Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Compulsive hoarding is a serious disorder that causes significant impairment in the home. While compulsive hoarding has been traditionally associated with obsessive-compulsive disorder (OCD), standard OCD treatments have been mostly ineffective for hoarding. Recent research has provided evidence that hoarding has a distinct profile that could indicate a separate disorder. Further understanding of hoarding may advance classification and treatment. One understudied aspect of hoarding is excessive acquisition. Acquisition behaviors in hoarding appear to share similarities with impulse control disorders. While preliminary research has suggested elevated impulsivity in those who hoard, prior studies have been inconsistent in their measurement of impulsivity. Also, the relationship between impulsivity and excessive acquisition behaviors remains unexplored. This study assessed impulsivity in hoarding (n = 32) and anxiety disorder (n = 32) participants using a multi-dimensional model of impulsivity. Participants underwent a diagnostic assessment and completed self-report forms and neuropsychological tasks measuring impulsivity. Participants also completed an experimental task to assess acquiring behaviors after a mood induction. Participants completed measures of affect and state impulsivity, before and after a negative or neutral mood induction. There were no significant differences between diagnostic groups on self-reported impulsivity levels. Significant between-group differences were found on several neuropsychological tasks. Those with hoarding had significantly poorer response inhibition and lowered levels of adaptive and maladaptive risk-taking than participants with anxiety disorders. A diagnosis of hoarding predicted these outcomes independent of social phobia, generalized anxiety disorder, and major depressive disorder. In the acquisition task, the hoarding group acquired significantly more items than the anxiety disorder group but there was not a significant interaction effect with mood induction condition. The hoarding group had a significantly greater increase in state impulsivity across time but there was also not an interaction effect with mood induction condition. An analysis designed to assess whether state impulsivity mediated the relationship between negative affect and acquisition behaviors failed to find a significant indirect effect. Overall, study findings suggest differences in impulsivity for those who hoard as compared to those with an anxiety disorder. A continued emphasis on understanding impulsivity in hoarding could further diagnostic classification and treatment development. / 2031-01-02

The current study examined the psychometric properties of the Pathways to Inflated Responsibility Beliefs Scale (PIRBS; Coles & Schofield, 2008), a measure designed to assess the theoretical pathways posited to contribute to responsibility beliefs in individuals with obsessive-compulsive disorder (OCD; Salkovskis et al., 1999). The primary aim of this study was to examine the factor structure, reliability, and validity of the measure in a diverse sample as well as to compare the properties of the scale across ethnic groups. The current sample consisted of 442 university students who completed questionnaire packets or an online survey. The results of an exploratory factor analysis suggested that a four-factor model with three items removed from the original PIRBS scale best fit the data. Confirmatory factor analyses in groups of African American and Caucasian participants indicated that neither the original PIRBS model nor the EFA-derived model adequately fit the data, but the latter model demonstrated comparable indicators of validity as well as an improvement in the internal consistency of the PIRBS Overprotection subscale. Evidence of the convergent and discriminant validity of the PIRBS was obtained through its associations with OCD-relevant constructs, including OC beliefs domains and symptoms, trait anxiety and worry, depression, parenting styles, a measure of childhood responsibility, and religiosity. Some differential associations were observed in these relationships across ethnic groups. Suggestions for future research and the clinical implications of research in this area are discussed.

Obsessive-compulsive disorder (OCD) contributes to significant distress and chronic individual and societal impairment (e.g., DuPont et al., 1995; Ruscio et al., 2010). Despite the effectiveness of existing exposure-based therapies, some clients do not achieve symptom reduction or remission (Öst et al., 2015). Thus, identification of the mechanisms of change in treatment and more focused interventions are warranted to improve intervention effectiveness (e.g., Zvolensky et al., 2006). Distress intolerance may be an important but understudied mechanism of change in treatment for OCD. The current study replicated and extended previous findings that were limited by a small sample size (Macatee & Cougle, 2015), lack of focus on OCD specifically (McHugh et al., 2014; Bornovalova et al., 2012; Williams et al., 2013), and the use of non-clinical participants (Cougle et al., 2011; Macatee & Cougle, 2015) by using a residential and intensive outpatient sample of patients diagnosed with OCD. The current study found that reductions in DI accounted for significant improvement in OCD severity beyond changes in biological sex, anxiety change, depression change. Further, reductions in DI significantly contributed to OCD treatment response. Limitations and future directions were discussed.

In this research I explore my Obsessive Compulsive Disorder (OCD) and make manifest equivalent experiences of it through art practice. I investigate my OCD through artistic enactments and test my equivalence of the framework obsessioncompulsion using installation art – an equivalence, which I suggest is a relationship between my embodied perception and my memory. My interpretation of equivalence contains characteristics that arguably align with common emotions of control and doubt, inflated sense of responsibility and fear of disaster, which, I suggest are accessible to an audience other than myself. As such, my artwork proposes that a viewer can experience my equivalence to some degree. I refer to writer David Batchelor's (1997) definition of equivalence as a starting point for this research, and question how my OCD reveals itself through memory and perception, by referring to Richard Shusterman's ideas regarding somaesthetic reflection (2008), Bergson's description of the structure of memory (2004), Paul Ricouer's link between memory and imagination (2006) and Gilles Deleuze's ideas regarding difference and repetition (2013). I also refer to theoretician Estelle Barrett and her ideas regarding “situated knowledge” (2010: 4-5) as a way to frame the subjective and personal nature of my artistic enquiry, regarding my equivalence of OCD. Within this thesis I place emphasis on art practice as a method of research and describe the processes I have used to explore my OCD and make manifest my equivalence. I refer to Clare Bishop’s (2005) phenomenological description of installation art and mimetic engulfment within this process as I consider them methods to reveal my equivalence, by making manifest the relationship between my memory and my perception, both of which are embodied experiences within my OCD. I discuss Ross G. Menzies and Padmal de Silva’s (2004) clinical definitions and descriptions of obsession, compulsion, memory deficit and checking, in addition to phenomenological and pragmatic ideas, regarding memory and perception, as a way to articulate my proposition that equivalence of my OCD is constructed of a interdependent relationship between two embodied experiences, which can be revealed through art practice. My research contributes to new knowledge as it suggests a new way of understanding OCD by employing a multi-disciplined approach to practice-led research.

Studies have shown that aberrant activity in some brain regions involved in the pathology of OCD overlaps similarly with individuals with addiction disorders. The reduced anxiety following a compulsion together with findings of diminished activation in the striatum during reward anticipation proposes a view of OCD being a behavior addiction. To investigate if there are consistent results across studies that support this view a systematic search of the literature was conducted. The keywords in the final search string used were: Obsessive-compulsive disorder, OCD, reward, risk, functional MRI, MRI, fMRI. Databases used for the search were Web of Science and PubMed. The inclusion criteria were studies that compared the neural activity during the anticipation phase of reward between OCD patients and healthy controls. The intervention and brain imaging used in the included studies were the monetary incentive delay task and fMRI. The main data extracted were the alterations in the striatum. Four studies were included in this review with inconsistent results. Three studies did not find any significant difference between OCD and healthy controls and therefore the findings in principle did not support the view of OCD being a behavior addiction. However, differences in study design between studies could be an explanation for the conflicting findings.

The present study applied the Investment Model (IM) to predict obsessive relational intrusion (ORI). Participants (n=685) were randomly assigned to read vignettes about a hypothetical relationship termination that manipulated 1) type of rejection, 2) level of investment, and 3) quality of alternatives. Next, participants were asked to report how likely it was that they would engage in pursuit (e.g., leaving gifts and calling) and aggressive (e.g., threatening behaviors) ORI. Contrary to predictions, results indicate that although level of investment affected one’s likelihood of engaging in ORI, quality of alternatives did not. Further, it was expected that a more explicit rejection would lead to greater ORI; however, I found that no rejection lead to more pursuit ORI than either internal or external rejection conditions.

No description available.

No description available.

One of the difficulties encountered by therapists working with individuals with obsessive-compulsive (OC) symptoms/disorder is the resistance of OC symptoms to change. A factor that may affect the prognosis for such individuals is the extent to which their symptoms result in positive or negative functional consequences. The current study describes the development, reliability, and validity of a new scale — the Obsessive Compulsive Self-Syntonicity of Symptoms Scale (OCSSSS) - that measures the positive and negative functional consequences of OC symptoms. Items were generated by the principal investigator and major professor after examining the research literature for OC and related disorders. Fifty-four items were generated, which yielded a robust, seven component structure through principal components analysis. Items were rated on a 1-5 Likert scale (1=extremely inconsistent - 5=extremely consistent) with an option of "not applicable" (coded as "0"). Higher scores on the OCSSSS indicated more perceived functional consequences of OC symptoms in an individual's daily life. The sample consisted of 634 students, who responded to an advertisement describing general examples of OC symptoms and who completed several measures online, including: 1) Yale Brown Obsessive Compulsive Scale, Self Report (Y-BOCS-SR); 2)Obsessive Compulsive Inventory Revised (OCI-R); 3) University of Rhode Island Change Assessment (URICA); 4) self-report of frequency of prior/current therapy; evaluation of the effectiveness of prior therapy; evaluation of the expected effectiveness of future therapy; and willingness to participate in future therapy; and 5) social/work adjustment. The OCSSSS was reliable and most items correlated with total score. The OCSSSS's total score and individual component scores were correlated with symptom severity, symptom type, subjective evaluations of treatment experiences, willingness to participate in treatment, avoidance, work and social adjustment, and stage of change. Regression analyses indicated the OCSSSS significantly predicts stage of change, controlling for symptom severity. / Master of Science

For me, architecture is a service--a way of helping people and the environment--and I wanted my thesis to reflect this idea. This thesis combines human rehabilitation and environmental remediation in order to study how these two types of healing interact. Specifically, the program of the building is a rehabilitation center for Obsessive-Compulsive Disorder (OCD) patients (who stereotypically have an obsession with order and cleanliness). Both the patients and the site are going through the process of healing, but they are doing so in ways that juxtapose each other: while the dirt, plants, and water on the site are made cleaner, the patients are undergoing therapy that helps them understand that it is okay to be "dirtier." This brings into question what the terms "clean" and "dirty" really mean. Through my year-long research into OCD rehabilitation, environmental remediation, and the meaning of dirt, I came across a quotation that summed up this idea within my thesis. It came from the appropriately titled book, Dirt: "A landscape architect's understanding of dirt--as a fertile medium--overturns the term's negative connotations to understand it as explicitly productive." (Born 8) Therefore, my thesis explores dirt's productivity and challenges visitors' and patients' preconceptions of order and disorder. Overall, however, my goal was to create a project that allowed a forgotten, polluted site to be reclaimed by the city and for the patients, through therapy, to reclaim their lives. / Master of Architecture / For me, architecture is a service—a way of helping people and the environment—and I wanted my thesis to reflect this idea. This thesis combines human rehabilitation and environmental remediation in order to study how these two types of healing interact. Originally, the program of my building was going to be a rehabilitation clinic for drug addicts, located on a polluted site that needed to be remediated, because then the patients and the site would have the parallel experience of being cleansed of poison. But Dr. Paul Emmons suggested that I instead design a rehabilitation center for OCD patients (who stereotypically have an obsession with order and cleanliness). This was intriguing to me because while the patients and the site would still both be healing, they would be doing so in ways that juxtaposed each other: while the dirt, plants, and water on the site would be made cleaner, the patients would be undergoing therapy that helped them understand that it is okay to be “dirtier.” This brought into question what the terms “clean” and “dirty” really mean. Through my year-long research into OCD rehabilitation, environmental remediation, and the meaning of dirt, I came across Mary Douglas’ book Purity and Danger, where she defines dirt as “matter out of place” and states: “As we know it, dirt is essentially disorder. There is no such thing as absolute dirt: it exists in the eye of the beholder” (Douglas 2). However, the most important and meaningful quote that summed up this idea within my thesis came from another book, appropriately titled Dirt: “A landscape architect’s understanding of dirt—as a fertile medium—overturns the term’s negative connotations to understand it as explicitly productive.” (Born 8) A simple example of redefining dirt that many of us already have in our homes is a pizza stone or cast iron pan, which are both seasoned with the leftover “dirt” of food. Neither of these items are ever meant to be cleaned with soap (they require only water) and the flavors of past foods help to enrich all future foods you make with it. Therefore, my thesis explores dirt’s productivity and challenges visitors’ and patients’ preconceptions of order and disorder. Overall, however, my goal was to create a project that allowed a forgotten, polluted site to be reclaimed by the city and for the patients, through therapy, to reclaim their lives.