Journal of Obsessive-Compulsive and Related Disorders最新文献

Background

Individuals with obsessive-compulsive disorder (OCD) are at increased risk for suicide. One potential risk factor is interoceptive sensibility (IS), which is one's subjective experience of bodily sensations. The current study examined the relationship between IS and current suicidal ideation and lifetime history of suicide attempt, controlling for relevant covariates.

Methods

Participants (N = 145) were a clinical sample of individuals with OCD from the New York City area. A clinical rater administered a diagnostic interview and an OCD severity assessment, and participants completed questionnaires about demographics, IS, and suicidality.

Results

Current suicidal ideation was associated with reduced trusting of the body, and lifetime history of suicide attempt was related to greater general awareness of sensation. These associations remained significant after controlling for covariates.

Conclusions

These results suggest that specific facets of IS may be associated with specific domains of suicidality. Decreased body trusting may represent a feeling of disconnection from the body that facilitates desire for death. Increased noticing of bodily sensations may lead to greater mental pain, which could interact with deficits in emotion regulation to increase risk for suicide attempt. Further research on the relationships between IS and suicidality in OCD is warranted.

The emotion of shame has been found to be closely related to obsessive-compulsive disorder (OCD). Thought-action fusion (TAF) might explain this relationship, but its causal role with regard to symptom-based shame is unclear. There is growing evidence showing that the metacognitive intervention of detached mindfulness (DM) helps to prevent the development of TAF and thereby shame. The current study investigates, (1) if a TAF induction condition with violent content increases shame compared to a control induction condition with neutral content in randomized nonclinical participants with heightened OCD symptoms (n = 88), and (2) if a subsequent brief DM intervention shows a preventive effect for developing shame compared to a control condition about mnemonic techniques. An ANOVA showed that shame in participants of the TAF induction significantly increased compared to the control condition. In a second ANOVA, the DM intervention failed to show a preventive effect on developing TAF and shame in a following TAF induction experiment compared to the control condition. The present findings suggest the importance of TAF beliefs for the development of shame. A more intense DM intervention or additional (meta-)cognitive interventions might be necessary to prevent the development of shame.

Individuals with body dysmorphic disorder (BDD) display selective attentional biases to threat. Oxytocin is an endogenous neuropeptide proposed to modulate attentional salience in social contexts. We conducted a secondary analysis applying drift diffusion modeling (DDM) to test whether individuals with BDD would display an attentional bias to threat, and whether oxytocin would modulate this bias. Eighteen participants with BDD and 15 healthy controls received an oxytocin or placebo nasal spray during two study visits, in randomized order, and completed a modified spatial cueing paradigm. DDM successfully parsed distinct task components demonstrating a selective attentional bias to disgust versus neutral faces in BDD compared to controls in the placebo condition, and a main effect of oxytocin on exacerbating this bias across participants. There were no effects using mean reaction time measures. DDM may reveal insights about attentional biases by utilizing trial-wise information. Oxytocin may exacerbate attentional biases to threat in BDD.

General scientific summary

Drift diffusion modeling successfully parsed distinct components of a modified spatial cueing task that assessed attentional biases in those with body dysmorphic disorder (BDD) and healthy controls that were missed in conventional analyses using mean reaction time measures. Individuals with BDD displayed an attentional preference for disgust versus neutral faces in the placebo condition, and oxytocin exacerbated this attentional bias.

Obsessive-compulsive and related disorders (OCRDs) are prevalent, debilitating, and chronic conditions that often go unrecognized and insufficiently treated, e.g., due to pronounced personal and logistic treatment barriers. Digital mental health interventions (DMHIs), including ecological assessment tools, provide promising pathways in enhancing the diagnosis, treatment, and prevention of OCRDs. However, evaluating DHMIs may also pose distinct challenges that require an iterative approach reaching from theory-informed, evidence-based, user-centered development to standardized and naturalistic investigation. This special issue presents a range of studies illustrating the current potential and limitations of DHMIs in OCRDs, further proposing a research agenda and future directions to advance effective digital care in the field.

Obsessive-compulsive disorder is an impairing psychiatric condition affecting 1–2% of adults and youth. Cognitive-behavioral therapy with exposure and response prevention (CBT) is an efficacious intervention but requires specialty training and access is often limited. While certain factors are associated with treatment access, one key barrier that has not been explored is the geographic availability of OCD treatment providers. Using integrated geographically-referenced data, we examined the geographic distribution of OCD CBT specialty providers across the state of Texas, with particular attention to the relationship to neighborhood socioeconomic disadvantage, insurance status, and rural versus urban status. We found that specialist providers are almost exclusively located inside the highly urbanized parts of the state, primarily in more affluent areas, and often only accept self-pay. The characteristics of the areas located the furthest away from specialty OCD care include a high proportion of persons identifying as Hispanic; a high proportion of non-English speakers, households with income below poverty; households with no vehicles; and persons with no health insurance. Average household income decreased as distances from specialist providers increased. Broadly, findings confirm that OCD CBT specialty providers are clustered in large socially advantaged areas and that economic disadvantage remains a significant barrier to care. As inadequate or inappropriate treatment of OCD is likely to result in sustained and impairing symptoms, this is of great concern.

Nonclinical hair-pulling is much more prevalent than hair pulling associated with a diagnosis of trichotillomania (TTM). However, little is known about nonclinical pulling. The purpose of this exploratory research was to begin characterizing a subset of nonclinical hair pullers we refer to as “untroubled pullers,” people who engage in recurrent, noncosmetic hair-pulling without associated distress or impairment. In a secondary analysis of two studies conducted online, untroubled pullers reported significantly lower symptom severity than did those diagnosed with TTM. The Big Five personality dimensions did not differentiate the groups in Study 1, but untroubled pullers endorsed significantly less disability, focused and automatic pulling, social anxiety, perceived risk in intimacy, and perfectionism in Study 2. These findings remained significant after controlling for symptom severity. Age and race resulted in mixed findings between the two studies, but no differences arose in other demographics. These findings suggest that symptom severity may not sufficiently explain differences in associated distress and impairment. Future studies are needed on how other constructs related to distress and impairment interact with hair-pulling behavior to provide insight into when pulling is associated with clinically significant distress or impairment.

Many individuals with obsessive-compulsive disorder (OCD) report sensory-based urges (e.g. ‘not-just-right experiences’) in addition to, or instead of, concrete fear-based obsessions. These sensations may be comparable to normative “urges-for-action” (UFA), such as the urge to blink. While research has identified altered functioning of brain regions related to UFA in OCD, little is known about behavioral patterns of urge suppression in the disorder. Using an urge-to-blink task as a model for sensory-based urges, this study compared failures of urge suppression between OCD patients and controls by measuring eyeblinks during 60-s blocks of instructed blink suppression. Cox shared frailty models estimated the hazard of first blinks during each 60-s block and recurrent blinks following each initial erroneous blink. OCD patients demonstrated a higher hazard of first and recurrent blinks compared to controls, suggesting greater difficulty resisting repetitive sensory-based urges. Within OCD, relationships between task outcomes and symptom severity were inconsistent. Findings provide support for a deficit in delaying initial urge-induced actions and terminating subsequent actions in OCD, which is not clearly related to clinical heterogeneity. Elucidating the nature of behavioral resistance to urges is relevant for informing conceptualizations of obsessive-compulsive psychopathology and optimizing treatment outcomes.

Although Cognitive Behavioural Therapy (CBT) is an effective treatment for Body Dysmorphic Disorder (BDD), substantial variability exists in patient responses. The aim of this systematic review was to synthesise the emerging literature on predictors and moderators of treatment response in CBT for BDD. EMBASE, MEDLINE®, and PsycINFO databases were systematically searched for studies reporting predictor and/or moderator analyses in samples of individuals with diagnosed BDD who received CBT specifically for this disorder. Methodological quality of included studies was assessed using the methodological index for non-randomised studies (MINORS). The search identified eleven studies, examining 56 predictor variables. Nine variables (e.g. insight, depression, BDD severity) emerged as significant predictors in some but not all studies. No variables were found to consistently predict outcome at post-treatment or follow-up. Only one study reported moderator analyses and found no significant effects. In summary, although certain variables, such as insight, depression, and BDD severity, may predict response to CBT for BDD, findings have been inconsistent and common methodological flaws (e.g. inadequate statistical power) reduce the strength of evidence. Further, methodologically-robust research is needed to identify predictors and moderators of responses to CBT for BDD, in order to inform optimisation of CBT and support clinical decision-making.

Trauma exposure has been associated with the development or worsening of obsessive-compulsive (OC) symptoms and predicts poorer response to treatment for OCD. Although several studies have examined the relationship between OC symptoms and trauma, extant research is limited by a dearth of studies considering both OC symptom dimensions and trauma type, and by a static conceptualization of OC symptoms. Because most individuals experience OC symptoms across dimensions, profiles of OC symptoms would better reflect the dynamic presentation of OC symptoms following trauma exposure. Accordingly, the aim of the present study was to replicate and extend prior work by examining both between-group and within-group how the presentation of OC symptom dimensions varies across several trauma types in a large sample of adults with a history of trauma exposure (N = 329). Participants were grouped based on the nature of their index trauma and a profile analysis was performed. Significant between-group differences provided evidence that certain types of traumatic events have unique associations with particular OC symptom dimensions. Moreover, unique profiles of OC symptoms characterize survivors of different trauma types, a conceptualization that provides nuance for how survivors present in the real world. Study limitations and implications are discussed.