Journal of Obsessive-Compulsive and Related Disorders最新文献

Current psychological models of obsessive-compulsive disorder account for a surprisingly small degree of variability in obsessive-compulsive (OC) symptoms in statistical models. The current study examined whether constructs from the inference-based approach to OCD (i.e., inferential confusion and fear of self) explain OC symptom dimensions above and beyond what is explained by the prevailing cognitive appraisal model. Undergraduate participants (N = 339) completed a battery of self-report questionnaires assessing OC symptoms, obsessive beliefs, inferential confusion, and fear of self. Results revealed that both psychological models together accounted for about one quarter of the variance in OC symptoms. The inference-based approach concepts most closely aligned with responsibility, symmetry, and unacceptable thoughts, and added explanatory value to appraisal models of these symptom domains. Limitations and future directions are discussed.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation procedure that is FDA-cleared for treating obsessive-compulsive disorder (OCD). Evidence suggests that controlling brain state during rTMS treatment can influence treatment outcomes. We present the case of a patient with refractory OCD who received symptom provocation immediately preceding rTMS treatment sessions. The patient experienced more subjective and objective improvement in OCD symptoms targeted by provocations than in other symptom domains. These results suggest the importance of brain state during rTMS and could be used to guide and optimize neuromodulation treatment for OCD.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) frequently co-occur, and phenotypic and functional similarities between the disorders necessitate assessment and treatment considerations by providers. To date, no research has reported on mental health treatment providers’ approach to, and barriers associated with, assessing and treating patients with this complex comorbidity. The present study included 169 mental health providers, the majority of whom were cognitive behaviorally-oriented specialists who had recently treated co-occurring OCD and PTSD. Having a doctorate degree and overall years of experience predicted greater perceived competence to assess and conceptualize co-occurring OCD and PTSD. Recent clinical experience with co-occurring OCD and PTSD predicted perceived competence to conceptualize and treat individuals with both disorders. PTSD specialists perceived themselves as more competent to treat co-occurring OCD and PTSD than non-PTSD specialists. Most providers indicated some barriers to adequate assessment and treatment of individuals with co-occurring OCD and PTSD, including competing priorities and lack of time. Implications of findings are discussed within the context of future training targets to equip providers with the tools needed to conduct comprehensive and accurate diagnostic and functional assessment, as well as provide evidence-based treatment tailored to the unique needs of individuals with co-occurring OCD and PTSD.

This systematic review analyzes the current literature on the potential therapeutic use of classic psychedelics (i.e., psilocybin, lysergic acid diethylamide [LSD], N,N-dimethyltryptamine [DMT], 5-methoxy-N,N-dimethyltryptamine [5-MeO-DMT], mescaline, and other classic psychedelic analogs utilized in preclinical models) in obsessive-compulsive disorder (OCD) and related disorders. Our search identified 23 articles meeting our predetermined eligibility criteria, comprising 2 non-systematic reviews, 11 preclinical studies investigating the use of classic psychedelics or analogs in preclinical models of OCD, 8 case studies or case reports, and 2 clinical trials. This review provides an up-to-date synthesis of psychedelic OCD research, bridging preclinical findings, historical case reports, and initial clinical trial outcomes. Psilocybin appears to be the most widely used classic psychedelic and is well-tolerated in both OCD and body dysmorphic disorder (BDD) populations, with some participants experiencing significant symptom reduction. This review contributes to our understanding of the potential of classic psychedelics (in particular LSD and psilocybin) as novel therapeutic interventions for OCD and related disorders, offering insights into future research directions and clinical applications in this emerging field.

Introduction

Contamination fears and associated washing behaviors are common in obsessive-compulsive symptoms (c-OCS). These fears and behaviors are often motivated by disease avoidance. The COVID-19 pandemic provided a unique opportunity to better understand c-OCS given that public health recommendations centered on behaviors common to c-OCS in non-pandemic times. This review systematically examined the nature of c-OCS associated with the COVID-19 pandemic.

Method

PubMed and PsycINFO databases were searched. A total of sixteen studies were retained (n = 16) using PRISMA guidelines.

Results

the present findings point to the relative infrequency of net-new c-OCS and the importance of elevated c-OCS prior to the pandemic in predicting worsening c-OCS during the pandemic.

Implications

Clinical implications in future pandemics as well as suggestions for future research are discussed.

Although exposure and response prevention (ERP) is recommended for adults with obsessive-compulsive disorder (OCD), some recipients do not fully respond while others improve and subsequently relapse. Identifying factors associated with poor outcomes is therefore highly important. We investigated behavioral avoidance as one potential factor. Data came from a large randomized controlled trial that delivered a concentrated ERP protocol over the course of four consecutive days in accord with the Bergen 4-Day Treatment (B4DT). Avoidance was assessed with the auxiliary item from the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Although behavioral avoidance did not predict acute outcome at immediate post-treatment, patients with substantial avoidance behaviors prior to treatment had worse long term (12-month) outcomes (increased OCD severity and greater functional impairment), after controlling for OCD severity at baseline. Avoidance significantly decreased from pre-to post-treatment but increased from post-treatment to 3-month and 12-month follow-up. Change in avoidance from post-treatment to 3-month follow-up predicted subsequent OCD worsening at 12-months, after controlling for change in global OCD severity. Results suggest that avoidant patients can benefit from concentrated ERP but may be at increased risk of poorer long-term outcomes. Future work should investigate strategies to identify and ameliorate worsening avoidance to reduce relapse.

Background

Skin Picking Disorder (SPD) is an oftentimes disabling disorder wherein people compulsively pick their skin. While sensory processing abnormalities have been examined in body-focused repetitive behaviors more broadly, relatively little attention has been played to the role of sensory processing in SPD specifically.

Methods

A total of 183 adults, 118 with SPD and 65 healthy controls, completed the Adolescent Adult Sensory Profile (AASP) to assess sensory processing patterns. Those with SPD also completed measures to assess skin picking severity, quality of life, and functional impairment. We examined whether scores on the four AASP subscales differ between individuals with SPD and healthy controls, and whether sensory processing among those with SPD affects disorder severity, quality of life, or functional impairment.

Results

Participants with SPD scored significantly higher on the AASP subscales of low registration, sensory sensitivity, and sensation avoiding than healthy controls (all p's < 0.01). There were no differences in sensation seeking between the two groups. Among those with SPD, those scoring “high” on the low registration subscale reported significantly greater skin picking severity and reduced quality of life as compared to those scoring lower on this subscale (p's < 0.001) Additionally, those scoring “high” on sensory sensitivity reported greater functional impairment than those scoring lower on this subscale (p < 0.01).

Conclusions

These data suggest that individuals with SPD display abnormalities in sensory processing relative to unaffected individuals. Future research should examine whether targeting sensory abnormalities among a subset of individuals with SPD may reduce the severity and associated burden caused by the disorder.

Background and aims

It has been suggested that there are multiple pathways leading to the development of Hoarding Disorder (HD). One suggested pathway is that early material deprivation can lead to hoarding primarily driven by a fear of further material deprivation: the present study examines the link between the recall of prior experience of deprivation and current beliefs about possessions including fear of future deprivation.

Method

A cross-sectional design dividing participants into three groups was used: individuals with hoarding with early material deprivation experience (HWD); individuals with hoarding without early material deprivation experience (HND); and community controls (CC). All groups completed measures assessing demographics, psychopathology, and three hoarding-related beliefs (fear of material deprivation, harm avoidance, attachment disturbance). The final sample size used for analysis was 74.

Results

There was no evidence of a difference between the HWD and HND groups in terms of fear of material deprivation or the other two hoarding-related beliefs. All three beliefs were raised in the HND and HWD groups relative to the CC group.

Discussion

Fear of material deprivation beliefs may motivate hoarding irrespective of any perceived experience of early material deprivation.

Stigma is a barrier to disclosure of psychiatric symptoms and treatment seeking among perinatal patients, including those with perinatal obsessive-compulsive disorder (POCD), perinatal depression (PPD), and postpartum psychosis (PPP). This study examines the relationship between stigma, illness recognition, and familiarity with illness in six distinct postpartum experiences. In a cross-sectional online survey, participants (N = 572) were randomized to one of six postpartum vignettes: subclinical, depression, psychosis, and three subtypes of obsessive-compulsive disorder: contamination, responsibility for harm, and sexual content. Participants were asked to provide a diagnostic label of the condition and rate different aspects of stigma. Sexual content POCD, responsibility for harm content POCD, and the subclinical vignettes were less likely to be accurately recognized than PPD, contamination POCD, and PPP. A multivariate analysis of variance revealed the sexual POCD and PPP vignettes were met with the highest level of stigma, while the subclinical condition, PPD, and contamination POCD were met with the lowest levels of stigma. Significant interactions were present between accurate recognition of the condition and type of vignette on stigma variables, with recognition generally being associated with lower stigma for POCD and PPD. This demonstrates the need for comprehensive educational efforts on perinatal mental health.

Despite its efficacy and effectiveness, exposure with response prevention (ERP) is underused in patients with obsessive-compulsive disorder (OCD). As this underuse of ERP may apply particularly to harm-related OCD, we investigated the theory-practice gap as well as negative beliefs and experiential avoidance as potential reasons for the underutilization of ERP with this group in a sample of trainee and qualified therapists.

We assessed 339 therapists’ general knowledge about ERP using a harm-related OCD case example and their utilization of ERP in clinical practice for harm-related OCD. Of the total sample, 74% of the therapists (n = 251) were CBT-oriented and 61% (n = 209) were in training. We assessed negative beliefs and experiential avoidance using the Therapist Beliefs about Exposure Scale (TBES) and the Acceptance and Action Questionnaire-II (AAQ-II).

While 74% of the therapist recommended ERP for the case example, only 43% admitted to using ERP for harm-related OCD in their clinical practice. ERP affinity of therapists in theory and practice was related to fewer negative beliefs about ERP, with large effect size (η_p² = 0.367 [CI_95% 0.285 − 0.433]) and lower experiential avoidance with small effect size (η_p² = 0.024 [CI_95% 0.001 − 0.059]) in the total sample.

We found evidence of a theory-practice gap in the treatment of harm-related OCD in a sample of trainee and qualified therapists. To ensure that patients with harm-related OCD content receive the evidence-based treatment they need, negative beliefs about ERP may represent a potential target.