Reuven Dar

Obsessive-Compulsive Disorder in a Birth Cohort of 18-Year-Olds: Prevalence and Predictors

OBJECTIVE To report descriptive epidemiological information on obsessive-compulsive disorder (OCD) in an unselected birth cohort of 930 males and females, aged 18 years. METHOD An epidermiological study of the prevalence of self-reported OCD at age 18, and a longitudinal analysis of the prospective predictors of OCD. RESULTS Using the Diagnostic Interview Schedule, the authors found a 1-year prevalence rate of 4%, with a male-female ratio of 0.7:1. The majority of OCD cases met criteria for a comorbid disorder, most commonly depression (62%), social phobia (38%), and substance dependence (alcohol 24%, marijuana 19%). CONCLUSIONS Data collected on the sample from birth to age 18 years indicated that many childhood risk factors theorized in the literature did not predict OCD in this sample. However, a history of depression and substance use were prospective risk factors for OCD.

Public Attitudes Toward Cancer Pain

This study examined public attitudes toward pain associated with cancer and its treatment. A variety of issues were assessed, including the extent to which pain is associated with cancer, fear of pain as a factor in the decision to delay seeking treatment, and concerns about the use of narcotic analgesics for pain control. A statewide sample of 496 adult Wisconsin residents completed a telephone interview. It was found that cancer was perceived as an extremely painful disease relative to other medical conditions. Eighteen percent of the respondents reported that they might be reluctant to seek medical attention due to fear of pain. Concerns about disease‐ and treatment‐related pain were rated as significant psychosocial concerns. There were multiple concerns expressed about the consequences of using narcotic analgesics for pain control. Implications for public education and patient management are discussed.

Misuse of Statistical Tests in Three Decades of Psychotherapy Research.

This article reviews the misuse of statistical tests in psychotherapy research studies published in the Journal of Consulting and Clinical Psychology in the years 1967-1968, 1977-1978, and 1987-1988. It focuses on 3 major problems in statistical practice: inappropriate uses of null hypothesis tests and p values, neglect of effect size, and inflation of Type I error rate. The impressive frequency of these problems is documented, and changes in statistical practices over the past 3 decades are interpreted in light of trends in psychotherapy research. The article concludes with practical suggestions for rational application of statistical tests.

Comparative neuropsychology of adult obsessive‐compulsive disorder and attention deficit/hyperactivity disorder: Implications for a novel executive overload model of OCD

Research implicates frontostriatal pathophysiology in both attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Nevertheless, ADHD is characterized with frontostriatal hypoactivity and OCD with hyperactivity. Furthermore, both disorders seem to lie on opposite ends of a clinical impulsive-compulsive continuum. While never having directly been compared, and despite these differences, OCD and ADHD appear to share similar neuropsychological impairments especially in executive functions. This study aimed at comparing adults with OCD and adults with ADHD on neuropsychological measures and behavioural impulsivity and OC measures. Thirty OCD, 30 ADHD, and 30 matched healthy control (HC) participants were administered a comprehensive neuropsychological battery and completed several questionnaires. The groups were compared on all neuropsychological and clinical measures and correlations between neuropsychological and clinical symptoms were computed. The ADHD and OCD groups performed more poorly than HC on all neuropsychological domains and most domain subtests. The ADHD group reported significantly higher impulsivity than the OCD group. OCD patients did not differ from HC on behavioural impulsivity. A unique dissociation was found between impulsivity and response inhibition where both clinical groups showed similar response inhibition deficit, but differed significantly on impulsivity. Moreover, a negative association between OC symptoms and response inhibition and a bias in self-perception of impulsivity was found only in the OCD group. We propose an executive overload model of OCD that views neuropsychological impairments in OCD as an epiphenomenon, according to which continuous attempts to control automatic processes are associated with obsessive thoughts overflow that causes an overload on the executive system.

Realism of confidence in obsessive-compulsive checkers.

The study examined whether obsessive-compulsive (OC) checkers have reduced confidence in their knowledge. OC checkers were compared with panic disorder (PD) patients and nonpatient controls using a calibration-of-knowledge procedure. Participants completed a general knowledge questionnaire, rated their confidence in each answer, and estimated the total number of correct answers. These responses were converted to 2 measures of confidence relative to performance--over/underconfidence and over/underestimation. OC checkers had lower scores than nonpatients did on both measures, whereas the PD patients did not differ from either group. For the OC checkers, relative confidence was inversely related to the severity of obsessions. The authors speculate that confidence may depend on a confirmation bias in testing hypotheses and that the reduced confidence in OC checkers may reflect a disconfirmation bias in this population.

Illusion of control and behavioral control attempts in obsessive-compulsive disorder.

The present research used the illusion-of-control paradigm to examine the relationships among obsessive-compulsive disorder (OCD) symptoms, behavioral control attempts, and illusory sense of control. Participants were presented with a preprogrammed sequence of aversive and neutral visual stimuli and were encouraged to attempt to control the sequence with keyboard presses. Participants rated their perceived level of control 3 times during the task. In addition, the authors used the repetitiveness of keyboard presses as a measure of rigid, compulsive-like behavior. In Study 1, this procedure was administered to a sample of 55 students who also completed measures of OCD and depression. In Study 2, the task was administered to 22 participants with OCD and 22 matched participants without OCD. In line with predictions, OCD symptoms were correlated with higher illusory sense of control and with more repetitive behavioral control attempts. The authors discuss the central role of control in OCD and specifically the relationships between need for control and compulsive rituals, which may be conceptualized as means for achieving an illusory sense of control over stressful life events.

Do smokers self-administer pure nicotine? A review of the evidence

RationaleNicotine is almost universally believed to be the primary agent motivating tobacco smoking and the main impediment to cessation. A principal argument in support of the presumed reinforcing properties of nicotine is that smokers self-administer pure nicotine. However, the evidence for nicotine self-administration in smokers has not been critically examined.ObjectivesTo review and examine the empirical basis for the assertion that smokers self-administer pure nicotine.MethodsWe reviewed all the studies we were able to locate that are cited as demonstrating self-administration of nicotine, isolated from tobacco, in normal smokers and non-smokers. These studies investigated self-administration of intravenous nicotine, nicotine gum and nicotine spray. Using the authors’ own criteria, we examined whether these studies in fact demonstrate nicotine-self administration.ResultsNone of the studies we reviewed demonstrated nicotine self-administration in smokers. Both smokers and non-smokers failed to show preference for nicotine over placebo in any of these studies, including in a series of six reports of overnight abstinent smokers having access to nicotine nasal spray, a rapidly absorbed form of nicotine.ConclusionsThe common statement that smokers self-administer pure nicotine lacks empirical support. Smokers in fact do not administer pure nicotine in any of the forms studied to date, even when abstinent and presumably nicotine-deprived. This conclusion necessitates a critical re-examination of the nicotine addiction thesis.

Marital Quality, Family Patterns, and Children's Fears and Social Anxiety

This study examined relationships among marital quality, family patterns, and childrens fears, and social anxiety. Two types of family patterns were studied, adaptability and cohesion. Mothers of children aged 5–6, drawn from kindergartens in northern Israel, completed Hebrew versions of the ENRICH scale (abridged, for marital quality), FACES-III (adaptability and cohesion), the FSSC-R (fears), and the SASC-R (social anxiety). Family cohesion was negatively correlated with marital quality and positively correlated with childrens social anxiety. Marital quality and family adaptability were inversely related to specific childrens fears. Childrens social anxiety was highly correlated with specific fears. These findings suggest that children from rigid, fused families or low quality marriages may be at risk for high levels of fears and social anxiety.

The effect of past-injury on pain threshold and tolerance

&NA; Forty male veterans who had been injured during their military service in the Israeli Defense Forces were assessed for pain threshold and tolerance in a thermal pain procedure. Based on their medical records, subjects were classified by three independent judges as having been either severely or lightly injured. Veterans who had been severely injured had much higher threshold and tolerance for thermal pain as compared to lightly injured veterans. These results are interpreted as supporting adaptation‐level theory, which implies that painful experiences can change the internal anchor points for the subjective evaluation of pain.

Neuropsychological Impairments and Their Association with Obsessive-Compulsive Symptom Severity in Obsessive-Compulsive Disorder

Neurobiological research in obsessive-compulsive disorder (OCD) consistently demonstrates an association between abnormal brain activity and symptom severity. Conversely, research addressing the corresponding neuropsychological impairments in OCD and their association with symptom severity has produced inconsistent results. This study reexamines neuropsychological performance and its association with symptom severity in 30 participants with OCD while controlling for confounding variables. We used a computerized neuropsychological battery that was expected to provide more objective and accurate information and minimize examinee-examiner interactions, which may affect performance by reducing anxiety. The OCD group revealed dysfunctions on all neuropsychological domains compared with controls. OCD severity correlated significantly with the composite performance, executive functions, and verbal domain indexes. These results did not change after controlling for depression severity. We suggest that controlling for potential confounding variables and using a computerized battery may have contributed to the association found between obsessive symptoms and neuropsychological impairments. Theoretical implications are discussed.