Causal attributions and OCD treatment response: A linguistic analysis of OCD patients' self-reported etiological explanations in intensive residential treatment.

In the present study, 43 obsessive-compulsive disorder (OCD) patients receiving cognitive-behavior therapy (CBT)/exposure and response prevention (ERP) in an intensive residential treatment program responded to an open-ended question about causal attributions (i.e., personal explanations for the etiology of their OCD) at baseline and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at baseline and treatment discharge. Baseline self-reported responses about causal attributions were qualitatively coded to derive predictors (biological/genetic, environmental, psychological, and interactional attributions). Predictors were entered into a binary logistic regression with Y-BOCS responder status (at least partial response [≥25% pre-post reduction] vs. no response) as the outcome. After controlling for length of stay and number of comorbid psychiatric diagnoses, only biological/genetic attributions uniquely predicted increased odds of treatment response, odds ratio = 10.04, p = 0.03. Biological/genetic attributions may reduce self-blame for symptoms or increase expectancy violation likelihood during treatment, thereby improving odds of response. Clinicians should assess OCD patients' causal attributions as part of routine clinical care to hopefully optimize treatment outcomes.

Common Symptom Presentations in Individuals With Probable Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are heterogeneous disorders that share common underlying factors, etiology, and symptoms. A small body of literature suggests common OCD symptom presentations may exist for this comorbid group, yet common comorbid PTSD symptom presentations remain unknown. The current study examined common symptom presentations in individuals with probable comorbid OCD + PTSD compared with those with a sole presentation of probable OCD or PTSD, controlling for overlapping symptoms, using a sample of 133 undergraduates. Individuals who exceeded cutoffs for probable OCD + PTSD endorse more severe OCD symptoms overall but report similar levels of PTSD symptoms compared with the respective diagnostic groups. Logistic regressions found that symptom domains present similarly overall in a comorbid presentation compared with the respective diagnostic groups, yet some OCD symptom domains were significantly more severe in the comorbid group compared with individuals with probable PTSD. Explanations for the unique contributions of symptoms are discussed, and clinical recommendations for addressing these domains are provided.

Re-Examining the Relationship Between Avoidance and Post-Traumatic Stress Symptoms in Rape Survivors Enrolled in Self-Defense Training: The Protective Effect of Activities Self-Efficacy.

Although many women do not report sexual victimization as motivation for seeking self-defense training, differences in self-efficacy suggest that self-efficacy deficits may influence survivors' desire to seek training. Lower self-efficacy, thought to negatively influence perceived confidence in one's ability to engage in everyday activities, may relate to avoidance of mundane activities and cause exacerbation of post-traumatic stress symptoms (PTSS). The current study examined a three-way interaction modeling the relationships between history of rape, activities self-efficacy, activities avoidance, and PTSS in a diverse sample of 233 women enrolled in self-defense training. Results suggest that survivors who avoid everyday activities experience increased PTSS, but this effect is mitigated by perceived self-efficacy to engage in these activities. Activities self-efficacy may promote resilience in rape survivors regardless of whether they actually engage in such activities. Training that targets self-efficacy, rather than actual engagement in activities, may be sufficient to reduce PTSS in rape survivors.

Reliability and Findings From an Instrument Examining Sexual Assault Disclosure Content and Context: The Sexual Assault Inventory of Disclosure.

Compared to the depth of research examining the impact of sexual assault disclosure and related responses from others, little is known about the content shared during disclosures. Categorizing survivors as disclosers or nondisclosers disregards the nuanced and complex nature of disclosure. To address this gap, the current studies examined the reliability and preliminary results of the Sexual Assault Inventory of Disclosure (SAID), an inventory of content shared during disclosures and the context in which it was shared. The SAID proved reliable and preliminary findings suggest that perceptions of disclosures as positive or negative are predicted by differences in content and context, above and beyond disclosure recipients' response. The current study also explored gender differences in disclosure. Additional findings, implications, and suggestions for future studies using the SAID are discussed.

Negative Consequences of Family Caregiving for Veterans With PTSD and Dementia.

Recent research shows veterans with posttraumatic stress disorder (PTSD) are twice as likely as other veterans to develop dementia. However, no studies to date have examined the impact of co-existing PTSD and dementia on family caregivers, who provide the majority of care to these veterans. Using the Stress Process Model, the current investigation explored the similarities and differences in psychosocial, health, and service use outcomes among caregivers assisting veterans with PTSD and dementia compared with caregivers assisting veterans with dementia only. Caregivers of veterans with PTSD and dementia indicated that their relative exhibited more difficult behavior symptoms and used more community services. These caregivers also reported more difficulties understanding veterans' memory problems and more physical strain. Together, results suggested caregivers of veterans with both PTSD and dementia were at greater risk of negative caregiving consequences. Implications and suggestions for future research are discussed.

Introduction to the special issue: Culturally sensitive approaches to conceptualization and treatment of psychiatric disorders.

Cognitive-behavioral therapy (CBT) is an effective treatment for a variety of psychiatric disorders. However, historic underrepresentation, misapplication of techniques, and neglected consideration for the unique experiences of marginalized groups-including racial, ethnic, sexual, and gender minorities-have led to mistrust of mental health treatment among these communities and decreased access to quality, evidence-based care. Although these treatments are not inherently harmful to individuals with marginalized identities, clinicians can cause harm if they do not consider the role of culture in their conceptualization, assessment, and treatment of individuals with marginalized identities. Thus, this Special Issue details important considerations for conceptualization, assessment, treatment, and research related to a variety of psychiatric disorders in individuals with marginalized identities. In particular, this Special Issue describes substance use disorders among Black men, eating disorders among queer and transgender individuals, obsessive-compulsive disorder in Hispanic and Latin American individuals, and social anxiety disorder in Black adolescents.

Disclosure of traumatic details and obsessive-compulsive contamination symptoms in sexual assault survivors.

OBJECTIVE: Contamination concerns are common following sexual victimization and are associated with increased attentional bias and difficulty disengaging from contamination cues. While most survivors of sexual trauma disclose their experience to others, it is unclear whether disclosure increases feelings of contamination or whether, consistent with the fever model of disclosure, existing contamination-related distress increases the amount of content shared during disclosure, indicative of attentional bias toward contamination-inducing aspects of the trauma memory. METHOD: Accordingly, the current study examined the directionality and relationships between contamination symptoms and content shared during sexual assault disclosure in 106 sexual assault survivors (76.4% women). Forced decision regression with subsequent independence test (RESIT) was used to identify directionality of relationships, and multivariate and linear regressions examined these proposed effects in the presence of assault and demographic characteristics. RESULTS: More severe contamination symptoms predicted greater sharing of details during sexual assault disclosure yet had no impact on sharing of emotions, cognitions, and beliefs during disclosures. Although RESIT suggested that contrary to other content domains, disclosure of social experiences may directionally predict contamination symptoms, this relationship did not retain statistical significance in a linear regression model. CONCLUSIONS: Findings support the fever model of disclosure and attentional bias theories regarding contamination-related stimuli, and suggest that survivors experiencing postassault contamination symptoms may be more likely fixate on the contamination-invoking details of the trauma memory when disclosing. Such fixation has the potential to interfere with typical treatment-related processes (e.g., habituation) and should be thoughtfully addressed to maximize treatment gains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Obsessive-compulsive disorder among individuals of Hispanic and Latin American ancestry: Cultural considerations for assessment and psychotherapy.

Research specific to obsessive-compulsive disorder (OCD) among individuals of Hispanic and Latin American (H/L) ancestry is limited, as are culturally relevant assessment and treatment recommendations. This article discusses the implications of underrepresentation of H/L populations in OCD research and emphasizes the need to consider issues related to assessment, treatment, and structural barriers that hinder delivery of culturally appropriate first-line psychotherapy. Recommendations for assessment and treatment are provided to aid clinicians in distinguishing culturally normative thoughts and behaviors from OCD, as well as to inform the implementation of psychotherapeutic interventions with cultural humility. This manuscript offers recommendations for future research to tackle health equity concerns with respect to assessment and treatment and structural factors limiting access to culturally appropriate psychotherapy. Wide-scale efforts are needed to comprehensively understand how H/L cultures intersect with various OCD presentations and to further disseminate treatments to populations that have historically lacked access to mental health care.

Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response.

BACKGROUND: Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. METHODS: The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs. RESULTS: Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. LIMITATIONS: Findings are limited by a naturalistic treatment sample with variation in treatment provision. CONCLUSIONS: Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.

Assessment of Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are commonly comorbid and share prominent features (e.g., intrusions, safety behaviors, and avoidance). Excellent self-report and clinician-administered assessments exist for OCD and PTSD individually, but few assess both disorders, and even fewer provide instruction on differential diagnosis or detection of comorbid OCD and PTSD. To address this gap in the literature, the current paper aims to (1) highlight diagnostic and functional similarities and differences between OCD and PTSD to inform differential diagnosis, (2) outline assessment recommendations for individuals with suspected comorbid OCD and PTSD, OCD with a significant trauma history or posttraumatic symptoms, or PTSD with significant obsessive-compulsive symptoms, and (3) explore future directions to evaluate and improve methods for assessing co-occurring OCD and PTSD.

The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder.

BACKGROUND: Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth. METHODS: A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis. RESULTS: Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged. LIMITATIONS: Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis. CONCLUSIONS: Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD.

Common rituals in obsessive-compulsive disorder and implications for treatment: A mixed-methods study.

Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rituals might cluster together and predict worsened severity and poorer treatment outcomes. In a retrospective sample of 641 adult patients who received intensive OCD treatment, the present study used a mixed-methods approach to (a) identify and validate treatment provider-identified rituals using the Yale-Brown Obsessive-Compulsive Scale, (b) identify clustering patterns of rituals, and (c) examine the impact of these clusters on severity and treatment outcomes. Sixty-two discrete rituals clustered into eight higher order ritual clusters: avoidance, reassurance, checking, cleaning/handwashing, just right, rumination, self-assurance, and all other rituals. At admission, reassurance predicted greater intolerance of uncertainty (IU) and rumination predicted less OCD severity. Only one ritual cluster-just right-predicted treatment outcomes; patients with just right rituals had worse IU at discharge and significantly longer length of treatment (average 7.0 days longer). Clinical observation can identify more nuanced and individualized rituals than self-report assessment alone. Patients presenting with just right rituals may benefit less from treatment focused on harm avoidance and habituation; instead, treatment should be tailored to the idiosyncrasies of incompleteness and not just the right experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introduction to the Special Issue: Conceptualization, Assessment, and Treatment of Obsessive-Compulsive Disorder and Co-Occurring Conditions.

Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 1%-2% and typically presents as a chronic condition with significant functional impairment. Comorbidity with OCD is the norm, with 90% of individuals with OCD also meeting diagnostic criteria for a co-occurring condition. Co-occurring conditions can complicate the conceptualization, assessment, and treatment of OCD, such as by intensifying existing symptoms, obscuring differential diagnosis of phenotypically and functionally similar symptoms, and interfering with cognitive behavioral treatment. This two-part special issue reviews extant literature and provides expert advice on conceptualizing, assessing, treating, and researching OCD with co-occurring conditions of depression, posttraumatic stress disorder, eating disorders, schizophrenia, hoarding disorder, panic disorder, obsessive-compulsive personality disorder, and illness anxiety disorder.

Symptom severity and presentation in comorbid OCD and PTSD: A clinical replication.

Individuals with comorbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) experience more severe OCD symptoms and poorer treatment response. Despite some evidence linking OCD symptom domains to trauma, only one study to date has examined typical OCD and PTSD presentations in individuals with OCD+PTSD, and findings were based on a nonclinical sample. The current study sought to replicate findings in a clinical sample of 1,014 patients diagnosed with OCD (n = 928), PTSD (n = 40), and OCD+PTSD (n = 46) in specialty OCD and anxiety treatment programs. Consistent with previous research, patients with OCD+PTSD reported more severe OCD yet similar severity PTSD symptoms and did not evidence a unique phenotypic presentation once symptom overlap and comorbid mood and personality disorders were considered. OCD+PTSD is equally as heterogeneous as OCD and PTSD alone. Implications for the research and treatment of OCD+PTSD are discussed, and assessment and treatment recommendations are provided.

Clinical Presentation and Treatment Trajectory of Gender Minority Patients With Obsessive-Compulsive Disorder.

Gender minorities experience unique minority stressors that increase risk for psychiatric disorders. Notably, gender minorities are four and six times more likely than their cisgender female and male peers, respectively, to be treated for or diagnosed with obsessive-compulsive disorder (OCD). Despite higher rates of OCD, more psychiatric comorbidities, and minority stressors, little is known about the clinical presentation and treatment outcomes of gender minorities with OCD. Using a sample of 974 patients in specialty treatment programs for OCD, the current study found that gender minorities reported more severe contamination symptoms and greater incidence of comorbid substance use/addiction, trauma/stressor-related, personality, and other/miscellaneous disorders compared to cisgender male and female patients. Despite significantly longer lengths of stay, gender minorities reported less symptom improvement across treatment compared to cisgender male and female patients. Findings underscore the need for continued research to improve the effectiveness and individualization of treatment for gender minorities with OCD.

Efficacy of intensive CBT telehealth for obsessive-compulsive disorder during the COVID-19 pandemic.

Despite evidence for the effectiveness of cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD), many individuals with OCD lack access to needed behavioral health treatment. Although some literature suggests that virtual modes of treatment for OCD are effective, it remains unclear whether intensive programs like partial hospitalization and intensive outpatient programs (PHP and IOPs) can be delivered effectively over telehealth (TH) and within the context of a global pandemic. Limited extant research suggests that clinicians perceive attenuated treatment response during the pandemic. The trajectory and outcomes of two matched samples were compared using linear mixed modeling: a pre-COVID in-person (IP) sample (n = 239) and COVID TH sample (n = 239). Findings suggested that both modalities are effective at treating OCD and depressive symptoms, although the pandemic TH group required an additional 2.6 treatment days. The current study provides evidence that PHP and IOP treatment delivered via TH during the COVID-19 pandemic is approximately as effective as pre-pandemic IP treatment and provides promising findings for the future that individuals with complicated OCD who do not have access to IP treatment can still experience significant improvement in symptoms through TH PHP and IOP treatment during and potentially after the pandemic.

Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters.

OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.

Co-Occurring Obsessive-Compulsive and Posttraumatic Stress Disorder: A Review of Conceptualization, Assessment, and Cognitive Behavioral Treatment.

Posttraumatic stress disorder (PTSD) co-occurs with obsessive-compulsive disorder (OCD) nearly 25% of the time, and rates of co-occurring OCD within PTSD populations are even higher. Several studies examining the impact of co-occurring OCD and PTSD with suggest attenuated treatment response, yet findings regarding symptom presentation in this population are mixed. Given phenotypic, functional, and sometimes etiological overlap in OCD and PTSD, differential diagnosis and specialized treatment can be a complex yet important undertaking. This paper reviews the current literature on co-occurring OCD and PTSD; describes the theoretical conceptualization for the intersection of OCD and PTSD; offers recommendations for differential assessment and cognitive behavioral treatment; and provides directions for future research on co-occurring OCD and PTSD.

Call to Action: Recommendations for Justice-Based Treatment of Obsessive-Compulsive Disorder With Sexual Orientation and Gender Themes.

Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance; identity concealment and discomfort; and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behavioral treatment of sexual orientation (SO) and gender-themed obsessive-compulsive disorder (OCD) has inadvertently reinforced anti-lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) stigma and contributed to minority stress in clients, treatment providers, and society at large. We present updated recommendations for treatment of SO- and gender-themed OCD through a more equitable, justice-based lens, primarily through eliminating exposures that contribute to minority stress and replacing them with psychoeducation about LGBTQ+ identities, and exposures to neutral and positive stimuli, uncertainty, and core fears. We also present recommendations for equitable research on SO- and gender-themed OCD.

OCD in the time of COVID-19: A global pandemic's impact on mental health patients and their treatment providers.

Individuals with obsessive-compulsive disorder (OCD) have evidenced resilience against large-scale crises, although emerging research on the impact of COVID-19 is mixed. Little is known about the impact of COVID-19 on mental health providers. Items from an instrument evaluating the impact of the September 11, 2001, terrorist attack were adapted to measure the impact of COVID-19 on emotions, cognitions, and behaviors. Using a sample of 65 patients with primary OCD diagnoses and OCD treatment providers in intensive programs for OCD and anxiety, the authors found that COVID-19 evidenced a less significant overall impact on patients than providers. Specifically, providers reported more significant impact on the amount of time spent worrying about COVID-19, taking additional cleaning and sanitization precautions, and time spent socializing with loved ones. Findings support previous literature indicating that individuals with OCD demonstrate resilience to large-scale crises, and offer insights into the specific struggles of providers who treat OCD.