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Depress Anxiety. 2011 Jun;28(6):495-500. doi: 10.1002/da.20820. Epub 2011 Apr 20.

Myth of the pure obsessional type in obsessive--compulsive disorder.

Author information

1
Department of Psychiatry, Center for Treatment and Study of Anxiety, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. monnica@mail.med.upenn.edu

Abstract

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.

PMID:
21509914
PMCID:
PMC3227121
DOI:
10.1002/da.20820
[Indexed for MEDLINE]
Free PMC Article

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