Articlebronze2011

Myth of the pure obsessional type in obsessive-compulsive disorder

Monnica T. Williams · Samantha G. Farris · Eric N. Turkheimer · Anthony Pinto · Krystal Ozanick · Martin E. Franklin +3 more

114 citations0/0 files storedDepression and Anxiety

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Obsessive-Compulsive Spectrum Disorders Psychoanalysis and Psychopathology Research Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Abstract

BACKGROUND: Several studies have identified discrete symptom dimensions in obsessive-compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC). This study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Because these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called "pure obsessions" may have been overlooked. METHOD: Participants (N = 201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms, as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis. RESULTS: Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts). CONCLUSIONS: This study suggests that the concept of the "pure obsessional" (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria.

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References

2000Diagnostic and Statistical Manual of Mental Disorders.1989The Yale-Brown Obsessive Compulsive Scale 2000Test Theory: A Unified Treatment 1999Test Theory: A Unified Treatment 2004Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder 1997Cognitive assessment of obsessive-compulsive disorder 1999Use of Factor-Analyzed Symptom Dimensions to Predict Outcome With Serotonin Reuptake Inhibitors and Placebo in the Treatment of Obsessive-Compulsive Disorder 2008Meta-Analysis of the Symptom Structure of Obsessive-Compulsive Disorder

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