Spanish version of the Dimensional Obsessive-Compulsive Scale (DOCS): psychometric properties and relation to obsessive beliefs

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.

Screening for Perinatal OCD: A Comparison of the DOCS and the EPDS

Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ (N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).

Gender-related romantic attachment and serum oxytocin level difference in adult patients with obsessive compulsive disorder

Background

Given the scarcity of data on gender-related romantic attachment changes and the potential role of oxytocin (OT) in the pathophysiology of obsessive-compulsive illness (OCD), the current study aimed to assess gender-related differences in romantic attachment characteristics and their relationship to serum oxytocin in a set of forty OCD cases compared with a similar group of healthy controls .Simultaneously examining the gender differences in serum oxytocin levels in OCD patients, the diagnosis of OCD patients was determined using DSM-5 criteria, and the severity of OCD was determined using the Y-BOCS rating scale. All of the patients were drug-free and not depressed. The romantic attachment was assessed using the “Experiences in Close Relationship” Questionnaire. Standard ELISA kits were used to assess plasma OT levels.

Results

Regarding romantic attachments, patients with obsessive compulsive disorder scored higher on the anxiety and avoidance domains than controls with no significant gender difference. Serum oxytocin was higher in patients with OCD than in healthy controls, indicating a possible underlying pathophysiology of the illness. Also, there was a significant gender difference, with female patients having higher serum oxytocin and symptoms severity being negatively associated.

Conclusions

Taken together, these findings propose that OT may play a role in OCD pathophysiology with gender specificity. Also, OCD associated with insecure romantic attachment.

Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis

BACKGROUND

Cognitive behavioral therapy (CBT) is a well-established treatment for people suffering from obsessive-compulsive disorder (OCD) and technology-based CBT applications are an emerging treatment option for people with OCD. These applications involve treatment protocols with automated content delivery and relatively low clinical contact. Whilst such CBT applications are promising, however, further investigation is needed to establish the efficacy of this treatment approach for individuals with OCD. The aim of the present study was to review the efficacy of technology-delivered CBT with minimal clinician support for OCD using a meta-analytic approach.

METHODS

Randomized controlled trials (RCT) were identified through PsycINFO, Medline and Scopus resulting in 18 eligible studies (n = 1707). Control conditions comprised both passive (namely no treatment, other treatments and waitlist controls) and active. Measurement of OCD symptoms improvement was the outcome in each study.

RESULTS

Participants in the technology-delivered CBT group scored lower on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (g = - 0.59, 95% CI = [- 0.99, - 0.18], p = 0.01), Y-BOCS and Dimensional Obsessive-Compulsive Scale (DOCS) combined (g = - 0.55, 95% CI = [- 0.87, - 0.24], p = 0.003) and Obsessive-Compulsive-Inventory-Revised (OCI-R) (g = - 0.36, 95% CI = [- 0.62, - 0.09], p = 0.02) at post-treatment than passive control groups. There were no significant findings when compared to controls with other treatments.

CONCLUSIONS

This meta-analysis suggests that technology-delivered CBT with low personal contact intensity, relative to passive control groups, is an efficacious and promising treatment option for individuals with OCD. Further research is needed to allow for a comparison with control groups with other treatments.

Die Validierung der Dimensional Obsessive-Compulsive Scale (DOCS) an einer deutschsprachigen Stichprobe

<b><i>Hintergrund:</i></b> PatientInnen mit Zwangsstörungen werden in klinischer Forschung und Praxis häufig nicht erkannt oder fehldiagnostiziert, wodurch es zu verzögerten und unzureichenden Behandlungen kommt. Ein Aspekt, der maßgeblich dazu beiträgt, sind unter anderem unzureichende Screening- und Diagnostikinstrumente, da bestehende Fragebögen zur Erfassung von Zwangsstörungen zu einem großen Teil Limitationen hinsichtlich ihrer psychometrischen Qualitäten und ihrer Aktualität unterliegen. Mit der Dimensional Obsessive-Compulsive Scale (DOCS) steht im englischsprachigen Raum seit mehreren Jahren bereits ein vielversprechendes Instrument zur Erfassung von Zwangsstörungen zur Verfügung. <b><i>Patienten und Methoden:</i></b> Ziel der vorliegenden Arbeit war es, erstmalig die Faktorstruktur sowie die psychometrischen Eigenschaften der deutschsprachigen DOCS-Version zu überprüfen. Hierzu wurden 177 PatientInnen (107 mit Zwangsstörung, 30 mit Angststörungen und 40 mit Depression) sowie eine nicht-klinische Kontrollgruppe mit 223 Probanden untersucht. <b><i>Ergebnisse:</i></b> Die vierfaktorielle Originalstruktur der DOCS konnte in explorativen und konfirmatorischen Faktoranalysen repliziert werden. Interne Konsistenzen und die zeitliche Stabilität der DOCS fielen akzeptabel bis sehr gut aus. Die Konstruktvalidität der DOCS-Gesamtskala fiel zufriedenstellend bis gut aus. Die Kriteriumsvaliditäten fielen bedingt zufriedenstellend aus. Die diagnostische Genauigkeit der DOCS fiel befriedigend aus. <b><i>Schlussfolgerung:</i></b> Die deutsche Version der DOCS ist ein robustes, reliables und erstmals validiertes Instrument zur dimensionalen Beschreibung des Schweregrads von Zwangsstörungen.

Psychometric Properties of the Dutch Dimensional Obsessive-Compulsive Scale (DOCS)

Abstract. The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report questionnaire aimed to measure the severity of obsessive-compulsive symptoms on four thematically different symptom dimensions (contamination, responsibility for harm, unacceptable thoughts, and symmetry and completeness). The DOCS was developed in the US in response to the insufficiency of existing OCD measures. The 20-item scale is used in research and clinical settings. We translated the DOCS into Dutch and examined the psychometric properties in a clinical sample. In addition, we further examined the US version of DOCS with respect to measurement invariance between patient and non-patients and also between the US and the Dutch version of the DOCS. The analyses showed that the Dutch version is a valid and reliable version of the DOCS. Measurement invariance tests indicated that patient scores can be validly compared with non-patient scores. Therefore, the DOCS is a good instrument to monitor the development of OCD, for example, during treatment. The same result was found for the US DOCS and the Dutch DOCS, hence US scores and Dutch scores can be validly compared. With these two studies we have extended our knowledge of the DOCS, beyond the common psychometric properties.

Emotional Processing and Personality as Predictors of Obsessive-compulsive Symptoms in College Students

The categorical definition of obsessive-compulsive disorder, and exclusive focus on thoughts and behaviors, have constrained the study and treatment of its symptoms. The present study's aim was to search for relationships among emotional processing dimensions, five major personality dimensions, and self-perceived obsessive-compulsive symptoms. The participants were 100 college students, and the questionnaires used were a selection of images from the International Affective Picture System (IAPS), the Self-assessment Manikin (SAM), the Dimensional Obsessive-Compulsive Scale (DOCS), and the NEO-FFI. We found differences in emotional processing dimensions between participants with high and low DOCS scores, grouped according to sex (d = .56); and evidence that the neuroticism and agreeableness dimensions predict self-perceived obsessive-compulsive symptoms. Emotional processing dimensions and personality are considered useful to comprehending obsessive-compulsive symptoms, which lends support to dimensional models of OC symptomatology, as well as planning and developing psychological interventions.

Examining the Relationships Between Perfectionism and Obsessive-Compulsive Symptom Dimensions Among Rural Veterans

Perfectionism, a trait-like individual difference variable reflecting the tendency to set extremely high standards along with critical evaluations of one's own behavior, has long been regarded as a risk and maintenance factor for obsessive-compulsive disorder (OCD). However, research exploring the relationship between these constructs is mixed. One explanation for these equivocal findings is the heterogeneous nature of OCD. Indeed, there is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. The current study examined the associations between self-reported perfectionism and OCD symptom dimensions controlling for probable depression status. The sample included 67 rural veterans. Results revealed a unique association between perfectionism and the unacceptable thoughts dimension of OCD. These findings are consistent with a growing body of literature demonstrating that OCD symptom dimensions have unique underlying dysfunctional beliefs.

Validation of the Bangla version of the Dimensional Obsessive-Compulsive Scale

BACKGROUND

Obsessive-compulsive disorder (OCD) is a common and severe psychiatric illness which affects about 1-3% of the population across the globe. The Dimensional Obsessive-Compulsive Scale (DOCS) is a 20-item self-report instrument that assesses the severity of OCD in four dimensions.

OBJECTIVES

We aimed to adapt and validate the DOCS in Bangla.

METHODS

This validation study was conducted from January 2016 to July 2017 using purposive sampling technique. A total of 100 OCD patients were recruited from OCD clinic of Bangabandhu Sheikh Mujib Medical University after considering the inclusion and exclusion criteria. We applied Bangla version of DOCS to collect data and assessed different forms of validity and reliability.

RESULTS

Cronbach's alpha of DOCS Bangla was 0.93 which signifies a good internal consistency. Cronbach's alpha of contamination domain was 0.92; responsibility domain 0.94, thought domain 0.91 and symmetry domain was found 0.93. Four factors were extracted from exploratory factor analysis with varimax rotation. Pearson correlation was 0.73 between the DOCS Bangla total global score and the Y-BOCS total score which signifies good criterion validity.

CONCLUSION

DOCS Bangla is a psychometrically reliable and valid tool for use in clinical settings, research and primary care setting to diagnose and manage OCD for Bangla speaking population.

A transcultural study of hoarding disorder: Insights from the United Kingdom, Spain, Japan, and Brazil

Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics-in particular age, marital status, and clinical expression-as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder.

Examining the role of sex differences in obsessive-compulsive symptom dimensions

Obsessive-compulsive disorder (OCD) is a notably heterogeneous disorder. As such, there has been increased interest in subtyping OCD into homogeneous entities using biological characteristics such as sex. Whereas there is large consensus in the literature regarding sex differences in the phenotypic expression of OCD, there are numerous disadvantages to how OCD has been previously measured and assessed. The present investigation explored potential sex differences in OCD symptoms using the Dimensional Obsessive Compulsive Scale (DOCS), a redesigned measure that more reliably assesses the four most commonly replicated OCD symptom dimensions. A large sample of community participants with elevated levels of OCD symptoms (N = 297) was recruited from an online crowdsourcing marketplace. Surprisingly, no differences in means were observed across sexes. However, results did reveal sex differences when examining relations between OCD dimensions. In particular, correlations between the OCD symptom dimensions were stronger in males compared to females. The common perception of OCD as a heterogeneous disorder may hold for females more so than for males. Future research should seek to replicate these findings using multimethod approaches including clinical, behavioral, and neuroimaging assessments.

The Dimensional Obsessive-Compulsive Scale: Development and Validation of a Short Form (DOCS-SF)

Accurately and reliably measuring the presence and severity of Obsessive-Compulsive Disorder (OCD) symptoms is essential for both routine clinical work and research. The current study investigated psychometric properties of the dimensional obsessive-compulsive scale-short form (DOCS-SF). DOCS-SF was developed and validated in Norwegian. DOCS-SF contains a checklist with four symptom categories and five severity items scored on a zero to eight scale yielding a total score of 0–40. Data were collected from adults with a current diagnosis of OCD (n = 204) and a community comparison group (n = 211). The results provided evidence of internal consistency and convergent validity, although evidence for discriminant validity was mixed. Evidence was also found for diagnostic sensitivity and specificity, and treatment sensitivity. The analyses suggested a cut-off score of 16. In summary, the data obtained proved similar to studies published on the original dimensional obsessive-compulsive scale. There is strong evidence for the reliability and validity of the DOCS-SF for assessing OCD symptoms in individuals with this condition and in non-clinical individuals.

"Not Just Right Experiences" as a psychological endophenotype for obsessive-compulsive disorder: Evidence from an Italian family study

The heart of the obsessional process may be considered the subject's underlying impression that "something is wrong" or "that something is not just as it should be". This phenomenon, labeled "not just right experiences" (NJREs), has increasingly been receiving attention as a possible marker of obsessive-compulsive disorder (OCD). The present study sought to add to the evidence that NJREs may be a putative endophenotype of obsessional symptoms. To this aim, measures of NJREs, obsessive-compulsive (OC) symptoms and psychological distress were compared in offspring of parents with and without OC symptoms. The offspring of parents with OC symptoms (N=120) reported higher frequency and severity of NJREs compared to offspring of parents without OC symptoms (N=106). Such differences remained significant for NJREs frequency and close to significance for NJREs severity, when general distress (i.e., anxiety and depression) was controlled. The possible role of NJREs as an endophenotype for OCD is discussed in reference to Gottesman and Gould criteria and the National Institute of Mental Health RDoC initiative.

Examination of a Bifactor Model of Obsessive-Compulsive Symptom Dimensions

Although obsessive-compulsive (OC) symptoms are observed along four dimensions (contamination, responsibility for harm, order/symmetry, and unacceptable thoughts), the structure of the dimensions remains unclear. The current study evaluated a bifactor model of OC symptoms among those with and without obsessive-compulsive disorder (OCD). The goals were (a) to evaluate if OC symptoms should be conceptualized as unidimensional or whether distinct dimensions should be interpreted and (b) to use structural equation modeling to examine the convergence of the OC dimensions above and beyond a general dimension with related criteria. Results revealed that a bifactor model fit the data well and that OC symptoms were influenced by a general dimension and by four dimensions. Measurement invariance of the bifactor model was also supported among those with and without OCD. However, the general OC dimension accounted for only half of the variability in OC symptoms, with the remaining variability accounted for by distinct dimensions. Despite evidence of multidimensionality, the dimensions were unreliable after covarying for the general OC dimension. However, the four dimensions did significantly converge with a latent OC spectrum factor above and beyond the general OC dimension. The implications of these findings for conceptualizing the structure of OCD are discussed.

Patient-reported outcomes in obsessive-compulsive disorder

The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and related measures that have been examined in the context of obsessive-compulsive disorder (OCD). The current review focused on patient-reported outcome measures (PROMs) that evaluated three broad outcome domains: functioning, health-related quality of life (HRQoL), and OCD-related symptoms. The present review ultimately included a total of 155 unique articles and 22 PROMs. An examination of the PROs revealed that OCD patients tend to suffer from significant functional disability, and report lower HRQoL than controls. OCD patients report greater symptom severity than patients with other mental disorders and evidence indicates that PROMs are sensitive to change and may be even better than clinician-rated measures at predicting treatment outcomes. Nonetheless, it should be noted that the measures reviewed lacked patient input in their development. Future research on PROMs must involve patient perspectives and include rigorous psychometric evaluation of these measures.