The psychology case study is one of the oldest research methods in the discipline. One individual, sometimes with an abnormality, is studied in great depth. Psychology, as a science, seeks to discern universal truths, so the study of atypical individuals must be done with caution. These unrepresentative studies, though, suggest avenues for future research. Some of psychology’s most rewarding findings have been influenced by initial case studies. These findings were then corroborated by representative, rigorous research methods, namely the experiment.
1. Phineas Gage
One of the few portraits of Phineas Gage, holding the same tampering iron that damaged his brain.
On a day in 1848, Phineas Gage, a mild-mannered railroad worker, used a tampering iron to pack gunpowder into a rock. But a spark accidentally detonated the gunpowder, causing the rod to shoot up through his left cheek and the top of his skull. His left frontal lobe was severely damaged, but he survived. In fact, he immediately sat up and was able to talk. But Gage’s personality dramatically changed. He became short-tempered, rude, impulsive, and immoral. Friends said he was “no longer Gage.” He lost his job as a foreman and spent some time traveling the road as a circus attraction.
Almost all of what we know about Gauge is from published accounts by Dr. John Martyn Harlow. For a case so often cited, relatively little is known about the Gage’s, namely his life before and after the accident. The extent of Gage’s personality changes may have been inaccurate. Later evidence show that Gauge, for the last decade of his life, worked the same job in two locations. This is not consistent with the image of Gage as a capricious, emotionless drifter.
Nonetheless, Gage’s early case study illustrated the significance of association areas, the areas of the cerebral cortex involved in the higher mental functions (thinking, learning, remembering, etc.) that make us truly human. It was also one of the first cases that showed a neurological basis for personality and behavior. More recent studies in psychology look into these possible connections between morality, emotion, and the brain. But they owe a debt of gratitude to Phineas Gage.
2. “Genie,” the feral child
Genie after being rescued, malnourished and unable to properly walk.
Genie is a relatively recent example of a feral child. Feral children are humans raised in social isolation, experiencing little or no human contact in their lives. Feral children are typically the result of either child abandonment or abuse. Due to malnourishment and lack of mental stimulation, feral children never fully cognitively develop.
Genie was such a child. Found in 1970 at the age of 13, Genie had spent most of her life confined in a bedroom, strapped to a potty chair. Her father had believed she was mentally retarded, so he took steps to “protect her.” He beat her every time she made a sound. Her physical and mental development was stunted, and she never learned to speak or walk properly.
After she was found and properly cared for, Genie progressed, learning to communicate nonverbally with her caretakers. But as funds and research interest dried up, she went through a series of foster homes and today, at age 54, is psychologically confined. She has regressed, reverting to her coping mechanism of silence.
Genie’s case contributed significantly to psychological and linguistic theory. It showed the significance of enculturation in acquiring social skills. From a young age, mental stimulation is needed for motor and sensory development. Without mental stimulation, neurogenesis is hindered. Feral children like Genie support the “critical period hypothesis” of language acquisition. After the first few years of life (a critical developmental period), learning a language becomes more difficult (almost impossible) for a human child. Missing this window. Genie never learned to speak a grammatically correct verbal language.
A portrait of H.M., Henry Molaison, in 1953.
Henry Gustav Molaison was perhaps the most important patient in the history of neuroscience. At the age of 9, a bicycle accident damaged his brain and caused him to suffer from seizures. In 1953, as a last resort for curing these convulsions, surgeons removed slivers of tissue from his hippocampus, an area we know now (thanks to HM) is critical in the formation of long-term memories. H.M. was left with severe anterograde amnesia. He basically lived in the past, unable to create new memories. Even his past memories were clouded by mild retrograde amnesia, leaving him only able to remember the gists of childhood events.
Dr. Brenda Milner’s study of H.M. paved the way for the study of human memory and memory disorders. In repeated trials, Dr. Milner told H.M. to perform a simple motor task, such as outlining a five-point star. Each time, H.M. recognized it as an entirely new experience. Yet he became more proficient at the task with practice. H.M. could be classically conditioned, learning things without the awareness of having learned them.
Thanks to Dr. Milner’s study, we know that memory consists of two systems that operate together. One is explicit, or declarative. It involves facts we know and can declare. It of course depends on the hippocampus, which H.M. had partially removed. The other is retention that is independent of conscious recollection: subconscious learning of motor functions. This finding revolutionized the understanding of memory and the neurological mechanisms behind it.
4. Jill Price
Jill Price, who published her story in a 2008 memoir.
Jill Price is one of the very few patients with hyperthymesia, an incredible memory that allows her to remember numerous obscure aspects of her life in incredible detail. She can, for example, remember what she had for dinner 20 years ago, on an ordinary August afternoon. This ability has caused her significant emotional trauma due to her remembrance of every derogatory remark or traumatic event in her life. Jill Price is still participating in psychological studies that hope to shed light on her condition.
Recent memory tests , however, show that Jill Price isn’t exactly a memory whiz, and that her abilities have been blown out of proportion. Mrs. Price cannot memorize a new list of words with great accuracy. Her memory is, in many respects, average. She can remember famous dates and names, but only if she finds them somehow relevant to herself. One of the key, previously underestimated, elements of Mrs. Price’s condition is her OCD-like symptoms. She hoards and feels a need to organize her life. Perhaps most significantly, she spends much of her time constantly thinking about herself and events in her life, elaborately encoding them into her memory.
All of this evidence, along with brain scans that show enlarged regions consistent with an OCD patient, suggests that Jill Price has a rare offshoot of Obsessive-compulsive disorder, and that her memories are a result of obsession. Only future research can corroborate or disprove this promising theory.
5. The John/John Case
David Reimer, formerly Brenda Reimer.
Dr. John Money was an influential sexologist that pioneered the theory of gender neutrality. He argued that, in the classic nature vs. nurture debate, nurture fully determined gender. Gender was supposedly malleable and determined in the first few years of cognitive development. Once the “gender gate” closed, a human’s gender identity was relatively stable.
The Reimer twins were circumcised at 6 months old. Unfortunately, the electrical equipment used in the circumcision malfunctioned, severely damaging Bruce Reimer’s penis. A few months later, his parents wrote to Dr. Money seeking help. Under his advice, Bruce Reimer was sexually reassigned in 1967. He was castrated and a vulva was surgically created. His parents attempted to raise him as a girl, Brenda.
In infrequent annual follow-ups, Brenda’s parents lied about the surgery’s success. Dr. Money then used this case study as proof of his controversial gender theory. The case revolutionized the way psychologists viewed gender, which apparently had no biological basis.
Growing up, Brenda acted masculine and was teased constantly at school. She could not socialize as a girl. Contrary to Dr. Money’s reports, she did not identify as female. At age 13, Brenda’s parents told her about her past. Brenda, relieved, then fully identified as a male, taking the name “David.” She underwent gender reassignment surgery and lived the rest of her life as a male.
Dr. Money failed to follow up with his patient because doing so would have shattered his influential theory. But David Reimer finally went public in 1997, telling his story with the aid of Dr. Milton Diamond, a noted rival of Dr. Money. David Reimer, who had suffered from depression throughout his life, committed suicide seven years later.
This landmark case study was frequently cited by the feminist movement, anthropologists, developmental psychologists and biologists, and psychiatrists to argue that nurture, not nature, explained all gender differences. Dr. Money’s theory became widely accepted. Intersex children, in accordance to this study’s findings, were regularly sexually reassigned.
The impact of this controversy is still being felt. The one case study that backed Dr. Money’s theory perfectly was unscientific, misleading, and unethical. Dr. Money’s legacy is posthumously harmed, and his theory is once again with valid proof.
Proceeding With Scientific Caution and Skepticism
As we’ve seen, case studies can be incredibly informative, despite dealing with a few atypical individuals. But the use of case studies in psychology must be done both carefully and ethically.
The John/Joan case was discussed last because it basically shows us everything the full range of a case study’s effects, both positive and negative. Case studies can provide opportunities for experimentation that cannot be artificially created. Two twin boys — one “normal” male and one to be raised as a female — gave Dr. Money a chance to put his theory to the test.
When a case study is correct, it can be used as definitive proof of one theory or disproof of another. But the above case study shows us that, when flawed, these studies can lead to misleading, incomplete, or downright false information. Not only are they not representative, the scientists studying them can be biased. Dr. Money fell in love with his own theory and refused to see any contrary evidence as reliable. A psychologist must be explicit about one’s biases when performing a case study, and avoid becoming too emotionally invested in a particular viewpoint.
Lastly, the use of case studies sometimes raises serious ethical concerns. A patient like H.M. was agreeable, otherwise healthy, and enjoyed participating in studies. But what about the others?
– Genie was treated well initially. But when it became clear that there could be no “Miracle Worker” to help her learn to fully verbally communicate, the scientific community lost hope and interest. Funding dried up. Genie’s foster parents, no longer generating scientific data, passed her on to another foster home. Genie was clearly exploited by her caretakers for their own means, which is evident in the custody battles over her (before, but not after, there was scientific funding available to study her). A unique opportunity to study an atypical individual can bring out the worst in psychologists. In focusing on gathering data, they seem to like Zambardo in the infamous Stanford prison experiment, forget that they are dealing with real people, sometimes facing serious emotional trauma.
– Jill Price’s condition had been exaggerated by early studies that ignored the OCD symptoms of her condition. If we all spent as much time as she did obsessing over the details of our personal lives, couldn’t we all have such a remarkable memory? By promoting her as a “superwoman,” perhaps we have enabled her condition and glamorized it, instead of allowing her to properly focus on undergoing therapy. Perhaps though, future studies will shed light on hyperthymesia as a form of OCD, leading to improved quality of life for individuals suffering from this rare disorder.
Lastly, we come to the David Reimer case, which is a recent reminder to psychologists about ethical concerns. Dr. Money’s scientific follow-ups were inappropriate. But the initial decision to perform the surgery was perhaps most disturbing. In retrospect, we know that it didn’t work out. It obviously caused a human being to undergo unnecessary trauma, and likely contributed to David Reimer’s sever depression, which ended in his 2004 suicide.
Should Dr. Money have done the study? One of the things that psychology has undoubtedly proved is that hindsight is 20/20. Perhaps a more interesting question is this: What if it worked? What if Brenda Reimer lived life as a healthy woman? Would that have been moral justification for such an experiment? What is the appropriate way for a parent to treat an intersex child? Should they choose a gender, or let their child choose it themselves later on life?
These are all questions that fall into a moral gray area that nobody, even scientists, can confidently navigate. For the many ethical concerns raised by case studies, we unfortunately have more questions than answers.
Phineas Gage – Personality change as a result of a head injury:
Genie: Nova’s Secret of the Wild Child special:
Developmental molecular biologist and author John Medina, on what we learned from HM:
A revealing 20/20 interview with Jill Price:
An news program clip on the John/John controversy:
Carey, B. (2008, December 04). H. M., an Unforgettable Amnesiac, Dies at 82. Retrieved May 01, 2011, from http://www.nytimes.com/2008/12/05/us/05hm.html
David Reimer: David Reimer The boy who lived as a girl. (2004, May 10). Retrieved May 01, 2011, from http://www.cbc.ca/news/background/reimer/
Dr Money and the Boy with No Penis. (n.d.). Retrieved May 01, 2011, from http://www.bbc.co.uk/sn/tvradio/programmes/horizon/dr_money_prog_summary.shtml
Gray, K., & Escherich, K. (2008, May 9). Woman Who Can’t Forget Amazes Doctors. Retrieved May 01, 2011, from http://abcnews.go.com/Health/story?id=4813052
James, S. D. (2008, May 07). Wild Child Speechless After Tortured Life. Retrieved May 01, 2011, from http://abcnews.go.com/Health/story?id=4804490
Macmillan, M., Macmillan, I., Macmillan, M., & Lena, M. L. (2009, July 30). Phineas Gage Information [Scholarly project]. In The Phineas Gage Information Page. Retrieved May 01, 2011, from http://www.deakin.edu.au/hmnbs/psychology/gagepage/
Marcus, G. (2009, March 23). Total Recall: The Woman Who Can’t Forget. Retrieved May 02, 2011, from http://www.wired.com/medtech/health/magazine/17-04/ff_perfectmemory?currentPage=all
Myers, D. G. (2010). Psychology. New York, NY.: Worth.
The Boy who was Turned into a Girl. (n.d.). Retrieved May 01, 2011, from http://www.bbc.co.uk/science/horizon/2000/boyturnedgirl.shtml
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Bethany M. Wootton | Blake F. Dear | Luke Johnston | Matthew D. Terides | Nickolai Titov
Obsessive-compulsive disorder (OCD) is a common anxiety disorder. Although effective treatments exist many patients experience difficulties accessing treatment. Treatments that are delivered remotely, such as bibliotherapy-administered CBT (bCBT) and internet-administered CBT (iCBT) have the potential to improve access to treatment. This study was a three group randomized controlled trial that aimed to examine the benefits and acceptability of these two remote treatment options in the treatment of OCD, compared to a waitlist control group. Participants in the bCBT and iCBT groups read five lessons and received twice-weekly contact from a remote therapist. The control group did not receive any clinical contact during this time. The results indicated that participants in both remote treatment conditions (bCBT and iCBT) improved from pre-treatment to post-treatment and pre-treatment to 3-month follow-up on the Yale-Brown Obsessive Compulsive Scale. Once the bCBT and iCBT groups completed treatment, the control group was provided the iCBT protocol but with clinician contact only once per week. Results from the control group, after receiving iCBT treatment, indicated that large effect sizes can be obtained with weekly contact. These results provide preliminary support for the use of either bCBT or iCBT in the remote treatment of OCD. © 2013 Elsevier Inc.
Adam S. Radomsky | Gillian M. Alcolado | Jonathan S. Abramowitz | Pino Alonso | Amparo Belloch | Martine Bouvard | David A. Clark | Meredith E. Coles | Guy Doron | Hector Fernández-Álvarez | Gemma Garcia-Soriano | Marta Ghisi | Beatriz Gomez | Mujgan Inozu | Richard Moulding | Giti Shams | Claudio Sica | Gregoris Simos | Wing Wong
Most cognitive approaches for understanding and treating obsessive-compulsive disorder (OCD) rest on the assumption that nearly everyone experiences unwanted intrusive thoughts, images and impulses from time to time. These theories argue that the intrusions themselves are not problematic, unless they are misinterpreted and/or attempts are made to control them in maladaptive and/or unrealistic ways. Early research has shown unwanted intrusions to be present in the overwhelming majority of participants assessed, although this work was limited in that it took place largely in the US, the UK and other 'westernised' or 'developed' locations. We employed the International Intrusive Thoughts Interview Schedule (IITIS) to assess the nature and prevalence of intrusions in nonclinical populations, and used it to assess (n=777) university students at 15 sites in 13 countries across 6 continents. Results demonstrated that nearly all participants (93.6%) reported experiencing at least one intrusion during the previous three months. Doubting intrusions were the most commonly reported category of intrusive thoughts; whereas, repugnant intrusions (e.g., sexual, blasphemous, etc.) were the least commonly reported by participants. These and other results are discussed in terms of an international perspective on understanding and treating OCD. © 2013 Elsevier Ltd.
Frederick Aardema | Richard Moulding | Adam S. Radomsky | Guy Doron | Jude Allamby | Eman Souki
Obsessions - particularly those directly relating to causing harm - often contain or imply evaluative dimensions about the self, reflecting a fear as to who the person might be - or might become. Following from research indicating that such beliefs are relevant to OCD, and the wider literature in social psychology regarding 'feared' or 'undesired' self-guides, the current study describes the development and validation of a new questionnaire-the Fear of Self Questionnaire, in 8- and 20-item versions. The questionnaire was piloted in two non-clinical samples (n=258; n=292). Exploratory and confirmatory factor analyses supported the unidimensionality of the measure. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g. obsessive beliefs, inferential confusion). Implications are discussed. © 2013 Elsevier Ltd.
A. E. Nordsletten | L. Fernández de la Cruz | A. Pertusa | A. Reichenberg | S. L. Hatch | D. Mataix-Cols
The Structured Interview for Hoarding Disorder (SIHD) is a semi-structured instrument designed to assist clinicians and trained interviewers with the nuanced diagnosis of hoarding disorder (HD). The manuscript introduces the rationale, development, and design of the SIHD and presents a test of the instrument's inter-rater reliability and convergent/discriminant validity. Ninety-nine individuals with self-reported hoarding behavior, originally recruited as part of a large two-wave epidemiological study, were evaluated in their homes using the SIHD. Diagnoses of HD were determined by consensus, following a best estimate diagnosis procedure. To enable the assessment of inter-rater reliability, a psych iatrist with extensive experience diagnosing HD also independently and blindly reviewed each participant's SIHD. In addition, agreement of SIHD diagnoses with those indicated by other screening instruments for HD and depression were examined. Results indicate "substantial" or "near perfect" inter-rater reliability for all core HD criteria and specifiers. Convergent and discriminant validity were, furthermore, excellent. Overall, the SIHD offers an intuitive, valid, and reliable means of diagnosing HD. The interview also facilitates the assessment of other relevant features, such as risk. We offer recommendations for its use in both research and clinical settings, as well as suggestions for the training of interviewers. © 2013.
Kathryn Ponniah | Iliana Magiati | Steven D. Hollon
We conducted a review to provide an update on the efficacy of psychological treatments for OCD in general and with regard to specific symptom presentations. The PubMed and PsycINFO databases were searched for randomized controlled trials (RCTs) published up to mid February 2012. Forty-five such studies were identified. Exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT) were found to be efficacious and specific for OCD. More purely cognitive interventions that did not include ERP or behavioral experiments were found to be possibly efficacious, as were Acceptance and Commitment Therapy, Motivational Interviewing as an adjunct to the established treatments, Eye Movement Desensitization and Reprocessing, and Satiation Therapy. There was little support for Stress Management or Psychodynamic Therapy. Although the majority of the studies recruited mixed or unspecified samples of patients and did not test for moderation, CBT was efficacious for obsessional patients who lacked overt rituals. One more purely cognitive intervention named Danger Ideation Reduction Therapy was found to be possibly efficacious for patients with contamination obsessions and washing compulsions. Although ERP and CBT are the best established psychological treatments for OCD, further research is needed to help elucidate which treatments are most effective for different OCD presentations. © 2013 Elsevier Ltd.
Laura J. Summerfeldt | Patricia H. Kloosterman | Martin M. Antony | Richard P. Swinson
Building upon work by Rasmussen and Eisen, our group has proposed a model comprising two core motivational dimensions underlying obsessive-compulsive symptoms: harm avoidance and incompleteness. The model has received increasing attention; however the structural soundness and divergence of its factors are yet to be investigated fully, either as symptom-specific motivations for clinical OCD symptoms or as stylistic traits in the nonclinical population. This paper presents four studies designed to investigate the structural validity of harm avoidance and incompleteness in clinical and nonclinical samples. Results yielded support across the method of assessment (interview, questionnaire), level of generality (symptom-specific state, trait), and population (clinical, nonclinical). Evidence was also found of the model's method invariance, with both factors strongly self-associated across method forms when ascertained as symptom-specific motivations. The results provide support for key assertions of the core dimensions model and also point to the utility of the interviewer-rated and questionnaire measures developed during this work: the Obsessive-Compulsive Core Dimensions Interview (OC-CDI) and Core Dimensions Questionnaire (OC-CDQ). Clinical and theoretical implications and challenges for future research are discussed. © 2014 Elsevier Ltd.
Randy O. Frost | Veselina Hristova | Gail Steketee | David F. Tolin
Research on hoarding over the last two decades has shown that hoarding disorder appears to be a distinct disorder that burdens the individual, the community and the families of people who hoard. Although hoarding clearly interferes with the daily functioning, especially in the context of extensive clutter, no validated measures of this interference have been developed. The present research examined the psychometric properties of the Activities of Daily Living in Hoarding scale (ADL-H) in two large samples of individuals with significant hoarding problems, one identified through the internet (n=363) and a second through clinical diagnostic interviews (n=202). The ADL-H scale test-retest (1-12 weeks), interrater and internal reliabilities ranged from .79 to .96. Convergent and discriminant validity were established through analyses of correlational data collected for measures of hoarding severity and non-hoarding psychopathology (obsessive-compulsive disorder [OCD], moodstate, attention deficit, and perfectionism/uncertainty), as well as through comparisons of scores among individuals with hoarding, hoarding plus OCD, OCD without hoarding, and community controls. The ADL-H scale appears to have strong psychometric properties and to be useful in clinical and research settings. Suggestions are made for expansion of the scale, and study limitations are noted. © 2012 Elsevier Ltd.
Eli R. Lebowitz
Despite the efficacy of E/RP and pharmacotherapy for OCD, many children do not respond adequately to therapy. Furthermore, many children exhibit low motivation or ability to actively participate in therapy, a requirement of E/RP. Research has underscored the importance of family accommodation for the clinical course and treatment outcomes of childhood OCD. Recent studies highlighted the potential of family involvement in treatment to enhance outcomes for challenging cases. These interventions however still require child participation. The goal of this clinical report is to describe an exclusively parent-based intervention and present preliminary indications of its acceptability, feasibility and potential efficacy. The Supportive Parenting for Anxious Childhood Emotions (SPACE) Program is a manualized treatment focused on reducing accommodation and coping supportively with the child's responses to the process. The theoretical foundation of the intervention is presented and its practical implementation is illustrated, with excerpts from the treatment manual and a clinical vignette. Preliminary results from the parents of 6 children, who refused individual therapy, are presented. Parents participated in 10 weekly sessions and reported high satisfaction and reduced child symptoms. Research is required to investigate the potential of SPACE as a complement or alternative to other evidence based interventions for childhood OCD. © 2013 Elsevier Inc.
© 2015 Elsevier Inc. For over a quarter century, a substantial body of literature investigating neuropsychological test performance in obsessive-compulsive disorder (OCD) has yielded inconsistent results. Thus, it has been continuously challenging to draw conclusions regarding an OCD-specific neuropsychological profile. In this comprehensive review of the neuropsychological literature in OCD, we critically review neuropsychological test performance by domain, as well as potential moderators of neuropsychological functions, proposed endophenotypes, neuropsychological predictors of treatment response, and contemporary controversies in the field. Previous qualitative/systematic reviews of this body of literature have repeatedly noted its inconsistency, concluding that more research is needed. Unfortunately, the accumulation of neuropsychological research is OCD has not yet promoted our ability to draw conclusions about a distinct neuropsychological profile of OCD. Thus, we conclude this review with novel suggestions for future investigations.
Adam S. Radomsky | S. Rachman | Roz Shafran | Anna E. Coughtrey | Kevin C. Barber
There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory-Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n=57), participants diagnosed with an anxiety disorder other than OCD (n=24) and in undergraduate student controls (n=410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n=30) and those whose OCD excluded concerns related to contamination fear (n=27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD. © 2013 Elsevier Ltd.
Clare M. Eddy | Andrea E. Cavanna
© 2014 Elsevier Inc. The strong genetic link between obsessive compulsive disorder (OCD) and Tourette syndrome (TS) raises the possibility that obsessions and compulsions may comprise an alternative phenotypic expression of tics. Both of these disorders are characterised by repetitive behaviours (RB) involving recurrent thoughts and/or actions, often linked to dangerous or taboo themes, which present fairly early in life and tend to follow a chronic waxing and waning course. Over time many studies have attempted to disentangle the clinical profiles of these disorders. This article explores the key differences revealed by research over the last few decades, examining the types of RB expressed, patients' accompanying phenomenological experience (e.g. cognitive and sensory correlates), the proposed neural bases for each condition, and common interventions. Attempts to distinguish between OCD and TS based on the specific types of RB have often met with limitations. However, existing literature pertaining to the phenomenological experience of OCD and TS indicates that a number of factors may help differentiate these commonly associated conditions. Furthermore, differences in the psychological and physiological correlates of RB in TS and OCD are broadly in accordance with neuroimaging data. Study findings could offer insight into the predominance of TS diagnosis in males, age-related changes in diagnoses and the association between more context-dependent tic-like behaviours and OCD in patients with TS. Future studies should explore relationships between the cognitive, emotional and sensory aspects of RB and patients' demographical characteristics, neuropsychological test performance, and neural profiles.
David A. Clark | Jon Abramowitz | Gillian M. Alcolado | Pino Alonso | Amparo Belloch | Martine Bouvard | Meredith E. Coles | Guy Doron | Hector Fernández-Álvarez | Gemma Garcia-Soriano | Marta Ghisi | Beatriz Gomez | Mujgan Inozu | Richard Moulding | Adam S. Radomsky | Giti Shams | Claudio Sica | Gregoris Simos | Wing Wong
A key assumption of contemporary cognitive-behavioral models of obsessive-compulsive disorder (OCD) is that obsessional thoughts exist on a continuum with "normal" unwanted intrusive thoughts. Recently, however, some authors have challenged this notion. The present study aimed to clarify (a) the extent that different types of intrusive thoughts in nonclinical individuals are associated with obsessionality, (b) the relative contribution of frequency, distress and control ratings to obsessionality, and (c) the extent that existing findings (primarily from North American or European samples) generalize to other countries in the world. Five hundred and fifty-four non clinical individuals from 11 different countries were administered an interview assessing the presence, frequency, distress, and perceived control of different types of intrusive thoughts. Participants also completed measures of obsessional beliefs, obsessive-compulsive (OC) symptoms, and depression. Results from data analyses supported the universality of unwanted intrusive thoughts, the continuity of normal and abnormal obsessions, and the specificity of dirt/contamination, doubt and miscellaneous intrusions to OC symptoms. Implications for intrusive thoughts as a potential vulnerability factor for OCD are discussed. © 2013 Elsevier Ltd.
David L. Pauls | Thomas V. Fernandez | Carol A. Mathews | Matthew W. State | Jeremiah M. Scharf
© 2014 Elsevier Inc. Georges Gilles de la Tourette, in describing the syndrome that now bears his name, observed that the condition aggregated within families. Over the last three decades, numerous studies have confirmed this observation, and demonstrated that familial clustering is in part due to genetic factors. Recent studies are beginning to provide clues about the underlying genetic mechanisms important for the manifestation of some cases of Tourette Disorder (TD). Evidence has come from different study designs, such as nuclear families, twins, multigenerational families, and case-control samples, together examining the broad spectrum of genetic variation including cytogenetic abnormalities, copy number variants, genome-wide association of common variants, and sequencing studies targeting rare and/or de novo variation. Each of these classes of genetic variation holds promise for identifying the causative genes and biological pathways contributing to this paradigmatic neuropsychiatric disorder.
Jennifer DiMauro | David F. Tolin | Randy O. Frost | Gail Steketee
Previous research indicates that people with hoarding sometimes under- or over-report the severity of their symptoms. This article examines the results of two separate studies that evaluate severity ratings made by participants with hoarding disorder (HD) in comparison to ratings by family members or independent evaluators. In Study 1, HD participants' ratings of the severity of the clutter in their home and their hoarding behaviors were less severe than those made by their friends or family members. This result may be accounted for by family members' rejecting attitudes towards the participant. In Study 2, HD participants appeared to under-report specific hoarding symptoms while over-reporting their overall global impression of hoarding severity. A three-pronged assessment approach is recommended in which ratings of hoarding severity are made by the HD participant, their family member, and an independent observer or clinician. Such an approach would better inform future research, and also clinical treatment. © 2013 Elsevier Inc.
Katharine A. Phillips | Ashley S. Hart | William Menard
The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) is a semi-structured, clinician-rated measure of current BDD severity used in many BDD studies, but only one previous study has examined its psychometric properties. We examined the BDD-YBOCS[U+05F3]s psychometric properties in 200 BDD subjects from a prospective, observational study. Test-retest reliability (n=64) and sensitivity to change with SRI treatment (n=63) were examined in subjects from serotonin-reuptake inhibitor efficacy studies in BDD. Intraclass correlation coefficients demonstrated excellent interrater and test-retest reliability; internal consistency was strong. Principal components factor analysis identified two factors accounting for 66% of the variance. Analyses with measures of depression, social phobia, and global symptoms/psychosocial functioning indicated good convergent and discriminant validity. Mean BDD-YBOCS scores significantly decreased with treatment, indicating sensitivity to change. A ≥30% decrease in BDD-YBOCS score corresponded well to at least "much improved", and ≥50% to "very much improved", on the Clinical Global Impressions-Improvement scale. These results provide additional support for the BDD-YBOCS's psychometric properties. © 2014 Elsevier Ltd.
Lawrence Scahill | Matthew Specht | Christopher Page
© 2014 Elsevier Inc. Background: Prevalence is a simple statement about the frequency of a disease in the population. For many medical conditions, including Tourette syndrome, there are true cases that have not been previously diagnosed due to problems of access to appropriate clinical services. Therefore, to obtain a trustworthy estimate of prevalence, it is necessary to go beyond cases identified in clinical settings and evaluate community samples. Method: We reviewed 11 community surveys in children with Tourette syndrome (TS) published since 2000. We also examined the frequency of co-occurring psychiatric conditions in community samples and large clinically-ascertained samples. Results: Transient tics are relatively common affecting as many as 20% of school-age children. The 11 studies reviewed here offer a wide range of estimates from 2.6 to 38 per 1000 children for TS. Six studies provide estimates in a narrower range from 4.3 to 7.6 per 1000 but the confidence interval around this narrower range remains wide. Six studies provided results on chronic tic disorders ranging from 3 to 50 per 1000 for Chronic Motor Tic Disorder and 2.5 to 9.4 per 1000 for Chronic Vocal Tic Disorder. Community samples and large clinically-ascertained samples consistently show high rates of ADHD, disruptive behavior and anxiety disorders in children with TS. Conclusions: The wide range of prevalence estimates for TS and chronic tic disorders is likely due to differences in sample size and assessment methods. The best estimate of prevalence for TS in school-age children is likely to fall between 4 and 8 cases per 1000. Clinical assessment of children with chronic tic disorders warrants examination of other problems such as ADHD, disruptive behavior and anxiety.
Caroline Schwartz | Sandra Schlegl | Anne Katrin Kuelz | Ulrich Voderholzer
This article systematically reviews the literature on (a) the proportions of treatment-seeking OCD patients in community-based studies as well as on (b) the proportion of cognitive-behavioral therapy (CBT) or behavior therapy (BT) administered in OCD as reported in studies based on treatment-seeking populations. The literature search was conducted in PsycInfo and PubMed. Inclusion criteria were: (1) studies for which adult subjects with an OCD diagnosis were recruited (2) n > 10 (3a) studies with data on the percentage of individuals seeking treatment for OCD symptoms in OCD subsamples of community studies or (3b) studies with data on the percentage of patients in treatment-seeking OCD populations receiving cognitive-behavioral therapy (CBT) or behavior therapy (BT) (4) publication written in English, German, French, Spanish, Portuguese or Italian. 20 articles met these criteria, 12 for part (a), and 8 for part (b) of the review. Findings indicate that a majority of OCD sufferers never seek help for this disorder. Moreover, only a minority of treatment-seekers with OCD seems to receive cognitive-behavioral therapy including exposure techniques. Studies with representative OCD patient samples are urgently needed to shed more light on the actual treatment situation, and to derive measures for the prevention of negative long-term outcome. © 2013 Elsevier Inc.
Richard Moulding | Frederick Aardema | Kieron P. O'Connor
Obsessive-compulsive disorder (OCD) is a highly disabling psychiatric disorder, characterized by the occurrence of intrusive, unwanted thoughts (obsessions), which lead to the performance of repetitive compulsions and/or rituals in order to reduce distress and prevent feared outcomes from occurring. In particular, one grouping of obsessive themes that has been highlighted in the clinical literature involves the predominance of thoughts that are highly repugnant to the individual; specifically, unwanted sexual or aggressive thoughts. Compared to other OCD themes, these thoughts may have distinct clinical characteristics, such as being linked to different forms of compulsions including covert rituals and thought-suppression, being linked to greater distress, and being rated as being more ego-dystonic. Theoretically, different mechanisms have been proposed that may underlie these obsessions, for example the meaning that the thought has for the individual has been highlighted, and the theme of obsessions has also been linked with negative self-related beliefs. Finally, such repugnant thoughts may also require specialized techniques in cogni tive behavioral therapy. This review outlines such clinical, theoretical and treatment-related aspects of this theme of OCD, and thereby highlights the impact of content on form in this disorder. © 2013 Elsevier Ltd.
Jesse R. Cougle | Han Joo Lee
Cognitive models of obsessive-compulsive disorder (OCD) (e.g., Rachman, 1997; Salkovskis, 1985) have been highly influential over the last few decades, garnering a wealth of research support. However, they have not generally led to improvements in the treatment of OCD. In the current paper, we argue that several features of OCD that cognitive models identify as dysfunctional may actually be non-pathological. Specifically, we discuss how dysfunctional beliefs central to cognitive theories may be epiphenomena and features of OCD assumed to be pathological (e.g., intrusion-related distress) may be normative. We also identify several gaps in the literature and present directions for future research. © 2013 Elsevier Ltd.