Obsessive compulsive disorder, checking, and non-verbal memory: a neuropsychological investigation.

There is considerable evidence in the literature for the presence of non-verbal and praxic memory deficits in OCD. Such deficits may represent the cognitive substrate of doubt-related phenomenon such as checking. Neuropsychological tests of non-verbal memory functioning and memory for actions were administered to patients with OCD (whose predominant symptom was checking) and a group of matched healthy controls. Significant differences were found between the experimental and control groups, suggesting some memory impairment in the OCD group; however, no significant relationship was found linking neuropsychological test indices with checking. Significant relationships were found linking recognition memory problems and immediate memory for actions with general symptom severity.

The neuropsychology of obsessive-compulsive disorder: a review and consideration of clinical implications.

Clinicians have suspected that obsessive-compulsive disorder (OCD) is associated with fundamental information-processing deficits beyond those attributable to mood disturbance alone. Neuropsychological investigations can be divided into four broad areas concerned with general intellectual functioning, an 'under-inclusive' thinking style, performance on tests sensitive to frontal lobe impairment and performance on tests of memory. This body of research is critically reviewed. It is suggested that there is modest evidence for the presence of non-verbal and praxic memory deficits in patients with OCD. These deficits are consistent with contemporary theories of fronto-striatal functioning and may represent the cognitive substrate of doubt-related phenomena such as checking. The demonstration of specific memory impairments in OCD may have significant implications for the revision of existing models of OCD and the development of novel treatment strategies that reduce doubt in compulsive checkers by increasing the distinctiveness of past actions.

Information-processing, storage characteristics and worry.

Eysenck (1984, Bulletin of the Psychonomic Society, 22, 545-548) suggested that storage characteristics may be an important determinant of worry, and postulated that prolonged worry occurs in individuals who have tightly organised clusters of worry-related information stored in long-term memory. These clusters reflect areas or domains of worry. Because the information is stored in tight clusters, it becomes more accessible, more rapidly activated and therefore retrieved more quickly. The Worry Domains Questionnaire (WDQ) (Tallis, 1991c) is used to determine which domain worried subjects most (Primary) and least (Secondary). Two experiments are reported using a word allocation task, which requires subjects to make categorical decisions, based on these worry domains. It is reported that priming facilitates the emergence of domain effects, thus providing support for a structural hypothesis. High worries take longer to reject negative words if they are from the Primary domain and have difficulty rejecting Primary domain words when they are under a congruent heading. In addition, high worriers are reported to show retarded latencies when attempting to process ambiguous information, consistent with Metzger et al.'s studies (1990, Journal of Clinical Psychology, 48, 76-88). It is suggested that the initiation and maintenance of worry is largely attributable to an elevated evidence requirement and this may link to the personality trait of perfectionism.

Investigation into the relationship between personality traits and OCD: a replication employing a clinical population.

The relationship between obsessional personality traits and Obsessive Compulsive Disorder (OCD) has long been the subject of debate. Although clinicians have asserted for nearly a hundred years that such a relationship exists, empirical investigations have failed to provide consistent support; however, none of these empirical investigations have undertaken analyses that control for the effect of mood variables. Employing a non-clinical sample, Rosen and Tallis (1995) [Behaviour, Research and Therapy, 4, 445-450] found that when mood variables are taken into account, a unique relationship between obsessional traits and obsessional symptoms emerges. A replication was undertaken on a large group of individuals with OCD. After the effects of depression and anxiety were removed from a correlational analysis, obsessional symptoms were found to be significantly associated with obsessional and passive aggressive traits. Obsessive Compulsive Disorder was not associated with any other grouping of traits as specified in the DSM-III-R (Axis II) classification system.

Compulsive washing in the absence of phobic and illness anxiety.

A new typology of washing compulsions has been proposed: those that arise from a sense of dirtiness, those that arise from a sense of mental pollution, and finally, those that arise from a fear of illness. A case series is reported suggesting that a further class of washing behaviour can be described attributable to the personality trait of perfectionism.

Investigation into the relationship between personality traits and OCD.

In the light of recent research suggesting that obsessive-compulsive disorder is more likely to be associated with constellations of personality traits other than obsessive-compulsive personality traits, the present study was undertaken to explore this relationship further and to remove the possibly confounding effects of general pathology, anxiety and depression. By using a non-clinical sample and partialling out the effects of anxiety and depression, it was found, contrary to recent research, that specific obsessional symptoms were only related to the traits of obsessive-compulsive personality disorder.

Obsessive-compulsive symptoms and the family.

A questionnaire study of 98 family members of individuals with obsessive-compulsive symptoms revealed that 60% of the family members were involved to some extent in rituals with the affected family member. Nearly all family members reported at least some degree of interference in their lives. Information was also gathered about the sort of rituals in which members were involved, how they responded to the demands of the affected relative to engage in the rituals, their beliefs and knowledge about compliance, and the degree to which the rituals interfered in their lives. The study highlights the possible need for support, advice, and education for family members of persons with obsessive-compulsive symptoms.

Does rapid eye movement desensitization facilitate emotional processing?

Recent years have seen considerable interest in rapid eye movement desensitization (REMD), a novel procedure for the treatment of traumatic memories and related conditions. REM is usually administered as a component of a broader therapeutic procedure, now termed eye movement desensitization and reprocessing (EMDR). On the basis of previous and largely uncontrolled work, it is not clear to what degree therapeutic gains can be attributed exclusively to REMD. Following exposure to a contrived trauma, Ss were allocated to one of three conditions: REMD; slow eye movement desensitization (SEMD); and stationary-imagery (SI; i.e. no eye movement). Emotional processing was significantly impaired in the REMD group compared to the SEMD and SI groups. No significant differences were found between the SEMD and SI groups.

Obsessions, responsibility and guilt: two case reports suggesting a common and specific aetiology.

Inflated responsibility, guilt and the psychological fusion of thought and action feature prominently in contemporary accounts of obsessional phenomena. Two cases are reported in which the presence of these features can be explained by a specific formative learning experience. Some implications for therapy are considered.

Primary hypothyroidism: a case for vigilance in the psychological treatment of depression.

Primary hypothyroidism is a relatively common endocrine disorder that develops insidiously and can mimic depression. Between 8 and 14 per cent of patients diagnosed as depressed may have some degree of hypothyroidism. It is recommended that clinical psychologists equip themselves with sufficient knowledge to recognize the disorder. Primary hypothyroidism is described with respect to its causes, course, investigation and treatment. Suggestions are made to help psychologists determine whether a medical referral is appropriate.

UCS inflation in the aetiology of a variety of anxiety disorders: some case histories.

This paper reports a number of case histories which illustrate the involvement of UCS inflation processes in the aetiology of a variety of anxiety disorders including agoraphobia, simple phobia, PTSD, obsessive-compulsive disorder and panic disorder. These cases are discussed in the context of: (i) renewed interest in cognitive features of conditioning models of anxiety disorders; and (ii) the implications that such models might have for an understanding of the aetiology and treatment of anxiety-based disorders.

The relationship between information-seeking and information-avoiding coping styles and the reporting of psychological and physical symptoms.

The present paper describes a prospective study of the relationship between information-seeking and information-avoiding coping styles ('monitoring' and 'blunting') and the reporting of both psychological and physical symptoms. The results suggested that blunting was directly associated with the reporting of both psychological symptoms and symptoms associated with opportunistic infections (such as colds, 'flu etc.). Furthermore, this association between blunting and symptom report was independent of initial symptom levels and of some other factors which have been shown to influence health status (i.e. the frequency of negative life experiences, the frequency of daily hassles and levels of trait anxiety). No significant relationships were found between monitoring and symptom report. It is argued that the most likely explanation of these results is that high blunters report more illness symptoms as a result of failing to respond to initial illness cues or seeking remedial treatment only at a later stage in the development of a disorder.

Worry and obsessional symptoms: a correlational analysis.

Several studies have suggested that worry and obsessional symptoms are systematically associated. In the present study, the relationship between worry and obsessional symptoms was confirmed. Measures included a worry content measure, a worry visual analogue scale, a modification of the everyday checking behaviours scale, and the MOCI. Worry was found to be more consistently associated with checking and doubting, than washing and slowness. It is suggested that worry and obsessional symptoms both occur in response to stress. In addition, it is suggested that worry and checking are functionally similar, and Generalised Anxiety Disorder may represent a 'cognitive' variant of obsessional checking.