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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

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

Thesis (PhD (Psychiatry))-- Stellenbosch University, 2006. / ENGLISH ABSTRACT: Obsessive-compulsive disorder (OCD), a debilitating psychiatric disorder, affects 2-3% of the general population, and represents a global health problem. Evidence from family studies suggests that genetic factors play a role in mediating disease development. However, the pattern of inheritance is not consistent with monogenic disorders, but is “genetically complex”. Case-control association analysis, which facilitates dissection of the genetic aetiology of complex disorders, has yielded many inconsistent results in OCD studies, making identification of predisposing alleles difficult. These discrepant findings can largely be attributed to inappropriate statistical methodology and the lack of OCD phenotypic resolution. Although classified as a single clinical entity according to structured algorithms, OCD probably represents a final common outcome of multiple underlying aetiologies. Thus, numerous clinical subtypes of the disorder have been proposed; these “intermediate” phenotypes may be more closely related to a particular genetic substrate than the higher order construct of OCD. Furthermore, although genes encoding serotonergic (5-HT) and dopaminergic components are most commonly investigated, it is likely that the behavioural manifestations of OCD are mediated by a broader network of interconnected neurotransmitter and signalling pathways. Consequently, the aim of the present study was two-fold: to address the factors that may have confounded previous genetic case-control association studies and to investigate the genetic aetiology of OCD phenotypes while accounting for these factors. Case and control individuals were drawn from the reportedly genetically homogeneous Afrikaner population. However, as no empirical evidence existed to support the absence of genetic substructure, which would confound genetic association studies, a Bayesian modelbased clustering algorithm (Structure), that groups individuals on the basis of observed genotype data, was employed to assess population stratification in both case and control Afrikaner subjects. OCD patients were clinically stratified by gender, symptom severity, age at onset, the presence of selected co-morbid disorders and the presence of selected symptom dimensions, to facilitate the identification of susceptibility genes more closely related with these subtypes. Candidate genes included those coding for components of the 5-HT (5-HT receptors 1Dβ, 2A, 2C and 6), dopaminergic (dopamine receptors 1, 2, 3 and 4, dopamine transporter and catechol-O-methyltransferase [COMT]), glutamatergic (glutamate receptor subunit 2B [GRIN2B]) and neurodevelopmental pathways (brain-derived neurotrophic factor [BDNF] and homeobox 8 [HoxB8]), as well as previously uninvestigated genes (angiotensinconverting enzyme I, inositol-trisphosphate, phospholipase-C-gamma 1 and estrogen receptor alpha). The relationship between variants in these genes and OCD (or OCD subtypes) was investigated in a single locus and a haplotype context, while meta-analyses using published population-based case-control association data were also conducted. Significant associations noted between distinct COMT variants and OCD implicated COMT in the development of a genetically discrete, gender-dependant, early-onset, tic-related phenotype in males. Furthermore, investigations of variations in BDNF and GRIN2B point towards a genetically distinct, neurodevelopmental subtype of the disorder, mediated, in males at least, primarily by dysfunctions in BDNF. The striking gender dimorphism noted in these associations indicates the possibility of an epigenetic hormonal influence. Moreover, the significant association of polymorphisms within GRIN2B, in both a single locus and haplotype context, suggests the involvement of this gene in mediating a phenotypic subtype characterised by an early-onset, more severe form of the disorder. The present investigation forms part of ongoing research to elucidate genetic components involved in the aetiopathology of OCD and OCD-related subtypes. Such studies may pave the way towards more efficacious pharmacotherapeutic strategies, which will ease the suffering of individuals who are afflicted with this incapacitating condition. / AFRIKAANSE OPSOMMING: Obsessiewe-kompulsiewe steuring (OKS) is 'n aftakelende psigiatriese siektetoestand wat 2- 3% van die algemene bevolking affekteer en 'n globale gesondheidsprobleem verteenwoordig. Familiestudies dui daarop dat genetiese faktore 'n rol in die ontwikkeling van hierdie siekte speel. Die patroon van oorerwing is egter nie verenigbaar met dié van monogeniese siektes nie, maar is geneties "kompleks". Geval-kontrole assosiasie-ontleding, wat die disseksie van die genetiese etiologie van komplekse siektes fasiliteer, het teenstrydige resultate in OKS gelewer en dit bemoeilik die identifikasie van predisponerende allele. Die teenstrydige bevindings kan grootliks aan ontoepaslike statistiese metodiek en die gebrek aan fenotipiese differensiasie in OKS toegeskryf word. Alhoewel dit volgens gestruktureer algoritmes as 'n enkele kliniese entiteit geklassifiseer word, verteenwoordig OKS waarskynlik die eindresultaat van veelvoudige onderliggende oorsake. Baie kliniese subtipes van die toestand is al voorgestel en dié "intermediêre' fenotipes mag nader verwant aan 'n spesifieke genetiese substraat as die hoër orde konsep van OKS wees. Verder, alhoewel die gene wat die serotonergiese (5-HT) en dopaminergiese komponente kodeer meestalondersoek word, is dit waarskynlik dat die gedragsmanifestasies van OKS deur 'n breër netwerk van intergekonnekteerde neuro-oordragstof- en seinoordragpaaie meegebring word Gevolglik was die doel van die huidige studie tweevoudig: om faktore wat vorige genetiese geval-kontrole assossiasie-studies verwar het aan te spreek en om die genetiese etiologie van OKS-fenotipes te ondersoek met in ag neming van hierdie faktore. Geval- en kontrole-individue is gekies uit die Afrikaner-bevolking wat as geneties homogeen beskryf kan word. Daar was geen empiriese bewyse vir die afwesigheid van 'n genetiese substruktuur (wat genetiese assossiasie-studies sou verwar),nie. Daarom is 'n Bayesiese model-gebaseerde groeperings-algoritme (Structure), wat individue op grond van waargenome genotipiese data groepeer, gebruik om die populasie-stratifikasie is beide gevalen kontrole- Afrikaner-individue te bepaal. OKS-pasiënte is klinies gestratifiseer volgens geslag, ernstigheid van simptome, ouderdom by aanvang van simptome, die teenwoordigheid van geselekteerde komorbiede siektetoestande en die teenwoordigheid van geselekteerde simptoomdimensies of -groepe, om die identifikasie van moontlike vatbaarheidsgene wat nader verwant is aan die verskillende subtipes te fasiliteer/vergemaklik. Kandidaatgene het ingesluit: dié wat kodeer vir komponente van die 5-HT-(5-HT reseptore IDB, 2A, 2C and 6), dopaminergiese (dopamienreseptore 1, 2, 3 and 4, dopamien-transporter and katesjol-O-metieltransferase [COMTJ), glutamatergiese (glutamaat-reseptor subeenheid 2B [GRIN2B]) and neuro-ontwikkelingspaaie (brein-gederiveerde neurotrofiese faktor [BDNF] en homeobox 8 [HoxB8]), sowel as die gene wat nie voorheen ondersoek is nie (angiotensien-omsettingsensiem I, inositol-trisfosfaat, fosfolipase-C-gamma 1 en estrogeen-reseptor alpha). Die verhouding tussen variante in hierdie gene en OKS (of OKS-subtipes) is ondersoek in 'n enkel-lokus en haplotipe konteks, en meta-analises, wat gepubliseerde bevolkings-gebaseerde geval-kontrole ontledingsdata gebruik het, is ook gedoen. Beduidende assosiasies gevind tussen spesifieke COMT-variante en OKS in mans, het daarop gedui dat COMT in die ontwikkeling van geneties-diskrete, vroeë-aanvang, senutrekking ("tics") -verwante fenotipe in mans betrokke is. Verder het ondersoeke van variasies in BDNF en GRIN2B daarop gedui dat 'n geneties-afsonderlike, neuro-ontwikkelings-subtipe van.OKS wat, ten minste in mans, primêr deur wanfunksie van BDNF meegebring word. Die opvallende geslags verskil wat in hierdie assosiasies gesien word, dui op die moontlikheid van 'n epigenetiese hormonale invloed. Bowendien, die beduidende assosiasie van polimorfismes in GRIN2B in beide die enkel-lokus en haplotipe konteks, dui op die betrokkenheid van hierdie geen in die meebring van 'n fenotipiese subtipe wat deur 'n vroeë aanvang, en meer ernstige vorm van die siekte gekenmerk word. Die huidige ondersoek vorm deel van voortgesette navorsmg om die genetiese komponente wat betrokke is by die etiopatologie van OKS en OKS-subtipes, bloot te lê. Sodanige studies kan die weg baan na meer doeltreffende farmakoterapeutiese strategieë wat die lyding van indi vidue wat deur hierdie aftakelende toestand geraak word, kan verlig.

Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder characterized by distressing persistent unwanted ideas or impulses (obsessions) and urges and/or compulsion to do something to relieve the associated anxiety caused by the obsession. The thematic content of the obsessions are highly variable, ranging from symmetry, contamination to aggressive concerns. Compulsions tend to be linked to the obsessions, but can also be idiosyncratic to the intrusive thought. According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, overestimation of threat and the over-control of thoughts. Despite much support for this hypothesis, there is a lack of specificity. This series of studies sought to determine the relationship between a number of cognitive beliefs and appraisal processes and obsessive-compulsive symptoms. This thesis presents the results of three studies. The first study was designed to investigate the hypothesis that certain beliefs are more prevalent in OCD, compared with other anxiety disorders. The second study expands on earlier findings by examining whether the six metacognitive beliefs proposed by the Obsessive Compulsive Cognitions Working Group, (OCCWG; 1997, 2001, & 2003) correlate with specific symptom-based OCD subtypes. The final study addresses some of the methodological weaknesses inherent in retrospective self-report measures by replicating the study using experimental techniques. Most importantly, this research was conducted from within the theoretical framework of Rachman (1993) and Salkovskis (1989) models which emphasise the misinterpretation of significance of the intrusive thoughts. The first study explored the relationship between thought-action fusion (TAF) and inflated responsibility beliefs across individuals diagnosed with obsessive compulsive disorder (OCD), an anxiety disorder other than OCD (anxious controls; AC), and a non-anxious control group (NAC). It was hypothesized that the OCD group would evidence significantly higher inflated responsibility and TAF scores, compared to the AC and NAC groups. In this study, non-clinical and clinical participants were recruited for research. The non-clinical group was comprised of undergraduate students (n = 22: mean age = 26.8; SD = 9.2). The clinical groups included 20 participants with OCD as their primary diagnosis (mean age = 32.1; SD = 11.9) and 21 individuals diagnosed with another anxiety disorder (mean age = 32.2; SD = 10.9). To measure inflated responsibility beliefs and thought action fusion, self-report questionnaires were administered to the participants. The results of this study demonstrated that inflated responsibility beliefs, while present in other anxiety disorders, were significantly higher in participants with OCD, even after controlling for depressed mood and TAF levels. No group differences emerged between the OCD and anxious groups on measures of TAF. Thus, it can be tentatively concluded that inflated responsibility beliefs may have a more robust relationship with OCD than TAF beliefs, which appear to act as a general vulnerability factor occurring along a continuum of anxiety disorders. The second study examined the associations between the six OCD-related beliefs: control of thoughts, importance of thoughts, responsibility, intolerance of uncertainty, overestimation of threat and perfectionism and five empirically derived OCD subgroups. Clinical participants with a primary diagnosis with OCD (n = 67: mean age = 38.0; SD = 11.7) were recruited over a period of two years from the Anxiety Disorders Unit. Participant responses were cluster analysed to form five stable groups: aggressive obsessions-checking compulsions (n = 22: mean age = 26.8; SD = 9.2); contamination obsessions-cleaning compulsions (n = 22: mean age = 26.8; SD = 9.2); symmetry concerns-ordering/arranging compulsions (n = 22: mean age = 26.8; SD = 9.2); hoarding obsessions-hoarding compulsions (n = 22: mean age = 26.8; SD = 9.2); and miscellaneous obsessions -miscellaneous compulsions (n = 22: mean age = 26.8; SD = 9.2). The second found that intolerance of uncertainty was significantly related to the contamination subgroup. While responsibility and threat estimation beliefs were higher in the aggressive-checking subgroup, these differences did not reach statistical significance. No other significant results were found, however, there was a non-significant trend for perfectionism beliefs to be higher in symmetry-ordering and hoarding subgroup. Following the results of this study, questions remained about whether the lack of significant findings reflected the generality of these beliefs or were due to methodological differences. This led to the development of the final study presented in this thesis. The purpose of the final study was to investigate whether the second study was limited by the method of assessment (e.g. self-report questionnaires). This study was unique, as it was the first of its kind to experimentally manipulate all six beliefs in empirically derived OCD subtypes. Twenty participants (mean age = 45.0; SD = 11.0) were chosen from the second study to form the following priori groups: contamination (n = 4: mean age = 44.5; SD = 9.5); aggressive (n = 6: mean age = 46.5; SD = 7.2); hoarding (n = 4: mean age = 47.2; SD = 6.9); and symmetry (n = 6: mean age = 41.8; SD = 17.4). Six behavioural experiments designed to reflect one of the six OCCWG beliefs were specifically developed and administered to the groups. Baseline scores were obtained using self-report questionnaires. The study found strong support for the use of experimental paradigms over self-report measures, as several significant interactions between cognitive beliefs and OCD symptom-based subtypes were found. Specifically, the hoarding subgroup evidenced significantly higher overall thought action fusion scores compared to those in the contamination group. The symmetry subgroup exhibited significantly higher anxiety than the aggressive group during the perfectionism task and demonstrated significantly higher scores on several items measuring perfectionism compared to the contamination group. Finally, over-estimation of threat beliefs was significantly higher in the contamination thoughts. No statistically significant group differences were found for controllability of thoughts, responsibility and intolerance of uncertainty. In conclusion, these studies collectively showed that in some cases of OCD certain beliefs appear highly applicable, whereas in others they are not. This finding may explain why some OCD patients have poor treatment outcomes as the beliefs and appraisals were highly variable across groups. These findings are of both theoretical and clinical significance because they add to the growing understanding that OCD may consist of distinct clusters of symptoms with different underlying motivations and beliefs. This finding is of clinical significance because treatment guidelines for OCD can become more specific, factoring into the therapy situation these underlying beliefs and appraisal processes. Lastly, the findings regarding inflated responsibility deserve special mention, given the significance of this construct in contemporary cognitive models. The results of the present studies were mixed with regard to responsibility as only the first study found a significant result. It appears that, like the other belief domains proposed by the OCCWG, responsibility may not be specific to all types of OCD and current cognitive models may benefit was shifting the emphasis to other belief domains.

No description available.

The goal of this investigation was to marry two theories of supportive communication outcomes in order to test a comprehensive model of social support for people with obsessive-compulsive disorder (OCD). The theoretical frameworks utilized in this investigation were the theory of conversationally-induced reappraisals and the dual-process theory of supportive communication outcomes. These theoretical frameworks provide a foundation for the conversation of how social network members can help their loved ones with OCD manage their distressing symptoms as they explore the types of social support message features (verbal person-centeredness) that are most productive in achieving emotional improvement for those experiencing emotional distress. The union of these two theories in the context of social support and OCD management led to the testing of seven hypotheses. Participants (n = 168) who self-identified as living with OCD at some point in their life were recruited to fill out an online questionnaire. Results indicated support for the theory of conversationally-induced reappraisals, but not for the dual-process theory of supportive communication outcomes. Overall, the findings of this investigation highlighted the utility of emotional support messages high in verbal person-centeredness as they led those with OCD to reassess the intrusive nature of their symptoms, a process which promoted overall affective improvement. These associations suggest that social network members can help their loved ones with OCD manage their symptoms through supportive communication.

Controlled scientific research into obsessive-compulsive disorder (OCD) in adulthood has considerably progressed over the past two decades; however, current research into childhood OCD is still in its infancy by comparison. As a result, current psychological conceptualisations of OCD during childhood, including approaches to treatment, are almost entirely based on adult models of the disorder. Previous research however, examining the clinical phenomenology of OCD has provided some evidence that OCD might be associated with different clinical correlates at different stages of development. In particular, there appears to be a bimodal distribution in terms of the age of onset of the disorder, a male predominance during childhood and adolescence compared to adulthood, stronger familial aggregation of OCD in early onset cases, and differences in the types of symptoms and the patterns of comorbidity across age groups. The first study aimed to assess the developmental continuity in clinical correlates of OCD across 3 distinct age groups, including; children (n = 40), adolescents (n = 44) and adults (n = 41). It was hypothesised that the sample of children would be predominantly male, and would have a higher familial aggregation of OCD and/or anxiety/depression in first-degree relatives. It was further hypothesised that there would be significant age-related differences in terms of specific symptoms, patterns of comorbidity, OCD severity, functional impairment, and level of insight and distress. The results of this study supported the developmental heterogeneity hypothesis, with significant differences occurring across age groups on a number of clinical features of OCD including age at onset, symptoms experienced, comorbidity, severity, insight and impairment. The recognition of developmental differences in clinical features of OCD will assist in the accurate assessment and diagnosis of the disorder, and will allow for refinement of current treatment strategies to ensure treatments effectively target features of the disorder as it presents at different developmental stages. While the cognitive theory of OCD is one of the most widely accepted accounts of the maintenance of the disorder in adults, no study to date has systematically evaluated this theory across children, adolescents and adults with the disorder. Until empirical investigation examines the applicability of this theory to children and adolescents, we know very little about the cognitive processes associated with OCD during childhood or adolescence. The second study investigated developmental differences in the cognitive processing of threat in a sample of children (n = 34), adolescents (n = 39) and adults (n = 38) with OCD. Using an idiographic assessment approach, as well as self-report questionnaires, this study evaluated cognitive appraisals of responsibility, probability, severity, thought-action fusion (TAF), thought-suppression, self-doubt and cognitive control. It was hypothesised that there would be age related differences in reported responsibility for harm, probability of harm, severity of harm, thought suppression, TAF, self-doubt and cognitive control. Results demonstrated that children with OCD reported experiencing fewer intrusive thoughts, which were less distressing and less uncontrollable than those experienced by adolescents and adults with OCD. Furthermore, responsibility attitudes, probability biases and thought suppression strategies were significantly higher in adolescents and adults with OCD, compared to children. Cognitive processes of TAF, perceived severity of harm, self-doubt and cognitive control were found to be comparable across age groups. These findings suggest that some cognitive biases associated with OCD in adults, are in fact also associated with OCD during childhood and adolescence, however there remains some discontinuity across specific cognitive processes. For a developmentally sensitive theory of OCD, further investigation is clearly warranted into other possible age related maintenance factors of this disorder. Implications of these 2 empirical investigations are highlighted and directions for future research are discussed.

Ortorexia Nervosa (ON) är ett idag relativt okänt fenomen och detfinns skilda åsikter angående vilken typ av problem det är. Det finns desom menar på att det kan vara en ätstörning eller ett tvångssyndrom.Studien genomfördes med syfte att undersöka hur utbrett ON är hosträningsintresserade människor samt undersöka om bassjälvkänsla ochförvärvad självkänsla kunde relateras på olika sätt till graden av ONsamt se ifall kön och ålder har någon inverkan på detta.Undersökningen genomfördes med enkäter som mätte graden av ONoch självkänsla på 102 deltagare. Det visade sig att 33% av antaletdeltagare hade poäng över tröskelvärdet för ON. Studiens äldre ochyngre deltagare visade sig vara de som fick högst poäng på testet förON, dock hittades ingen skillnad beträffande kön. Inga signifikantasamband mellan ON och de två typerna av självkänsla kunde hittas.Idag är forskningen bristfällig inom ON och fler studier behövs.

Although research supports cognitive behaviour therapy (CBT) as the treatment of choice for childhood obsessive compulsive disorder (OCD) and recommends family involvement (e.g., AACAP, 1998; Barrett, Healey-Farrell, & March, 2004a), little is known about the role of the family in the development, maintenance, and treatment of childhood OCD. Furthermore, although significant improvements are found in treatment response, many children remain symptomatic (de Haan, 2006). Objective: The aims of the study were to examine (1) the perceptions of the family environment among family members and if child perceptions change with treatment and (2) treatment response and child and family characteristics that may predict treatment response. Gender differences were also examined. Method: This study involved 82 children (ages 8 to 17 years) receiving CBT for OCD and a concurrent parent program. Children and parents were assessed at initial, pre-, and post-treatment with questionnaires, a symptom severity interview, a family environment questionnaire, and child self-report measures of anxiety and depression. Pre-treatment data were used for the prediction of treatment response. Results: Child and parent perceptions of the family environment differ in terms of family expressiveness, with children perceiving their family as being ‘distressed.’ Although girls and boys had similar perceptions of their family environment, girls’ perceptions were more in agreement with their parents than boys. Children’s ratings of family cohesiveness were ‘normal’ at pre-treatment, and increased significantly at post-treatment; however, this was not meaningful when gender was considered. We found a similar treatment response to past research. Different characteristics were found to predict treatment response for boys and girls, with more predictors being identified for girls. Conclusions: Results emphasize the importance that families may have in the treatment of OCD and in our attempt to find predictors, as well as the need to examine boys and girls separately. This research is critical to refine and tailor treatment techniques to match child and family characteristics.