Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder

Extent, Profile and Specificity of Visuospatial Impairment in Obsessive-Compulsive Disorder (OCD)

Recent reviews on the neurocognitive profile of patients diagnosed with obsessive-compulsive disorder (OCD) have converged on the assumption that both visuospatial and especially nonverbal memory performance are impaired in OCD. However, as most prior studies have contrasted performance of OCD patients with healthy controls only, no inferences can yet be drawn about the specificity of these deficits to OCD. Further, the administration of complex and multifunctional tasks limit conclusions about clearly defined cognitive deficits. The present study compared 71 OCD patients to 30 healthy and 33 psychiatric control participants on a large battery of visuospatial and nonverbal memory tasks at two time-points. In addition, a visuospatial battery (VS battery), which assesses a wide range of elementary visuospatial functions, was administered. While OCD patients performed worse than healthy controls on some complex tasks (e.g., Block Design), no visuospatial component proved to be impaired specifically in OCD. OCD patients and controls performed similarly on parameters of nonverbal memory. Regarding organizational strategy, OCD patients performed worse than healthy (but not psychiatric) control participants on two out of three Rey-figure trials (copy and immediate). It is suggested that prior research overestimated the severity and significance of visuospatial and nonverbal memory impairment in OCD.

Clinical obsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: where are the differences?

Contemporary cognitive models of obsessive-compulsive disorder (OCD) assume that clinical obsessions evolve from some modalities of intrusive thoughts (ITs) that are experienced by the vast majority of the population. These approaches also consider that the differences between "abnormal" obsessions and "normal" ITs rely on quantitative parameters rather than qualitative. The present paper examines the frequency, contents, emotional impact, consequences, cognitive appraisals and control strategies associated with clinical obsessions in a group of 31 OCD patients compared with the obsession-relevant ITs in three control groups: 22 depressed patients, 31 non-obsessive anxious patients, and 30 non-clinical community subjects. Between-group differences indicated that the ITs frequency, the unpleasantness and uncontrollability of having the IT, and the avoidance of thought triggers obtained the highest effect sizes, and they were specific to OCD patients. Moreover, two dysfunctional appraisals (worry that the thought will come true, and the importance of controlling thoughts) were specific to OCD patients. The OCD and depressed patients shared some dysfunctional appraisals about their most disturbing obsession or IT (guilt, unacceptability, likelihood thought would come true, danger, and responsibility for having the IT), whereas the non-obsessive anxious were nearer to the non-clinical participants than to the other two groups of patients. The OCD patients showed an increased use of thought control strategies, with overt neutralizing, thought suppression, and searching for reassurance being highly specific to this group.

Florida obsessive-compulsive inventory: Development, reliability, and validity

The Florida Obsessive-Compulsive Inventory (FOCI) is a new self-report questionnaire that has separate scales for symptom enumeration (The Checklist) and evaluation of symptom severity (Severity Scale). The present research investigated the FOCI in a sample of 113 patients with obsessive-compulsive disorder (OCD). The results indicated that the FOCI Severity Scale is internally consistent (alpha = .89) and highly correlated with the total score from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989 a). The correlations of the FOCI Severity Scale with measures of depression and global severity of psychopathology were similar to those obtained with the Y-BOCS Total Severity Score. The FOCI Symptom Checklist had adequate reliability (K-R 20 = .83) and moderate correlations (rs < .45) with the FOCI Severity Scale, the Y-BOCS scales, and measures of depression and severity of psychopathology. These findings imply concurrent validity for the FOCI Severity Scale. A strength of the FOCI is that it offers a quick evaluation of both presence and severity of OCD symptoms. An important limitation is that the FOCI does not assess the severity of individual symptoms.

Severity of subjective cognitive impairment in patients with obsessive-compulsive disorder and depression

Previous research on obsessive-compulsive disorder (OCD) has consistently found cognitive impairments in the domains of executive and nonverbal (memory) functioning, particularly in patients with comorbid depressive symptoms. In contrast, little is known about the degree to which such deficits are cognizant to patients or the degree to which these impairments interfere with daily activities. The aim of the present study was to assess prevalence and specificity of subjective cognitive dysfunction in OCD patients. A self-rating scale, the Subjective Neurocognition Inventory (SNI), was administered to 67 OCD patients upon admission to hospital. Forty healthy and 30 depressed participants served as controls. Relative to healthy participants, OCD patients reported greater impairment on SNI subscales measuring psychomotor speed, selective and divided attention. Impairments in the OCD group were particularly pronounced in patients with severe OCD or depressive psychopathology. OCD patients were no more disturbed than depressed participants on any of the domains tested. Memory problems were only reported by a minority of OCD patients-even in patients with checking compulsions. In conjunction with prior studies showing few memory difficulties in non-depressed OCD patients, present findings further challenge the memory deficit hypothesis which claims that checking compulsions are a dysfunctional compensation for real or imagined forgetfulness.

What are the roles of perfectionism and responsibility in checking and cleaning compulsions?

Empirical findings revealed that an inflated sense of responsibility has a major impact on obsessive-compulsive symptomatology (OCS). Another cognitive variable, perfectionism, is also theoretically linked to OCS. The assumption about the insufficient but necessary role of perfectionism for OCS and the view of perfectionism as a manifestation of avoidance of serious consequences led us to explore the role of an important cognitive mediator (responsibility) in this relationship. The present study aimed to explore the mediational role of responsibility for the effects of perfectionism on checking and cleaning symptom profiles of OCS in a nonclinical population in Turkey. Findings of the present study suggested that responsibility appraisals mediate effects of self-oriented and socially prescribed perfectionism on checking and the effect of socially prescribed perfectionism on cleaning. There was a partial mediation for self-oriented perfectionism on cleaning. The findings are discussed within the scope of current literature and implications for clinical applications are suggested.

The mediating effects of misinterpretation of intrusive thoughts on obsessive-compulsive symptoms

Perfectionism and inflated responsibility have both been identified as risk factors for the development and maintenance of obsessive-compulsive (OC) symptoms. The aim of the present study was to test whether the relationships between these two variables and OC symptoms are mediated by the misinterpretation of intrusive thoughts (MIT). Three hundred and three university students completed the Frost Multidimensional Perfectionism Scale, the Maudsley Obsessional Compulsive Inventory, the Responsibility Attitude Scale, and the Responsibility Interpretations Questionnaire. MIT was found to partially mediate the relationship between responsibility attitudes and OC symptoms. MIT also partially mediated the relationship between concern over mistakes and OC symptoms, even after controlling for responsibility attitudes. Both concern over mistakes and responsibility attitudes were significant predictors of MIT and OC symptoms, but responsibility was the stronger predictor when all of the variables were included in the model. Clinical implications for the treatment of OCD are discussed.

The relationship between obsessive-compulsive symptoms and appraisals of emotional states

A new measure assessing respondents' perceptions of the threat posed by their own emotions (the Perception of Threat from Emotion Questionnaire; the PTEQ) is presented. A range of data relating to the psychometric properties of the PTEQ indicates that it is a reliable measure of people's stable beliefs about their emotions, and is not highly correlated with either mood or measures of responsibility and thought-action fusion. In a student sample, regression analyses indicate that responses to the PTEQ significantly predict responses to a general measure of obsessionality (the Padua Inventory), even when levels of depression and anxiety are controlled for. Moreover, when compared with measures of responsibility and thought-action fusion, the PTEQ emerges as the strongest independent predictor of obsessionality. Of the seven different emotions to which the PTEQ relates, it is found that beliefs about 'anger' are the strongest predictor of obsessionality. Implications of these findings are discussed.

Cognitive-behavioural theory and therapy for obsessive-compulsive disorder in children and adolescents: current status and future directions

Obsessive-compulsive disorder is recognised to be much more common than once thought, and increased awareness of prevalence has been associated with an increase in clinical and research attention. However, while the cognitive behavioural model of OCD has received considerable empirical support from adult studies, there has been relatively little investigation of this model in childhood populations. Although this literature is beginning to emerge, initial evaluations suggest there may be important differences between childhood and adult OCD with regard to the cognitive, behavioural, and family factors implicated in the etiology and maintenance of the disorder. Despite this, cognitive-behavioural interventions have been largely modelled on their adult counterparts, and there has been little evaluation of the effectiveness of various treatment components. This paper therefore seeks to critically review the current status of CBT for children and adolescents with OCD, addressing both cognitive behavioural theory and therapy. Current issues in clinical practice will be identified, gaps in the knowledge base will be highlighted, and the paper will conclude by making specific recommendations regarding the integration of research and practice.

Are “obsessive” beliefs specific to OCD?: A comparison across anxiety disorders

Cognitive models of obsessive-compulsive disorder (OCD) assign a central role to maladaptive beliefs about threat, uncertainty, importance and control of thoughts, responsibility, and perfection. Previous research has demonstrated that such beliefs relate to specific OCD symptoms in a theoretically meaningful way. The aim of the present study was to determine whether these beliefs are endorsed more strongly by OCD patients than by those with other anxiety disorders. Eighty-nine adult OCD patients, 72 anxious control (AC) patients, and 33 nonclinical control (NCC) participants completed a measure of obsessive beliefs as well as measures of depression and trait anxiety. Compared to NCCs and ACs, OCD patients more strongly endorsed beliefs related to threat estimation, tolerance of uncertainty, importance and control of thoughts, and perfectionism, but not inflated responsibility. Using revised, condensed subscales, OCD patients differed from ACs on beliefs about perfectionism and certainty and about importance and control of thoughts, but not on beliefs about threat estimation and inflated responsibility. When controlling for depression and trait anxiety, the OCD and AC group did not differ on most belief domains, except for a belief that it is possible and necessary to control one's thoughts. Results are discussed in light of evolving cognitive-behavioral theories that highlight appraisals of thought control and the use and effectiveness of varying thought control strategies.

A check on the memory deficit hypothesis of obsessive-compulsive checking

A number of recent studies have challenged the hypothesis that patients with obsessive-compulsive disorder (OCD) display global memory deficits. An alleviated form of the memory deficit hypothesis posits that OCD patients share deficits to vividly recall memory episodes. According to the latter view, checking rituals can be understood as counter-productive coping strategies to "enrich" memory episodes in order to make them more distinctive. A source memory task was administered to 27 OCD (17 checkers) and 51 healthy participants. Along with confidence judgments, a remember-know procedure was employed to assess whether OCD patients display problems with conscious/vivid recollection. Patients with or without checking compulsions did not exhibit differences to controls on source memory accuracy and meta-memory. Patients forgot more self-generated items, which, however, was related to comorbid depressive but not OCD symptoms. Findings challenge the ubiquity of memory deficits in OCD. To account for the inconclusive pattern of results in the literature, it is suggested that patients mistrust their memories and adopt checking rituals only when perceived responsibility is inflated.

Obsessive-compulsive symptoms: the contribution of metacognitions and responsibility

Two different cognitive models of obsessive-compulsive symptoms were evaluated. One model [Salkovskis, P. M. (1985). Obsessional-compulsive problems a cognitive-behavioral analysis. Behaviour Research and Therapy, 23, 571-583.] gives a central and necessary role to beliefs and appraisals concerning responsibility. The other [Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley.] attaches a central and necessary role to metacognitive beliefs about the meaning and danger of thoughts/feelings and the need for control. We tested the unique contributions of responsibility or metacognitions to obsessive-compulsive symptoms whilst controlling for their intercorrelations and worry. Consistent with each model, responsibility and metacognitions were positively associated with obsessive-compulsive symptoms, even when worry was controlled for. However, responsibility was not associated with obsessive-compulsive symptoms when metacognitions and worry were controlled, but the relationship between metacognitive beliefs and obsessive-compulsive symptoms was independent of responsibility and worry. Responsibility did not add anything to the variance in symptoms explained by metacognitions. The data provide further support for the metacognitive model.

Treatment of obsessive–compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention

The efficacy of contemporary cognitive therapy for obsessive-compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.

Are there interactions among dysfunctional beliefs in obsessive compulsive disorder?

Contemporary cognitive models of obsessive-compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive-compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive-compulsive symptoms. To investigate this issue, data from 248 obsessive-compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2- and 3-way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive-compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.

Control theory and psychopathology: an integrative approach

Perceptual control theory (PCT; Powers, 1973) is presented and adapted as a framework to understand the causes, maintenance, and treatment of psychological disorders. PCT provides dynamic, working models based on the principle that goal-directed activity arises from a hierarchy of negative feedback loops that control perception through control of the environment. The theory proposes that psychological distress arises from the unresolved conflict between goals. The present paper integrates PCT, control theory, and self-regulatory approaches to psychopathology and psychotherapy and recent empirical findings, particularly in the field of cognitive therapy. The approach aims to offer fresh insights into the role of goal conflict, automatic processes, imagery, perceptual distortion, and loss of control in psychological disorders. Implications for psychological therapy are discussed, including an integration of the existing work on the assessment of control profiles and the use of assertive versus yielding modes of control.

Not just right experiences and obsessive-compulsive features: experimental and self-monitoring perspectives

Individuals with obsessive-compulsive disorder (OCD) often report compulsions aimed at reducing feelings of something not being just right or sensations of incompleteness. Research using self-report questionnaires has demonstrated a link between not just right experiences (NJREs) and OCD symptoms (Behav. Res. Therapy 41 (2003) 681; Anxiety, 1 (1995) 208). Extending previous work, this paper presents experimental and self-monitoring data on NJREs in an undergraduate sample. NJREs produced distress and urges to change something, but feared consequences were rare. Stronger responses were found for naturally occurring self-monitored NJREs compared to NJREs elicited in the laboratory. Several significant relationships were found between features of NJREs and OC symptoms and constructs theoretically related to OCD (e.g., responsibility, incompleteness), but no significant relationships were found between features of NJREs and non-OCD-related constructs (worry, depressive symptoms, social anxiety). Further consideration of NJREs will be useful in improving our understanding of the phenomenology, neurobiological substrates, and treatment, of OCD.

The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers

Obsessive compulsive disorder (OCD) is a highly debilitating neuropsychiatric condition with estimated lifetime prevalence of 2-3%, more than twice that of schizophrenia. However, in contrast to other neuropsychiatric conditions of a comparable or lesser prevalence, relatively little is understood about the aetiology, neural substrates and cognitive profile of OCD. Despite strong evidence for OCD being familial, with risk to first-degree relatives much greater than for the background population, its genetic underpinnings have not yet been adequately delineated. Although cognitive dysfunction is evident in the everyday behaviour of OCD sufferers and is central to contemporary psychological models, theory-based studies of neurocognitive function have yet to reveal a reliable cognitive signature, and interpretation has often been confounded by failures to control for co-morbidities. The neuroimaging findings in OCD are amongst the most robust reported in the psychiatric literature, with structural and functional abnormalities frequently reported in orbitofrontal cortex, anterior cingulate cortex, and caudate nucleus. In spite of this, our relative lack of understanding of OCD neurochemical processes continues to impede progress in the development of novel pharmacological treatment approaches. Integrating the neurobiological, cognitive, and clinical findings, we propose that OCD might usefully be conceptualised in terms of lateral orbitofrontal loop dysfunction, and that failures in cognitive and behavioural inhibitory processes appear to underlie many of the symptoms and neurocognitive findings. We highlight existing limitations in the literature, and the potential utility of endophenotypes in overcoming these limitations. We propose that neurocognitive indices of inhibitory functions may represent a useful heuristic in the search for endophenotypes in OCD. This has direct implications not only for OCD but also for putative obsessive-compulsive spectrum conditions including attention deficit hyperactivity disorder, Tourette's syndrome, and trichotillomania (compulsive hair pulling).

Thought–action fusion: Review of the literature and future directions

Thought-action fusion (TAF) is the tendency for individuals to assume that certain thoughts either imply the immorality of their character or increase the likelihood of catastrophic events. The burgeoning literature on TAF is reviewed. It is not clear whether TAF refers to a specific appraisal style, a more enduring belief, or a combination of both. Inconsistent definitions of magical thinking have hindered better understanding of the relationship between TAF and magical thinking. Much work remains to be done to improve assessment and measurement of TAF. TAF is associated with tendencies towards obsessive-compulsive disorder (OCD) and may contribute to its symptoms. However, the literature investigating TAF and other variables implicated in OCD remains inconclusive. It is suggested that TAF is not specific to OCD, but also prevalent in other anxiety disorders. TAF appears to be moderately related to depressive symptoms and a similar bias may contribute to preoccupations in eating disorders. TAF is also associated with the presence of psychological disorders in children and adolescents. Educational and cognitive therapy approaches to reduce TAF and consequent symptoms are discussed, and suggestions for further research made.

Responsibility attitude in a sample of Iranian obsessive-compulsive patients

BACKGROUND

The study of distorted beliefs about responsibility attitude and interpretation has become the central theme in Salkovskis' (1985) and Rachman and Hodgson's (1980) models of Obsessive-Compulsive Disorder (OCD).

AIMS

The aim of this research is to assess the responsibility attitude in Iranian OCD patients.

METHODS

Twenty OCD patients were selected through available sampling from the case referred to psychology clinics. Two other patient groups comprised of 20 non-OCD anxiety disorder patients and 20 non-clinical participants were also chosen as comparison groups. All participants completed the Responsibility Attitude Scale (RAS) and Responsibility Interpretation Questionnaire (RIQ).

RESULTS

Analyses revealed statistically significant differences between OCD group and comparison groups on both RAS and RIQ. In addition, both RAS and RIQ scores were associated with the severity of OCD assessed by the Yale-Brown scale.

CONCLUSIONS

These findings suggest that responsibility attitude and interpretations are the prominent features of OCD in Iranian patients and are associated with the severity of illness.

Feared identity and obsessive-compulsive disorder

We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits.

Inflated Responsibility and Perseverative Checking: The Effect of Negative Mood

This article reports the results of 2 experiments designed to test predictions from the mood-as-input hypothesis on the role of inflated responsibility in perseverative checking. Through the use of an analog checking task in both experiments, the authors showed that perseveration, as indicated by a range of measures relevant to compulsive checking, was affected by a combination of the level of inflated responsibility and the valency of mood at the outset of checking. In particular, inflated responsibility significantly facilitated checking perseveration only in the context of a negative mood and was not a sufficient condition for checking perseveration to occur. These effects of the various configurations of inflated responsibility and mood valency are predicted by the mood-as-input hypothesis.

Thought suppression and its effects on thought frequency, appraisal and mood state in individuals with obsessive-compulsive disorder

Leading models of obsessive-compulsive disorder (OCD) implicate thought suppression as a key factor in the escalation and persistence of the disorder. This experiment examined the effects of suppression on the frequency of obsessional thoughts in 50 individuals with a primary diagnosis of OCD, and also investigated the effects of participants' appraisals regarding their failures in thought control on distress about intrusive thoughts and on mood. Participants' most upsetting obsessional thought was primed and they then monitored its occurrence over two 4-min intervals. In the first interval, half of the participants were instructed to suppress their obsessional thought and half were instructed not to suppress any thoughts. In the second interval, all participants were given the 'Do Not Suppress' instructions. Participants rated their suppression effort and discomfort over thought occurrences after each interval and recorded their appraisals of thought recurrences during the first interval. Mood state was then reassessed. No ironic effect of suppression on frequency was noted. However, negative appraisals of thought recurrences were associated with more discomfort over thought occurrences and more negative mood at Time 2. These findings suggest that interpretations regarding failures in thought control may be of central importance in understanding obsessional problems.

Cognitive Predictors of Obsessive–Compulsive Symptoms in Adolescence: A Preliminary Investigation

This study examined relations among responsibility attitudes, metacognitive beliefs, and obsessive-compulsive (O-C) symptoms in youth. One hundred sixty-six nonclinical youth (ages 13 to 17 years) completed the following: Responsibility Attitude Scale (RAS; Salkovskis et al., 2000); Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A; Cartwright-Hatton et al., 2004); Children's Depression Inventory-Short Form (CDI-S; Kovacs, 1985); Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978); the Leyton Obsessional Inventory-Child Version Survey Form (LOI-CVS; Berg, Whitaker, Davies, Flament, & Rapoport, 1988). Participants endorsed a range of responsibility and metacognitive beliefs, and both responsibility and metacognition were positively correlated with O-C symptoms. However, when age, sex, and depression were controlled, only metacognition was a predictor of O-C symptoms. The findings suggest metacognition and responsibility may be important correlates of O-C symptoms in youth.

Development and preliminary validation of the Meta-cognitions Questionnaire-Adolescent Version

This study describes the development of the Meta-cognitions Questionnaire for Adolescents (MCQ-A). The adult version of this questionnaire has been widely used, and the meta-cognitive theory of emotional disorders has become influential in the adult literature. This study sought to examine the prevalence and emotional correlates of meta-cognition in adolescents. The MCQ-A was administered to 177 schoolchildren aged 13 through 17 years, together with measures of emotional well-being. Factor analysis suggested a five-factor solution similar to that reported for the adult version. Internal consistency of the scale was high. Scores ranged from low to high across the age range, suggesting that meta-cognitive beliefs are well-established by adolescence. Scores on the MCQ-A were highly correlated with a number of measures of emotional symptoms. The MCQ-A is a reliable and valid instrument for measuring meta-cognitive beliefs in adolescents. Young people aged between 13 and 17 years report a range of types and levels of meta-cognitive beliefs and these are positively associated with emotional symptoms.

Psychometric properties of the Thought–Action Fusion Scale in a Turkish sample

The aim of the present study was to reveal the cross-cultural utility of the Thought-Action Fusion Scale (TAFS; J. Anxiety Disord. 10 (1996) 379). Thought-action fusion (TAF) refers to the tendency to overvalue the significance and the consequences of thoughts. Two hundred and fifty one undergraduate Turkish students participated in the current study. The reliability and validity analyses of the Turkish version of the scale indicated that the TAFS had adequate psychometric properties in a Turkish sample. Consistent with the original TAF, the Turkish version of TAFS revealed two subscales as TAF-Likelihood and TAF-Morality. Reliability analysis showed that TAF Scale and its factors had adequate internal consistencies and split-half reliability coefficients. Confirming the expectations, TAFS scores were found to be significantly and positively correlated with obsessive-compulsive symptoms, responsibility, and guilt measures. Moreover, it was found that people with high obsessive-compulsive symptoms had higher TAFS scores than those with low symptoms.

Cognitive appraisals in young people with obsessive-compulsive disorder

BACKGROUND

A number of cognitive appraisals have been identified as important in the manifestation of obsessive-compulsive disorder (OCD) in adults. There have, however, been few attempts to explore these cognitive appraisals in clinical groups of young people.

METHOD

This study compared young people aged between 11 and 18 years with OCD (N = 28), young people with other types of anxiety disorders (N = 28) and a non-clinical group (N = 62) on three questionnaire measures of cognitive appraisals. These were inflated responsibility (Responsibility Attitude Scale; Salkovskis et al., 2000), thought-action fusion--likelihood other (Thought-Action Fusion Scale; Shafran, Thordarson & Rachman, 1996) and perfectionism (Multidimensional Perfectionism Scale; Frost, Marten, Luhart & Rosenblate, 1990).

RESULTS

The young people with OCD had significantly higher scores on inflated responsibility, thought-action fusion--(likelihood other), and one aspect of perfectionism, concern over mistakes, than the other groups. In addition, inflated responsibility independently predicted OCD symptom severity.

CONCLUSIONS

The results generally support a downward extension of the cognitive appraisals held by adults with OCD to young people with the disorder. Some of the results, however, raise issues about potential developmental shifts in cognitive appraisals. The findings are discussed in relation to implications for the cognitive model of OCD and cognitive behavioural therapy for young people with OCD.

Symptom dimensions in obsessive-compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure

Although obsessive-compulsive disorder (OCD) is regarded as a unitary nosological entity, it encompasses a rich variety of heterogeneous mental and behavioural phenomena. The identification of clinical subtypes within this broad concept has been a focus of attention in recent years. In the present study, we administered a clinician-rated scale, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) with the Y-BOCS Symptom Checklist (Y-BOCS CL), as well as a self-report questionnaire, the Padua Inventory revised (PI-R), to 150 outpatients with OCD. A principal component analysis on the Y-BOCS CL, along with the PI-R, identified 6 consistent symptom clusters: (1) contamination obsessions and cleaning compulsions, (2) sexual/religious/somatic obsessions and checking, (3) high risk assessment and checking, (4) impulses and fear of loss of control, (5) need for symmetry and exactness, and ordering and counting compulsions, and finally (6) rumination. The Y-BOCS CL and PI-R showed great overlap and consistency regarding content and severity of the OCD symptoms. On inspection of items with identical content, only half of the items showed significant agreement. Both inventories have unique factors: rumination is represented solely in the PI-R, somatic obsessions and checking solely in the Y-BOCS CL. This means that the use of both clinician-administered and self-report measures is recommended, so that the entire spectrum of symptoms is represented.

Empirical investigations of thought suppression in OCD

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) implicate thought suppression as a key factor in the development and persistence of the disorder. There is now more than a decade of research on thought suppression and its effects as they pertain to OCD. This paper briefly reports on initial thought suppression research and then offers a detailed review of recent thought suppression research that has directly examined the role of suppression in OCD. Theoretical and methodological issues in using thought suppression paradigms to understand OCD are discussed. It is concluded that this body of work continues to yield inconsistent findings with respect to the effects of suppression on thought frequency, although there are some consistent findings that suggest that suppression is driven by negative thought appraisal and is associated in turn with greater OCD symptomatology. Thus, there is support in this work for key tenets of cognitive-behavioural models of OCD. Suggestions for future research directions are offered.

Examination of emotional Stroop interference in obsessive–compulsive disorder

Previous research has produced conflicting findings on whether or not patients with subclinical or manifest obsessive-compulsive disorder (OCD) share an attentional bias for anxiety-related material. In the present study, 35 OCD patients were compared with 20 healthy controls on their performance in an emotional Stroop paradigm. Nine different stimulus conditions were compiled, including sets for depression-related and anxiety-related words as well as stimuli from two constructs with a potential relevance for the pathogenesis and maintenance of OCD symptomatology: responsibility and conscientiousness. Patients did not show enhanced interference for any of the conditions. Syndrome subtype and severity, avoidance and speed of information processing did not moderate results. The present study concurs with most prior research that OCD patients display no interference effect for general threat words. It deserves further consideration, that emotional interference effects in OCD as seen in other anxiety disorders occur when using idiosyncratic word material with a direct relation to the individual's primary concerns.

Inflated responsibility and the use of stop rules for catastrophic worrying

The present paper reports the results of two experiments designed to test some predictions from a mood-as-input explanation of catastrophic worrying (). In particular, these experiments attempted to identify whether worriers possess characteristics that would contribute to the use of relatively strict 'as many as can' closure rules for catastrophising. Experiment 1 demonstrated that high worriers begin a catastrophising task with higher self-reported levels of responsibility towards fully considering all issues involved, than low worriers. Experiment 2 suggested that inflated responsibility has a causal effect on perseveration at the catastrophising task (rather than being a simple non-causal by-product of excessive worrying), and that inflated responsibility exacerbates catastrophising only in conjunction with negative mood. This suggests a relatively complex relationship between responsibility and mood, where there are mood conditions in which high responsibility does not generate greater persistence than low responsibility. These findings are consistent with predictions from a mood-as-input account of catastrophic worrying, and provide evidence for a putative mechanism that mediates the influence of variables such as inflated responsibility on perseveration.

An examination of the cognitive processes involved in childhood obsessive-compulsive disorder

The cognitive theory of obsessive-compulsive disorder (OCD) is the most widely accepted account of the aetiology and maintenance of this disorder in adults. This paper investigated whether cognitive processes were evident in a sample of children with a primary diagnosis of OCD. Using an idiographic approach, as proposed by the Obsessive-Compulsive Cognitions Working Group, this paper assessed cognitive appraisals of responsibility, probability, severity, thought-action fusion, self-doubt and cognitive control. Ratings of these cognitive appraisals were obtained across a sample of children with OCD, and were compared with ratings from a clinical control group of anxious children and a non-clinic control group. It was hypothesised that consistent with the cognitive theory of OCD, children in the OCD group would display higher estimations of these cognitive processes in comparison to anxious and non-clinic children. Results of this investigation provide preliminary support for a cognitive conceptualisation of OCD during childhood. OCD children reported significantly higher ratings of responsibility, severity, thought action fusion and less cognitive control in comparison to non-clinic children. OCD children could also be clearly differentiated from anxious children on ratings of cognitive control. Implications of this investigation are discussed and directions for future research are highlighted.

Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension

In a follow-up study to [J. Anxiety Disord., in press] examination of inflated perception of responsibility for harm among individuals with obsessive compulsive disorder (OCs), 22 OC checkers, 24 OC non-checkers, and 25 non-anxious controls (NACs) completed the Obsessive Compulsive Responsibility Scale (OCRS), which consisted of written descriptions of Low-Risk (LR), Moderate-Risk (MR), and High-Risk (HR) scenarios. In LR and MR scenarios, OC checkers reported greater perception of responsibility for harm and greater relief upon rectifying the situation, than did NACs. OC checkers also reported greater urges to rectify LR situations than did NACs. OC non-checkers did not differ from NACs on any of the scales. No group differences emerged for HR scenarios. The results suggest that, compared to OC non-checkers and to NACs, OC checkers have an inflated perception of responsibility for harm; and that this perception leads to a need to rectify potentially harmful situations.

Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory

In 1995 the Obsessive Compulsive Cognitions Working Group initiated a collective process to develop two measures of cognition relevant to current cognitive-behavioural models of OCD. An earlier report (Behav. Res. Therapy, 35 (1997) 667) describes the original process of defining relevant domains. This article describes the subsequent steps of the development and validation process: item generation, scale reduction, and initial examination of reliability and validity. Two scales were developed. The Obsessive Beliefs Questionnaire consists of 87 items representing dysfunctional assumptions covering six domains: overestimation of threat, tolerance of uncertainty, importance of thoughts, control of thoughts, responsibility, and perfectionism. The Interpretation of Intrusions Inventory consists of 31 items that refer to interpretations of intrusions that have occurred recently. Three of the above domains are represented: importance of thoughts, control of thoughts, and responsibility. The item reduction and validation analyses were conducted on clinical and non-clinical samples from multiple sites. Initial examination of reliability and validity indicates excellent internal consistency and stability and encouraging evidence of validity. However, high correlations indicating overlap between some of the scales, particularly importance of thoughts, control of thoughts, and responsibility will need to be addressed in subsequent empirical and theoretical investigations.

Causing harm and allowing harm: a study of beliefs in obsessional problems

This study investigates two factors hypothesised as relevant to obsessional problems because of the way in which they influence decisions whether or not to act to prevent harm. These are (i) the way in which intrusive thoughts increase the internal awareness of harm, and confront the person with the possibility of taking action to prevent such harm and (ii) the extent to which there is some obvious external factor which increases awareness of the possibility of preventing harm. Obsessional patients, anxious and non-clinical controls completed a scale which systematically measured these factors across a wide range of situations. Results across all situations evaluated confirmed previous findings that both obsessionals and nonobsessionals were more likely to report acting to prevent harm when awareness of it is prompted by an intrusion than when it is not. It was also found that participants in all groups acted more 'obsessionally' when a scenario is described in ways which suggest that harm may be by 'commission' than when it is described in terms of an 'omission'. When scenarios about which each individual is most disturbed were analysed, anxious and non-clinical controls continued to differentially rate omission and commission situations; as predicted, this differential was not present for obsessional patients. It is concluded that obsessionals are more sensitive to omission than are nonobsessionals when considering scenarios about which they are concerned, and that this sensitivity is one factor influencing the decision whether to act to prevent harm.