Further psychometric properties of the Yale-Brown Obsessive Compulsive Scale - Second Edition.

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a widely used clinician-rated measure for assessing obsessive-compulsive symptoms. Although numerous studies have supported its reliability and validity, improved phenomenological understanding of obsessive-compulsive disorder (OCD) suggests the need for modifications to item content, structure, and scoring. Consequently, the Yale-Brown Obsessive Compulsive Scale - Second Edition (Y-BOCS-II) was developed. While the Y-BOCS-II shows initial promise, minimal data exist in examining the psychometric properties of the Y-BOCS-II English version. In response, the Y-BOCS-II was administered to 61 adult patients with a principal diagnosis of obsessive-compulsive disorder. The internal consistency for the scores on the Obsession Severity (α=.83), Compulsion Severity (α=.75), and Total Severity (α=.86) scales were acceptable to good. The inter-rater reliability for the severity scale scores was excellent (ICC=.97-99) and the test-retest reliability was acceptable (r=.64-81). Strong convergent validity was observed between the Y-BOCS-II Total Severity scale and other measures of obsessive-compulsive symptom severity and related impairment. Good divergent validity was supported by non-significant correlations between the Total Severity score and measures of anxiety and impulsiveness, though a moderate correlation was observed with depressive symptoms. Collectively, the Y-BOCS-II generally possesses sound psychometric properties and appears to be a viable alternative to the original Y-BOCS.

Mediators and moderators of functional impairment in adults with obsessive-compulsive disorder.

The current study examined correlates, moderators, and mediators of functional impairment in 98 treatment-seeking adults with obsessive-compulsive disorder (OCD). Participants completed or were administered measures assessing obsessive-compulsive symptom severity, functional impairment, resistance against symptoms, interference due to obsessive-compulsive symptoms, depressive symptoms, insight, and anxiety sensitivity. Results indicated that all factors, except insight into symptoms, were significantly correlated with functional impairment. The relationship between obsessive-compulsive symptom severity and functional impairment was not moderated by patient insight, resistance against obsessive-compulsive symptoms, or anxiety sensitivity. Mediational analyses indicated that obsessive-compulsive symptom severity mediated the relationship between anxiety sensitivity and obsessive-compulsive related impairment. Indeed, anxiety sensitivity may play an important contributory role in exacerbating impairment through increases in obsessive-compulsive symptom severity. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and obsessive-compulsive related impairment. Implications for assessment and treatment are discussed.

Evidence-based assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children.

Body-focused repetitive behavior (BFRB) is an umbrella term for debilitating, repetitive behaviors that target one or more body regions. Despite regularly occurring in youth, there has been limited investigation of BFRBs in pediatric populations. One reason for this may be that there are few reliable and valid assessments available to evaluate the presence, severity and impairment of BFRBs in youth. Given the shift toward evidence-based assessment in mental health, the development and utilization of evidence-based measures of BFRBs warrants increasing attention. This paper examines the available evidence-base for assessments in youth across three BFRB-related disorders: compulsive skin picking, chronic tic disorders and trichotillomania. Based upon present empirical support in samples of youth, recommendations are made for an evidence-based assessment of each condition.

Exploring the boundaries of memory distrust from repeated checking: increasing external validity and examining thresholds.

Checking behavior is among the most common forms of compulsions in OCD. Recent research suggests that repeated checking decreases memory confidence, and supports theoretical models of how repeated checking is maintained. The current paper presents findings from two studies exploring the boundaries of memory distrust from repeated checking. Results of study 1 show that repeated checking of a real stove decreases memory confidence, vividness, and detail (i.e., metamemory), and leads to a greater reliance on knowing as a source of memory, without meaningfully altering memory accuracy. Results of study 2 suggest that these changes in metamemory are observed after performing a relatively low number of checks on one occasion. The findings are considered within the context of theoretical models of checking and future directions are delineated.

Psychometric properties of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Patient Version.

In obsessive-compulsive disorder (OCD), family accommodation is a frequently occurring phenomenon that has been linked to attenuated treatment response, increased obsessive-compulsive symptom severity, and lower levels of functioning. No patient-report version of family accommodation exists, with available measures relying on relatives as informants. However, adult patients with OCD often present to clinical services alone, frequently making it impractical to obtain information from these informants. Consequently, a standardized patient-reported measure of family accommodation proves salient in clinical practice. The present study examined the psychometric properties of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Patient Version (FAS-PV). Sixty-one adults with OCD were administered clinician-rated measures of OCD symptom severity and self-report questionnaires examining functional impairment, family functioning, and emotional/behavioral difficulties. Fifty-four relatives completed self-report measures assessing family accommodation and family functioning. The majority of the adult OCD participants (89%) endorsed at least 1 type of accommodating behavior in the previous week. The FAS-PV total score demonstrated good internal consistency and test-retest reliability. Convergent validity was evidenced by strong associations with scores on another measure of family accommodation, OCD symptom severity, OCD-related family functioning, anxiety, and functional impairment. Divergent validity was supported through nonsignificant correlations with depressive symptoms and impulsivity. The FAS-PV did not significantly differ from the relative-reported measure of family accommodation in terms of the internal consistency or mean of the total scores. Ultimately, the FAS-PV scores demonstrated sound psychometric properties and validity in assessing family accommodation from the patient's perspective, encouraging its use in research and clinical practice.

Do Higher Self-Reports of Social Anxiety Translate to Greater Occurrence of Social Anxiety Disorder in Asian Americans Compared to Caucasian Americans?

This study was designed to clarify the discrepancy between data showing higher self-reported levels of social anxiety in Asian Americans (Horng, 2004; Okazaki, 1997, 2000, 2002) but lower lifetime prevalence rates of social anxiety disorder (SAD) in Asian Americans compared to Caucasian Americans (Hwu, Yeh, & Chang, 1989; Lee et al., 1990b; Takeuchi et al., 1998). Results revealed that based on responses on the self-report Social Phobia Inventory (SPIN), Asian Americans endorsed higher levels of social anxiety symptoms and were more likely to meet a threshold for "high social anxiety," using the diagnostic cutoff score of 19 or higher on the SPIN. However, when clinician-formulated diagnoses were assigned, there was no evidence for significant differences in the prevalence of SAD in Asian Americans versus Caucasian Americans. Explanation of the results, their implications, limitations, and future directions are discussed.

The nature, assessment, and treatment of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects between 1% to 2% of individuals and causes considerable impairment and disability. Although > 50% of individuals experience symptom onset in childhood, symptoms can continue to develop throughout adulthood. Accurate and timely assessment of clinical presentation is critical to limit impairment and improve prognosis. Presently, there are 2 empirically supported treatments available for OCD in children and adults, namely cognitive-behavioral therapy and pharmacotherapy with serotonin reuptake inhibitors. This article provides an introduction to the phenomenology, etiology, and clinical course of OCD. Assessment practices used to evaluate symptom severity are described, and evidence-based treatment options are reviewed, with appropriate distinctions drawn between children and adults. Finally, recommendations for assessment and treatment practices for OCD are explicated.