Associations in the Course of Personality Disorders and Axis I Disorders Over Time.

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic and Comorbid Anxiety Symptoms in a National Anxiety Screening Sample: Implications for Clinical Interventions.

Questionnaire data from 2,033 participants in the National Anxiety Disorders Screening Day sample were used to assess the presence of panic and comorbid anxiety problems. These participants were selected from more than 15,000 attendees on the basis of never having received treatment for a psychiatric disorder and meeting screening criteria for panic disorder. With each comorbid anxiety problem (generalized anxiety disorder, posttraumatic stress disorder, social phobia, and obsessive-compulsive disorder), participants had a corresponding increase in interference in daily living as well as readiness to seek treatment. The addition of generalized anxiety or depression with panic symptoms resulted in marked increases in interference scores. Clinical treatment implications for panic disorder are discussed in terms of the effects of comorbid anxiety problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope and Guidance for Parents of Children with OCD: A Review of Freeing Your Child from Obsessive-Compulsive Disorder.

Reviews the book "Freeing Your Child from Obsessive-Compulsive Disorder," by T.E. Chansky (see record 2000-16012-000). This is a concise and helpful resource for parents who are seeking active participation as an agent in their child's treatment of Obsessive-Compulsive Disorder (OCD). It is likely that one book alone will never be sufficient to help a child and/or parent through an entire course of treatment for OCD; rather, change appears to come through a combination of many resources, including information, books, professional support, and skill development. As part of a comprehensive intervention approach, this book provides a "roadmap" for parents seeking a helping role in supporting their child's treatment trajectory. Although this book contains invaluable information for parents, the information and guidelines will be best understood and most effectively employed when parents are consulting with a qualified psychologist. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale.

Although several measures of obsessive-compulsive (OC) symptoms exist, most are limited in that they are not consistent with the most recent empirical findings on the nature and dimensional structure of obsessions and compulsions. In the present research, the authors developed and evaluated a measure called the Dimensional Obsessive-Compulsive Scale (DOCS) to address limitations of existing OC symptom measures. The DOCS is a 20-item measure that assesses the four dimensions of OC symptoms most reliably replicated in previous structural research. Factorial validity of the DOCS was supported by exploratory and confirmatory factor analyses of 3 samples, including individuals with OC disorder, those with other anxiety disorders, and nonclinical individuals. Scores on the DOCS displayed good performance on indices of reliability and validity, as well as sensitivity to treatment and diagnostic sensitivity, and hold promise as a measure of OC symptoms in clinical and research settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dynamics and dangers of entitlement.

Excessive entitlement can accompany a range of other problems presented by patients encountered in psychotherapy. In its problematic form it is conceptualized here as having roots in emotional deprivation in childhood, especially when the child was used as a narcissistic extension by parents. This "special" role becomes a learned attitude and behavior and a refuge and defense against the hurt, shame, and fear resulting from this experience. Anger and vindictiveness provoked by this coercion and deprivation can reach dangerous, murderous proportions, with defensive entitlement demanding redress and revenge. A journalistic account illustrative of these unfortunate consequences is provided and interpreted. Psychodynamic treatment of excessive entitlement in an obsessive-compulsive patient, using an object relations approach, is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Le trouble obsessionnel-compulsif et l'insight: Une revue critique de la littérature.

It is assumed that an individual suffers from obsessive-compulsive disorder (OCD) with poor insight when he or she does not recognize for most of the time that his or her obsessions/compulsions are unreasonable (American Psychiatric Association, 2000). In this critical review of research concerning insight in obsessions, overvalued ideas and delusions, we propose several factors that should be considered when evaluating insight. The instruments frequently used to evaluate insight in OCD patients are critically discussed. Often they assess insight principally in medical terms (e.g., the capacity to recognize that one's behaviour is the result of a mental disorder) without considering the cognitive dimensions. Other instruments designed specifically for OCD assess insight on the basis of the anticipated consequences of not executing one ritual but these instruments do not distinguish this from obsessional doubts. Measures of insight for OCD may need to consider that OCD has several independent components and conviction may vary according to level initial doubt as well to type of consequence. A multidimensional model that evaluates three cognitive dimensions of insight in OCD patients is presented (the Inference Based Approach). This cognitive model establishes a clear distinction between the obsessional doubts, the anticipated consequences and the degree of conviction in the need to perform the ritual. Further recommendations are presented to evaluate insight in OCD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and psychometric evaluation of the Yale–Brown Obsessive-Compulsive Scale—Second Edition.

The Yale–Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989) is acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. A number of areas where the Y-BOCS may benefit from revision have emerged in past psychometric studies of the Severity Scale and Symptom Checklist. Therefore, we created the Yale–Brown Obsessive-Compulsive Scale—Second Edition (Y-BOCS–II) by revising the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format. One hundred thirty treatment-seeking adults with OCD completed a battery of measures assessing OCD symptom severity and typology and depressive and anxious symptomology. Interrater and test–retest reliability were assessed on a subsample of participants. The Y-BOCS–II showed strong internal consistency for the Symptom Checklist (Kuder–Richardson-20 = .91) and Severity Scale (α = .89). Test–retest and interrater reliabilities were both high (intraclass correlations > .85). Confirmatory factor analyses did not show adequate fit with previous models of the Y-BOCS. Exploratory factor analysis revealed a two-factor solution generally consistent with the Obsession and Compulsion Severity subscales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of worry and depressive symptoms. Taken together, the Y-BOCS–II has excellent psychometric properties in assessing the presence and severity of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS–II may provide an alternative method of assessing symptom presence and severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder.

Objective: To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). Method: Thirty adults with OCD were randomized to EX/RP (n = 15) or EX/RP augmented by motivational interviewing strategies (n = 15). Both treatments included 3 introductory sessions and 15 exposure sessions. Because there were no significant group differences in adherence or outcome, the groups were combined to examine the effects of patient adherence on outcome. Independent evaluators assessed OCD severity using the Yale–Brown Obsessive Compulsive Scale. Therapists assessed patient adherence to between-session EX/RP assignments at each session using the Patient EX/RP Adherence Scale (PEAS). Linear regression models were used to examine the effects of PEAS scores on outcome, adjusting for baseline severity. The relationship between patient adherence and other predictors of outcome was explored using structural equation modeling. Results: Higher average PEAS ratings significantly predicted lower posttreatment OCD severity in intent-to-treat and completer samples. PEAS ratings in early sessions (5–9) also significantly predicted posttreatment OCD severity. The effects of other significant predictors of outcome in this sample (baseline OCD severity, hoarding subtype, and working alliance) were fully mediated by patient adherence. Conclusions: Patient adherence to between-session EX/RP assignments significantly predicted treatment outcome, as did early patient adherence and change in early adherence. Patient adherence mediated the effects of other predictors of outcome. Future research should develop interventions that increase adherence and then test whether increasing adherence improves outcome. If effective, these interventions could then be used to personalize care. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive versus behavior therapy in the group treatment of Obsessive-Compulsive disorder.

This study examined the effects of cognitive-behavior therapy (CBT) compared with traditional behavior therapy (exposure and response prevention [ERP]) in the group treatment of obsessive-compulsive disorder. Of the 76 participants who started treatment, 38 were wait-listed for 3 months before treatment to assess possible course effects. Both treatments were superior to the control condition in symptom reduction, with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up. In terms of clinically significant improvement, treatment groups were equivalent on the conclusion of treatment, but 3 months later significantly more ERP participants met criteria for recovered status. Only 1 of 7 belief measures changed with treatment improvement, and the extent of this cognitive change was similar between CBT and ERP groups. Discussion includes consideration of optimal formats for the delivery of different types of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Representation of Four Personality Disorders by the Schedule for Nonadaptive and Adaptive Personality Dimensional Model of Personality.

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive-compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals with PDs to manifest negative affects and interpersonal detachment. Furthermore, the model appeared to successfully distinguish specific PDs, a property that represents a particular challenge for dimensional models of personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)