Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis.

Importance: Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. Objective: To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD). Design, Setting, and Participants: In this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability. Main Outcomes and Measures: Performance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis. Results: Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (ß [SE], -0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (ß [SE], -0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (ß [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: ß [SE], -0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: ß [SE], 0.39 [0.66]; P = .56; categories completed: ß [SE], -0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (ß [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (ß [SE],-0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing. Conclusions and Relevance: Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.

The relationship between perceived social support and severity of body dysmorphic disorder symptoms: the role of gender.

OBJECTIVE: Whether social support is associated with severity of body dysmorphic symptoms is unknown. To address this gap in the literature, the present study aims to examine the association between three domains of perceived social support (i.e., family, friends, and significant others) and severity of body dysmorphic disorder symptoms. METHOD: Participants (N = 400) with symptoms consistent with diagnosis of body dysmorphic disorder completed measures of symptomatology and social support via the internet. RESULTS: More perceived social support from friends and significant others was associated with less severe body dysmorphic disorder symptoms for males, and more perceived social support from family and friends was associated with less severe body dysmorphic disorder symptoms among females. Additionally, gender moderated the association between perceived social support from significant others and symptom severity, such that perceived social support from a significant other was significantly negatively associated with body dysmorphic symptom severity in males, but not females. CONCLUSION: The present study implicates social support as an important area of future body dysmorphic disorder research.

The relationship between perceived social support and severity of body dysmorphic disorder symptoms: the role of gender / O efeito do gênero sobre a relação entre suporte social apreendido e gravidade dos sintomas do transtorno dismórfico corporal

OBJECTIVE: Whether social support is associated with severity of body dysmorphic symptoms is unknown. To address this gap in the literature, the present study aims to examine the association between three domains of perceived social support (i.e., family, friends, and significant others) and severity of body dysmorphic disorder symptoms. METHOD: Participants (N = 400) with symptoms consistent with diagnosis of body dysmorphic disorder completed measures of symptomatology and social support via the internet. RESULTS: More perceived social support from friends and significant others was associated with less severe body dysmorphic disorder symptoms for males, and more perceived social support from family and friends was associated with less severe body dysmorphic disorder symptoms among females. Additionally, gender moderated the association between perceived social support from significant others and symptom severity, such that perceived social support from a significant other was significantly negatively associated with body dysmorphic symptom severity in males, but not females. CONCLUSION: The present study implicates social support as an important area of future body dysmorphic disorder research.

OBJETIVO: Não há informação sobre o impacto do suporte social apreendido sobre a gravidade dos sintomas do transtorno dismórfico corporal. A fim de investigar essa relação, este estudo visa avaliar a associação entre três domínios do suporte social apreendido (familiares, amigos, e relacionamentos amorosos significativos) e a gravidade dos sintomas do transtorno dismórfico corporal. MÉTODO: Os participantes (N = 400) com sintomas compatíveis com o diagnóstico de transtorno dismórfico corporal preencheram questionários sobre seus sintomas e suporte social via internet. RESULTADOS: Foi encontrada correlação inversa estatisticamente significativa entre a apreensão do suporte social por parte de amigos e relacionamentos amorosos e a gravidade dos sintomas de transtorno dismórfico corporal em homens. Do mesmo modo, foi encontrada correlação inversa e estatisticamente significativa entre a apreensão do suporte social por parte de familiares e amigos e gravidade dos sintomas de transtorno dismórfico corporal em mulheres. Além disso, gênero foi um moderador da associação entre apreensão do suporte social por parte de relacionamentos amorosos e gravidade dos sintomas de transtorno dismórfico corporal. A apreensão de suporte social por parte de relacionamentos amorosos mostrou-se inversamente associada à gravidade dos sintomas de transtorno dismórfico corporal em homens, mas não em mulheres. CONCLUSÃO: Este estudo demonstra a importância da avaliação do suporte social apreendido em estudos futuros envolvendo pacientes com transtorno dismórfico corporal.

Treatment utilization and barriers to treatment engagement among people with body dysmorphic symptoms.

OBJECTIVES: Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with an imagined or minor appearance flaw. Many aspects of BDD remain unknown, such as rates of treatment utilization, types of treatment sought, and barriers to treatment. The present study sought to examine rates and patterns of treatment utilization as well as barriers to treatment among individuals with body dysmorphic symptoms. METHODS: The present study consists of 401 individuals with symptoms consistent with a diagnosis of BDD who completed self-reported measures of treatment utilization and barriers to treatment in an internet survey. RESULTS: Consistent with past research, results showed that individuals with probable BDD reported seeking non-mental health treatments for BDD (e.g., plastic surgery). Additionally, an examination of treatment barriers demonstrated significant barriers for the sample for the three domains examined: logistic and financial; stigma, shame, and discrimination; and treatment skepticism. Secondary analyses revealed a differential endorsement of treatment barriers across ethnic groups for all three barrier domains. CONCLUSION: These data suggest that BDD is still an underrecognized disorder with marked barriers to treatment. Increased education and dissemination efforts are warranted.

Barriers to treatment and service utilization in an internet sample of individuals with obsessive-compulsive symptoms.

BACKGROUND: Despite the increasing dissemination of treatment for Obsessive-Compulsive Disorder (OCD) in the past decade, the majority of individuals with OCD are not receiving appropriate treatment. This study examined rates of treatment utilization and barriers to treatment in an internet sample of individuals with self-reported OCD. METHODS: One hundred and seventy-five participants completed an online survey examining OCD symptoms, psychosocial measures, barriers to treatment, and treatment utilization. RESULTS: Sixty percent of the sample reported receiving treatment for their OCD symptoms. The majority of participants who sought pharmacotherapy received SSRIs, whereas the majority who sought psychotherapeutic treatment received "talk therapy." The cost of treatment, lack of insurance coverage, shame, and doubt that treatment would be effective were the most commonly endorsed barriers to treatment among the sample. CONCLUSIONS: Findings demonstrated relatively low treatment utilization rates among the sample, with many participants receiving treatments other than the gold-standard medication and psychotherapy treatments (i.e. SSRIs and cognitive behavioral therapy, respectively). Furthermore, a large portion of the sample endorsed many barriers to treatment seeking, such as logistic and financial barriers; stigma, shame, and discrimination barriers; and treatment perception and satisfaction barriers. This study highlights the need for more effective treatment dissemination in OCD.