Rachel C. Leonard

Just to be certain: Confirming the factor structure of the Intolerance of Uncertainty Scale in patients with obsessive-compulsive disorder

Intolerance of uncertainty (IU) is a cognitive construct in obsessive-compulsive disorder (OCD); yet no studies exist confirming the factor structure of the most widely used measure of IU, the intolerance of uncertainty scale (IUS), in OCD patients. Moreover, no studies have examined how scores on this measure relate to OCD symptom dimensions. Accordingly, the present study examined a 12-item two-factor revised version of the IUS (IUS-12) in 205 OCD patients. Confirmatory factor analysis verified the scales two-factor structure. The measure also demonstrated high internal consistency and the IUS-12 was correlated moderately with another self-report measure of IU. Finally, theoretically consistent and specific relationships emerged between the IUS-12 and OCD symptom dimensions. These findings are discussed in terms of implications for the assessment and treatment of OCD, and specifically how elevated scores on the IUS-12 subscales may be utilized to identify subtleties in the presentation of OCD-related problems with IU.

Predictors of quality of life and functional impairment in Obsessive–Compulsive Disorder

Obsessive-compulsive disorder (OCD) is the 10th leading cause of disability among health conditions; yet, relatively little research has focused on quality of life (QOL) and functional impairment in OCD. The present study extended existing work by examining correlates and predictors of QOL and functional impairment in 96 treatment-seeking OCD patients (in intensive outpatient and residential settings). In a model including OCD symptoms and related phenomena, and symptoms of depression and anxiety, two main findings emerged: (a) depressive symptoms predicted both QOL and functional impairment, and (b) contamination symptoms predicted functional impairment. These findings are discussed in terms of the implications for studying QOL and functional impairment in OCD. Future research should investigate the factors that predict changes in QOL and functional impairment following treatment.

Male clinical norms and sex differences on the Eating Disorder Inventory (EDI) and Eating Disorder Examination Questionnaire (EDE-Q)

OBJECTIVE Evidence indicates that males account for a significant minority of patients with eating disorders (EDs). However, prior research has been limited by inclusion of small and predominantly non-clinical samples of males. This study aimed to (1) provide male clinical norms for widely used ED measures (Eating Disorder Examination Questionnaire [EDE-Q] and Eating Disorder Inventory-3 [EDI-3]) and (2) examine sex differences in overall ED psychopathology. METHOD Participants were 386 male and 1,487 female patients with an ED diagnosis aged 16 years and older who completed the EDE-Q and EDI-3 upon admission to a residential or partial hospital ED treatment program. RESULTS Normative data were calculated for the EDE-Q (global and subscales) and the EDI-3 (drive for thinness, body dissatisfaction, and bulimia). Analyses of variance (ANOVAs) used to examine sex, ED diagnosis, and their interaction in relation to overall ED psychopathology revealed a consistent pattern of greater severity among females for ED psychopathology. DISCUSSION This study provides clinical norms on the EDE-Q and the EDI-3 for males with clinically diagnosed EDs. It is unclear whether the greater severity observed in females reflects qualitative differences in ED presentation or true quantitative differences in ED severity. Additional research examining the underlying nature of these differences and utilizing male-specific ED measures with clinical samples is warranted.

Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders

Purpose: Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. Methods: A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale—Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures. Main Results: Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission. Conclusion: Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases.

Residential treatment outcomes for adolescents with obsessive-compulsive disorder

Abstract Objective: We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context. Method: One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed measures at admission and discharge. Almost all (92.4%) participants had at least two diagnoses and nearly half (44.2%) had three or more. Treatment consisted of intensive ERP (i.e., approximately 26.5 hr per week), additional cognitive behavioral therapy interventions, and medication management within a residential setting. In contrast to the samples reported on in the vast majority of other pediatric OCD trials, participants in the current study were living apart from their families and were immersed within the treatment setting, with staff members available at all times. Results: Paired sample t-tests revealed significant decreases in OCD and depression severity. Conclusions: Results suggest that residential treatment for adolescents with OCD using a multimodal approach emphasizing ERP can be effective for complex cases with significant comorbidity. Results were comparable with several randomized controlled trials.

Investigating Treatment Outcomes Across OCD Symptom Dimensions in a Clinical Sample of OCD Patients

Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.

Self-Punishment as a Maladaptive Thought Control Strategy Mediates the Relationship Between Beliefs About Thoughts and Repugnant Obsessions

Cognitive-behavioral models of obsessive–compulsive disorder (OCD) propose that erroneous beliefs about the importance and need to control thoughts lead individuals with OCD to overuse maladaptive thought control strategies such as worry and self-punishment. These strategies are thought to backfire, leading to obsessional symptoms. Whereas previous studies have examined predictors of the use of thought control strategies, none have investigated these strategies as mediators in the prediction of OCD symptom severity. An additional gap in the literature is the lack of attention to OCD symptom dimensions. The present study, therefore, extended existing work by examining thought control strategies as mediators of the relationship between obsessive beliefs and OCD symptom dimensions in a treatment-seeking sample of 102 adults with OCD. In line with our hypotheses, the use of punishment (but not worry) as a thought control tactic mediated the relationship between dysfunctional beliefs about the importance/control of thoughts and unacceptable obsessions. These findings are discussed in terms of the conceptualization and treatment of OCD. Future research should investigate the extent to which these various thought control strategies may be helpful versus harmful using idiographic measures of thought control and employing experimental designs.

Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder

Illness anxiety and OCD symptoms appear to overlap in their presentation as well as in other conceptually important ways (e.g., dysfunctional cognitions). Little research, however, has directly examined these putative relationships. The present study examined the extent to which illness anxiety symptoms were associated with OCD symptom dimensions and relevant cognitive factors in a large treatment-seeking sample of patients with OCD. Patients completed a battery of self-report measures of OCD and health anxiety symptoms and related cognitive biases. Results from regression analyses indicated that illness anxiety symptoms were associated with harm obsessions and checking rituals, as well as with the tendency to overestimate threat and responsibility for harm. Illness anxiety was not associated with perfectionism. Conceptual and clinical implications of these findings are discussed.

Secondary Psychometric Examination of the Dimensional Obsessive-Compulsive Scale Classical Testing, Item Response Theory, and Differential Item Functioning

The Dimensional Obsessive-Compulsive Scale (DOCS) is a promising measure of obsessive-compulsive disorder (OCD) symptoms but has received minimal psychometric attention. We evaluated the utility and reliability of DOCS scores. The study included 832 students and 300 patients with OCD. Confirmatory factor analysis supported the originally proposed four-factor structure. DOCS total and subscale scores exhibited good to excellent internal consistency in both samples (α = .82 to α = .96). Patient DOCS total scores reduced substantially during treatment (t = 16.01, d = 1.02). DOCS total scores discriminated between students and patients (sensitivity = 0.76, 1 − specificity = 0.23). The measure did not exhibit gender-based differential item functioning as tested by Mantel–Haenszel chi-square tests. Expected response options for each item were plotted as a function of item response theory and demonstrated that DOCS scores incrementally discriminate OCD symptoms ranging from low to extremely high severity. Incremental differences in DOCS scores appear to represent unbiased and reliable differences in true OCD symptom severity.

Affective predictors of the severity and change in eating psychopathology in residential eating disorder treatment: The role of social anxiety

ABSTRACT Despite evidence documenting relationships between eating disorder (ED) psychopathology, depression, and anxiety, little is known regarding how social anxiety is related to ED symptoms in treatment. Therefore this study examined associations between depression, general anxiety, social anxiety, and ED psychopathology at the beginning and end of treatment (EOT) among patients (N = 380) treated in a residential ED program. Participants completed measures of ED psychopathology and affective variables. Higher depression and general anxiety, but not social anxiety, were related to higher ED psychopathology at baseline. However, social anxiety emerged as a unique predictor of ED psychopathology at EOT such that participants with higher social anxiety evidenced less improvement in ED psychopathology. Findings suggest that social anxiety has specific relevance to treatment in EDs, which may reflect shared mechanisms and underlying deficits in emotion regulation.