Given the high rates of treatment drop-out and non-compliance within empirically-based treatments for OCD, it is important to increase our understanding of factors that impact the treatment process. Two studies were conducted to evaluate the clinical utility of the Obsessive Compulsive Consequences Scale-Revised (OCCS-R) and increase understanding of the relationships between the prognostic factors of motivation, insight, treatment compliance and treatment outcome. Study 1 used maximum likelihood Confirmatory Factor Analysis to show the OCCS-R's four factor solution was an adequate fit in a sub-clinical college population. Study 2 evaluated the clinical utility of the OCCS-R for predicting treatment outcome and its relationship to identified predictor variables. The OCCS-R predicted treatment drop-out but did not predict symptom improvement. Some support was found for predicted relationships between the OCCS-R and its factors, a general measure of motivation and treatment compliance. No variables predicted symptom improvement. Insight and initial symptom severity predicted treatment motivation which in turn predicted treatment compliance. / Ph. D.

Este estudo avaliou 106 crianças e adolescents com TOC e 44 probandos controle. Estes probandos e seus 465 familiares de primeiro grau foram avaliados por entrevistadores treinados, usando entrevistas semi-estruturadas. Diagnósticos foram determinados pelo DSM-IV, pelo processo de estimativa de diagnóstico. Comparados aos "familiares controle", "familiares caso" tiveram risco significativamente aumentado para TOC (22.7% vs. 0.9%) e tiques (11.6% vs. 1.7%). Houve uma correlação significativa entre as idades de início do TOC nos probandos e seus familiares. Estes dados sugerem que o TOC de início precoce é um transtorno altamente familiar. / The current study examined 106 children and adolescents with OCD and 44 control probands. These probands and their 465 first-degree relatives were assessed by trained interviewers, using standardized semi-structured interviews. Diagnoses were assigned according to DSM-IV criteria, through the best-estimate process. Compared to control relatives, case relatives had higher age-corrected recurrence risks of OCD (22.7% vs. 0.9%) and tics (11.6% vs. 1.7%). There was a significant correlation between the ages of onset of OCD in probands and their affected relatives. These data suggest that childhood onset OCD is a highly familial disorder.

This study explored the experiences of members of an OCD support group, utilising a qualitative design, social constructionist approach, and a systemic framework. Participants were obtained through purposive sampling; data was collected via faceto- face semi-structured interviews with four participants. It emerged that these participants attended two OCD support groups (initial support group and sub-support group). The participants’ experiences were analysed using thematic analysis. Major findings: the participants’ motivation to attend both support groups was to reduce their OCD symptoms and improve functioning. The initial support group was a professional-led psychoeducational support group while the sub-support group was a self-help psychotherapeutic group. The groups also complemented each other with information from the initial support group being implemented in the sub-support group. The participants reported to have benefitted from participation in both support groups as their OCD symptoms reduced and their daily functioning improved. Recommendations for future research were discussed. / Psychology / M.A. (Clinical Psychology)

Este estudo avaliou 106 crianças e adolescents com TOC e 44 probandos controle. Estes probandos e seus 465 familiares de primeiro grau foram avaliados por entrevistadores treinados, usando entrevistas semi-estruturadas. Diagnósticos foram determinados pelo DSM-IV, pelo processo de estimativa de diagnóstico. Comparados aos "familiares controle", "familiares caso" tiveram risco significativamente aumentado para TOC (22.7% vs. 0.9%) e tiques (11.6% vs. 1.7%). Houve uma correlação significativa entre as idades de início do TOC nos probandos e seus familiares. Estes dados sugerem que o TOC de início precoce é um transtorno altamente familiar. / The current study examined 106 children and adolescents with OCD and 44 control probands. These probands and their 465 first-degree relatives were assessed by trained interviewers, using standardized semi-structured interviews. Diagnoses were assigned according to DSM-IV criteria, through the best-estimate process. Compared to control relatives, case relatives had higher age-corrected recurrence risks of OCD (22.7% vs. 0.9%) and tics (11.6% vs. 1.7%). There was a significant correlation between the ages of onset of OCD in probands and their affected relatives. These data suggest that childhood onset OCD is a highly familial disorder.

Le trouble obsessionnel-compulsif (TOC) se caractérise par la présence d’obsessions et/ou de compulsions. À la lumière de l’hétérogénéité du TOC et de la présence de styles de pensées et de comportements de type TOC chez des personnes présentant d’autres problèmes de santé mentale, certains ont fait valoir la nécessité de créer une catégorie des troubles du spectre obsessionnel-compulsif et d’identifier les processus cognitifs communs qui sous-tendent ces troubles afin d’élaborer des théories et des traitements plus parcimonieux. Une tendance générale à douter de ses sens et de ses facultés cognitives semble être le pivot des troubles obsessionnels. Selon l’approche basée sur les inférences, le doute obsessionnel est suscité par un processus de raisonnement erroné, soit la confusion inférentielle (CI). La CI implique (1) une méfiance vis-à-vis des sens et (2) une importance indue accordée aux possibilités imaginaires. La faible confiance cognitive (CC), un processus cognitif similaire, renvoie à une méfiance par rapport à son attention, sa perception et sa mémoire. Cette thèse a visé à étudier la CI et la faible CC en tant que potentiels facteurs cognitifs transdiagnostiques dans le spectre de l’obsessionnalité. Le premier article constitue une revue systématique avec méta-analyse destinée à évaluer le rôle de la CC pour différents sous-types du TOC et à examiner à quel degré la faible CC est associée aux symptômes du TOC. On a constaté que les individus atteints d’un TOC présentent une plus faible CC que les témoins sains, mais que celle-ci ne semble pas spécifique au TOC. L’article a aussi souligné la nécessité d’employer des tâches idiosyncratiques, ciblant les distorsions de la pensée propres au TOC, afin de bien mesurer la CC. Dans le cadre du deuxième article, le but a été d’approfondir cette piste de recherche en examinant le rôle commun de la faible CC et de la CI pour les différents sous-types du TOC, en procédant à des analyses de grappes avec un échantillon de 128 patients atteints d’un TOC. Alors qu’il a été constaté que la faible CC correspondait davantage aux sous-types de vérification et « tout à fait juste », la CI semble pertinente pour un plus large éventail de profils TOC. Le troisième article examine le rôle de la CI chez les troubles des conduites alimentaires (TCAs) en provoquant la CI expérimentalement. Des participantes atteintes d’un TA (n = 18) et des femmes témoins saines (n = 18) ont été assignées à l’une des deux conditions expérimentales : pour la condition CI élevée, les participantes ont visionné des vidéos où des séquences clés étaient manquantes, ce qui suscitait la CI; pour la condition CI faible, les participantes ont visionné les vidéos intégrales. Chez le groupe TA assigné à la condition CI élevée, on a observé une tendance à présenter un état de CI post-vidéos supérieur, un recours accru au comportement de neutralisation et, enfin, davantage de symptômes TOC. En somme, les résultats de cette thèse soulignent la pertinence de la CI et de la faible CC en tant que facteurs cognitifs transdiagnostiques sur le spectre obsessionnel-compulsif. / Obsessive-compulsive disorder (OCD) is a severe mental health disorder that involves obsessions and/or compulsions. In light of the heterogeneity of OCD and of the presence of OCD-like thinking and behaviors in several disorders, some have argued for the necessity of a new category of obsessive-compulsive spectrum disorders. Considering the overlap between various disorders characterized by obsessionality, there is a need for the identification of common cognitive processes that underpin these disorders in order to formulate more parsimonious explanations and treatments for these conditions. A general tendency to doubt the senses and cognitive faculties appears as central to obsessional disorders. According to the inference-based approach, the obsessional doubt is elicited by a faulty reasoning process known as inferential confusion (IC), that implicates (1) a distrust of the senses, and (2) an investment in imaginary possibilities. A similar construct is low cognitive confidence, which is defined as a distrust of one’s attention, perception and memory. The overarching goal of this thesis was to examine IC and low cognitive confidence as potential transdiagnostic cognitive factors across the spectrum of obsessionality. The first thesis article evaluated the role of cognitive confidence across OCD subtypes and examined the extent to which poor cognitive confidence is associated with OCD symptomatology by conducting a systematic review with a meta-analysis. This article led to the conclusion that individuals with OCD have lower cognitive confidence than healthy controls, but that it is unclear if cognitive confidence is specific to OCD, such that the use of idiosyncratic tasks appears to be required in order to correctly capture cognitive confidence in OCD. The second thesis article furthered this investigation by examining the joint role of low cognitive confidence and IC across OCD subtypes by performing cluster analyses using a sample of 128 individuals with OCD. While cognitive confidence was found to more relevant to the checking and “just right” subtypes, IC appeared to be relevant to a wider range of OCD profiles. The third thesis article sought to examine the role of IC in eating disorders by inducing IC experimentally. Female participants with an eating disorder (n = 18) and healthy controls participants (n = 18) were recruited. Participants were assigned to one of two experimental conditions: in the High IC condition, participants watched videos with key sequences missing – provoking a distrust of the senses and lending more space for the imagination, thus triggering IC. In the Low IC condition, participants watched videos without sequences missing. The eating disorder group assigned to the High IC condition demonstrated a trend for higher levels of state IC, greater neutralization behavior and higher OCD symptoms than those who were assigned to the Low IC condition. Taken together, the results of the present thesis underline the relevance of IC and cognitive confidence as transdiagnostic cognitive factors across the obsessive-compulsive spectrum.

Body Dysmorphic Disorder (BDD) and Obsessive Compulsive Disorder (OCD) share many similarities such as the presence of obsessions and compulsions, a similar age of onset and also similar activation of underlying structures within the brain related to obsessions and compulsion formation. The recently published DSM-V (Diagnostic and Statistical Manual for Mental Disorders; American Psychiatric Association, 2013) has grouped the two conditions together in a chapter entitled Obsessive Compulsive -and related disorders, recognising the similarities in presentation. This appeared to echo the classification within the NICE guidelines for OCD and BDD (National Institute for Health and Care Excellence, 2006) where the two conditions were grouped together on the presence of obsessions and compulsions, neurological evidence pointing to the activation of brain areas responsible for obsessive thoughts and compulsive acts alongside strong familial links. Both OCD and BDD were understood (from both sets of guidelines) to respond well to the use of Selective Serotonin Re-uptake Inhibitors and the treatment use of Cognitive Behavioural Therapy. This qualitative research study focuses on the gap in existing literature by studying the lived experience of individuals living with obsessions and compulsions. Much focus has historically remained on understanding the clinical symptomology and underlying constructs as related to living with obsessions and compulsions, through the use of questionnaires or brain imaging. With recent changes in the DSM-V (Statistical Manual for mental Disorders; American Psychiatric Association, 2013) recognising OCD and BDD as part of the same family of conditions, it appeared timely to focus on the individuals living with OCD or BDD and their sense and meaning making as informed by their experiences of obsessions and compulsions.

<p>Obsessive-compulsive disorder (OCD) is a devastating illness that afflicts around 2% of the world's population with recurrent distressing thoughts (obsessions) and repetitive ritualistic behaviors (compulsions). While dysfunction at excitatory glutaminergic excitatory synapses leading to hyperactivity of the orbitofrontal cortex and head of the caudate - brain regions involved in reinforcement learning - are implicated in the pathology of OCD, clinical studies involving patients are unable to dissect the molecular mechanisms underlying this cortico-striatal circuitry defect. Since OCD is highly heritable, recent studies using mutant mouse models have shed light on the cellular pathology mediating OCD symptoms. These studies point toward a crucial role for deltaFosB, a persistent transcription factor that accumulates with chronic neuronal activity and is involved in various diseases of the striatum. Furthermore, elevated deltaFosB levels results in the transcriptional upregulation of Grin2b, which codes GluN2B, an N-methyl-D-aspartate glutamate receptor (NMDAR) subunit required for the formation and maintenance of silent synapses. Taken together, the current evidence indicates that deltaFosB-mediated expression of aberrant silent synapses in caudate medium spiny neurons (MSNs), in particular D1 dopamine-receptor expressing MSNs (D1 MSNs), mediates the defective cortico-striatal synaptic transmission that underlies compulsive behavior in OCD.</p> / Dissertation

Huvudsyftet med föreliggande studie var att undersöka skillnader mellan crossfitutövare och traditionellt gymaktiva i muskelsträvan, träningsrelaterat instagram-användande, tvångsmässig passion och träningsmängd samt undersöka samband avseende dessa variabler. Vidare undersökte studien om exponering för tränings- och utseenderelaterade bilder, tvångsmässig passion samt ökat träningsbeteende efter exponering för bilder på instagram kan predicera muskelsträvan. Genom en kvantitativ forskningsansats fick deltagarna besvara en enkät innefattande mätinstrumenten: Godin Leisure- Time Exercise Questionnaire, The Passion Scale, Drive for muscularity scale. Utifrån ett bekvämlighetsurval rekryterades 156 deltagare (66 män och 89 kvinnor, en person uppgav inte kön) i åldern 16-65 år (M=28). Studien visar att crossfitutövare har mer muskelsträvan, träningsrelaterat instagram-användande, tvångsmässig passion samt träningsmängd jämfört med traditionellt gymaktiva. Muskelsträvan visade positiva samband med träningsrelaterat instagram-användande, tvångsmässig passion samt träningsmängd. Vidare visade studien att exponering för tränings- och utseenderelaterade bilder på Instagram, tvångsmässig passion samt ökat träningsbeteende efter exponering för bilder på Instagram kan predicera muskelsträvan. För framtida forskning föreslås att undersöka om andra grupper med stort träningsrelaterat instagram-användande också har mer muskelsträvan samt tvångsmässig passion.

9 Summary This thesis deals with obsessive-compulsive disorder in connection with the practice of social work. It draws attention to numerous problems of anxiety disorders in society, risk factors for the development of anxiety disorders and risks in the social sphere. It also analyzes in detail obsessions, compulsions, manifestations and diagnosing of OCD and, last but not least, the practice of social work with the obsessive-compulsive disorder. Social work with people suffering from obsessive-compulsive disorder may be more challenging overall, requiring increased patience, knowledge of social workers, and the ability to use some important methods. The same importance is dedicated to managing clients to refer to follow-up professional help. People with OCD deserve support from experts and acceptance by the public, which is also a reason why it is so important to have knowledge of obsessive-compulsive disorder and do not underestimate this issue..

This qualitative study explores the unconscious life of four children diagnosed with Obsessive-Compulsive Disorder (OCD) specifically related to selfconcept, personality, and psychopathology using a case study approach. A review of literature on childhood OCD is presented and the study is located within a psychodynamic theoretical framework. Findings indicate that the children are emotionally maladjusted, with high levels of anxiety and psychopathology. They have low self-esteem and poor body images, mostly tending towards immaturity. Two of the children have personality disturbances (neurotic, hysterical personalities). All the children have disturbed superegos (harsh or neurotic). Although their symptoms are currently mild, and some have ceased, analysis suggests they have been repressed and continue to affect them. They are sexually preoccupied and conflicted due to the unsuccessful resolution of the Oedipus complex. They have poor impulse control and considerable anger and aggression (mostly overt). They experience their environment as unstable and frightening and have anxieties about physical injury and being watched. The boys have regressed sex drives and homosexual tendencies, and have not identified with their fathers. The girls have identified with their mothers but experience masturbation guilt and blocked sexual drives, causing anxiety and moodiness. The children are all highly defended and escape from feelings of helplessness, inadequacy, and isolation, and discharge anxiety and aggressive instincts by using the defenses of undoing, reaction formation, acting-out, fantasy (sometimes violent), projection, displacement, and intellectualisation. Their strong dependency needs suggest fixation in the oral stage of psychosexual development. They tend towards self-directed aggression and depression. Most have family histories of mood disorders (particularly depression), and obsessions linked to fears of economic hardship due to parental illness or death. Most have histories of anxiety disorders or anxiety-related problems, and family histories of anxiety disorders and/paternal OCD. They all experienced a personally traumatic event precipitating the onset of OCD.