Augmented reality beauty filters (ARB) have gained popularity on social media platforms, raising concerns about their potential to exacerbate appearance concerns. To explore these risks, this experimental study examined multimodal state effects of viewing unmodified, vs. ARB-modified, “self” or “other” images, implementing a novel free-viewing paradigm in a sample varying in appearance concerns.N = 91 participants identifying as women were randomized to one of four conditions in which they viewed counterbalanced sequences of unmodified, vs. ARB-modified, facial photos of their own, vs. a confederate face. Before and after trials, we assessed state affect, body dissatisfaction, degree of conviction about being unattractive, and self-esteem. We further explored the effect of model-congruent trait predictors (i.e., BDD symptoms and social comparison tendencies) on image exposure response.Results revealed increases in state body dissatisfaction and conviction about being unattractive following exposure to “other” faces modified by the “Teenage Look”, vs. “Bold Glamour”, filter. Trait BDD symptoms and upward appearance comparison did not predict differential responses to ARB.Taken together, these findings suggest that youth-promoting ARB might induce maladaptive cognitive-affective responses even after brief exposure. Future research should replicate and expand these findings to inform efforts toward platform regulation, prevention and intervention programs for appearance-related social media use.
Sexual functioning and satisfaction in OCD remain underexplored domains in clinical research and practice. This systematic review synthesised evidence on sexual dysfunction and satisfaction in individuals with OCD or obsessive–compulsive (OC) symptoms or dimensional obsessive-compulsive symptoms in community samples.Eligible studies were included if they assessed adolescents/adults with a primary OCD diagnosis or clinically significant obsessive-compulsive symptoms or examined dimensional obsessive-compulsive symptoms in community samples. Outcomes included sexual dysfunction and sexual satisfaction assessed with standardised instruments.Eleven studies were included. Evidence from two studies indicated prevalence rates of sexual dysfunction ranging from 50% to 55.45% among individuals with OCD. In one case–control study, sexual dysfunction was more prevalent in OCD than in healthy controls (50% vs. 30%). Orgasmic dysfunction emerged as the most impaired domain, with a prevalence of 46% in individuals with OCD, compared with 16% in healthy controls, 26% in individuals with generalised anxiety disorder, and 32% in individuals with major depressive disorder.Findings regarding the other sexual domains were heterogeneous. Some studies reported greater sexual inhibition and poorer sexual functioning, whereas one study reported higher sexual excitation propensity. Other found no significant differences between OCD and comparison groups. The role of sex and pharmacological treatment remained inconclusive.OCD appears to be associated with sexual functioning impairments, particularly orgasmic dysfunction. However, conclusions remain provisional due to methodological limitations and substantial heterogeneity. Routine assessment of sexual health should be integrated into OCD care, and future longitudinal, powered studies are needed to clarify mechanisms, moderators, and treatment implications.
The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) is a concentrated, exposure-based intervention delivered in a group format. Research into the B4DT has proliferated in the last decade. However, there has been no systematic review of the literature on the B4DT to date. This systematic review aimed to evaluate the effectiveness, long-term outcomes, acceptability, and factors affecting outcomes of the B4DT for OCD. Any peer-reviewed study published in English between 2012 and February 2026 which evaluated the B4DT for OCD in at least one of these domains was eligible for inclusion. A search of PubMed, PsycInfo, Scopus, Embase, the Cochrane Library, ProQuest Dissertations and Theses, and EBSCO Open Dissertations was conducted in March 2026. Owing to a lack of randomised controlled trials (RCTs), results were synthesised in a narrative review. Thirty-eight eligible studies were identified, including 27 studies with original data. Combining all intervention studies using original data yielded a total sample of 1144 B4DT participants. Only one RCT of the B4DT was identified. All intervention studies included in the review found the B4DT to be an effective treatment for OCD. There is also evidence to suggest that treatment gains are maintained long-term. Satisfaction ratings of the treatment were high, while attrition rates were low. Various predictors of treatment outcomes were identified. However, the overall quality of the evidence pertaining to the B4DT was poor, since almost all studies lacked comparators. Future research should evaluate the B4DT against current first-line treatments for OCD using RCTs.
For over a decade, research has supported that obsessive-compulsive disorder (OCD) is frequently misdiagnosed and not treated with OCD-specific, empirically supported treatments (ESTs) by healthcare professionals. This has resulted in barriers for those seeking effective treatments. Empirical findings are mixed regarding predictors for misdiagnosis and non-OCD-specific treatment recommendations among mental health professionals. Additionally, there is a dearth of research investigating licensed mental health counselors' (LMHCs) accuracy in OCD assessment and treatment recommendations. In this study, we examined LMHCs’ diagnostic impressions and treatment recommendations for OCD across subtypes, focusing on (a) accuracy of diagnosis, (b) whether OCD-specific ESTs were recommended, and (c) whether theoretical orientation, years of experience, and clinical specialty influenced OCD diagnosis and treatment recommendations. Case vignettes were used in an online survey to gather data from LMHCs (N = 130) who were asked to diagnose and provide treatment recommendations based on the presented symptoms. Over 62% of LMHCs accurately diagnosed OCD and recommended OCD-specific ESTs across varying subtypes. LMHCs were six times more likely to diagnose OCD accurately in nontaboo subtypes. Those with a theoretical orientation that included an OCD-specific EST (exposure therapy, CBT, ACT) were over five times more likely to recommend an OCD-specific EST. These results supported that OCD treatment remains an issue in the field, with LMHCs, among other types of mental health professionals, contributing to the concerns.
Harm reduction approaches for hoarding involve taking steps to reduce risks and harms associated with hoarding behaviour. Developing a sensible intervention plan involves first assessing the health and safety issues that commonly arise in hoarded homes. This paper describes the development of the Home Environment Assessment Tool for Hoarding (HEATH) tool and three field studies exploring its psychometric properties. The tool was developed collaboratively with professionals who have frontline experience responding to cases involving hoarding and was informed by a Community Advisory Board that included people with lived experience of hoarding. Study 1 showed strong evidence of the HEATH's content validity based on ratings from an independent sample of experts. In collaboration with four community-partner agencies in Ontario, Study 2 showed good evidence of convergent validity through strong correlations between the HEATH and other indicators of health and safety issues and domestic functioning. Evidence of discriminant validity was observed in weaker correlations between the HEATH and measures of hoarding symptoms such as difficulty discarding or excessive acquisition. Finally, Study 3 tested criterion validity by comparing HEATH scores from two distinct programs in an older adult services agency, one of which was specifically for concerns about hoarding. The HEATH is a useful tool that can be used with minimal training to assess environmental risk in hoarded homes and to communicate about those risks with clients.
Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with perceived appearance flaws, often leading to high psychological burden and engagement in cosmetic procedures rather than seeking psychological help. This study explored clinical characteristics and cosmetic procedure utilization in an online sample, including individuals meeting DSM-5 criteria for BDD based on a self-report measure (hereafter referred to as probable BDD; pBDD; n = 1837), subclinical symptoms (n = 392), and no or unremarkable appearance concerns (n = 166). Participants completed standardized measures assessing BDD symptoms, appearance concerns, mental health and cosmetic surgery history.A total of 29.5% of individuals with pBDD had undergone at least one cosmetic procedure and even more were interested in future surgeries (68.0%). Satisfaction with past procedures was low, supporting that cosmetic treatments rarely address BDD psychopathology. Hierarchical regression analyses yielded that both BDD symptom severity and stronger conviction in appearance-related beliefs predicted cosmetic surgery intent, whereas only symptom severity predicted past surgery behavior.Gender-based analyses (women vs. men) revealed no significant overall difference in surgery rates (30.7% vs. 25.8%). However, women more often pursued or planned facial and breast procedures, whereas men more frequently reported hair-related concerns and interventions. Women also reported higher symptom severity and more financial barriers to surgery.Only 9.4% of individuals with pBDD reported a formal diagnosis of BDD, underscoring persistent treatment barriers and under-recognition. These findings highlight the need for early screening, especially in cosmetic and dermatological contexts, and treatment concepts including modules addressing the wish for cosmetic procedures.
Difficulties in motivation may interfere with successful treatment of hoarding problems. Values clarification is an evidence-based process that may theoretically lead to more consistent motivation over time. Therefore, this randomized controlled trial tested the impact of written exercises targeting values clarification, delivered twice-daily in a prototype mobile app, relative to a control condition that also involved writing about belongings without targeting cognitive-behavioral processes, and a waitlist control. Participants (N = 99) were American adults with clinically significant hoarding symptoms. The sample was mostly White and mostly women; they varied in social class and most reported having at least one disability. All conditions improved significantly on the primary outcome of overall hoarding severity. The values clarification condition improved significantly relative to waitlist on most outcomes, including clutter, distress, and hoarding-related disability; however, the values condition was not significantly different from the control writing condition on most outcomes. In momentary data, the values condition improved significantly over time on motivation to declutter, items discarded, and items acquired, compared to the control writing condition. Overall, results suggest that values clarification may have benefits for motivation and improving hoarding-related behaviors. However, in this high-frequency, low-intensity intervention, values clarification alone did not lead to significant improvement relative to an active control on broader hoarding symptoms. Notable limitations include a sample that was relatively low in hoarding severity and lacked diversity in important ways, reliance on self-report rather than clinician diagnosis, and a brief timeframe.
Objective: Impaired social cognition may contribute to the development and maintenance of body dysmorphic disorder (BDD), yet evidence is often inconsistent or limited to a single task or domain. This study aimed to characterise the social-cognitive profile of individuals with BDD across multiple domains (theory of mind (ToM), emotion recognition, pragmatic inference and empathy). Methods: Participants were 61 individuals with BDD and 61 healthy controls. Social cognition was assessed using six tasks: the Hinting Task (inferential ToM), the Awareness of Social Inference Test-Short (TASIT-S; ToM), Reading the Mind in the Eyes Test (ToM), Bell-Lysaker Emotion Recognition Task, TASIT-S Part 1 and Penn Emotion Recognition Test (dynamic and static emotion recognition), TASIT-S 'say' (pragmatic inference) and the Questionnaire of Cognitive and Affective Empathy (empathy). Results: The BDD group showed selective differences rather than global impairment. Group differences included: participants with BDD demonstrated enhanced TASIT-S ToM (d = 0.48, 95% CI [0.11, 0.85]), heightened (static) anger recognition (d = 0.67, 95% CI [0.29, 1.06]), superior pragmatic inference (d = 0.61, 95% CI [0.24, 0.98]) and elevated cognitive empathy (d = 0.49, 95% CI [0.09, 0.89]), driven by perspective taking, while Hinting was lower (d = -0.42, 95% CI [-0.78, -0.06]). No effects were associated with clinical variables. Conclusions: Social cognition in BDD is not broadly impaired, instead showing a pattern of heightened sensitivity to threat cues and difficulties with higher-order inferential reasoning. If replicated, these findings may inform cognitive-behavioural approaches by identifying automatic threat responses and inferential social reasoning as potential therapeutic targets.
Cognitive therapy (CT) for obsessive-compulsive disorder (OCD) is often underemphasized, despite accumulating empirical support. This brief communication revisits historical concerns regarding CT, tracing their origins to early trials characterized by poor fidelity to OCD-specific protocols, conceptual overlap between CT and ERP, and the use of generic cognitive techniques that may function as reassurance-like interventions. We reviewed contemporary evidence showing that when CT was delivered using OCD-specific protocols that target maladaptive beliefs (e.g., inflated responsibility, perfectionism, intolerance of uncertainty), outcomes were comparable to ERP. We also examined symptom worsening from two clinical trials and found that CT showed no evidence of systematic symptom deterioration or iatrogenic harm. Clinical and guideline implications are considered, emphasizing that CT should not replace ERP but be recognized as a complementary, evidence-based option. Clarifying misconceptions about CT may reduce barriers to care, broaden access to effective treatment, and support more flexible, patient-centered approaches to OCD.
Cognitive behavioral therapy with exposure and response prevention (ERP) is widely regarded as the first-line psychological treatment for pediatric obsessive-compulsive disorder (OCD), yet barriers to implementation remain, and many clinicians report discomfort or lack of knowledge in delivering ERP. This naturalistic longitudinal study examined demographics, clinical practice characteristics, and self-reported perceived learning of clinicians enrolled in the International OCD Foundation's Pediatric Behavior Therapy Training Institute (BTTI), an intensive training program for pediatric ERP for OCD. Clinicians (N = 159) who attended one of six in-person pediatric BTTI trainings from 1/2016-11/2019 completed pre-and post-training assessments and at 6-month follow-up. Main analyses used multiple imputation for missing data. As hypothesized, results showed significant improvements from pre-to post-training in clinician-reported comfort in assessing/treating pediatric OCD with a large effect size (p < .001; ES = 0.95), which remained significant at follow-up. We were unable to detect significant changes in positive beliefs about exposure (ES = 0.12), proportions of patients with OCD in clinicians' caseloads (ES = 0.33), or percentage of session time devoted to ERP (ES = 0.02); although some models were significant in sensitivity analyses. At follow-up, most clinicians (72%) reported using all skills learned in the program, although some barriers persisted, such as challenges conducting exposures outside of the office. Findings support the effectiveness of the pediatric OCD BTTI in increasing clinicians' self-reported comfort in assessing and treating OCD in children/adolescents but provide limited evidence of objective changes in ERP implementation. Future efforts should incorporate objective fidelity measures, measure patient outcomes, address barriers to skills use, and increase accessibility to ERP training.
Repetitive negative thinking (RNT, e.g., worry and rumination) is a maintaining factor in obsessive-compulsive disorder (OCD). Studies have shown that training people to make fewer negative interpretations of ambiguous scenarios (known as cognitive bias modification training for interpretations or ‘CBM-I’) reduces RNT among individuals with anxiety and depression. This is the first study to investigate the effect of imagery-enhanced CBMI-I on RNT among individuals with elevated obsessive-compulsive (OC) symptoms.Individuals scoring above clinical cut-off for OCD were presented with a series of OCD-relevant ambiguous scenarios and either received imagery-enhanced CBM-I training, in which scenarios were resolved positively and participants generated vivid mental images of the positive outcome (N = 25), or an active control condition in which the same scenarios were presented without positive resolution (N = 25). They then completed a measure of interpretation bias and a proxy measure of RNT.Individuals in the CBM-I condition generated significantly more positive interpretations following training than those in the control condition. However, this effect did not carry over to the measure of RNT.Future research should consider matching CBM-I training to more idiosyncratic obsessional concerns, more intensive training or using alternative measures of RNT, to determine whether interpretation bias maintains RNT in OCD, or if other potential mechanisms are indeed involved.
Obsessive-compulsive disorder (OCD) is marked by the paradoxical coexistence of patients' ritualized actions and the patients' awareness of their lack of causal efficacy. The Illusory Contingency Task provides an experimental analogue for this ambivalence by inducing superstitious behaviors and beliefs under controlled conditions. We administered the Illusory Contingency Task to 75 participants (26 patients with OCD, 24 with anxiety disorders, and 25 healthy controls). In the task, participants moved a cartoon mouse on a 3 & times; 3 grid toward a piece of cheese, with success determined by a hidden time-based contingency (trial duration >= 4 s). We analyzed behavioral indices and participants' explicit convictions based on illusory rules determining success. Contrary to our preregistered hypotheses, patients with OCD did not form stronger superstitious beliefs than controls. However, they achieved fewer successful trials than patients with anxiety disorders. Post hoc analyses indicated that this reduced success was associated with lower exploratory behavior. These findings suggest that patients with OCD have difficulty adapting problem-solving strategies under illusory contingencies and highlight the potential of the Illusory Contingency Task as a paradigm for studying the exploration-exploitation trade-off in OCD.
Comorbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) is associated with more a severe overall clinical presentation compared to OCD without PTSD. However, existing research has largely focused on White, non-Hispanic/Latino populations, limiting generalizability of this complex comorbidity to diverse ethnic groups. Using data collected from the multisite Latin American Trans-ancestry INitiative for OCD genomics (LATINO) study, this study sought to replicate and extend previous findings regarding the clinical presentation associated with comorbid OCD and PTSD (OCD + PTSD). Differences in OCD severity, OCD symptom dimensions, OCD-related insight, avoidance, pathological doubt, and quality of life were compared across 1995 Latin American adults (M age = 31.54) with OCD alone (31.6%), OCD with other comorbidities (54.6%), and OCD + PTSD (13.8%), and psychiatric comorbidities were compared between participants with OCD + PTSD and OCD with other comorbidities. Replicating and extending prior research, individuals with OCD + PTSD had more severe clinical presentations across all domains, with the largest effect size found for quality of life. Consistent with previous research, these findings indicate that the presence of PTSD is associated with worse OCD clinical severity among Latin Americans, underscoring the necessity for comprehensive assessment strategies and integrated treatment approaches.
Safety behaviors are actions aimed at temporarily reducing distress, but they maintain long-term anxiety by preventing disconfirmation of feared outcomes. However, the determinants of excessive safety behavior use remain unclear. Perceived vulnerability to disease (PVD) captures individual differences in behavioral immune system sensitivity and is said to comprise two components: germ aversion and perceived infectability. While PVD has been linked to heightened anxiety in contexts involving potential illness or contamination, its unique role in safety behavior use among anxious populations remains unclear. Accordingly, the present investigation examines the extent to which the components of PVD uniquely predict safety behavior use in two analogue samples. In study 1, hierarchical multiple regression indicates that germ aversion, but not perceived infectability, significantly predicted greater safety behavior use among those with elevated health anxiety (n = 106) when other disease-specific and non-specific symptoms are also included in the model. This finding was replicated among participants high in contamination fear in study 2 (n = 79). These findings suggest that germ aversion is an affective component of PVD that plays a central role in driving maladaptive safety behaviors among those at risk for ‘disease avoidance disorders’, while cognitive beliefs about susceptibility to infection (i.e., perceived infectability) appear less influential. Directly targeting the affective determinants of germ aversion (i.e., disgust) during treatment for disorders characterized by disease avoidance may reduce motivation to engage in excessive use of safety behaviors.
Disgust is a primary emotion implicated in the onset and maintenance of contamination-related obsessive-compulsive (OC) symptoms. Research suggests that disgust comprises two distinct facets: disgust propensity (DP, the tendency to experience disgust across various situations) and disgust sensitivity (DS, the intensity of disgust and its negative interpretation). Although both DP and DS have been linked to contamination-related OC symptoms, most studies have examined them separately and/or relied solely on self-reported information. The present study investigated whether DP and DS uniquely predict in-vivo disgust ratings and discrete behavior. Nonclinical undergraduate students (N = 115) completed self-report measures and a contamination-based behavioral approach task (BAT). The major result revealed that DP-but not DS-significantly predicted both in-vivo disgust and behavioral approach. As such, DP may be the more relevant disgust construct in predicting both subjective and behavioral responses to contamination stimuli. A second result was that self-reported contamination-related OC symptoms significantly predicted behavioral approach but not in-vivo disgust ratings. Our study aimed to better understand the relationship between disgust facets and contamination-related OC symptoms, to assist in the development of more targeted approaches to understanding and treating contamination-related OC symptoms.
