John E. Calamari

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.

Obsessive-compulsive disorder subgroups : a symptom-based clustering approach

Although obsessive-compulsive disorder (OCD) is often considered a heterogeneous condition, there is no generally accepted subtype typology. Cluster analysis was used to identify definitive symptom-based groupings of 106 OCD patients. A stable cluster solution was achieved and five patient subgroups were identified based on their pattern of symptoms on the Yale-Brown (Y-BOCS) symptom checklist: harming, hoarding, contamination, certainty and obsessionals. The five subgroups were characterized by dominant symptom patterns and significant secondary concerns reflecting the symptom heterorgenaity often seen in the clinical presentation of obsessional patents. Between cluster differences on multiple symptom measures were evaluated and several meaningful differences were identified. Cluster analytic procedures may prove to be a useful tool for identifying a functional taxonomy of OCD subtypes.

Too much thinking about thinking?: metacognitive differences in obsessive-compulsive disorder

Negative appraisals of intrusive thoughts and beliefs about the importance of thoughts are considered core mechanisms in cognitive models of obsessive-compulsive disorder (OCD). In refinements of cognitive theory, differences in metacognitive processes have been emphasized. Cartwright-Hatton and Wells [J. Anxiety Disord. 37 (1997) 279-296] found that cognitive self-consciousness (CSC), a tendency to be aware of and monitor thinking, was the only metacognitive dimension that differentiated OCD patients from patients with generalized anxiety disorder. To evaluate the relative importance of different cognitive processes to OCD, we administered an expanded CSC scale and two state-of-the-art measures of thought appraisals and beliefs. Scores on the CSC scale reliably differentiated OCD patients (n=30), from an anxious comparison group (OAD, n=25) after controlling for scores on the two cognition measures. The tendency to excessively reflect upon ones cognitive processes may increase opportunities for negative appraisals of intrusive thoughts, foster over-importance of thought beliefs, and increase the likelihood of developing OCD.

Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy

A symptom-based subgroup taxonomy for obsessive-compulsive disorder (OCD) was evaluated and refined. The Yale-Brown Obsessive-Compulsive Scale symptom checklist was scored and cluster analysis was conducted with a sample of OCD patients (N = 114). Results were compared to Calamari et al.s (Behaviour Research and Therapy 37 (1999) 113) five subgroup model. Rules for determining the number of subgroups supported a more complex model. In between sample comparisons, a stable contamination subgroup was found in both a five and seven subgroup taxonomy. Between sample stability was not as strong for Harming, Obsessionals, Symmetry, and Certainty subgroups. Hoarding, as a distinctive subgroup, was unstable in separate samples. When the Calamari et al. sample and the present sample were combined (N = 220), we found a reliable Hoarding subgroup. More interpretable and stable models emerged with the combined samples suggesting that large clinical samples are needed to identify OCD subgroups. Greater support was found for a seven subgroup taxonomy based subgroup interpretability and validation measure differences. The potential utility of symptom-based subgroup models of OCD and alternative approaches are discussed. Identification of reliable and valid OCD subtypes may advance theory and treatment.

Thought Suppression in Obsessive-Compulsive Disorder

The volitional suppression of thoughts andrelated increases in intrusions has been posited as amodel for clinical disorders, includingobsessive-compulsive disorder (OCD). Personallyrelevant, negative intrusive thoughts were elicited fromparticipants with OCD and nonclinical (NC) subjects. Thenegative thoughts reported by OCD patients were highlyrelated to core clinical obsessions. Participants with OCD reported more intrusive thoughts than didNC subjects regardless of whether they attempted tosuppress obsessional intrusions. Group- orexperimental-condition related thought enhancement orrebound was not found, but a greater percentage of theOCD suppression group experienced thought rebound thandid the NC suppression group. Volitional thoughtsuppression maybe but one of many response strategies employed by individuals with OCD when negativeintrusive thoughts occur.

Panic attack symptomatology and anxiety sensitivity in adolescents

The relationship between panic attack symptoms, anxiety sensitivity, and academic performance was evaluated in a sample of 77 high school students. Although it has been suggested that children and adolescents are unlikely to experience panic attacks and panic disorder, the results of recent studies suggest that symptoms frequently occur in this age group. Evaluation of symptoms reported on the Panic Attack Questionnaire revealed that 39% of our sample experienced panic attacks, and that five subjects (6.5%) met diagnostic criteria for panic disorder at some time during their life. Furthermore, a significant correlation between scoring on the PAQ and scores on the Childhood Anxiety Sensitivity Index, a fear of anxiety measure, was found. Results suggest that there is a relationship between anxiety sensitivity and panic symptomatology in adolescents, a finding comparable with the adult literature. The observed relationship between anxiety sensitivity and panic symptomatology in adolescents is congruent with theorizing that anxiety sensitivity is a cognitive risk factor for the development of panic disorder.

A Taxometric Study of Hypochondriasis Symptoms

Hypochondriasis has been conceptualized as both a distinct category that is characterized by a disabling illness preoccupation and as a continuum of health concerns. Empirical support for one of these theoretical models will clarify inconsistent assessment approaches and study designs that have impeded theory and research. To facilitate progress, taxometric analyses were conducted to determine whether hypochondriasis is best understood as a discrete category, consistent with the DSM, or as a dimensional entity, consistent with prevailing opinion and most self-report measures. Data from a large undergraduate sample that completed 3 hypochondriasis symptom measures were factor analyzed. The 4 factor analytically derived symptom indicators were then used in these taxometric analyses. Consistent with our hypotheses and existing theory, results supported a dimensional structure for hypochondriasis. Implications for the conceptualization of hypochondriasis and directions for future study are discussed.

Subtypes of obsessive-compulsive disorder: Implications for specialized cognitive behavior therapy

Although obsessive-compulsive disorder (OCD) is a heterogeneous condition, OCD subtypes have received limited attention in trials of cognitive behavior therapy (CBT). Because many patients with OCD do not respond optimally to CBT, it is important for clinicians to consider whether variability in treatment response is related to symptom presentation. Treatment modifications for patients without overt compulsions or with hoarding symptoms show promise. In this article we discuss the available research addressing the treatment of OCD subtypes, review the clinical characteristics and treatment recommendations for prominent OCD subtypes, raise the prospect of using dysfunctional beliefs as a potentially helpful conceptual approach to subtyping OCD and matching treatment to subtypes, and consider future directions in the treatment of OCD subtypes.

Psychopathy is related to negative affectivity but not to anxiety sensitivity.

Although the hypothesis that psychopathic individuals are characterized by a reduced capacity for experiencing anxiety is central to many theories of psychopathy, most prior studies have examined anxiety and fear measures generally considered outdated in the literature. Moreover, prior findings are mixed, with several studies reporting no relationships between psychopathy and anxiety, and others suggesting negative relationships for the affective, interpersonal aspects of the disorder and positive relationships for the antisocial behavior dimension. To examine whether psychopathy dimensions are associated with contemporary measures of anxiety, the Anxiety Sensitivity Index and State Trait Anxiety Inventory-Trait scale were administered to 157 male inmates. Participants also completed the MMPI-derived Welsh Anxiety Scale (WAS), commonly used in psychopathy studies. Analyses provide no evidence for a negative relationship between psychopathys affective, interpersonal factor and anxiety sensitivity after controlling for trait anxiety. Trait anxiety and WAS scores were positively associated with the antisocial behavior dimension of psychopathy. Findings do replicate prior relationships between the WAS and psychopathy, suggesting the WAS may measure aspects of negative affectivity that differ from anxiety.

Relations between anxiety sensitivity and panic symptoms in nonreferred children and adolescents.

Anxiety sensitivity (AS), the fear of anxiety-related sensations, has been posited to be a cognitive risk factor for the development of anxiety disorders but has been understudied in youth. The purpose of the present investigations was to evaluate relations between AS and panic symptoms in nonreferred children and adolescents. In Study 1, (N = 113, mean age, 13.98). scores on the Childhood Anxiety Sensitivity Index (CASI) predicted the experience of uncued panic attacks after controlling for general anxiety and depression, although the total variance accounted for was small. In Study 2 (N = 52; mean age, 9.48), the Panic/ Agoraphobia subscale of the Spence Childrens Anxiety Scale was used as the criterion variable. CASI score again predicted panic symptoms after controlling for trait anxiety and depression. Identification of a risk factor for panic attacks and panic disorder in youth will have important implications for etiologic theory, intervention, and prevention.