Gemma García-Soriano

Symptom dimensions in obsessive–compulsive disorder: From normal cognitive intrusions to clinical obsessions

Cognitive behavioral models of obsessive-compulsive disorder (OCD) assume continuity between normal obsessional intrusive thoughts (OITs) and obsessions. However, this assumption has recently been criticized. This article examines this issue using a new instrument (the Obsessional Intrusive Thoughts Inventory, INPIOS) specifically designed to assess the frequency and content of 48 OITs, which was completed by 734 community subjects and 55 OCD patients. Confirmatory factor analysis suggests six first-order factors included in two second-order factors, one containing aggressive, sexual, religious, immoral and repugnant OITs, and the other containing contamination, doubts and checking, symmetry and order, and superstition OITs. This structure integrates the research on OC symptoms and OITs. The INPIOS showed excellent known-groups validity, and it adequately represented obsessions as well as OITs. OCD and community subjects experience OITs representative of all types of obsessional contents. The dimensional structure is discussed in terms of OIT/obsessive-compulsive symptom structures currently proposed.

Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature.

Obsessive-compulsive disorder (OCD) is a disabling disorder that can be successfully treated. However, a high percentage of sufferers neither ask for nor receive treatment for their symptoms, or they delay seeking treatment. The factors underlying the treatment-seeking behaviour of OCD patients are still not clear. This review includes 12 studies published before April 2014 that analyse the possible variables related to the delayed help-seeking behaviour of OCD patients. Studies showed that individuals who asked for help were more impaired and reported poorer quality of life. Help-seeking behaviour was associated with greater insight, severity, specific obsessive-compulsive symptoms, such as aggressive and other unpleasant obsessions, and comorbidity. Common barriers to seeking treatment were shame about the symptoms or about asking for treatment, not knowing where to find help, or inconveniences associated with treatment. Inconsistencies among the reviewed studies highlight the need to further evaluate the variables that keep OCD patients from seeking help. The review highlights the need for educational campaigns designed to detect underdiagnosed OCD individuals and improve access to mental health services, which could shorten delays in seeking treatment and, therefore, reduce the personal and financial costs of OCD. Guidelines for educational programs and future lines of research are discussed.

Dysfunctional Belief Domains Related to Obsessive-Compulsive Disorder: A Further Examination of their Dimensionality and Specificity

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/ or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N = 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients.

Strategies to Control Unwanted Intrusive Thoughts: Which are Relevant and Specific in Obsessive- Compulsive Disorder?

Current cognitive-behavioral approaches to Obsessive-Compulsive Disorder (OCD) propose that chronic thought suppression and other dysfunctional strategies to control negative unwanted intrusions play an important role in the genesis and/or maintenance of the disorder. However, little empirical research has been devoted to investigating which control and/or suppression methods are used most often by OCD patients, and which could be considered specific to OCD. The purpose of the present study was to provide evidence with regard to these issues. With this end, 39 clinical OCD patients, 23 depressed patients, 25 non-obsessive anxious patients, and 30 community adults completed two measures of thought control/suppression strategies: the reduced Spanish version of the Thought Control Questionnaire (TCQ-r) and the White Bear Suppression Inventory (WBSI). Participants also completed measures of OCD, depressive and anxious symptoms. The results indicated that, in OCD patients, the chronic tendency to suppress negative unwanted thoughts (WBSI) was associated with Punishment (TCQ) and, to a lesser extent, with Worry and Reappraisal. When examining between-group differences, punishment for having negative intrusions proved to be OCD-relevant and OCD-specific, since OCDs were distinguishable from the other three groups on this measure. However, Distraction, Social control, Reappraisal, and Worry strategies were shown to be control strategies that were not specifically used by OCD participants or by those with anxiety and depressive disorders.

Symptom dimensions in obsessive-compulsive disorder: differences in distress, interference, appraisals and neutralizing strategies.

BACKGROUND AND OBJECTIVES Cognitive proposals about the mediating role of misinterpretations, emotional reactions, and control strategies in the escalation of obsessional intrusive thoughts (OIT) to clinical obsessions have received only partial support. This study aims to examine these variables, taking into account the obsession/OIT contents and the severity of the obsessive-compulsive disorder (OCD). METHODS After identifying their most upsetting OIT/obsession, 61 OCD patients and 61 non-clinical individuals assessed the associated distress, interference and appraisals, and the strategies used to control the obsession/OIT. RESULTS Compared with the nonclinical subjects, OCD individuals scored higher on all variables. The obsessions severity was associated with high disturbance, interference and dysfunctional appraisals, whereas the compulsions severity was related to specific control strategies. Different obsessional contents produced similar emotional disturbance and interference. However, obsessional contents influence the amount of adscription to different dysfunctional appraisals and the frequency of use of several control strategies. LIMITATIONS Our conclusions are limited by the scarce number of patients representing the various obsessive contents, specially order. CONCLUSIONS Overall, superstitious obsessions were more dysfunctionally appraised than the other obsessional contents, inducing both covert and overt neutralizing strategies, whereas contamination obsessions were less dysfunctionally appraised.

Study of obsessive compulsive beliefs: relationship with eating disorders.

BACKGROUND The relationship between Eating Disorders (ED) and Obsessive Compulsive Disorder (OCD) has been extensively studied in the last few years. However, little effort has been devoted to studying the link between these disorders with regard to their distorted beliefs. AIMS The first objective of the study was to analyze the differences in OCD-related beliefs among ED subtypes and the general population, controlling for age, Body Mass Index, and obsessionality. The second objective was to explore which OCD beliefs explain ED symptomatology. METHOD Seventy-nine ED patients without OCD comorbidity, divided into diagnostic subtypes, and 50 community participants completed the Obsessive Beliefs Spanish Inventory-Revised and measures of ED and OCD symptomatology. RESULTS There were no differences found among clinical ED subtypes in obsessive beliefs, but the bulimia nervosa purgative subtype and binge eating groups obtained significantly different scores from the community group on Thought-Action-Fusion (TAF)-likelihood and TAF-moral, respectively. OCD symptomatology had the most important predictive effect on ED symptoms, followed by Overestimation of Threat, BMI and FPA-moral. CONCLUSIONS The different patterns of beliefs among subtypes reflect what other studies have suggested about the relevance of the presentation of ED symptoms associated with restriction, purges and binge without purges. Our results agree with the transdiagnostic perspective of ED.

Exploring the role of obsessive–compulsive relevant self-worth contingencies in obsessive–compulsive disorder patients

This article examines whether self-worth contingencies in the personal domains of cleanliness, morality, hoarding, certainty, accuracy, religion and respect for others have specific associations with obsessive symptoms and cognitions in individuals with obsessive-compulsive disorder (OCD). Fifty-seven patients with a primary diagnosis of OCD completed the Obsessional Concerns and Self Questionnaire (OCSQ), designed to assess the extent to which respondents consider OCD content domains relevant to their self-worth, along with a battery of other instruments. Results indicate that the OCSQ is more associated with OCD than with non-OCD anxiety symptoms, and that it is also associated with comorbid depressive symptoms in OCD patients. Moreover, the OCSQ-Order and Cleanliness and Hoarding dimensions are associated with their symptom counterparts (i.e., contamination, checking, order, hoarding and neutralizing). OCSQ domains were highly associated with dysfunctional beliefs about obsessions. However, only the OCSQ scores, but not the dysfunctional beliefs, predicted OCD symptoms. These results support cognitive conceptualizations implicating self-concept in OCD development, and they suggest the need to further analyze the influence of self-worth in OCD development and maintenance.

What do Spanish adolescents think about obsessive-compulsive disorder? Mental health literacy and stigma associated with symmetry/order and aggression-related symptoms

Obsessive-compulsive disorder (OCD) is a frequent and disabling disorder with a long delay in seeking help that could partly be due to poor mental health literacy and stigmatizing attitudes. This study analyzes the mental health literacy and stigma associated with symmetry/order and aggression-related OCD in a Spanish adolescent sample. This age group was chosen because adolescence is a vulnerable period for the development of OCD, and adolescents are often reluctant to seek professional help. One hundred and two non-clinical adolescents read two vignettes describing symmetry/order and aggression-related OCD. Then, referring to these two vignettes, they answered questions related to problem recognition, causality perception, need for treatment, treatment recommendations, and stigma. Results show that a high percentage of adolescents recognize the interference of order- and aggression-related OCD, consider that a peer with order- or aggression-related OCD needs treatment, and would recommend a formal source of help. Although order symptoms are highly recognized as OCD by adolescents, aggression-related OCD is frequently misidentified as schizophrenia or depression. Results also show higher levels of stigmatizing attitudes in adolescents, associated with aggression-OCD (versus order-OCD), especially in male adolescents and adolescents with no previous experience with mental health services/providers. Results suggest the need to develop school-based programs emphasizing OCD content heterogeneity, especially the aggression, sexual, and religious contents, and work toward eliminating stigma.