An ecological momentary assessment of OCD-relevant intrusions: Frequency, feared self, and concealment.

This study provides the first examination of the frequency, characteristics, and dynamics surrounding daily experiences of OCD-relevant intrusions among non-clinical participants (N = 54, Nobs = 2314) using ecological momentary assessment. It also examines the extent to which self-related constructs-participants' feared-self beliefs and their tendency to conceal aspects of self-relate to such intrusive phenomena. Participants completed a baseline questionnaire before reporting state depressed mood and intrusions up to five times per day (at semi-random intervals) for 14 days. Results suggest that questionnaire measures may result in underreporting of the frequency of intrusions, with most participants (80%) reporting at least one intrusion across the momentary observations, and 20% of observations indicating intrusive phenomena experienced since the previous momentary report. Baseline factors including OCD-related beliefs and feared self were related to the proportion of intrusions experienced, whereas self-concealment was not. Within the moment, state feared-self predicted intrusion-related distress, duration, perceived importance, the urge to act, and the need to control thoughts. The urge to conceal within the moment was significant but negatively related to perceived importance and the urge to act. Overall, this study provides evidence for the relevance of momentary measures of intrusions, and adds to evidence for self-beliefs in the dynamics of the disorder.

The association between trichotillomania symptoms and emotion regulation difficulties: A systematic review and meta-analysis.

BACKGROUND: Emotion regulation is postulated to play an important role in Trichotillomania (TTM). Whilst a growing number of studies have examined the relationship between emotion regulation difficulties and TTM symptoms, there have been no attempts to evaluate the overall strength of this association or the quality of the evidence base. METHOD: This systematic review and meta-analysis aimed to synthesise findings from studies that have examined the relationship between emotion regulation difficulties and TTM symptoms, to inform future TTM treatment targets. We identified 17 studies that met inclusion criteria. From these studies, 32 correlation coefficients were extracted for meta-analysis. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess risk of bias amongst the included studies. RESULTS: There was a moderately sized association between TTM symptoms and ER difficulties, (r adjusted = 0.32, 95 % CI [0.28, 0.37], t = 15.58 (df = 11.86), p < 0.0001) that was moderated by sample size (F(df1 = 1, df2 = 30) = 4.597, b = -0.0001, SE = 0.0001, 95 % CI [-0.0002; 0.0000], p = 0.040) and differences between types of emotion regulation measures (Q(df = 1) = 4.06, p = 0.044). LIMITATIONS: The data analysed was correlational, therefore causality was unable to be determined. Comorbidities were not able to be examined as a moderator. CONCLUSION: This study provided a preliminary integration of the evidence and demonstrated that individuals with higher levels of TTM severity appear to exhibit decreased overall emotion regulation abilities and strategies.

Cross-sectional direct and indirect relationships between the corrupted feared self and obsessive-compulsive symptoms in a clinical sample: The role of mental contamination.

OBJECTIVES: There is a significant relationship between a general feared self and contact contamination concerns in obsessive-compulsive disorder (OCD), especially when the influence of mental contamination is considered a part of this relationship. However, these associations have not been explored in a clinical OCD sample when using each dimension of the multidimensional conceptualization of the feared self as the predictor (i.e., the corrupted, culpable, and malformed feared selves). METHODS: We tested these associations using a cross-sectional design. Specifically, a sample of patients diagnosed with OCD (N = 417) completed a series of self-report measures of OCD symptoms and its related constructs. We also explored these associations with unacceptable thoughts as the outcome, rather than contamination concerns, due to unacceptable thoughts having evidenced strong associations with the feared self and mental contamination. RESULTS: After controlling for relevant cognitive (i.e., obsessive beliefs) and affective (i.e., depressive symptoms) constructs and comorbidity, the corrupted feared self was found to have a direct link, along with an indirect link through mental contamination, with symptoms of contact contamination and unacceptable thoughts. CONCLUSIONS: The fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns. The corrupted feared self and mental contamination should therefore be targeted in treatments for repugnant obsessions and contamination-related OCD.

Exploring predictors of aggressive intrusive thoughts and aggressive scripts: Similarities and differences in phenomenology.

Experiencing a thought about harming or injuring another person is commonly reported by the general population. Aggressive intrusive thoughts (AITs) and aggressive scripts are two constructs commonly used to define the experience of thinking about harming another person. However, they are generally investigated separately and with two significantly different population groups; respectively, individuals with obsessive-compulsive disorder and people with a history of violent behavior. AITs and aggressive scripts are assumed to have very different implications for violence risk assessment, but conceptual overlap and an absence of empirical research renders this assumption premature. Using a battery of self-report measures, this study aimed to investigate the differential predictors of AITs and aggressive script rehearsal in a nonclinical sample. Additionally, using regression analyses, the predictors of self-reported aggressive behavior were explored in a sample of 412 adults (73% females; Mage = 31.96 years, SD = 11.02). Violence-supportive beliefs and frequency of anger rumination predicted the frequency of aggressive script rehearsal, and aggressive script rehearsal, anger rumination, and violence-supportive beliefs predicted a history of aggressive behavior. In contrast, obsessive beliefs were predictive of AITs, and only AITs were related to ego-dystonicity. Both AITs and aggressive script rehearsal were related to the use of thought control strategies. These findings support the contributions that maladaptive beliefs have in the experience of aggressive scripts and AITs. Beliefs about violence, a history of aggressive behavior, and ego-dystonicity appear to differentiate aggressive scripts from AITs.

Examining the role of brooding, distress, and negative urgency in dysregulated behaviors: A cross-sectional study in treatment-seeking young people.

OBJECTIVE: Dysregulated behaviors including substance use, disordered eating, and nonsuicidal self-injury (NSSI) have significant negative implications for individuals and health systems. It is therefore paramount to understand factors influencing behavioral dysregulation, to inform prevention and treatment approaches. The literature suggests that distress and rumination (brooding) prompt individuals to engage in behavioral dysregulation for distraction (Emotional Cascade Model), although these concepts have limited investigation in clinical, treatment-seeking samples, particularly alongside negative urgency. This cross-sectional study sought to examine the relationships of brooding, distress, and negative urgency with behavioral dysregulation, as well as the moderating effect of negative urgency between brooding and behavioral dysregulation, in treatment-seeking young people. METHOD: A total of 385 treatment-seeking young people completed cross-sectional, self-report measures of distress, rumination, negative urgency, and engagement in dysregulated behaviors (NSSI, alcohol use, drug use, binge eating, and purging) over the past 1-3 months. RESULTS: Structural equation modeling revealed that only negative urgency, and not brooding or distress, had a significant positive relationship with behavioral dysregulation. Negative urgency did not significantly moderate the relationship between brooding and behavioral dysregulation. CONCLUSIONS: These findings reinforce the importance of considering negative urgency in the conceptualization, prevention, and treatment of behavioral dysregulation, and contribute to the knowledge of the relationship between brooding and various dysregulated behaviors within a treatment-seeking sample.

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.

The Impact of Diagnostic Status on Quality of Life in Irritable Bowel Syndrome.

BACKGROUND: The aim of the study was to examine the impact of diagnostic status (i.e., having a clinical diagnosis of irritable bowel syndrome (IBS) or being symptomatic but undiagnosed on quality of life (QoL)). We also examined whether the relationships between QoL and variables such as symptom frequency, pain catastrophizing, visceral sensitivity, and psychological distress are moderated by diagnostic status. METHODS: The online sample comprised 404 participants (Mage = 33.59, SD = 12.43), of which 98 had been diagnosed with IBS and 306 were symptomatic but undiagnosed. RESULTS: The findings suggest that even after adjusting for symptom frequency, those diagnosed with IBS experience poorer QoL, relative to those without a diagnosis. Moreover, there was evidence that the relationship between specific QoL domains (namely, sex, food avoidance, and health worry) and psychological variables (namely, pain catastrophizing, and depression) was moderated by diagnostic status. CONCLUSION: The results indicate that diagnostic status in relation to IBS has psychological implications for QoL outcomes distinct from symptom frequency, age, and gender. This highlights a substantial gap in our current understanding of how a diagnosis of IBS can impact the lives of those suffering from IBS symptomology and calls into question the intended purpose of diagnosis.

An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study.

Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control (ERIC) addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms. Methods: Seventy nine young people (50.6% male; M = 19.30; SD = 2.94) were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression (with random intercept) was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes. Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size (Mean Change = -10.24, 95% CI (-14.41, -6.06; Cohen's dav = -0.53), in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness. Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population.

Development and validation of the multidimensional version of the fear of self questionnaire: Corrupted, culpable and malformed feared possible selves in obsessive-compulsive and body-dysmorphic symptoms.

In recent years, cognitive-behavioural models of OCD have increasingly recognized the potential role of feared possible selves in the development and maintenance of OCD, while simultaneously re-examining factors that have historically been linked to self-perceptions in OCD. The current article describes the development and validation of a multidimensional version of the Fear of Self Questionnaire (FSQ-EV) in a non-clinical (N = 626) and clinical OCD sample (N = 79). Principal component analyses in the non-clinical sample revealed three conceptually and factorially distinct components revolving around a feared corrupted possible self, a feared culpable possible self and a feared malformed possible self. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms. In particular, the corrupted feared self predicted OCD symptoms independently from depression and other related self-constructs and obsessive beliefs, while also strongly interacting with importance and control of thoughts in the prediction of almost all specific symptoms of OCD. Results are consistent with the notion that self-constructs can be conceptually and empirically distinguished from obsessive beliefs and appraisals with significant potential to improve our understanding of OCD and related disorders.

A qualitative examination of the relationship between rumination, distress, and dysregulated behaviours in vulnerable young people.

OBJECTIVES: Young people accessing mental health treatment in Australia frequently engage in dysregulated behaviours, such as substance misuse, deliberate self-harm (DSH), and binge eating and purging. Rumination has been identified as a correlate of behavioural dysregulation; however, a qualitative examination of the functional relationship between ruminative processes and distress and subsequent engagement in dysregulated behaviours has not yet been conducted. This study aimed to explore the characteristics of rumination in young people and examine how this process relates to engagement in DSH, binge eating and purging, and substance misuse in a sample of treatment-seeking young people. DESIGN: A qualitative research methodology was used gain an in-depth understanding of participants' experience of rumination as it relates to their engagement in dysregulated behaviours. METHODS: Twelve treatment-seeking young people were interviewed about their experience of rumination in the context of a recently recalled situation where they engaged in a dysregulated behaviour. Interview data were analysed using thematic analysis. RESULTS: Themes included the following: (1) triggers to behavioural dysregulation; (2) characteristics and content of rumination; (3) key precipitants to dysregulated behaviours (rumination, distress, and prior ineffective were at managing rumination); and (4) distraction from rumination and regulation of distress as short term, positively reinforcing consequences of dysregulated behaviours, while ongoing cycles of rumination and psychological distress were identified as long-term consequences. CONCLUSIONS: DSH, binge/purge behaviours, and substance misuse represent maladaptive ways to distract from intense and pervasive rumination in this cohort of young people. Theoretical and treatment implications pertaining to these findings are discussed. PRACTITIONER POINTS: Rumination is a common experience in young people who engage in dysregulated behaviours including deliberate self-harm, binging and purging, and substance misuse Engagement in behavioural dysregulation functions to distract from rumination, which negatively reinforces further engagement in dysregulated behaviours. Interventions in this population should focus on the development of adaptive skills that provide the same level of distraction provided by the physical sensations associated with engaging in a dysregulated behaviour.

The things that make us: self and object attachment in hoarding and compulsive buying-shopping disorder.

Excessive or maladaptive object attachment is the defining feature of Hoarding Disorder (HD) and the acquisition process within Compulsive Buying-Shopping Disorder (CBSD). In recent years, the relationship of object attachment within HD and CBSD to individual's self-concept has become the focus of direct research. On the basis of this literature, it seems that an underdeveloped, ambivalent, or discrepant self-concept could be a vulnerability for dysfunctional object attachment behavior. Further, the importance of objects in buttressing and extending self-concept, both individually and in relationship to others, appears to be a central function underlying pathological object attachment. An important future direction of research is whether directly addressing self-concept can serve as the next advancement for psychological treatments for these debilitating disorders.

Health-Related Quality of Life in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.

Irritable bowel syndrome (IBS) affects up to 20% of the global population and is associated with impaired health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate differences in HRQoL of those with IBS compared with healthy controls and to examine whether HRQoL improves following psychological intervention. Online databases were searched for articles from 2002 to 2017. Studies were screened and data extracted according to predetermined criteria. A total of 4,154 citations were identified from which 36 were eligible for inclusion. Eight studies compared HRQoL of those with IBS (n = 822) with that of healthy individuals (n = 3,809). Those with IBS suffered significant impairment across all HRQoL domains compared with healthy individuals, with the majority of effects (Cohen's d) being moderate to large. Twenty-eight studies investigated HRQoL in IBS following psychological intervention (n = 1,308) relative to controls (n = 1,006). All HRQoL domains improved with large effects following treatment; however, maintenance of these effects was inconsistent. Those with IBS experience poorer HRQoL than the wider community; nevertheless, psychological interventions are associated with improved HRQoL across all domains. High-quality studies are needed to better inform gastroenterological nurses of which interventions are most efficacious in alleviating the burden of IBS, and which IBS subpopulations would benefit.

Assessing beliefs about the consequences of not just right experiences: Psychometric properties of the Not Just Right Experience-Sensitivity Scale (NJRE-SS).

Although current cognitive conceptualizations of obsessive-compulsive disorder (OCD) emphasize that rituals are performed in order to avoid overtly threatening outcomes, it has also been noted that there are individuals for whom the attempt to correct "not just right experiences" (NJREs) rather than dangerous outcomes per se appear important. This article examines the idea that individuals have differing tolerances for-or sensitivity to-NJREs, in a similar manner as occurs regarding for other experience such as the distinction between disgust propensity and disgust sensitivity. In Study 1, using a nonclinical Italian sample, the NJRE-Sensitivity Scale (NJRE-SS) was created and refined. Its final version consisted of eight items loading on two subscales-an intolerance of NJREs due to their perceived interference with cognitive tasks and due to their interference with enjoyment of life. In Study 2, the factor structured was confirmed in a separate sample. The measure was found to have convergent validity with related measures including a separate measure assessing the severity and frequency of NJREs themselves. However, the NJRE-SS predicted OCD symptoms over-and-above the general NJRE measure, with particularly the interference with cognitive tasks subscale being of importance. Clinical implications are discussed.

Using photo-elicitation and interpretative phenomenological analysis to explore possessions as links to self-concept and the identities of others in hoarding disorder.

OBJECTIVES: The aim of this study was to explore the importance of possessions as extensions of self-concept and connections to significant others for people that hoard. DESIGN: A total of 10 participants were recruited through hoarding group treatment programmes. Participants photographed significant possessions in their home and discussed these in semi-structured interviews. RESULTS: Analysis of transcripts using interpretative phenomenological analysis revealed three interrelated superordinate themes: (1) time travels with you; (2) possessions are me, they're a reflection of my life; and (3) they're linked: I look at them and I think of people. Challenging early life factors were the source of significant self-uncertainty. Possessions were often touchstones of self-confidence and reminders of both positive and negative relationships. CONCLUSIONS: The results highlight the many dimensions of possessions' links to both self-concept and the identities of others, providing a distinct contribution to the hoarding literature. Implications for future research and treatment are discussed. PRACTITIONER POINTS: Problematic attachments to items may be formed as a compensatory response to challenging early life experiences. Possessions may reflect self-confidence, uniqueness, and be perceived to be physical extensions of who people that hoard are. Belongings can be reminders of interpersonal relationships for people that hoard.

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.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions / Expresión transcultural y naturaleza transdiagnóstica de las intrusiones mentales no deseadas

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

The Beliefs in Trichotillomania Scale (BiTS): Factor analyses and preliminary validation.

OBJECTIVES: The role of cognitions and beliefs in trichotillomania (TTM; hair pulling disorder) has been the subject of only limited investigation. This study aimed to develop and validate the Beliefs in TTM Scale (BiTS). METHODS: A pool of 50 items based upon themes identified in previous research was administered online to 841 participants with and without self-reported problematic, non-cosmetic hair pulling behaviours. RESULTS: Exploratory and confirmatory factor analyses conducted in randomly split-halves of the sample supported retention of 14 items comprising three factors: negative self-beliefs, low coping efficacy, and perfectionism. CONCLUSIONS: The BiTS demonstrated satisfactory psychometric properties and all three subscales significantly correlated with greater hair pulling severity. Negative self-beliefs predicted hair pulling severity over and above mood symptoms, suggesting the importance of addressing self-construals in psychological treatments for TTM. Validation in a clinician diagnosed sample is required. PRACTITIONER POINTS: Research supports cognitive therapies for treating trichotillomania (hair pulling disorder), although studies investigating the nature and role of cognitions and beliefs in this disorder have been lacking. This study developed and validated a self-report measure of three styles of beliefs most relevant to trichotillomania: negative self-beliefs, low coping efficacy, and perfectionism. Negative self-beliefs predicted the severity of trichotillomania symptoms over and above depression and anxiety, suggesting such cognitions may not necessarily be due to comorbidities. Future research should validate the new measure in a clinician diagnosed sample, and therapies for trichotillomania may be enhanced by targeting shame specifically.

The relationships between socially prescribed perfectionism, in-group affect, negative urgency, and disordered eating in women.

Socially prescribed perfectionism (SPP) is often considered as a key risk factor for disordered eating (DE). However, current conceptualizations of SPP largely assume that this perfectionism pressure is non-specific (i.e., a global pressure), despite research indicating that for females experiencing DE, female-dominated groups impose this pressure (as a perceived norm). Furthermore, this relationship may be mediated by a negative reaction to this pressure, in the form of impulsivity (or negative urgency). To date, no research has investigated whether the relationship between SPP and DE is mediated by negative urgency, nor has there been research clarifying how in-group identification relates to DE, independent of SPP and negative urgency. To address these gaps, we assessed these variables in 147 female dieters (Mage  = 25.12 years, SD = 3.08) using a cross-sectional design. Consistent with our hypotheses, negative urgency fully mediated the link between female-based SPP and disordered eating, while female-based in-group affect (identification) was predictive of disordered eating (although the latter relationship was not sustained in a multiple regression model). These findings suggest that the SPP from other women may relate to DE through increasing negative urgency, and that the link between in-group (female) affect and DE may be better explained by SPP's link to DE.

Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11?

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.

Cost-effectiveness of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

Economic analyses of treatments for OCD have been limited. This study analysed the comparative economic benefits and costs of an internet-based CBT (iCBT) relative to internet-based progressive relaxation therapy (iPRT) control. These were benchmarked against current estimates for face-to-face CBT (ffCBT) sourced from literature. The benefits to society of providing increased access to treatment was assessed using a cost-benefit analysis based upon productivity gains arising from treatment. Identification of the most cost-effective treatment amongst the three treatments was assessed using a cost-effectiveness analysis based upon both effectiveness as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS) and percentage of responders. The cost-effectiveness analysis showed iCBT to be the most cost effective treatment of the three analysed, followed by ffCBT based upon percentage of responders and iPRT based upon overall effectiveness of treatment. The cost-benefit analyses showed all treatment options delivered substantial benefits to society. These benefits ranged from three to thirty-five times the cost of providing treatment, depending on the assumptions used and the treatment provided, with iCBT showing the greatest ratio of benefits to costs but the ffCBT providing the greatest absolute benefits. Overall, the findings provide support for increased access to CBT intervention, for all patients with OCD; with online therapist-assisted modes of delivery as a cost-effective alternative to existing face-to-face treatments. Further work to more accurately quantify the benefits and costs resulting from CBT treatment modalities is required to support these preliminary findings.