EC Psychology And Psychiatry

Purpose: To examine intolerance of uncertainty, maladaptive coping strategies, and perfectionism as predictors of an obsessive- compulsive disorder (OCD) diagnosis. p>Methods: Outpatients (N = 549) referred to the START Clinic for Mood and Anxiety Disorders in Toronto from 2011-2014 completed a structured clinical interview (MINI International Neuropsychiatric Interview Plus) and were subsequently administered a series of self-report questionnaires. Included in these questionnaires were the Intolerance of Uncertainty Scale (IUS), the Hewitt Multidimen- sional Perfectionism Scale (MPS) and the Coping Inventory of Stressful Situations Scale (CISS). Multiple binary logistic regression analyses were performed using the diagnosis of OCD as the outcome variable and the total scores on each of the scales (and their associated subscales) as separate predictor variables of OCD. p>Results: Total scores on the IUS and the MPS significantly predicted an OCD diagnosis (p < .001 and p < .05, respectively), with greater IU and maladaptive perfectionism correlating with an increased likelihood of being diagnosed with OCD. While total scores on the CISS did not predict an OCD diagnosis, sub-factors 1 and 2 of the CISS (specifically, task-oriented and emotion-oriented coping) did predict an OCD diagnosis (p < .05). Furthermore, factor 1 of the IUS 2-factor model (IUS-negative) and factors 2 and 3 of the IUS 4-factor model (IUS-inability to act and IUS-avoid, respectively) were significant predictors of OCD (p < .001). None of the subscales within the MPS individually predicted an OCD diagnosis. p>Conclusions: Maladaptive perfectionism, coping strategies and intolerance of uncertainty, predicted the diagnosis of OCD. The sub- scales were potentially stronger predictors and better moderators of this relationship, providing information about the nature of OCD and its treatment. Future studies should examine these features in determining potential differential outcomes in response to treatment for OCD.

key words: Features that Predict; Comorbidity; Intolerance of Uncertainty; Perfectionism; Treatment Implications; Yale-Brown Obses- sive Compulsive Scale (YBOCS)

1. Murray Christopher JL., et al. “The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: summary” (1996).
2. Kessler Ronald C., et al. “Severity of 12-month DSM-IV disorders in the national comorbidity survey replication adolescent supplement”. Archives of General Psychiatry 69.4 (2012): 381-389.
3. Torres Albina R., et al. “Epidemiology, comorbidity, and burden of OCD”. Obsessive-compulsive Disorder: Phenomenology, Pathophysiology, and Treatment (2017).
4. García-Soriano G., et al. “Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature”. Psychiatry Research 220.1-2 (2014): 1-10.
5. Marques Luana., et al. “Barriers to treatment and service utilization in an internet sample of individuals with obsessive–compulsive symptoms”. Depression and Anxiety 27.5 (2010): 470-475.
6. Rasmussen Steven A and Jane L Eisen. “The epidemiology and differential diagnosis of obsessive compulsive disorder”. The Journal of Clinical Psychiatry 53 (1994): 5-10.
7. Reed Graham F. “Obsessional experience and compulsive behaviour: A cognitive-structural approach”. Volume 34 (1985).
8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric (2013).
9. Fontenelle LF., et al. “The descriptive epidemiology of obsessive–compulsive disorder”. Progress in Neuro-Psychopharmacology and Biological Psychiatry 30.3 (2006): 327-337.
10. Ruscio AM., et al. “The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication”. Molecular Psychiatry 15.1 (2010): 53-63.
11. Politis Spyridon., et al. “Epidemiology and comorbidity of obsessive–compulsive disorder in late adolescence: a cross-sectional study in senior high schools in Greece”. International Journal of Psychiatry in Clinical Practice 21.3 (2017): 188-194.
12. Viana MC and Andrade LH. “Lifetime prevalence, age and gender distribution and age-of-onset of psychiatric disorders in the São Paulo Metropolitan Area, Brazil: results from the São Paulo Megacity Mental Health Survey”. Revista Brasileira de Psiquiatria 34.3 (2012): 249-260.
13. Nelson Elliot and John Rice. “Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study”. American Journal of Psychiatry 154.6 (1997): 826-831.
14. Adam Yuki., et al. “Obsessive–compulsive disorder in the community: 12-month prevalence, comorbidity and impairment”. Social Psychiatry and Psychiatric Epidemiology 47.3 (2012): 339-349.
15. Blom Rianne M., et al. “Obsessions in normality and psychopathology”. Depression and Anxiety 28.10 (2011): 870-875.
16. De Bruijn C., et al. “Subthreshold symptoms and obsessive–compulsive disorder: evaluating the diagnostic threshold”. Psychological Medicine 40.6 (2010): 989-997.
17. Fullana MA., et al. “Obsessive–compulsive symptom dimensions in the general population: Results from an epidemiological study in six European countries”. Journal of Affective Disorders 124.3 (2010): 291-299.
18. American Psychiatric Association. “Diagnostic and statistical manual of mental disorders revised (DSM-III-R)”. Washington DG (1987).
19. Bartz Jennifer A and Eric Hollander. “Is obsessive–compulsive disorder an anxiety disorder?” Progress in Neuro-Psychopharmacology and Biological Psychiatry 30.3 (2006): 338-352.
20. Dugas Michel J., et al. “The Role of Intolerance of Uncertainty in Etiology and Maintenance”. In RG Heimberg, C L Turk and DS Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice. New York, NY, US: Guilford Press (2004): 143-163.
21. Tolin David F., et al. “Intolerance of uncertainty in obsessive-compulsive disorder”. Journal of Anxiety Disorders 17.2 (2003): 233-242.
22. Holaway Robert M., et al. “A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder”. Journal of Anxiety Disorders 20.2 (2006): 158-174.
23. Fergus Thomas A and Kevin D Wu. “Do symptoms of generalized anxiety and obsessive-compulsive disorder share cognitive processes?” Cognitive Therapy and Research 34.2 (2010): 168-176.
24. Carleton R Nicholas. “Into the unknown: A review and synthesis of contemporary models involving uncertainty”. Journal of Anxiety Disorders 39 (2016): 30-43.
25. Buhr Kristin and Michel J Dugas. “Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry”. Journal of Anxiety Disorders 20.2 (2006): 222-236.
26. Counsell Alyssa., et al. “Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms”. Psychiatry Research 252 (2017): 63-69.
27. Koerner Naomi., et al. “What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder”. Cognitive Behaviour Therapy 46.2 (2017): 141-161.
28. Calleo Jessica S., et al. “Obsessions and worry beliefs in an inpatient OCD population”. Journal of Anxiety Disorders 24.8 (2010): 903- 908.
29. Grayson Jonathan B. “OCD and intolerance of uncertainty: Treatment issues”. Journal of Cognitive Psychotherapy 24.1 (2010): 3-15.
30. Hewitt Paul L and Gordon L Flett. “Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology”. Journal of Personality and Social Psychology 60.3 (1991): 456-470.
31. Hewitt Paul Louis and Gordon L Flett. “Multidimensional perfectionism scale (MPS): Technical manual”. MHS (2004).
32. Reuther Erin T., et al. “Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive-compulsive symptom severity”. Depression and Anxiety 30.8 (2013): 773-777.
33. Ashby Jeffrey S and Linda Pak Bruner. “Multidimensional Perfectionism and Obsessive-Compulsive Behaviors”. Journal of College Counseling 8.1 (2005): 31-40.
34. Goodman Wayne K., et al. “The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability”. Archives of General Psychiatry 46.11 (1989): 1006-1011.
35. Taylor Steven., et al. “How are dysfunctional beliefs related to obsessive-compulsive symptoms?” Journal of Cognitive Psychotherapy 24.3 (2010): 165-176.
36. De Cuyper Kathleen., et al. “Psychometric properties of the Multidimensional Perfectionism Scale of Hewitt in a Dutch-speaking sample: Associations with the Big Five personality traits”. Journal of Personality Assessment 97.2 (2015): 182-190.
37. McWilliams Lachlan A., et al. “Use of the Coping Inventory for Stressful Situations in a clinically depressed sample: Factor structure, personality correlates, and prediction of distress”. Journal of Clinical Psychology 59.4 (2003): 423-437.
38. Endler Norman S and James DA Parker. “Assessment of multidimensional coping: Task, emotion, and avoidance strategies”. Psychological Assessment 6.1 (1994): 50.
39. O’Brien Tess Byrd and Anita DeLongis. “The interactional context of problem‐, emotion‐, and relationship‐focused coping: the role of the big five personality factors”. Journal of Personality 64.4 (1996): 775-813.
40. Shewchuk Richard M., et al. “Trait influences on stress appraisal and coping: An evaluation of alternative frameworks”. Journal of Applied Social Psychology 29.4 (1999): 685-704.
41. Eisen, Jane L., et al. “Five-year course of obsessive-compulsive disorder: predictors of remission and relapse”. The Journal of Clinical Psychiatry 74.3 (2013): 233-239.
42. Sheehan DV., et al. “The Mini–International Neuropsychiatric Interview (MINI): the development and validation of a structured psychiatric interview for DSM–IV and ICD-10”. Journal of Clinical Psychiatry 59.20 (1998): 22-33.
43. Freeston Mark H., et al. “Why do people worry?” Personality and Individual Differences 17.6 (1994): 791-802.
44. Hewitt Paul L., et al. “The Multidimensional Perfectionism Scale: Reliability, validity, and psychometric properties in psychiatric samples”. Psychological Assessment: A Journal of Consulting and Clinical Psychology 3.3 (1991): 464-468.
45. Lecrubier, Yves, et al. “The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI”. European Psychiatry 12.5 (1997): 224-231.
46. Buhr Kristine and Michael J Dugas. “The intolerance of uncertainty scale: Psychometric properties of the English version”. Behaviour Research and Therapy 40.8 (2002): 931-945.
47. Dugas Michel J., et al. “Intolerance of uncertainty and problem orientation in worry”. Cognitive Therapy and Research 21.6 (1997): 593-606.
48. Birrell Jane., et al. “Toward a definition of intolerance of uncertainty: A review of factor analytical studies of the Intolerance of Uncertainty Scale”. Clinical Psychology Review 31.7 (2011): 1198-1208.
49. Rotomskis Augustinas. “Psychometric Properties of the Intolerance of Uncertainty Scale (IUS) in a Lithuanian-speaking population”. Journal of European Psychology Students 5.1 (2014): 25-30.
50. Sexton Kathryn A and Michel J Dugas. “Defining distinct negative beliefs about uncertainty: Validating the factor structure of the Intolerance of Uncertainty Scale”. Psychological Assessment 21.2 (2009): 176-186.
51. Berenbaum Howard., et al. “Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality”. Journal of Anxiety Disorders 22.1 (2008): 117-125.
52. Cook Stephen W and P Paul Heppner. “A psychometric study of three coping measures”. Educational and Psychological Measurement 57.6 (1997): 906-923.
53. Cosway Richard., et al. “The Coping Inventory for Stressful Situations: Factorial structure and associations with personality traits and psychological health”. Journal of Applied Biobehavioral Research 5.2 (2000): 121-143.
54. Takagishi Yukihiro., et al. “Factor Structure of the Coping Inventory for Stressful Situations (CISS) in Japanese Workers”. Psychology 5.14 (2014): 1620-1628.
55. Gentes Emily L and Ayelet Meron Ruscio. “A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder”. Clinical Psychology Review 31.6 (2011): 923-933.
56. De Silva Padmal. “Obsessive-compulsive disorder”. Adult Psychological Problems. Taylor and Francis (2014): 143-162.
57. Morein-Zamir Sharon., et al. “Tolerating uncertainty in OCD, do patients require more information to make decisions?” European Neuropsychopharmacology 27.6 (2017): 613-614.
58. Wheaton Michael G., et al. “Behavioral avoidance predicts treatment outcome with exposure and response prevention for obsessive– compulsive disorder”. Depression and Anxiety 35.3 (2018): 256-263.
59. Tolin David F., et al. “Are “obsessive” beliefs specific to OCD?: A comparison across anxiety disorders”. Behaviour Research and Therapy 44.4 (2006): 469-480.