The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive-compulsive disorder sample

Reduced resting-state functional connectivity of default mode network subsystems in patients with obsessive-compulsive disorder

OBJECTIVES

Neuroimaging studies have reported extensive resting-state functional connectivity (rsFC) abnormalities in the default mode network (DMN) in patients with obsessive-compulsive disorder (OCD), but findings are inconsistent. DMN can be divided into three subsystems: core, dorsal medial prefrontal cortex (dMPFC), and medial temporal lobe (MTL). This study aimed to explore abnormalities in rsFC strength within and between DMN subsystems in OCD patients, and their relationship with clinical symptoms.

METHODS

This study recruited 39 OCD patients and 45 healthy controls (HCs). OCD symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). The seed-to-seed method was used to construct rsFC matrix. The rsFC strength within and between the three DMN subsystems were calculated.

RESULTS

Compared to the HC group, the OCD group exhibited reduced rsFC strength within core subsystem (F = 7.799, p = 0.007, Bonferroni corrected p = 0.042). Further, this reduction was also observed in the unmedicated OCD group (n = 19), but not in the medicated OCD group (n = 18). In addition, rsFC strength within core subsystem was negatively correlated with the obsession subscale of YBOCS in the OCD group (r = -0.512, p = 0.004, Bonferroni corrected p = 0.008). Further, this correlation was also significant in the unmedicated OCD group, but not in the medicated OCD group.

CONCLUSIONS

Our findings suggest that reduced rsFC strength within core subsystem is a feature of OCD patients and may serve as a potential biomarker of obsession severity. Moreover, pharmacological treatments may affect rsFC strength in DMN.

An ecological momentary assessment of OCD-relevant intrusions: Frequency, feared self, and concealment

This study provides the first examination of the frequency, characteristics, and dynamics surrounding daily experiences of OCD-relevant intrusions among non-clinical participants (N = 54, Nobs = 2314) using ecological momentary assessment. It also examines the extent to which self-related constructs-participants' feared-self beliefs and their tendency to conceal aspects of self-relate to such intrusive phenomena. Participants completed a baseline questionnaire before reporting state depressed mood and intrusions up to five times per day (at semi-random intervals) for 14 days. Results suggest that questionnaire measures may result in underreporting of the frequency of intrusions, with most participants (80%) reporting at least one intrusion across the momentary observations, and 20% of observations indicating intrusive phenomena experienced since the previous momentary report. Baseline factors including OCD-related beliefs and feared self were related to the proportion of intrusions experienced, whereas self-concealment was not. Within the moment, state feared-self predicted intrusion-related distress, duration, perceived importance, the urge to act, and the need to control thoughts. The urge to conceal within the moment was significant but negatively related to perceived importance and the urge to act. Overall, this study provides evidence for the relevance of momentary measures of intrusions, and adds to evidence for self-beliefs in the dynamics of the disorder.

A mobile app to challenge obsessional beliefs in adolescents: a protocol of a two-armed, parallel randomized controlled trial

BACKGROUND

Adolescence is a crucial stage for the development of OCD symptoms that, in most cases, persist into adulthood. This requires designing preventive strategies tailored to this population. Therefore, we aim to describe the study protocol that will be used to examine the effectiveness of a mobile health application to challenge obsessional beliefs in adolescents.

METHODS

A two-armed randomized controlled trial will be conducted on an adolescent sample from the general population. The experimental group will use the intervention module (GGOC-AD) of a mobile app on the GGtude platform for 14 days whereas the control group will use a non-active module (GGN-AD) of said app. Primary outcome measures will be obsessional beliefs and obsessive-compulsive symptoms, and secondary measures will be self-esteem and emotional symptoms. Three assessment points will be conducted at baseline, post-intervention, and one-month follow-up. A linear multiple regression model with an intention to treat approach will be used. The expected total sample size will be 55 participants.

DISCUSSION

We expect that the intervention group will show a reduction in obsessional beliefs and OCD-symptoms at post and follow-up in comparison with the control group. Additionally, we expect that the app will improve participants' self-esteem. This study could provide an accessible mobile health tool to prevent OCD-related symptoms in adolescents.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06033391 . Registered September 4, 2023.

Cross-sectional direct and indirect relationships between the corrupted feared self and obsessive-compulsive symptoms in a clinical sample: The role of mental contamination

OBJECTIVES

There is a significant relationship between a general feared self and contact contamination concerns in obsessive-compulsive disorder (OCD), especially when the influence of mental contamination is considered a part of this relationship. However, these associations have not been explored in a clinical OCD sample when using each dimension of the multidimensional conceptualization of the feared self as the predictor (i.e., the corrupted, culpable, and malformed feared selves).

METHODS

We tested these associations using a cross-sectional design. Specifically, a sample of patients diagnosed with OCD (N = 417) completed a series of self-report measures of OCD symptoms and its related constructs. We also explored these associations with unacceptable thoughts as the outcome, rather than contamination concerns, due to unacceptable thoughts having evidenced strong associations with the feared self and mental contamination.

RESULTS

After controlling for relevant cognitive (i.e., obsessive beliefs) and affective (i.e., depressive symptoms) constructs and comorbidity, the corrupted feared self was found to have a direct link, along with an indirect link through mental contamination, with symptoms of contact contamination and unacceptable thoughts.

CONCLUSIONS

The fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns. The corrupted feared self and mental contamination should therefore be targeted in treatments for repugnant obsessions and contamination-related OCD.

Further validation of the Multidimensional Version of the Fear-of-Self Questionnaire in a Persian non-clinical and clinical obsessive-compulsive disorder sample

Previous research has shown that vulnerable self-themes and feared self-perceptions may play an important role in the development and maintenance of obsessive-compulsive disorder (OCD). In particular, the recently validated Multidimensional Version of the Fear-of-Self Questionnaire (FSQ-MV) has shown strong relationships with OCD symptoms independent of cognitive constructs and negative mood in non-clinical samples. The current study aimed to further evaluate the validity and reliability of a Persian version of the FSQ-MV in OCD patients (N = 300), as well as non-clinical individuals (N = 300). Participants completed a set of scales evaluating feared self-perceptions and OCD-related symptoms/conditions. The results showed that the Persian version of the FSQ-MV replicated the three-factor structure of the original scale in non-clinical and OCD patients. The FSQ-MV and its subscales had excellent reliability. Additionally, the FSQ-MV was significantly associated with related cognitive constructs, as well as OCD symptoms and their severity, in both samples. The feared self, especially the corrupted feared self, was a significant unique predictor of OC symptomology, especially for repugnant obsessions, and OCD severity. The study confirmed the validity and reliability of the Persian version of the FSQ-MV. Moreover, cognitive conceptualizations may benefit from a consideration of the feared self in OCD, which may play an important role in its development, maintenance and severity.

The Role of Personality, Self-Disclosure, and Envy in Maladaptive Social Media Engagement

Through online social networks (OSNs), individuals establish and maintain social connections to satisfy their need to belong. Recent research suggests that taken too far, one's need to belong can increase envy and lead to maladaptive social media behavior aligned with obsessive-compulsive disorder (OCD). This study examines the role of two personality traits, one's intrinsic need to belong and trait reactance, on feelings of envy and the self-disclosure processes that lead to OCD on social networks. A sample of 354 U.S. adult users of Facebook completed a survey measuring individuals' need to belong, trait reactance, envy, self-disclosure, and OSN-OCD. Regression analyses reveal that need to belong and trait reactance both independently and interactively relate to envy, and that self-disclosure mediates the relationship between envy and OCD on social networks. Those with low trait reactance appear at the lowest risk of OSN-OCD no matter their need to belong. The highest risk profile for online OCD is found in those with both high trait reactance and high need to belong. Overall, our findings support further exploration of one's intrinsic need to belong and trait reactance as personality indicators of risk for OSN-OCD.

Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice

A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.