RESUMEN
BACKGROUND: Repeated checking in OCD can be understood from a cognitive perspective as the motivated need to achieve certainty about the outcome of a potentially risky action, leading to the application of Elevated Evidence Requirements (EER) and overuse of subjective criteria. METHOD: Twenty-four obsessional checkers, 22 anxious controls, and 26 non-clinical controls were interviewed about and rated recent episodes where they felt (a) they needed to check and (b) checked mainly out of habit (i.e. not obsessionally). RESULTS: Both subjective and objective criteria were rated as significantly more important in obsessional checkers than in controls; obsessional checkers also used more criteria overall for the termination of the check, and rated more criteria as "extremely important" than the control groups. The termination of the check was rated as more effortful for obsessional checkers than for the comparison groups. Analysis of the interview data was consistent with the ratings. Feelings of "rightness" were associated with the termination of a check for obsessional checkers but not for controls. CONCLUSION: Results were consistent with the proposal that the use of "just right feelings" to terminate checking are related to EER.
Asunto(s)
Conducta Obsesiva/psicología , Trastorno Obsesivo Compulsivo/psicología , Adulto , Ansiedad/psicología , Estudios de Casos y Controles , Emociones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Conducta Obsesiva/clasificaciónAsunto(s)
Trastorno de Personalidad Limítrofe/clasificación , Trastorno de Personalidad Limítrofe/diagnóstico , Síntomas Afectivos/clasificación , Síntomas Afectivos/diagnóstico , Trastorno de Personalidad Limítrofe/terapia , Emociones , Humanos , Conducta Obsesiva/clasificación , Conducta Obsesiva/diagnóstico , Escalas de Valoración Psiquiátrica , Factores de RiesgoRESUMEN
Obsessive-compulsive disorder (OCD) has been recognized as mainly characterized by compulsivity rather than anxiety and, therefore, was removed from the anxiety disorders chapter and given its own in both the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Beta Draft Version of the 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11). This revised clustering is based on increasing evidence of common affected neurocircuits between disorders, differently from previous classification systems based on interrater agreement. In this article, we focus on the classification of obsessive-compulsive and related disorders (OCRDs), examining the differences in approach adopted by these 2 nosological systems, with particular attention to the proposed changes in the forthcoming ICD-11. At this stage, notable differences in the ICD classification are emerging from the previous revision, apparently converging toward a reformulation of OCRDs that is closer to the DSM-5.
Asunto(s)
Conducta Compulsiva/clasificación , Trastorno de Personalidad Compulsiva/clasificación , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/clasificación , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Clasificación Internacional de EnfermedadesAsunto(s)
Trastorno Obsesivo Compulsivo , Adulto , Comparación Transcultural , Humanos , India , Masculino , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/etnología , Trastorno Obsesivo Compulsivo/psicología , Escalas de Valoración PsiquiátricaAsunto(s)
Conducta Compulsiva/fisiopatología , Conducta Obsesiva/fisiopatología , Trastornos Fóbicos/fisiopatología , Comorbilidad , Conducta Compulsiva/clasificación , Conducta Compulsiva/epidemiología , Humanos , Conducta Obsesiva/clasificación , Conducta Obsesiva/epidemiología , Trastornos Fóbicos/clasificación , Trastornos Fóbicos/epidemiologíaRESUMEN
Several studies have linked obsessive-compulsive symptoms to specific obsessive-compulsive cognitions, however methodologies have varied, and no study has determined obsessive-compulsive symptoms using the most widely used clinician rating scale, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Considering that almost all studies that used factor analysis to ascertain OCD symptom dimensions were based on the Y-BOCS and that self-report instruments assessing obsessive-compulsive symptoms correlate poorly with the Y-BOCS, there is a need to use the Y-BOCS to examine the relationship between obsessive-compulsive cognitions and obsessive-compulsive symptom dimensions. This study examined the relationship between five Y-BOCS-derived obsessive-compulsive symptom dimensions and the three obsessive-compulsive cognitive domains identified by the obsessive-beliefs questionnaire (OBQ). The symmetry/ordering symptom dimension was associated with increased perfectionism/intolerance of uncertainty, the unacceptable/taboo thoughts symptom dimension was associated with increased importance/control of thoughts and the doubt/checking symptom dimension was associated with increased responsibility/threat estimation. There was no statistical evidence of an association between any OBQ belief sub-scale and the hoarding symptom dimension nor the contamination/cleaning symptom dimension. The findings encourage symptom-based approaches to cognitive-behavioural therapy for some OCD symptoms and call for further research on cognitions associated with contamination/cleaning symptoms and hoarding.
Asunto(s)
Cognición , Conducta Compulsiva/clasificación , Conducta Compulsiva/psicología , Conducta Obsesiva/psicología , Trastorno Obsesivo Compulsivo/psicología , Escalas de Valoración Psiquiátrica , Terapia Cognitivo-Conductual , Análisis Factorial , Femenino , Trastorno de Acumulación/psicología , Humanos , Entrevista Psicológica , Modelos Lineales , Masculino , Persona de Mediana Edad , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/clasificación , Análisis de Componente Principal , Autoinforme , Índice de Severidad de la Enfermedad , PensamientoRESUMEN
Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition. Although structural brain alterations have been consistently reported in OCD, their interaction with particular clinical subtypes deserves further examination. Among other approaches, a two-group classification in patients with autogenous and reactive obsessions has been proposed. The purpose of the present study was to assess, by means of a voxel-based morphometry analysis, the putative brain structural correlates of this classification scheme in OCD patients. Ninety-five OCD patients and 95 healthy controls were recruited. Patients were divided into autogenous (nâ=â30) and reactive (nâ=â65) sub-groups. A structural magnetic resonance image was acquired for each participant and pre-processed with SPM8 software to obtain a volume-modulated gray matter map. Whole-brain and voxel-wise comparisons between the study groups were then performed. In comparison to the autogenous group, reactive patients showed larger gray matter volumes in the right Rolandic operculum. When compared to healthy controls, reactive patients showed larger volumes in the putamen (bilaterally), while autogenous patients showed a smaller left anterior temporal lobe. Also in comparison to healthy controls, the right middle temporal gyrus was smaller in both patient subgroups. Our results suggest that autogenous and reactive obsessions depend on partially dissimilar neural substrates. Our findings provide some neurobiological support for this classification scheme and contribute to unraveling the neurobiological basis of clinical heterogeneity in OCD.
Asunto(s)
Encéfalo/patología , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/patología , Adulto , Análisis de Varianza , Mapeo Encefálico , Estudios de Casos y Controles , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Conducta Obsesiva/patología , Trastorno Obsesivo Compulsivo/clasificaciónRESUMEN
We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS.
Asunto(s)
Conducta Compulsiva/clasificación , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/clasificación , Trastornos por Estrés Postraumático/clasificación , Adulto , Conducta Compulsiva/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducta Obsesiva/diagnóstico , Trastorno Obsesivo Compulsivo/diagnóstico , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/diagnósticoRESUMEN
The earliest descriptions of obsessive-compulsive disorder (OCD) were religious, as was the understanding of their origins. With the emancipation, religion in OCD was relegated to its status today: a less common symptom of OCD in most Western societies known as scrupulosity. The frequency of scrupulosity in OCD varies in the literature from 0% to 93% of cases, and this variability seems predicated on the importance of religious belief and observance in the community examined. Despite the similarities between religious ritual and compulsions, the evidence to date that religion increases the risk of the development of OCD is scarce. Scrupulosity is presented as a classic version of OCD, with obsessions and compulsions, distress, and diminished functioning similar to those of other forms of OCD. The differentiation between normal religiosity and scrupulosity is presented, and the unique aspects of cognitive-behavioral therapy in treating scrupulosity, especially in religious populations, are reviewed.
Asunto(s)
Conducta Compulsiva/clasificación , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/clasificación , Terapia Cognitivo-Conductual , Conducta Compulsiva/diagnóstico , Conducta Compulsiva/terapia , Humanos , Conducta Obsesiva/diagnóstico , Conducta Obsesiva/terapia , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/terapia , Religión y PsicologíaRESUMEN
Stalking is a widespread phenomenon describing a pattern of intrusive and threatening behaviour that leads to the victim's perception of being harassed and of him or her being rendered fearful. Physical assault and even homicide may occur in the context of stalking. Anglo-Saxon studies have revealed a lifetime prevalence of being a victim of stalking ranging from 4-7% in men and 12-17% in women. Recently, these rates have been confirmed by the first community based study carried out in Germany. As a stalker can have a number of victims during his or her lifetime, the prevalence of stalkers may be less than this, although at present data for this are lacking. Although the phenomenology of stalking appears to be rather homogenous, fairly distinct stalker typologies and perpetrator-victim relationships have to be considered. Requests for psychiatric and forensic assessment of stalkers are increasing. According to the German penal code, psychiatrists must provide expert opinion on criminal responsibility and the placement of stalkers. So far, all typologies of stalkers refer to the Anglo-Saxon cultural background and do not consider the special needs of German forensic psychiatry. In particular, the psychopathological dimension is widely neglected in common typologies. The present paper proposes a multiaxial typology of stalking that considers the psychopathological dimension, the relationship between stalker and victim and motivational aspects. Consequences for the forensic psychiatric assessment according to section 20, 21 StGB are outlined. It should be pointed out that stalking is not a new diagnostic category, but only involves, at a descriptive level, deviation from a normal behavioural pattern. The central components of the forensic psychiatric assessment remain the known diagnostic categories, the effects of which on behaviour can be analysed.
Asunto(s)
Psiquiatría Forense/legislación & jurisprudencia , Responsabilidad Legal , Conducta Obsesiva/clasificación , Conducta Obsesiva/diagnóstico , Guías de Práctica Clínica como Asunto , Acoso Sexual/clasificación , Acoso Sexual/legislación & jurisprudencia , Víctimas de Crimen/estadística & datos numéricos , Conducta Peligrosa , Alemania , Humanos , Conducta Obsesiva/epidemiología , Conducta Obsesiva/psicología , Pronóstico , Acoso Sexual/psicología , Acoso Sexual/estadística & datos numéricosRESUMEN
The phenomenological distinction between delusions and obsessions has been the subject of much debate in psychiatry. Some authors feel these symptoms are distinct nosological entities, while others argue that they reflect manifestations of the same symptom and are distinguishable on the basis of the level of insight a patient displays. In this report we describe the case history of a lady who presented with an obsessional disorder. The symptom was resistant to standard treatments and subsequently became more delusional in nature. We review the literature in terms of the classification of obsessions and delusions and offer assistance to clinicians in terms of the diagnosis and treatment of cases where the distinction between these phenomena is not clear and offer alternative means of classifying these symptoms based on insight.
Asunto(s)
Deluciones/diagnóstico , Conducta Obsesiva/diagnóstico , Adulto , Terapia Cognitivo-Conductual , Terapia Combinada , Deluciones/clasificación , Deluciones/psicología , Deluciones/terapia , Depresión Posparto/clasificación , Depresión Posparto/diagnóstico , Depresión Posparto/psicología , Depresión Posparto/terapia , Diagnóstico Diferencial , Femenino , Fluoxetina/uso terapéutico , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Conducta Obsesiva/clasificación , Conducta Obsesiva/psicología , Conducta Obsesiva/terapia , Embarazo , PsicopatologíaRESUMEN
Stalking behaviour has long been recognized as causing great distress and prolonged psychological problems in many victims. Individuals subjected to stalking often feel powerless and helpless in the face of such unwelcome intrusions into their daily lives. There now seems to be a greater awareness and understanding of the phenomenon which, in turn, may encourage individuals affected to seek help.
Asunto(s)
Víctimas de Crimen/legislación & jurisprudencia , Conducta Obsesiva/clasificación , Víctimas de Crimen/psicología , Femenino , Humanos , Masculino , Conducta Obsesiva/etiología , Conducta Obsesiva/psicología , Relaciones Padres-Hijo , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
Two studies investigated the phenomenon of obsessive relational intrusion (ORI), defined as repeated and unwanted pursuit and invasion of one's sense of physical or symbolic privacy by another person, either stranger or acquaintance, who desires and/or presumes an intimate relationship. In Study 1, we sought to identify the incidence of a broad range of relationally intrusive behaviors, to identify the coping responses employed by victims of ORI, and to assess the associations between coping responses and ORI behaviors. Study 2 assessed the perceived degree of severity of ORI behaviors. Results revealed that each of 63 ORI behaviors was experienced by 3-78% of respondents in three different samples. Factor analysis revealed four types of ORI behavior: pursuit, violation, threat, and hyper-intimacy. Responses for coping with ORI consisted of interaction, protection, retaliation, and evasion. Virtually all intrusive behaviors were perceived to be annoying. Some types of ORI behaviors were perceived to be relatively more threatening, upsetting and privacy-invading than others. Although sex differences were not observed for the incidence of ORI or coping, women consistently perceived ORI behaviors to be more annoying, upsetting, threatening, and privacy-invading than did men.
Asunto(s)
Adaptación Psicológica , Actitud , Víctimas de Crimen/psicología , Relaciones Interpersonales , Conducta Obsesiva/prevención & control , Conducta Obsesiva/psicología , Privacidad/psicología , Acoso Sexual/prevención & control , Acoso Sexual/psicología , Adolescente , Adulto , Análisis Factorial , Humanos , Incidencia , Masculino , Conducta Obsesiva/clasificación , Conducta Obsesiva/epidemiología , Índice de Severidad de la Enfermedad , Factores Sexuales , Acoso Sexual/clasificación , Acoso Sexual/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Stalking has been relatively understudied compared to other dimensions of intimate partner violence. The purpose of this article was to examine concurrent and subsequent intimate partner abuse, strategic responses and symptomatic consequences of severe stalking experienced by battered women. Thirty-five battered women classified as "relentlessly stalked" and 31 infrequently stalked battered women were compared. Compared to infrequently stalked battered women, relentlessly stalked battered women reported: (a) more severe concurrent physical violence, sexual assault and emotional abuse: (b) increased post-separation assault and stalking; (c) increased rates of depression and PTSD; and (d) more extensive use of strategic responses to abuse. Results underscore the scope and magnitude of stalking faced by battered women and have implications for assessment and intervention strategies.
Asunto(s)
Adaptación Psicológica , Mujeres Maltratadas/psicología , Conducta Obsesiva/psicología , Calidad de Vida , Acoso Sexual/psicología , Maltrato Conyugal/psicología , Enfermedad Aguda , Adulto , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Entrevista Psicológica , Análisis Multivariante , Conducta Obsesiva/clasificación , Conducta Obsesiva/prevención & control , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Acoso Sexual/clasificación , Acoso Sexual/prevención & control , Maltrato Conyugal/clasificación , Maltrato Conyugal/prevención & control , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Although obsessive-compulsive disorder (OCD) has long been a unitary diagnosis, there is much recent interest in its potential heterogeneity, as manifested by symptom subgroups. This study evaluated existing models of symptom structure in a sample of 203 individuals with OCD. Using confirmatory factor analysis, we examined the ability of each model to account for two levels of data: a priori symptom groupings (second-order) and individual symptoms, identified by the Yale-Brown Obsessive Compulsive Scale symptom checklist. Four models were examined: a single-factor, a two-factor (i.e., obsessions and compulsions), and two multidimensional models, comprising three and four factors. Adequate fit was found solely for the four-factor model--specifying obsessions/checking, symmetry/ordering, contamination/cleaning, and hoarding--but only at the second-order level; it did not account for relationships among discrete symptoms. Parameter estimates showed within-factor heterogeneity, as well as overlap between factors, most notably the two representing checking and contamination-related symptoms. The implications of these findings are discussed. Results provide evidence for the multidimensionality of OCD symptoms, but suggest that a comprehensive model has yet to be identified. They also point to the inadequacy of groupings based solely upon overt behavioural similarities (e.g., 'checking'). Recommendations are made for future research.
Asunto(s)
Conducta Compulsiva/clasificación , Conducta Obsesiva/clasificación , Trastorno Obsesivo Compulsivo/clasificación , Adulto , Distribución de Chi-Cuadrado , Análisis Factorial , Femenino , Humanos , Masculino , Modelos Psicológicos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: We report a survey of the content of obsessions in children with autism spectrum conditions. We use the term 'obsessions' narrowly, to indicate strong, repetitive interests. We predicted that obsessions would not cluster randomly, but rather would occur significantly more often in the domain of 'folk physics' (an interest in how things work), and significantly less often in the domain of 'folk psychology' (an interest in how people work). These predictions were tested relative to a control group of 33 children with Tourette syndrome. AIMS: To examine the content of autistic obsessions, and to test the theory that these reflect an evolved cognitive style of good folk physics alongside impaired folk psychology. METHOD: Ninety-two parents returned a questionnaire designed to determine the subject of their child's obsessional interests. The results were analysed in terms of core domains of cognition. RESULTS: Both predictions were confirmed. CONCLUSIONS: These results suggest that impaired folk psychology and superior folk physics are part of the cognitive phenotype of autism. A content-free theory of obsessions is inadequate.
Asunto(s)
Síndrome de Asperger/psicología , Trastorno Autístico/psicología , Conducta Obsesiva/psicología , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Femenino , Humanos , Masculino , Conducta Obsesiva/clasificación , Síndrome de Tourette/psicologíaRESUMEN
Self-focus has been thought to be an important factor in the development and maintenance of depression. The disposition to focus attention inward has been measured by the Private Self-Consciousness Scale (PSCS), which does not reflect the duration of self-focusing. Study 1 aimed to develop a Self-Preoccupation Scale (SPS) that would reflect both the degree and duration of self-focusing. In addition, a new concept, external-preoccupation-the maintenance of external-focus on a specific object-was proposed as a risk factor of depression. An External-Preoccupation Scale (EPS) was developed to measure this. Both the SPS and EPS showed excellent internal consistency and test-retest reliability. Study 2 aimed to examine the relationship between the SPS, EPS, and PSCS and depression. The EPS was not significantly correlated with depression scales. The moderate correlations of the SPS with the depression scales were significantly higher than the correlations of the PSCS with the depression scales.
Asunto(s)
Depresión/psicología , Personalidad , Escalas de Valoración Psiquiátrica , Psicometría/métodos , Adulto , Atención/fisiología , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Narcisismo , Conducta Obsesiva/clasificación , Conducta Obsesiva/diagnóstico , Conducta Obsesiva/psicología , Escalas de Valoración Psiquiátrica/normas , Psicometría/normas , Reproducibilidad de los Resultados , Autoevaluación (Psicología)RESUMEN
This study examines worry themes among 87 anxiety disorder patients divided into three groups: (a) 24 primary generalized anxiety disorder (GAD) patients, (b) 25 secondary GAD patients, and (c) 38 other anxiety disorder patients (primarily obsessive-compulsive disorder, social phobia and panic disorder with agoraphobia). Structured and free-recall measures were used to measure five worry themes: relationships, work, finances, physical threat, and the future. Both types of measures revealed that GAD patients worry more about the future than non-GAD patients. Further, post hoc analyses testing for linear relationships indicated that primary GAD patients worry more about the future than secondary GAD patients who in turn worry more about the future than other anxiety disorder patients. The results suggest that although worry about immediate problems may not differentiate GAD patients from other anxiety disorder patients, high levels of worry about future events may be a distinguishing feature of GAD.
Asunto(s)
Trastornos de Ansiedad/psicología , Ansiedad/psicología , Conducta Obsesiva/clasificación , Pensamiento , Adaptación Psicológica , Adulto , Trastornos de Ansiedad/clasificación , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Análisis Multivariante , Conducta Obsesiva/psicología , TiempoRESUMEN
Previous research by Rachman and de Silva (1978, Behaviour Research and Therapy, 16, 233-248) and by Salkovskis and Harrison (1984, Behaviour Research and Therapy, 22, 549-552) has shown that abnormal and normal obsessions are similar in content. The present study examined whether the same is true for abnormal and normal rituals. A sample of normal subjects (N = 150) were asked about their idiosyncratic rituals. A majority of them (54.7%) indicated that they had such rituals. While these rituals were less frequent, less intense, and less often associated with negative affect than the compulsions of a sample of patients with obsessive-compulsive disorder, differences in terms of content between normal and abnormal rituals were small. Experts often tended to misclassify abnormal compulsions as normal rituals. By and large, the present findings indicate that there is continuity between abnormal and normal compulsions.