The causes and consequences of shame in obsessive-compulsive disorder

Movement Toward Dimensional Symptom Models of Comorbid Obsessive-Compulsive Disorder and Eating Disorders

Obsessive-compulsive disorder (OCD) and eating disorders (EDs) are highly comorbid. Despite the high comorbidity, there is little understanding of why these disorders coexist and even less research on how to best treat this co-occurrence. In this article, we review the literature on comorbid OCD-ED and discuss potential underlying shared mechanisms, including anxiety/avoidance, perfectionism, intolerance of uncertainty, habit formation, disgust, shame and guilt, rumination, metacognitive beliefs, and shared biological characteristics. We then discuss prior models of OCD-ED comorbidity and shift the perspective from latent or categorical models to dimensional symptom models (e.g., network models). We describe how dimensional symptom models could advance the conceptualization, treatment, and prevention of comorbid OCD-ED. Next, we discuss how idiographic (one-person) symptom models could advance personalized treatment and provide a treatment example. Finally, we discuss future research needed to advance the field and improve treatment outcomes.

Gender differences in the relationship between obsessive-compulsive symptoms and suicide risk among psychiatric outpatient adolescents: the role of depressive symptoms, anxiety symptoms, and sleep disturbances

Background

Suicide has become one of the leading causes of death among adolescents, with an increased risk observed in the psychiatric outpatient population. Therefore, exploring its risk factors is crucial. Obsessive-compulsive symptoms, being common in this patient group, warrant investigation into their impact mechanisms on suicide risk.

Methods

This study enrolled 526 outpatient adolescents [396 females (75.29%); Mage = 15.39, SD = 1.23] who completed relevant questionnaires and provided demographic data during their clinic visit.

Results

Obsessive-compulsive symptoms positively predicted suicide risk in both males and females, with depressive symptoms mediating this effect. Sleep disturbances played a mediating role only in females, while anxiety symptoms did not mediate the relationship in either gender.

Conclusion

Clinicians should pay closer attention to adolescents presenting with obsessive-compulsive and depressive symptoms, as well as female adolescents with sleep disturbances, to mitigate their elevated suicide risk.

Obsessive-compulsive symptoms and related risk and protective factors in Black individuals in Canada

Background

Data from the United States showed that Black individuals face unique issues related to obsessive-compulsive disorder (OCD). However, Canadian research on OCD among Black individuals remains very limited. The present study aims to document obsessive-compulsive (OC) symptoms and related risk and protective factors in Black individuals aged 15 to 40 years old in Canada.

Methods

A total of 860 Black individuals (75.6% female) aged 15-40 years were recruited as part of the Black Community Mental Health in Canada (BcoMHealth) project. Independent t-tests, ANOVA, and multivariable linear regressions were used to assess OC symptom severity and identify risk and protective factors.

Results

Black individuals presented high levels of OC symptoms. Results showed that Black individuals born in Canada experienced more OC symptoms compared to those born abroad. Results also showed that there were no differences between Black women, Black men, and those who identified their sex as "other." Everyday discrimination, internalized racism, and microaggressions positively predicted OC symptoms, while social support negatively predicted OC symptoms.

Limitations

Limitations of this study include its cross-sectional nature, which prevents us from establishing causal links, not assessing for the clinical diagnosis of OCD, and using self-report measures. Results support that different forms of racial discrimination contribute to the development and severity of OC symptoms in Black individuals in Canada. Social support may play a protective role for those individuals. These factors must be considered in future research and in the assessment and treatment of Black individuals with OCD.

Reasons for seeking internet-delivered treatment for individuals with obsessive-compulsive disorder

OBJECTIVES

Patients with obsessive-compulsive disorder (OCD) face multiple barriers when accessing treatment and rarely receive best-practice cognitive behaviour therapy (CBT) when they seek help. Remote treatments, such as internet-delivered CBT (ICBT), enhance access to evidence-based treatments. To date, no known studies have examined the reasons individuals seek remote treatment over traditional in-person treatment for OCD. Thus, the aim of the current study was to examine the treatment histories of individuals who completed ICBT for OCD and their reasons for seeking ICBT.

METHODS

One hundred and sixty-six participants (Mage = 33.88; SD = 13.41, 71.7% female) were included in the study.

RESULTS

Almost three-quarters of the sample had previously spoken to a health professional about their OCD symptoms. General practitioners were the most frequently consulted health professionals initially (41.7%), while psychologists were the most frequently consulted overall (81.7%). Supportive counselling (74.2%) and medication (72.5%) were the most common forms of treatment ever received. Of those who had received CBT for OCD, only 20.0% (12.5% of the overall sample) likely received best-practice CBT. The most frequently endorsed reasons for seeking ICBT over in-person treatment related to having no access to face-to-face treatment in the community (25.9%) and having found previous face-to-face treatment unhelpful (24.1%). Group differences in reasons for seeking ICBT over face-to-face treatment emerged based on geographical location, OCD severity and presence of comorbid depressive symptoms.

CONCLUSIONS

Evidence-based treatment for OCD is underutilized in the community highlighting the need to develop and disseminate evidence-based remote treatments for OCD.

Assessment of Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are commonly comorbid and share prominent features (e.g., intrusions, safety behaviors, and avoidance). Excellent self-report and clinician-administered assessments exist for OCD and PTSD individually, but few assess both disorders, and even fewer provide instruction on differential diagnosis or detection of comorbid OCD and PTSD. To address this gap in the literature, the current paper aims to (1) highlight diagnostic and functional similarities and differences between OCD and PTSD to inform differential diagnosis, (2) outline assessment recommendations for individuals with suspected comorbid OCD and PTSD, OCD with a significant trauma history or posttraumatic symptoms, or PTSD with significant obsessive-compulsive symptoms, and (3) explore future directions to evaluate and improve methods for assessing co-occurring OCD and PTSD.

The association between OCD and Shame: A systematic review and meta-analysis

BACKGROUND

Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed.

OBJECTIVES

Our review systematically examines the association of shame with OCD and unacceptable thoughts.

METHODS

The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model.

RESULTS

The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [-0.467, 0.9708], harm obsessions r = .224, CI [-0.190, 0.638] and symmetry concerns r = .200, CI [-0.108, 0.509].

LIMITATIONS

Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant.

CONCLUSIONS

Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.

Long-term disability in common mental disorders in Chinese community: evidence from a five-year follow-up study

BACKGROUND

Common mental disorders are general term for mental disorders with high disability rates and significant social burden. The purpose of this study was to determine the degree of long-term disability associated with common mental disorders and to interpret the relationship between common mental disorders and long-term disability.

METHODS

Participants in the 2013 China Mental Health Survey were followed up by telephone between April and June 2018. This study evaluated long-term disability over a five-year period using the World Health Organization's Disability Assessment Schedule 2.0. Poisson regression was used to analyze the relationship between common mental disorders and long-term disability.

RESULTS

A total of 6269 patients were followed up by telephone. In patients with common mental disorders, the prevalence of disability ranged from 7.62% to 43.94%. The long-term disabilities were significantly associated with dysthymic disorder (DD, RR:2.40; 95% CI:1.87-3.03), major depressive disorder (MDD, RR:1.63; 95% CI:1.34-1.98), generalized anxiety disorder (GAD, RR:1.95; 95% CI:1.15-3.09), obsessive-compulsive disorder (OCD, RR:1.68; 95% CI:1.24-2.22) and alcohol use disorder (AUD, RR: 1.42; 95% CI:0.99-1.96).

CONCLUSIONS

In China, common mental disorders raise the risk of long-term disability, and there is a critical need for monitoring patients with DD, MDD, GAD, OCD, and AUD. For improved quality of life and reduced disability levels, more resources need to be dedicated to mental health in the future.

Self-promotion and online shaming during COVID-19: A toxic combination

A public shaming frenzy has spread through social media (SM) following the instigation of lockdown policies as a way to counter the spread of COVID-19. On SM, individuals shun the idea of self-promotion and shame others who do not follow the COVID-19 guidelines. When it comes to the crime of not taking a pandemic seriously, perhaps the ultimate penalty is online shaming. The study proposes the black swan theory from the human-computer interaction lens and examines the toxic combination of online shaming and self-promotion in SM to discern whether pointing the finger of blame is a productive way of changing rule-breaking behaviour. A quantitative methodology is applied to survey data, acquired from 375 respondents. The findings reveal that the adverse effect of online shaming results in self-destructive behaviour. Change in behaviour of individuals shamed online is higher for females over males and is higher for adults over middle-aged and older-aged.