control participants. These images were more vivid and detailed and typically involved visual and organic (internal body) sensations. The study also found that BDD images were linked to early stressful memories, and that images were more likely than verbal thoughts to be linked to these memories. Implications for theory and clinical practice are discussed.

Social learning theory and cognitive behavioral models of body dysmorphic disorder.

Contemporary cognitive behavioral models of body dysmorphic disorder are reviewed, whereby the first by Neziroglu and colleagues emphasizes conditioning processes and relational frame theory and the latter by Veale emphasizes information processing. A brief review of the existing cognitive behavioral therapy research follows the presentation of the models. The majority of publications on BDD continue to deal with phenomenology and epidemiology, and much more research on cognitive behavioral treatment is needed. Treatment research should be geared towards testing elements of the models explicated in this article, and randomized controlled trials are greatly needed.

Self-discrepancy in body dysmorphic disorder

OBJECTIVES According to self-discrepancy theory (SDT), depression, social anxiety, eating disorders and paranoia result from different types of conflicting self-beliefs. Body dysmorphic disorder (BDD) consists of a preoccupation with imagined or slight defects in ones appearance, which is often associated with a depressed mood and social anxiety. SDT was therefore applied to BDD patients to further understand their beliefs about their appearance. DESIGN Using a comparative group design, BDD patients were compared against a non-patient control group. METHOD A sample of 149 participants, consisting of three groups - BDD (72), BDD preoccupied with their weight and shape (35), and controls (42) - completed a modified version of the Selves Questionnaire (Higgins, Bond, Klein, & Strauman, 1986) requiring them to list and rate physical characteristics according to the following standpoints: (a) self-actual; (b) self-ideal; (c) self-should; (d) other-actual; and (e) other-ideal. RESULTS BDD patients displayed significant discrepancies between their self-actual and both their self-ideal and self-should. However, there were no significant discrepancies in BDD patients between their self-actual and other-actual or other-ideal domains. Analysis of variance using depression and social anxiety scores as covariates revealed a significant difference for both the self-ideal and self-should discrepancy. CONCLUSION The results suggest that BDD patients have an unrealistic ideal or demand as to how they should look. BDD patients are more like depressed patients (rather than social phobics or bulimics), being more concerned with a failure to achieve their own aesthetic standard than with the perceived ideals of others.

Exercise and mental health

This paper reviews the mood altering properties of exercise and its potential in the prevention and treatment of mental disorders. The role of the brain monoamines, opioid peptides, the sympathetic nervous system, and cognitive behavioural theory as mediating pathways for the psychological benefits of exercise is critically examined. Clinical trials on exercise are reviewed and suggestions are made for future research in this field.

Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder

Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy, has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.