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Compr Psychiatry. 2017 May;75:117-124. doi: 10.1016/j.comppsych.2017.03.004. Epub 2017 Mar 12.

An investigation of doubt in obsessive-compulsive disorder.

Author information

1
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jacks@jhmi.edu.
2
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
4
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA.
5
Department of Psychiatry, College of Physicians and Surgeons at Columbia University and the New York State Psychiatric Institute, New York City, New York, USA.
6
Department of Psychiatry, University of Southern California School of Medicine, Los Angeles, California, USA.
7
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA.
8
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
9
Department of Psychiatry and Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
10
Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver.
11
Laboratory of Clinical Science, National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA.
12
Unit of Statistical Genomics, Division of Intramural Research, National Institute of Mental Health, Bethesda, MD, USA.

Abstract

BACKGROUND:

Clinicians have long considered doubt to be a fundamental characteristic of obsessive-compulsive disorder (OCD). However, the clinical relevance of doubt in OCD has not been addressed.

METHODS:

Participants included 1182 adults with OCD who had participated in family and genetic studies of OCD. We used a clinical measure of the severity of doubt, categorized as none, mild, moderate, severe, or extreme. We evaluated the relationship between doubt and OCD clinical features, Axis I disorders, personality and personality disorder dimensions, impairment, and treatment response.

RESULTS:

The severity of doubt was inversely related to the age at onset of OCD symptoms. Doubt was strongly related to the number of checking symptoms and, to a lesser extent, to the numbers of contamination/cleaning and hoarding symptoms. Doubt also was related to the lifetime prevalence of recurrent major depression and generalized anxiety disorder; to the numbers of avoidant, dependent, and obsessive-compulsive personality disorder traits; and to neuroticism and introversion. Moreover, doubt was strongly associated with global impairment and poor response to cognitive behavioral treatment (CBT), even adjusting for OCD severity and other correlates of doubt.

CONCLUSIONS:

Doubt is associated with important clinical features of OCD, including impairment and cognitive-behavioral treatment response.

PMID:
28359017
PMCID:
PMC5479326
DOI:
10.1016/j.comppsych.2017.03.004
[Indexed for MEDLINE]
Free PMC Article

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