Global prevalence of smoking among individuals with obsessive-compulsive disorder and symptoms: a systematic review and meta-analysis.

Disease from nicotine dependency continues to be a leading cause of preventable death worldwide, and therefore research that elucidates potential correlates of tobacco use may facilitate the advancement of research, clinical practice, and policy in this area to target this public health challenge. One potential tobacco use correlate is obsessive-compulsive disorder (OCD) phenomena. The growing research evidence on the association between tobacco use and OCD phenomena is mixed, making it difficult to synthesize extant findings into meaningful conclusions. Indeed, there has never been a systematic review or meta-analysis of this area of research. To this end, a systematic review was carried out with studies between 1988 and 2021, and from this review, 71 independent estimations (n = 10,475; Females = 51.95%; mean age = 37.29, SD = 13.78) were extracted for meta-analysis. We found that about three in ten participants with OCD are likely to use tobacco, which is higher than the general population. The prevalence was the same among OCD participants at all levels (those with symptomology but no confirmed diagnosis, those surpassing a clinical cutoff for OCD but no confirmed diagnosis, and those with a confirmed OCD diagnosis). The results also indicated considerable variability across study results and a wide confidence interval associated with the tobacco use prevalence rate among those with OCD phenomena. The findings provide support for continued study of this comorbidity, perhaps with longitudinal and experimental designs to test for reciprocal associations between tobacco use and OCD phenomena in the service of targeting nicotine dependence as a substantial global public health concern.

Emotion dysregulation and hoarding symptoms: A systematic review and meta-analysis.

OBJECTIVES: Much of the research on hoarding is focused on cognition and behavior, with less focus on emotion and its regulation. METHOD: A comprehensive search yielded nine studies (out of 5581) from which to draw data for the current study. Across the eight studies (nine independent effect sizes) which provided data for 1595 total participants (Meanage = 34.46, SD = 8.78; 64.26% females). RESULTS: Emotion dysregulation had a medium association with hoarding symptoms (r = 0.43). The effect was strong (r = 0.61) in some populations and weaker (r = 0.19) in others. However, it was higher in nonclinical samples than in clinical samples. Also, the strength of the association between hoarding and emotion regulation differed by the type of hoarding measures adopted in the individual studies. Moreover, there were no statistically significant differences between emotion dysregulation facets and hoarding. CONCLUSION: The findings highlight the importance of studying emotions and emotion regulation in hoarding.

Comorbidity of obsessive-compulsive disorder and symptoms with nicotine dependence: Observational epidemiologic evidence from US-representative and psychiatric outpatient population-based samples.

Despite emerging evidence linking obsessive-compulsive disorder and symptoms (OCS) and nicotine dependence (ND), this comorbidity has received little research. To address this, the current investigation highlights evidence of this comorbidity in two epidemiologic datasets: (1) US nationally-representative survey (i.e., National Comorbidity Study-Replication; NCS-R), and (2) a psychiatric clinical epidemiology dataset (i.e., the Methods to Improve Diagnostic Assessment and Services; MIDAS). For NCS-R (n = 2088), interviews were carried as part of extensive data collection, including OCS symptom count and ND diagnosis. For MIDAS (n = 1257), as part of receiving mental health services at a US hospital outpatient treatment program, participants received diagnostic interviews, including evaluation of ND and obsessive-compulsive disorder (OCD), with OCS being characterized by self-reported symptom count. Results from NCS-R indicate that rates of current ND increased from 3.1% to 10.8% as OCS symptom count increased. Results from the MIDAS clinical sample exhibited a similar trend, but with higher overall figures compared to the US-representative NCS-R sample, with rates of current ND increasing from 18.3% to 41.4% as OCS count increased. In both datasets, OCS was positively associated with current (but not prior) ND after adjusting for psychiatric and sociodemographic covariates. For MIDAS, after adjusting for covariates, OCD diagnostic status was not associated with ND. Findings from this study lend support for the OCS-ND comorbidity in clinical and non-clinical populations and suggests that the OCS-ND link may be obscured when obsessive-compulsive phenomena is modeled as a dichotomous diagnostic variable versus as a dimensional construct.

Brooding Over the Closet: Differentiating Sexual Orientation Rumination and Sexual Orientation Obsessions.

Two concepts that describe repetitive thoughts regarding an individual's sexual orientation-sexual orientation rumination and sexual orientation obsessions-have been introduced into the research literature. Despite the fact that these concepts have similarities, important distinctions exist with regard to their theoretical underpinnings, development, and catalyst of stress. As these concepts have never been teased apart in the research literature, understanding how these concepts are similar and different is particularly important. To this end, the present overview synthesizes the current literature regarding these concepts with the purpose of providing a decisional framework for differentiating sexual orientation rumination and sexual orientation obsessions and suggesting areas of future research.

A Standardized Approach to Calculating Clinically Significant Change in Hoarding Disorder Using the Saving Inventory-Revised.

This shorter communication explores the concept of clinically significant change in treatment outcome studies for hoarding disorder. We argue that cross-study comparisons have been hindered due to researchers using different formulations to assess individual change. As a result, we propose that researchers adopt a standardized approach to calculating rates of clinically significant change for the Saving Inventory-Revised (SI-R) based on Jacobson and Truax's (1991) two-step method. Specifically, we recommend that individuals whose SI-R total scores have reduced by at least 20 points and whose post-treatment score is 38 or less be classified as recovered. Individuals whose total score decreases by 20 points or more, but whose post-treatment score remains above 38, should be classified as improved but not recovered. Individuals whose total score increases by 20 or more points should be classified as deteriorated. Any individual whose total score has changed by less than 20 points should be classified as not changed. By adopting these criteria, researchers will facilitate cross-study treatment outcome comparisons and aid in our understanding of the impact that hoarding treatment has on its recipients.

Characterization of Family-Directed Care Coordination and Involvement in Behavioral Treatments in an Autism-Specific Medicaid Waiver.

Services for children with autism spectrum disorder (ASD) and their families have evolved with the advent of the Medicaid waiver, leading to more family-based coordination of care. Evaluating family involvement, the current investigation compared 230 families of children with ASD receiving Medicaid waiver services to a propensity-score matched group of 230 families who were waiting for such services (i.e., registry families). Compared to the registry, waiver families reported more involvement in service planning tasks, but not activities related to future-planning, managing crisis situations, or searching for and securing funding. Additional analyses characterize waiver families as engaging in high levels of coordinating and delivering behavioral interventions for their child. Implications for family burden and future programming for waiver programs are discussed.

Proof of concept study of the development of a survey protocol for adults with ASD participating in community-based programs.

There is limited research regarding the effectiveness of community-based services for young adults with autism spectrum disorder (ASD) as they transition out of school and enter a more autonomous life stage. This study utilized a two-phase, mixed methods design to determine the feasibility and participant acceptability of a protocol developed to standardize an assessment of program effectiveness for young adults with ASD at a community-based center. Field notes, participant interviews, and clinical observations were combined with descriptive analysis of participant survey responses. This study offers insights into the process of effective outcomes measurement for young adults with ASD participating in community-based programs. Administration of the study's protocol is feasible; however, alternative methods of data collection should continue to be explored. Furthermore, research in the form of a pilot study is needed to further determine the protocol's facility for assessing program outcomes in young adults with ASD.

The Role of Choice and Control in the Impact of Autism Waiver Services on Family Quality of Life and Child Progress.

Home and Community-Based Services (HCBS) Waivers provide support and services to families with a child/youth with autism spectrum disorder (ASD). Research indicates HCBS Waivers are positively related to family quality of life (FQoL) and Child Progress. This study replicated and expanded prior research using propensity score matching of 460 families. Results support prior findings that HCBS waivers have a positive impact on FQoL and aspects of child progress. This study also found that having choices in the selection of services and service providers, as well as control over day-to-day provision of services, strengthened both the child and family impacts of the Waiver services. In addition, the study provides preliminary evidence for psychometric properties of a quick and inexpensive parent-report of ASD severity.

The Mediating Role of Emotion Regulation Difficulties in the Relationship Between Self-Compassion and OCD Severity in a Non-Referred Sample.

Self-compassion involves extending kindness and understanding to one's self. Research has demonstrated inverse relationships between self-compassion and maladaptive constructs associated with obsessive-compulsive disorder (OCD), including emotion regulation (ER) difficulties. The current study sought to explore associations between self-compassion, ER difficulties, and OCD severity. Data were collected at the International Obsessive-Compulsive Disorder Foundation convention from 62 attendees who reported having a diagnosis of OCD (51% male, mean age 35.9 years). Findings demonstrated that self-compassion and ER difficulties were associated with overall OCD severity. Results also indicated that ER difficulties mediated relationships between self-compassion and overall OCD severity, as well as the severity of two OCD symptom dimensions, responsibility for harm and unacceptable thoughts. These findings suggest that self-compassion and ER difficulties may be involved in the maintenance and severity of OCD.

The latent profile analysis of Chinese adolescents' anxiety: Examination and validation.

The main purpose of current study was to investigate the characteristics of anxiety in Chinese adolescents using Latent Profile Analysis (LPA) with the Screen for Child Anxiety Related Emotional Disorders. LPA was conducted with a sample of 2158 participants aged 12-20 years from 3 urban schools in Beijing, China. Results suggested a best-fitting model with three profiles: Low Group with Diffuse Types of Anxiety, Moderate Group with Predominant Generalized and Social Anxiety and High Group with Predominant Somatization Anxiety. Additional analyses using Regression Mixture Modeling suggested that older adolescents and girls were significantly more likely to be classified into the High Group with Predominant Somatization Anxiety. Finally, in support of the construct validity of the anxiety profiles, differential negative cognitions, especially the subscales measuring cognitions about social threat and physical threat, predicted the anxiety profiles. The current study supports an intuitive model of adolescent anxiety in a large, non-Western population with clinical implications for anxious adolescents in China.

The Normative Nature of Aggressive Intrusive Thinking Among an Underserved Incarcerated Population Compared With a Student Sample.

Aggressive intrusive thoughts (AITs) are unwanted and repetitive thoughts, impulses, or desires that enter into consciousness involuntarily. The current study compared the frequency of and distress from AITs in a sample of inmates jailed for violent crimes ( n = 78) versus college students ( n = 103; that is, participant status). The relationship between psychopathic traits and AITs was also explored. Results indicated that, although there were no differences between students and inmates, AIT frequency was positively associated with Primary Psychopathy. However, there was no significant interaction between participant status (i.e., inmate vs. student) and psychopathy. Finally, there were no significant main or interactions effects in the model predicting AIT distress. These findings demonstrate that AIT frequency is a normative cognitive experience that occurs in both nonviolent and violent individuals, and provides further evidence for an association between psychopathic traits and unwanted aggressive cognition.

Missed diagnoses in African Americans with obsessive-compulsive disorder: the structured clinical interview for DSM-IV Axis I disorders (SCID-I).

BACKGROUND: Research on the utility of structured interviews in assessing OCD is scarce, and even more so, in its use for OCD in African Americans. The purpose of this study was to examine the utility of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) in detecting OCD in African Americans when used by well-trained, culturally competent clinicians. METHODS: Seventy-four African American adults with OCD were assessed with the SCID-I and additional measures of OCD. RESULTS: Results revealed the poor diagnostic utility of the SCID OCD section (SCID-OCD), with 66.2% (N = 49) correctly identified and 33.8% (N = 25) incorrectly diagnosed. Participants receiving the correct diagnosis were more likely to endorse compulsive behaviors, specifically ordering compulsions, and experience greater symptom severity. CONCLUSION: The lack of sensitivity for identification of OCD is discussed as the SCID-OCD seems to often miss a true diagnosis of OCD in African Americans.

Automatic thoughts as a predictor of internalizing and externalizing problems in Chinese adolescents: A test of the cognitive content-specificity hypothesis with age effects.

The main aim of the current study was to test the cognitive content-specificity hypothesis across internalizing and externalizing problems in Chinese adolescents. The participants consisted of 2,158 adolescents aged 11-19 years from three middle schools, and they completed a number of measures assessing a wide range of automatic thoughts and syndromes related to internalizing and externalizing problems. Multivariate regression analyses demonstrated that thoughts about social threats, personal failure and hostility were the strongest predictors of anxiety, depression, and externalizing problems, respectively. Age was a statistically significant, albeit modest, moderator of the relationship between automatic thoughts about social threat and anxiety. The current study provides support for the cognitive content-specificity hypothesis in internalizing and externalizing problems in a Chinese sample.

Transdiagnostic emotional vulnerabilities linking obsessive-compulsive and depressive symptoms in a community-based sample of adolescents.

BACKGROUND: Transdiagnostic emotional vulnerabilities are suspected to underlie psychopathologic comorbidity but have received little attention in adolescent emotional pathology literature. We examined distress tolerance, anxiety sensitivity, and anhedonia as concomitant transdiagnostic mechanisms that account for (i.e., statistically mediate) the covariance between adolescent obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) symptoms. METHOD: Data on MDD, OCD, and the three aforementioned transdiagnostic vulnerabilities were collected from a community-based sample of 3,094 ninth graders in a large metropolitan area and analyzed using mixed effects modeling to evaluate mediation effects. RESULTS: Individually and when controlling for each other, all three transdiagnostic vulnerabilities mediated the relation between OCD and MDD symptoms both before and after adjusting for demographics. CONCLUSIONS: Distress tolerance, anxiety sensitivity, and anhedonia may be unique mechanisms accounting for comorbidity between OCD and MDD symptoms in youth. Longitudinal evaluation of these candidate transdiagnostic emotional vulnerabilities in adolescent OCD-MDD comorbidity is warranted.

Obsessive-compulsive symptoms and negative affect during tobacco withdrawal in a non-clinical sample of African American smokers.

The association between obsessive-compulsive (OC) symptomatology and smoking is poorly understood, particularly in African Americans-a group subject to smoking- and OC-related health disparities. In a non-clinical sample of 253 African American smokers, we tested the negative reinforcement model of OC-smoking comorbidity, purporting that smokers with higher OC symptoms experience greater negative affect (NA) and urge to smoke for NA suppression upon acute tobacco abstinence. Following a baseline visit involving OC assessment, participants completed two counterbalanced experimental visits (non-abstinent vs. 16-h tobacco abstinence) involving affect, smoking urge, and nicotine withdrawal assessment. OC symptom severity predicted larger abstinence-provoked increases in overall NA, anger, anxiety, depression, fatigue, urge to smoke to suppress NA, and composite nicotine withdrawal symptom index. African American smokers with elevated OC symptoms appear to be vulnerable to negative reinforcement-mediated smoking motivation and may benefit from cessation treatments that diminish NA or the urge to quell NA via smoking.

Interpersonal hostility and suspicious thinking in obsessive-compulsive disorder.

Individuals with obsessive-compulsive disorder (OCD) may struggle with hostility and suspicious thinking, but this has not been the subject of much research. The purpose of this study is to examine the relationship between hostility, suspicious thinking, and OCD severity. Participants included 66 outpatients in treatment for OCD, 27 in treatment for other disorders, and 68 students (n=161). All completed the Inventory of Hostility and Suspicious Thinking (IHS), a measure of psychotic thinking/paranoia, the Obsessive Compulsive Inventory-Revised (OCI-R), the Beck Depression Inventory (BDI-II), and the Beck Anxiety Inventory (BAI). As expected, the IHS was significantly positively correlated with the BAI and BDI-II. Additionally, regression analyses revealed that individuals with OCD have higher levels of hostility than students. Hostility was also significantly positively associated with increased OCD severity. Hostility and suspicious thoughts are prominent in anxiety disorders in general, and thus necessitate continued research.

State Design and Use of Medicaid 1915(c) Waivers and Related Benefits to Provide Services to Children and Youth With Autism Spectrum Disorder.

Medicaid is the most significant source of funding for medical services for individuals with autism spectrum disorder (ASD). We surveyed state Medicaid directors or their designees regarding their use of autism specific 1915(c) waivers and other Medicaid benefits to provide services to children and youth with ASD, with a response rate of 84%. Ten states used autism-specific waivers to provide services. These waivers varied in the number of children served, eligibility criteria and services provided, among other characteristics. Issues related to the number of children to serve and the specific services to provide were perceived to be the most difficult waiver design issues, while provider geographic distribution, capacity and expertise were perceived to be the most difficult implementation concerns. States used a variety of additional Medicaid state plan services (e.g., the optional rehabilitation benefit) and 1915(c) waivers (e.g., a more general waiver serving individuals with intellectual and developmental disabilities) to provide services to children and youth with ASD. Thus, continuing to examine the adequacy and effectiveness of state use of a range of Medicaid benefits, including autism-specific 1915(c) waivers is critical. Expanding the evidence base for intervention effectiveness is important as well.

MMPI-2 Item Endorsements in Dissociative Identity Disorder vs. Simulators.

Elevated scores on some MMPI-2 (Minnesota Multiphasic Inventory-2) validity scales are common among patients with dissociative identity disorder (DID), which raises questions about the validity of their responses. Such patients show elevated scores on atypical answers (F), F-psychopathology (Fp), atypical answers in the second half of the test (FB), schizophrenia (Sc), and depression (D) scales, with Fp showing the greatest utility in distinguishing them from coached and uncoached DID simulators. In the current study, we investigated the items on the MMPI-2 F, Fp, FB, Sc, and D scales that were most and least commonly endorsed by participants with DID in our 2014 study and compared these responses with those of coached and uncoached DID simulators. The comparisons revealed that patients with DID most frequently endorsed items related to dissociation, trauma, depression, fearfulness, conflict within family, and self-destructiveness. The coached group more successfully imitated item endorsements of the DID group than did the uncoached group. However, both simulating groups, especially the uncoached group, frequently endorsed items that were uncommonly endorsed by the DID group. The uncoached group endorsed items consistent with popular media portrayals of people with DID being violent, delusional, and unlawful. These results suggest that item endorsement patterns can provide useful information to clinicians making determinations about whether an individual is presenting with DID or feigning.

Dissociative, depressive, and PTSD symptom severity as correlates of nonsuicidal self-injury and suicidality in dissociative disorder patients.

The present study investigates whether symptom severity can distinguish patients diagnosed with dissociative identity disorder and dissociative disorder not otherwise specified with a recent history of nonsuicidal self-injury (NSSI) and suicide attempts from those patients without recent self-harm. A total of 241 clinicians reported on recent history of patient NSSI and suicide attempts. Of these clinicians' patients, 221 completed dissociative, depressive, and posttraumatic stress disorder symptomatology measures. Baseline cross-sectional data from a naturalistic and prospective study of dissociative disorder patients receiving community treatment were utilized. Analyses evaluated dissociative, depressive, and posttraumatic stress disorder symptom severity as methods of classifying patients into NSSI and suicide attempt groupings. Results indicated that dissociation severity accurately classified patients into NSSI and suicidality groups, whereas depression severity accurately classified patients into NSSI groups. These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with dissociative disorders and have implications for self-harm prevention and treatment.

State adoption of Medicaid 1915(c) waivers for children and youth with Autism Spectrum Disorder.

BACKGROUND: The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically, with one in every 68 children in the U.S. currently diagnosed with ASD. Medicaid is the primary public funder of health care services for individuals with ASD. One mechanism state Medicaid agencies can use to craft ASD-specific services is a 1915(c) waiver. OBJECTIVE: This study investigated what state policy makers perceived to be primary success factors and barriers to adopting an ASD specific 1915(c) waiver, as well as what services and supports are available in each state for children and transition-age youth with ASD. METHODS: Data were collected by contacting state Medicaid directors via email with an electronic survey, with an 84% response rate. RESULTS: Support from state legislators and parents and family members were the primary success factors in adopting an ASD specific waiver. The primary barrier was insufficient funding. States not adopting an ASD specific waiver also perceived that children and youth with ASD were served sufficiently well through other Medicaid benefits. Analysis of specific services indicated that the majority of states provide their services to children and transition age youth with ASD through a 1915(c) waiver for individuals with intellectual or developmental disabilities, often coupled with an ASD specific waiver for children, another 1915(c) waiver for children, and/or a another 1915(c) waiver, most often for children with serious emotional disturbance. CONCLUSION: Further research is needed to determine which approach(es) is most effective in enhancing access and improving outcomes for children and youth with ASD.