Thesis (M. A. in Psychology)--Vanderbilt University, Aug. 2009. / Title from title screen. Includes bibliographical references.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 1999. / Vita. Includes bibliographical references (leaves 209-234).

Thesis (M. Soc. Sc.)--University of Hong Kong, 2008. / Includes bibliographical references (p.39-48).

Thesis (M.A.)--Rowan University, 2009. / Typescript.

Thesis (Ph. D.)--University of Massachusetts Amherst, 2009. / Open access. Includes bibliographical references (p. 99-108). Print copy also available.

The present scoping review of the literature was conducted to analyze all studies of assessment and treatment approaches for individuals diagnosed with obsessive compulsive disorder (OCD) and intellectual disabilities (ID). Search terms were used to identify articles published in behavioral journals. The criteria for the articles reviewed included articles that were peer-reviewed and empirical articles. Online search engines used contained information from the Journal of Applied Behavior Analysis, Journal of Experimental Analysis, The Psychological Record, Behavior Analysis in Practice, The Analysis of Verbal Behavior, and The Behavior Analysis. Key words used in the procedural method of searching for information included obsessive compulsive disorder, OCD, obsessions, compulsions, obsessive hand washing, ordering, checking, praying, counting, repetition, delusional beliefs, grandiose thoughts, controlled thoughts, hoarding, anxiety, panic, fears, germs, look feel sound just right, contamination, and excessive worries. The findings included total of 13,785 articles. After screening for duplication and relevant citations, 13 scoping reviews were identified as meeting eligibility criteria. The present paper reviewed what articles were available with respect to assessments and treatments among individuals with obsessive compulsive disorders and individuals with intellectual disabilities. The result of this study was that one article was found meeting the criteria of assessments and treatments among individuals with obsessive compulsive disorder and intellectual disabilities. The indication, as a result of this study, is that the current literature for assessments and treatments of the symptoms of obsessive compulsive disorders and intellectual disabilities is lacking, and future research is indicated.

Thesis (MSc)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Please see fulltext for abstract / AFRIKAANSE OPSOMMING: Sien asb volteks vir opsomming

Thesis (PhD (Psychiatry))--University of Stellenbsoch, 2005. / Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by significant heterogeneity. It has been suggested that classification of OCD into more homogeneous subtypes, and identification of their associations with etiological factors (e.g. genetic variants, or psychological trauma), and outcome (e.g. disability and treatment response), may be useful. The identified subtypes are not definitive yet and continue to be subject to revision. The overall objective of this dissertation was to assess comprehensively a sample of OCD patients, and to use cluster analytic methods to delineate valid OCD subtypes. Methods: Patients meeting DSM-IV criteria for a primary diagnosis of OCD (N=261) on the Structured Clinical Interview for Axis I Disorders - Patient Version (SCID-I/P), with ages ranging from 16 to 71, took part in the study. The newly developed Structured Clinical Interview for the Diagnosis of putative Obsessive-Compulsive Spectrum Disorders (SCIDOCSD) was administered to assess OCD-related conditions not covered by the SCID-I/P. OCD subtyping, based on OCD symptomatology (assessed with the Yale-Brown Obsessive- Compulsive Symptom Checklist [YBOCS-CL]), and based on comorbidity with the OCD spectrum of disorders (assessed with the SCID-OCSD), proceeded along the following lines: Firstly, latent class cluster analysis (LCA), a categorical analogue to traditional factor analysis (FA), and with many advantages compared to FA, was implemented with the (nine) most frequently endorsed OC symptoms. Secondly, in an attempt to remedy some of the limitations of the LCA (e.g. increased potential for computational instability when additional indicators / symptoms were included), cluster analyses (Ward’s method) were performed on all of the items of the YBOCS-CL and SCID-OCSD, respectively, for all OCD patients. The associations of cluster scores with demographic variables (age, gender), clinical variables (age of onset, obsessive-compulsive symptom severity and dimensions, level of insight, temperament, childhood trauma, treatment response) and genotypes were then examined, using Spearman correlation coefficients, one-way analysis of variance (ANOVA), and Mann- Whitney U-tests, where appropriate. Results: The findings suggested that increased presentation of symptoms characteristic of each of the clusters of cases was associated with specific demographic and clinical characteristics, which substantiated the presence of distinct clinical subtypes of OCD. Cluster analysis of the 45 selected items of the YBOCS-CL in this sample of OCD patients identified 6 separate clusters; these clusters were labelled “Contamination fears / washing”, “Hoarding / collecting”, “Symmetry / ordering / counting / arranging / repeating”, “Sexual”, “Somatic, religious and diverse” and “Harm-related”. Increased presentation of symptoms characteristic of each of the clusters was associated with specific demographic, clinical and, in some cases, genetic characteristics. Of note, the findings indicated the L/L (met/met) genotype of COMT Val158Met polymorphism plays a major role in the increased manifestation of sexual, somatic, religious and diverse, and harm-related symptoms of OCD, as such contributing to the relatively limited data on OC symptom subtypes and genetics. However, the fact that the associated features did not clearly and uniquely differentiate clusters and that clusters were significantly correlated with one another suggested that the delineation of the OCD complex into OC symptom clusters is not the only way to approach the heterogeneity characteristic of OCD. Nevertheless, the significant comorbidity with OCSD’s in the identified clusters (e.g. tics associated with sexual obsessions / compulsions) highlighted the significant relationship of OCD with the OCSD’s. This again raised the question about the way in which the OCSD’s “fit” with the standard OC symptomatology outlined in the YBOCS-CL. A cluster analysis of OCSD’s in OCD patients identified a Tourette’s syndrome / tics subtype of OCD (part of the so-called “reward deficiency” cluster), as well as an impulsivity subtype, and a somatic subtype – each associated with specific clinical and demographic variables. Here, a significant relationship between the identified clusters and the investigated dopaminergic and serotonergic polymorphisms was not found, suggesting that variants in other genes in these systems should also be explored. Conclusion: The main finding was that OCD is indeed a heterogeneous disorder that may be subtyped into different symptom dimensions. The identified OCD subtypes with their associated features were to a large extent consistent with previously published data. However, in contrast to factor analysis, LCA provided a novel, appropriate and advantageous statistical analysis strategy for the data. Furthermore, to our knowledge, the attempt to classifiy OCD according to comorbid OCSD’s was the first cluster analysis based on a prospective comprehensive interview investigating a range of OCSD’s. As such, although the dimensional structure of OCD is still not entirely understood, the categorization of our OCD patients into different groups and the investigation of their respective features have gone beyond the literature and thus add another dimension to the increasing efforts to fully delineate OCD subtypes.

Cognitive models of obsessive-compulsive disorder (OCD) suggest that an ambivalent self-concept and dysfunctional beliefs play an important role in the pathogenesis of OCD. Early attachment experience is argued to be the main process through which such ambivalent self-representations develop. The current study investigated self-concept clarity, a broader construct than ambivalence, attachment security, obsessive-compulsive (OC)-relevant beliefs and their relation to OC symptoms. Forty four people who reported experiencing OC symptoms were compared to 34 individuals who reported no mental health difficulties. People who experienced OC symptoms exhibited significantly less self-concept clarity, less attachment security and higher levels of OC-related beliefs. Once levels of depression were controlled for, no significant relationship between attachment security and self-concept clarity was found in the OCD group. OC symptoms were not significantly correlated with self-concept clarity in the OCD group, although significant negative relationships were found between self-concept clarity and specific OC symptoms. Evidence was found to support the notion that OC-relevant beliefs mediate the relationship between self-concept clarity and OC symptoms, in addition to mediating the relationship between attachment anxiety and OC symptoms. Implications for attachment theory and cognitive models of OCD are discussed, along with clinical and research implications.

There is growing support for the use of acceptance and commitment therapy (ACT) as a treatment for adults with obsessive-compulsive disorder (OCD). No research has been published to date on the use of ACT as a treatment for adolescent OCD. To begin investigating ACT for youth OCD, a multiple baseline study was conducted. The primary measure was self-monitoring of compulsions and assessor completed (CYBOCS). Three adolescent participants, ages 12 to 17, were treated with 8 to 10 sessions of ACT (without exposure). Results showed that the intervention was successful for all participants, with a 40% mean reduction in self-reported compulsions. Near absence of compulsions was reported by two of three participants at posttreatment. CY-BOCS ratings decreased by an average of 28.2%. Treatment procedures were rated by participants and parents as highly acceptable. Experimental and clinical implications of results are discussed. Data suggest that ACT may be a viable treatment as an alternative or an adjunct to exposure-based treatments.