Myth of the pure obsessional type in obsessive-compulsive disorder
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BACKGROUND: Several studies have identified discrete symptom dimensions in obsessive-compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC). This study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Because these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called "pure obsessions" may have been overlooked. METHOD: Participants (N = 201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms, as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis. RESULTS: Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts). CONCLUSIONS: This study suggests that the concept of the "pure obsessional" (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria.
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Excessive habit formation may be a contributor to OCD.
“This notion that excessive habit formation may be a contributor to OCD is consistent with recent data suggesting that compulsivity might play a more prominent role in OCD than previously assumed (36).”
From Enhanced avoidance habits in obsessive-compulsive disorder (2014) · cites this paper as [36]
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- Authors
- Williams, M. T., Farris, S. G., Turkheimer, E., Pinto, A., Ozanick, K., Franklin, M. E., Liebowitz, M., Simpson, H. B., & Foa, E. B.
- Affiliations
- University of Pennsylvania (US)
- University of Virginia (US)
- New York State Psychiatric Institute (US)
- Drexel University (US)
- Corresponding author
- Williams, Monnica T.
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2011-04-20
- Volume
- 28
- Issue
- 6
- Pages
- 495-500
- ISSN
- 1091-4269 (ISSN-L)
- PMC
- PMC3227121
- OpenAlex
- W2129374538
- Cited by
- 113
- References
- 28
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 7 · 2019: 4 · 2018: 5 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 9 · 2013: 12 · 2012: 5
- FWCI
- 10.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K24MH091555, MH45436, 080221, R01MH045404, R01MH-45404, R01 MH-045404-17S1, MH45404, K23MH080221, R01 MH-, R01MH045436, R01MH-45436)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, obsessions and compulsions, reassurance seeking, symptom dimensions, DSM-5 diagnostic criteria
- MeSH terms
- Adult, Ceremonial Behavior, Clomipramine, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Personality Assessment, Taboo, Thinking, Cognitive Behavioral Therapy, Selective Serotonin Reuptake Inhibitors
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