Dysmorphic and illness anxiety-related unwanted intrusive thoughts in individuals with obsessive-compulsive disorder.

BACKGROUND/OBJECTIVE: Unwanted intrusive thoughts (UITs) are considered normal variants of the obsessions found in obsessive-compulsive disorder (OCD). Similarly, intrusive and persistent preoccupations about appearance defects in body dysmorphic disorder (BDD) and images and thoughts about illness in illness anxiety disorder (IAD) are abnormal variants of the thoughts and concerns about appearance and health found in non-clinical individuals. This study examines whether patients with OCD have frequent and distressing UITs with contents related to BDD and IAD, in addition to OCD-related UITs. METHOD: Thirty-nine participants with OCD (Mage = 32.45, standard deviation [SD] = 11.57; 63% men) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT), designed to assess obsessional, dysmorphic and illness anxiety UITs and their associated functional consequences (emotions, appraisals, and neutralizing or control strategies). RESULTS: Up to 71% of the individuals with OCD experienced the three UIT modalities. As expected, OCD-related UITs were the most frequent, although were no differences among the three UIT contents in terms of the disturbance they caused. The OCD intrusions were the most interfering, egodystonic and dysfunctionally appraised, and they instigated more neutralizing behaviours. Nonetheless, all UITs instigate the need to do something to alleviate the discomfort caused by their intrusion and attempts to suppress them. CONCLUSION: UITs with different contents not always related to typical obsessive themes are a common experience in patients with OCD. These UITs could have detrimental consequences for the course of the disorder itself, and they should be adequately addressed in both the assessment and treatment of these patients.

The HEXACO-100 Across 16 Languages: A Large-Scale Test of Measurement Invariance.

The HEXACO Personality Inventory-Revised (HEXACO-PI-R) has become one of the most heavily applied measurement tools for the assessment of basic personality traits. Correspondingly, the inventory has been translated to many languages for use in cross-cultural research. However, formal tests examining whether the different language versions of the HEXACO-PI-R provide equivalent measures of the 6 personality dimensions are missing. We provide a large-scale test of measurement invariance of the 100-item version of the HEXACO-PI-R across 16 languages spoken in European and Asian countries (N = 30,484). Multigroup exploratory structural equation modeling and confirmatory factor analyses revealed consistent support for configural and metric invariance, thus implying that the factor structure of the HEXACO dimensions as well as the meaning of the latent HEXACO factors is comparable across languages. However, analyses did not show overall support for scalar invariance; that is, equivalence of facet intercepts. A complementary alignment analysis supported this pattern, but also revealed substantial heterogeneity in the level of (non)invariance across facets and factors. Overall, results imply that the HEXACO-PI-R provides largely comparable measurement of the HEXACO dimensions, although the lack of scalar invariance highlights the necessity for future research clarifying the interpretation of mean-level trait differences across countries.

Dysfunctional beliefs as mediators between illness-related intrusive thoughts and health anxiety symptoms.

BACKGROUND: Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs. AIM: The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms. METHOD: A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI). RESULTS: Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms. CONCLUSIONS: The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.

The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report.

Objectives: To assess the rates of co-occurring putative 'behavioural addictions' in patients with obsessive-compulsive disorder (OCD).Methods: Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples.Results: Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a 'clinical diagnosis' to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder.Conclusions: Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive 'spectrum' disorders.

Treatments used for obsessive-compulsive disorder-An international perspective.

OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.

International prescribing practices in obsessive-compulsive disorder (OCD).

OBJECTIVES: To assess rates of psychotropic medication use in patients with obsessive-compulsive disorder (OCD) in seven different countries on five continents and to compare these with international treatment guidelines. METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their patients with OCD and on their incidence of psychotropic use. Consistency of summary statistics across countries was evaluated. RESULTS: The data came from Brazil (n = 955), Italy (n = 750), South Africa (n = 555), Japan (n = 382), Australia (n = 213), India (n = 202) and Spain (n = 82). The majority (77.9%; n = 2445) of the total sample of 3139 participants received a psychotropic medication. Consistent with international guidelines, selective serotonin reuptake inhibitors (SSRIs) were most commonly used (73.5%, n = 1796), but their use ranged from 59% in Australia to 96% in Japan. Clomipramine use varied from 5% in Japan and South Africa to 26% in India and Italy. Atypical antipsychotic use ranged from 12% in South Africa to 50% in Japan. CONCLUSIONS: Pharmacotherapy for OCD varied significantly across sites. Prospective studies are required to determine the cultural, pharmacoeconomic and pharmacogenomic factors that may play a role in the variation in prescribing practices internationally and whether these variations influence treatment outcomes. Copyright © 2016 John Wiley & Sons, Ltd.

Obsessional and Eating Disorder-related Intrusive Thoughts: Differences and Similarities Within and Between Individuals Vulnerable to OCD or to EDs.

Unwanted intrusive cognitions constitute the normal variant of clinically significant intrusive cognitions found in disorders such as obsessive-compulsive disorder (OCD) and eating disorders (EDs). This study investigates whether individuals who are vulnerable to OCD or EDs experience more intrusions than people with no vulnerability to these disorders, and it examines the consequences of obsessional (OITs) and eating disorder (EDITs) intrusions in the same individuals, taking into account their susceptibility to OCD, EDs or neither of the two. From a sample of 922 participants, three groups were formed: risk of OCD (n = 92), risk of EDs (n = 41) and a no-risk group (n = 100). EDITs were more frequent than OITs in the two risk groups. Within-group comparisons showed that in the OCD-risk group, the OIT had more negative consequences (interference, emotional distress, dysfunctional appraisals and neutralizing strategies) than the EDIT, whereas in the ED-risk group, the OIT and the EDIT instigated similar negative consequences. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Intrusive thoughts in obsessive-compulsive disorder and eating disorder patients: a differential analysis.

The present study aims to compare the unwanted intrusions experienced by obsessive-compulsive (OCD) and eating disorder (ED) patients, their appraisals, and their control strategies and analyse which variables predict the intrusions' disruption and emotional disturbance in each group. Seventy-nine OCD and 177 ED patients completed two equivalent self-reports designed to assess OCD-related and ED-related intrusions, their dysfunctional appraisals, and associated control strategies. OCD and ED patients experienced intrusions with comparable frequency and emotional disturbance, but OCD patients experienced greater disruption. Differences appeared between groups on some appraisals and control strategies. Intolerance to uncertainty (OCD group) and thought importance (ED group) predicted their respective emotional disturbance and disruption. Additionally, control importance (OCD group) and thought-action fusion moral (OCD and ED groups) predicted their emotional disturbance. OCD and ED share the presence of intrusions; however, different variables explain why they are disruptive and emotionally disturbing. Cognitive intrusions require further investigation as a transdiagnostic variable.

Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs) with contents related to Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Illness Anxiety Disorder (IAD), and Eating Disorders (EDs) are highly prevalent, independently of the cultural and/or social context. Cognitive-behavioral explanations for these disorders postulates that the escalation from common UMIs to clinically relevant symptoms depends on the maladaptive consequences (i.e., emotions, appraisals, and control strategies) of experiencing UMIs. This study examines, from a cross-cultural perspective, the cognitive-behavioral postulates of the maladaptive consequences of having UMIs. METHOD: Non-clinical 1,473 participants from Europe, the Middle-East, and South America completed the Questionnaire of Unpleasant Intrusive Thoughts to assess the maladaptive consequences of experiencing highly disturbing OCD, BDD, IAD, and EDs-related UMIs. RESULTS: Findings revealed main effects for both the country and the consequences associated with the four UMI contents. Interaction effects between the consequences of each UMI content and the sample location were also observed. CONCLUSIONS: Cognitive-Behavioral models for OCD, BDD, IAD, and EDs should be implemented along with socio-cultural variables that increase the understanding of the role of these variables in the phenomenology of UMIs and their associated consequences.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM) de contenidos relacionados con el Trastorno Obsesivo-Compulsivo (TOC), el Trastorno Dismórfico Corporal (TDC), la Ansiedad por la Enfermedad (AE), y los Trastornos Alimentarios (TAs) son muy prevalentes, independientemente de la cultura y/o el contexto social. Las explicaciones cognitivo-conductuales de esos trastornos postulan que la escalada de IM normales a síntomas clínicamente relevantes depende de las consecuencias desadaptativas (i.e., emociones, valoraciones y estrategias de control) de las IM. Este estudio examina los planteamientos sobre dichas consecuencias desde una perspectiva transcultural. MÉTODO: 1.473 participantes de Europa, Oriente Medio y Suramérica completaron el Inventario de Pensamientos Intrusos Desagradables para evaluar las consecuencias desadaptativas de experimentar IM muy molestas con contenidos de TOC, TDC, AE y TAs. RESULTADOS: Se obtuvieron efectos principales tanto para el país como para las consecuencias asociadas con los cuatro contenidos de IM, así como efectos de interacción entre las consecuencias de cada modalidad de IM y la localización de la muestra. CONCLUSIONES: Los modelos cognitivo-conductuales sobre el TOC, el TDC, la AE y los TAs deben complementarse con variables socioculturales que aumenten la comprensión del papel de esas variables en la fenomenología de las IM y sus consecuencias asociadas.

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up.

Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).

Eating-related Intrusive Thoughts Inventory: exploring the dimensionality of eating disorder symptoms.

The aims of this study were, first, to examine the structure and validity of the Eating-related Intrusive Thoughts Inventory (INPIAS), a self-report questionnaire designed to assess eating disorders related to intrusive thoughts (EDITs), and second, to explore the existence of a continuum ranging from normal to abnormal thought intrusions related to eating, weight, and shape. Participants were 574 (408 women) nonclinical community individuals. Analyses revealed that EDITs can be clustered into three sets: appearance-dieting, need to exercise, and thoughts-impulses related to eating disorders. EDITs' consequences showed a two-factor structure: emotional consequences/personal meaning and thought-action fusion responsibility; and four factors of strategies: "anxiety," suppression, obsessive-compulsive rituals, and distraction. The sample was then divided according to reported restrained eating. The High dietary restraint group reported a higher frequency of EDITs, whereas differences in the other factors were mediated by depression, anxiety, and obsessionality. The results suggest that eating disorder-related cognitions are experienced by nonclinical individuals, and distributed on a continuum.

Illness-related intrusive thoughts and illness anxiety disorder.

INTRODUCTION: Intrusive thoughts about health threats (illness-ITs) are a potential cognitive risk factor for the development and maintenance of illness anxiety disorder (IAD). This study analyzes the dimensionality of illness-ITs from normalcy to psychopathology, and it evaluates whether the appraisals instigated by the Its mediate between these thoughts and IAD symptoms. METHODS: Two groups of individuals participated in the study and completed the Illness Intrusive Thoughts Inventory and the Whiteley Index. The first group was composed of 446 non-clinical community participants. Of them, 264 individuals (68.6% women; Mage  = 30.03 [SD = 13.83]) reported having experienced an upsetting illness-IT in the past three months and were then included in the main analyses. The second group included 31 patients with a current main diagnosis of IAD based on DSM-5 criteria (51.6% women; Mage  = 32.74 [SD = 9.69]). Their severity was assessed with the Hypochondriasis Yale-Brown Obsessive-Compulsive Scale -Modified version, with scores ranging from 15 to 58 (M = 46.12, SD = 9.41). RESULTS: Illness-ITs are common in both non-clinical individuals and in patients with IAD, and they instigate dysfunctional emotional, cognitive, and behavioral consequences, although with greater intensity in patients than in non-clinical individuals. The relationship between illness-ITs and IAD is mediated by overestimation of threat and thought-action fusion-probability appraisals. CONCLUSION: Illness-ITs are a dimensional cognitive experience. The way they are appraised facilitates their escalation into symptoms of IAD. PRACTITIONER POINTS: Provides support for the cognitive explanatory model of IAD and its usefulness in clinical practice. Indicates that the way people interpret and react to naturally occurring intrusive thoughts about illness seems to be a vulnerability marker for developing an illness anxiety disorder. Emphasizes that the meaning that patients with IAD ascribe to their intrusive thoughts about illnesses must be a main target in the cognitive-behavioral treatment of IAD. Suggests that the importance of intrusive thoughts in IAD does not lie in the frequency with which they are experienced, but in the way, they are appraised/interpreted, which is what determines whether they become a clinically significant symptom. Indicates that the relationship between illness intrusive thoughts and IAD symptoms in non-clinical individuals is based on: overestimating the negative consequences of experiencing an illness intrusive thought; and the appraisal that having such a thought would increase its likelihood of coming true. Shows that the frequency of illness-related intrusive cognitions is associated with worse cognitive and behavioral consequences.

Group versus individual cognitive treatment for obsessive-compulsive disorder: Changes in severity at post-treatment and one-year follow-up.

BACKGROUND: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. AIMS: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. METHOD: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. RESULTS: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. CONCLUSIONS: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity.

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/ or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N = 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients.

To seek advice or not to seek advice about the problem: the help-seeking dilemma for obsessive-compulsive disorder.

BACKGROUND: Although obsessive-compulsive disorder (OCD) is associated with considerable distress, it has been reported that OCD patients delay considerably in seeking treatment for their problem. The present study aimed to explore some variables hypothetically involved in the help-seeking process among OCD patients. METHODS: Twenty-six OCD patients without comorbid conditions completed the Interview of Help-Seeking, specifically designed for this study, which assesses to what extent patients delay seeking treatment for their problem, and three group of variables: factors influencing the recognition of the problem, reasons for delaying the treatment-seeking, and reasons for finally seeking treatment. Participants also completed OCD measures, as well as a questionnaire on thought control strategies. RESULTS: The mean length of delay in seeking treatment was 39.38 (SD = 50.95) months, and a great variety of reasons for delaying were observed. The OCD patients who delayed consultation longer, in comparison with patients who delayed less time, used fewer social control strategies, and they were less aware of the interference and behavioral changes associated with the problem. CONCLUSIONS: To gain more insight about the problem and to experience greater interference from the symptoms were determinants in the active search for help. Conversely, the main barriers to the help-seeking were the fears of stigma and the meaning of the thought contents. Additionally, the fact that patients are willing to disclose their obsessions to other people may favor an adequate representation of the problem and the need to seek mental health treatment.

Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling condition with a wide variety of clinical presentations including contamination fears, fear of harm, and relationship-related obsessions. Cognitive behavioral models of OCD suggest that OC symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and associated dysfunctional strategies used to manage them. OCD-related maladaptive beliefs including inflated responsibility, importance and control of thoughts, perfectionism, and intolerance for uncertainty increase the likelihood of such misinterpretations. OBJECTIVE: Considering accumulating evidence suggesting that mobile health (mHealth) apps based on cognitive-behavioral principles may lead to significant reductions in psychopathological symptoms, we assessed the effectiveness of a novel cognitive training app (GGRO) designed to challenge OCD-related beliefs. METHODS: A total of 97 students were randomized to groups undertaking immediate-use (iApp) or delayed use (dApp) of GGRO. All participants were requested to complete Web-based assessments, with questionnaires relating to maladaptive beliefs, mood, and OC symptoms at baseline (T1), 15 days from baseline (T2), and 30 days from baseline (T3). Participants in iApp group started using the app at baseline and continued using the app for 15 consecutive days. They were then requested to stop using the app until T3. Participants in the dApp group were requested to wait for 15 days and only then start using the app (crossover) for 15 consecutive days. RESULTS: All participants used the app for a mean of 14.07 (SD 1.41) days with 2.94 levels per day. Consistent with previous findings, app use was associated with medium-large effect size reductions in both iApp (n=51) and dApp (n=46) groups. In the iApp group, all effects remained significant during the 15 days of follow-up. Analyses focusing on the first two assessment occasions revealed significant treatment × repeated measures interactions on maladaptive beliefs, several OC symptom measures, and self-esteem. CONCLUSIONS: This study provides further evidence for the efficacy of GGRO as a mobile-delivered training exercise that is useful for reducing OCD-related beliefs and symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT03571464; https://clinicaltrials.gov/ct2/show/NCT03571464 (Archived by WebCite at http://www.webcitation.org/7675sYPsH).

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility.

BACKGROUND/OBJECTIVE: The Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis. METHOD: A total of 342 community participants (61.6% women; M age = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; M age = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive. RESULTS: The original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis. CONCLUSIONS: The SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults.

INTRODUCCIÓN/OBJETIVO: El Inventario Breve de Ansiedad por la Salud (SHAI, por sus iniciales en inglés) es un autoinforme ampliamente empleado para evaluar ansiedad por la salud. El objetivo es evaluar la estructura factorial del SHAI, sus propiedades psicométricas, y exactitud diferenciando entre población española no clínica y pacientes con hipocondría. MÉTODO: Un total de 342 participantes extraídos de la población general (66% mujeres, M edad  = 35, DT = 14,91) y 31 pacientes con hipocondría (51,6% mujeres; M edad  = 32,74, DT = 9,69 completaron el SHAI y otros autoinformes de síntomas hipocondriacos, depresión, sensibilidad a la ansiedad, preocupaciones y obsesivo-compulsivos. RESULTADOS: La estructura de dos factores propuesta originalmente fue seleccionada como la mejor estructura debido a su parsimonia y soporte empírico (Factor 1: Probabilidad de enfermar; Factor 2: Consecuencias negativas enfermedad). La versión española del SHAI muestra una buena consistencia interna, y validez de constructo, concurrente y discriminante. El punto de corte de 40,5 (puntuación total) permite distinguir entre los individuos no clínicos y los pacientes con elevada ansiedad por la salud o hipocondría. CONCLUSIONES: El SHAI es un instrumento adecuado para la detección de ansiedad por la salud en población adulta hispano hablante.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. METHOD: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. RESULTS: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. CONCLUSIONS: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. MÉTODO: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. RESULTADOS: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. CONCLUSIONES: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos.

[Perception of dyspnea and treatment adherence in asthmatic patients]. / Percepción de la disnea y cumplimiento terapéutico en pacientes con asma.

OBJECTIVE: The majority of studies show that treatment adherence in chronic diseases such as asthma does not exceed 50%. Although the reasons may vary, it is clear that lack of treatment adherence is a determining factor in poor disease control. An association has also been observed between lack of perception of dyspnea and difficult-to-control asthma and with the occurrence of fatal or near-fatal asthma attacks. In this study we therefore attempted to demonstrate that one of the reasons that asthmatic patients do not adhere to treatment is a failure to perceive dyspnea associated with bronchial obstruction. PATIENTS AND METHODS: We analyzed 2 groups of patients with moderate persistent asthma who had all been prescribed the same chronic treatment (a dose of inhaled drug administered with a dry powder inhaler every 12 hours). The first group comprised 24 patients (16 women and 8 men; mean [SD] age, 44 [15] years) who took the medication almost every day. The second group contained 24 patients (16 women and 8 men; mean [SD] age, 48 [14] years) who did not use the medication or only took it occasionally. There were no significant differences between the groups in terms of age, sex, percentage of smokers, socioeconomic and educational level, anxiety, depression, or spirometry variables. A histamine challenge test was carried out in all patients and the dyspnea perceived after each dose of the drug was measured on a modified Borg scale. The dose of histamine leading to a 20% reduction in forced expiratory volume in 1 second (FEV(1)), perception of dyspnea associated with a 20% reduction in FEV(1) (PS(20)), and the change in dyspnea measured on the Borg scale between baseline and 20% reduction in FEV(1) were analyzed. Patients were also classified as poor perceivers of dyspnea if the change in perception of dyspnea on the modified Borg scale was less than or equal to zero. RESULTS: The group of patients with poor treatment compliance had a lower PS(20) (2.27 [1.9] vs 3.51 [1.8], P=.03) and change in Borg score (1.64 [1.9] vs 2.7 [1.84], P=.057), and they were more often poor perceivers of dyspnea (50% vs 21%, P=.034). CONCLUSIONS: There is a relationship between treatment adherence and dyspnea perception, such that poor perception is among the reasons for poor treatment adherence in patients with asthma.

Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions.

Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (M age = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to "do something", to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.

ANTECEDENTES/OBJETIVO: Las intrusiones mentales no deseadas (IM) son la variante normativa de obsesiones en el Trastorno Obsesivo-Compulsivo (TOC), preocupaciones por defectos en el Trastorno Dismórfico Corporal (TDC), imágenes sobre enfermedad en Hipocondría (TH) y pensamientos sobre alimentación en los Trastornos Alimentarios (TA). El objetivo fue examinar similitudes y diferencias en las relaciones funcionales de los cuatro contenidos de IM, adoptando una perspectiva intra-sujeto. MÉTODO: 438 estudiantes universitarios y participantes de la comunidad (M edad = 29,84; DT = 11,41; 70,54% mujeres) completaron el Inventario de Pensamientos Intrusos Desagradables, que evalúa las relaciones funcionales (emociones, valoraciones y estrategias de neutralización/control) de las IM más molestas con contenidos TOC, TDC, TH y TA. RESULTADOS: Las IM-TH evocaron más emociones negativas, las IM-TOC fueron las que más interfirieron y las IM-TA las que menos. Todas fueron igualmente egodistónicas. Las IM-TOC fueron las más disfuncionalmente valoradas por las mujeres, pero los hombres valoraron los cuatro contenidos de forma similar. Todas las IM promovieron la necesidad de "hacer algo" para controlarla/neutralizarla. CONCLUSIONES: Las similitudes en las relaciones funcionales de intrusiones relacionadas con contenidos del TOC, el TDC, el TH y los TA apoyan su naturaleza transdiagnóstica, pudiendo contribuir a la comprensión de los factores comunes entre esos trastornos.