OBJECTIVES:This study investigated the roles of feared self and inflated responsibility in obsessive-compulsive tendencies through an online experiment. DESIGN:A total of 185 participants (Mage = 28.11, SD = 9.12) were randomly assigned to either a heightened responsibility or control condition, then primed with feared self scenarios (morality or culpability) or neutral control scenarios presented through vignettes. METHODS:Participants completed a neutral baseline vignette. They were then randomly assigned to responsibility conditions (heightened vs. low) and priming conditions (morality feared-self, culpable feared-self or neutral control) involving vignette tasks with embedded spelling and grammatical errors for participants to identify. Responsibility was manipulated via instructional framing emphasizing the clinical importance of responses, and participants were allowed to review their responses, providing a behavioural measure of checking. Discomfort ratings (0-100 scale) and response times were recorded as outcome measures. RESULTS:The responsibility manipulation did not lead to significant variance in outcome variables, while participants' existing level of feared self and the feared-self manipulation were linked to a significant increase in average levels of discomfort. CONCLUSIONS:These findings provide experimental evidence that feared-self plays a fundamental cognitive-affective role in obsessive-compulsive tendencies. This underscores the importance of integrating feared-self processes into cognitive models to better understand discomfort-related responses in obsessive-compulsive phenomena.

While intolerance of uncertainty (IU) is recognized as a contributing factor in obsessive-compulsive disorder (OCD), further research is needed to elucidate the underlying mechanisms linking these constructs. Specifically, the roles of beliefs regarding loss of control, transdiagnostic coping response styles [such as repetitive negative thinking (RNT) and depressive rumination], and OCD-specific coping mechanisms (e.g., experiential avoidance and mental rituals focused on intrusive thoughts) within this relationship remain unclear and warrant investigation. This research evaluated the direct and indirect associations of IU with OCD symptoms by exploring potential mediating mechanisms in a large, clinically diagnosed OCD sample (n = 408). Participants completed both self-report questionnaires and clinician-administered interviews. IU demonstrates an indirect effect on OCD symptom, independent of comorbid conditions. This relationship was fully mediated by maladaptive beliefs concerning loss of control, a transdiagnostic coping (e.g., depressive rumination, but not though the RNT), and OCD-coping strategies, including experiential avoidance and mental rituals directed at intrusive thoughts. This study highlights that the interplay between IU and OCD symptoms depends on the degree to which people with OCD exhibit a fear of losing control and engage in transdiagnostic response styles (e.g., depressive rumination) and coping methods revolving around intrusive thoughts in the context of OCD. Consequently, interventions aimed at reducing IU in the context of OCD symptoms should target beliefs concerning loss of control and both transdiagnostic and obsession-specific coping strategies.

Recent literature suggests that the feared self, a version of self that one is afraid of becoming, is related to obsessive-compulsive (OC) phenomena. However, as this construct is not specific, the existence of the feared self itself does not fully explain why some people may develop obsessive-compulsive disorder (OCD) while others do not. This indicates that other constructs may play a role, in particular those that may influence the tendency of individuals endorsing negative imagined possibilities over reality-including inferential confusion and magical ideation. Inferential confusion is a reasoning bias specific to OCD and may be able to explain how OC symptoms develop from more general vulnerable self-themes and intrusions commonly reported in the general population. Additionally, magical ideation is another important cognitive bias that could explain the strong beliefs individuals with OCD have with respect to the effectiveness of compulsive rituals. However, to our knowledge, no study to date has investigated the relationships among these three constructs. Using a nonclinical population (N = 385), this study supported the proposed moderated-mediation model conducted via PROCESS. The link between the feared self and OCD symptoms was mediated by inferential confusion, and magical ideation was a moderator of the effects of inferential confusion. This study contributes to the literature by providing empirical support for the role of the feared self in predicting OC symptoms. It elucidates how a vulnerable self-view may escalate to OCD symptoms via inferential confusion, with the relationship strengthened further by beliefs in magical ideation which is often employed by individuals under stress. SUMMARY: While feared self is associated with obsessive-compulsive (OC) phenomena, on its own it is insufficient to explain why only some individuals may develop symptoms. The reasoning bias of inferential confusion, where individuals endorse imagined possibilities over reality, was found to mediate this relationship. Magical ideation, the tendency to have beliefs that defy culturally accepted laws of causality, amplified the effects that inferential confusion had on OC symptom severity. While a nonclinical study, this suggests that clinical interventions that directly target cognitive biases such as inferential confusion and magical ideation, along with feared self, may enhance treatment efficacy.

ObjectiveUntil recently, empirical studies had been limited with respect to investigating factors that influence the onset and maintenance of hair pulling disorder (HPD), particularly regarding the role of dysfunctional cognitions and beliefs. The primary aim of this study was to examine the relationships between symptom severity and belief domains in a sample with hair pulling disorder compared with non-clinical participants, using the Beliefs in Trichotillomania Scale (BiTS); a recently developed measure of relevant negative self-beliefs, coping efficacy beliefs, and perfectionist cognitions.MethodTwenty adults with HPD and 43 age- and gender-matched control participants completed the BiTS and several measures of related constructs.ResultsHPD severity was significantly and positively correlated with negative self-beliefs and low coping efficacy, but not perfectionism, even after controlling for anxiety and depressive symptoms. Focussed hair pulling, but not automatic hair pulling, was correlated with each BiTS domain; however, once anxiety and depressive symptoms were controlled for, the significant relationship between focussed hair pulling and perfectionism was no longer apparent. The BiTS psychometric properties demonstrated good internal consistency and differentiated clinical from non-clinical participants, with clinical participants endorsing greater negative self-beliefs, lower coping efficacy, and greater perfectionism compared with control participants.ConclusionsNegative self beliefs, low coping efficacy, and perfectionism have differential relationships with HPD severity and hair pulling styles, variable on the presence of co-occurring anxiety and depressive symptoms. While further support for the BiTS internal consistency was obtained, future examination of divergent validity with a more diverse range of constructs is required. What is already known about this topic: Current cognitive-behavioural interventions for hair pulling disorder are designed to facilitate behaviour change by targeting the habit-formation and emotion-regulation mechanisms that maintain hair pulling behaviours.The Beliefs in Trichotillomania Scale (BiTS) measures three belief domains found to be relevant to hair pulling disorder: negative self beliefs, low coping efficacy, and perfectionism.Some cognitive-behavioural interventions additionally target cognitions and beliefs, however, few studies have investigated the relationships between relevant belief domains and hair pulling disorder severity and styles.What this topic adds: Independent of co-occurring anxiety and depressive symptoms, negative self beliefs and low coping efficacy, but not perfectionism, were associated with hair pulling severity.Negative self beliefs, doubts about one's coping efficacy, and perfectionism were all associated with focussed hair pulling behaviours, but not automatic hair pulling behaviours. However, perfectionism was no longer correlated with focussed hair pulling upon controlling for anxiety and depressive symptoms.Assessment for these domains of dysfunctional beliefs, as part of formulation-driven cognitive-behavioural interventions for hair pulling disorder, is appropriate.

Hoarding Disorder (HD) is marked by the inability to discard possessions, and often excessive acquiring, which results in cluttered living spaces that substantially disrupt daily life. While the Saving Inventory-Revised (SI-R) serves as a reliable and valid tool for assessing hoarding severity, its length may preclude routine use. We aimed to develop a valid shorter version of the scale using Item Response Theory and Confirmatory Factor Analysis in a non-selected sample of 2890 individuals and a clinical HD sample of 200 participants, which were divided into test and confirmatory samples in a 2:1 ratio. This led to a 9-item SI-R9, containing the original three subscales of discarding, clutter and acquiring; and an ultra-brief 3-item scale, the SI-R3. The original and revised versions demonstrated construct, convergent, and divergent validity. Significant gender differential was noted on some items, particularly those from the full SI-R, but was small in nature. Clinical cut-offs for all three scales showed good sensitivity and specificity. In conclusion, the SI-R3 and SI-R9 were successfully developed from the original scale, we hope that clinicians and researchers will benefit from reduced administration time, improved compliance, and more cost-effectiveness, and this will lead to greater use in clinical and research settings.

Thoughts about harming another person are a common phenomenon and can be understood through two different constructs: aggressive intrusive thoughts and aggressive scripts. Aggressive intrusive thoughts are commonly investigated in Obsessive Compulsive Disorder, and aggressive scripts are reported by offender populations. The current review explores whether aggressive intrusive thoughts and aggressive scripts share similarities with regards to well established features from intrusive thought research, including frequency, intrusiveness, influence of maladaptive appraisals, associated emotional experiences, and thought control strategies. A targeted systematic review was deemed inappropriate due to the nature of the review and the lack of specific literature in the area. To inform this critical review, a literature search was conducted using relevant key words, and references from established research in the area were examined. Findings from this study identify that some features including frequency, distress, and thought control strategies are relevant to aggressive scripts.Understanding the relationship these features have with aggressive scripts may prove beneficial for not only differentiating this construct from intrusive thoughts but for also informing risk assessment and intervention for those who experience them.

Background Emotion regulation is postulated to play an important role in Trichotillomania (TTM). Whilst a growing number of studies have examined the relationship between emotion regulation difficulties and TTM symptoms, there have been no attempts to evaluate the overall strength of this association or the quality of the evidence base.Method This systematic review and meta-analysis aimed to synthesise findings from studies that have examined the relationship between emotion regulation difficulties and TTM symptoms, to inform future TTM treatment targets. We identified 17 studies that met inclusion criteria. From these studies, 32 correlation coefficients were extracted for meta-analysis. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess risk of bias amongst the included studies.Results There was a moderately sized association between TTM symptoms and ER difficulties, (r adjusted = 0.32, 95 % CI [0.28, 0.37], t = 15.58 (df = 11.86), p < 0.0001) that was moderated by sample size (F(df1 = 1, df2 = 30) = 4.597, b = -0.0001, SE = 0.0001, 95 % CI [-0.0002; 0.0000], p = 0.040) and differences between types of emotion regulation measures (Q(df = 1) = 4.06, p = 0.044).Limitations The data analysed was correlational, therefore causality was unable to be determined. Comorbidities were not able to be examined as a moderator.Conclusion This study provided a preliminary integration of the evidence and demonstrated that individuals with higher levels of TTM severity appear to exhibit decreased overall emotion regulation abilities and strategies.

ObjectivesFeared self refers to an individual's "possible" self that has undesired qualities or characteristics and has been linked to obsessive compulsive symptoms. However, feared self may also relate to eating disorder pathology, given the importance of views of self in the disorder.MethodThis questionnaire-based study in a non-clinical sample (N = 238) examined whether a feared self would independently predict the symptom severity of obsessive-compulsive disorder (OCD) and eating disorders (ED), while controlling for potential comorbidity of the respective symptoms. A secondary aim was to examine whether emotion regulation moderated the relationship between a feared self and OCD symptoms and a feared self and ED symptoms.ResultsFeared self was a significant unique predictor of symptoms of both disorders. Emotion regulation was not found to significantly moderate the relationship between feared self and either OCD or ED symptoms, although emotion regulation was a significant independent predictor of the respective symptoms.ConclusionsThe study is one of the first to show that a feared self uniquely predicts ED symptoms, over-and-above coexisting OCD symptoms. As such, the results provide support for feared self as a potential transdiagnostic factor. Implications and limitations are discussed. What is already known about this topic: Feared self is increasingly linked with OCD and body dysmorphic symptoms.Given the importance of self, it may also relate to eating disorder symptoms.Emotion regulation has been linked with psychopathology, but the interaction with feared self has not been explored.What this topic adds: The results support feared self as a potential transdiagnostic factor for OCD and eating disorders.The specific type of feared self differed in terms of the most relevant predictor for the different disorders.Emotion regulation predicted both disorders but did not moderate feared self.

BACKGROUND:Recent studies have shown that individuals with obsessive-compulsive disorder (OCD) tend to endorse a feared self that they perceive to be immoral, insane and/or dangerous. The current study investigated the relationship between morality-related feared self, self-relevance and OC-related cognitions and behaviours such as moral deliberation, threat interpretation bias, discomfort, urge to act and likelihood of acting in OC-relevant situations in a non-clinical sample. METHOD:A total of 78 participants (27 female, Mage = 29.85, SD = 9.8) underwent a priming study. Participants had their feared-self primed firstly via an unscrambling task in either a feared self or neutral condition and secondly via a writing task about moral transgressions. The response time for these tasks was recorded as a measurement of moral deliberation. Further, self-relevance was primed by having half of the participants' complete tasks that referenced their actions, whereas half of the participants completed tasks that referenced others' actions. RESULTS:It was found that participants' pre-existing level of feared self was linked to threat interpretation bias, discomfort and urge to act in OC-relevant situations. A primed sense of feared self and self-relevance also demonstrated significant links to changes in OC-relevant symptoms. CONCLUSION:These results indicate that environmental cues related to morality may lead to OC-related symptoms.

This study provides the first examination of the frequency, characteristics, and dynamics surrounding daily experiences of OCD-relevant intrusions among non-clinical participants (N = 54, Nobs = 2,314) using ecological momentary assessment. It also examines the extent to which self-related constructs—participants’ feared-self beliefs and their tendency to conceal aspects of self—relate to such intrusive phenomena. Participants completed a baseline questionnaire before reporting state depressed mood and intrusions up to five times per day (at semi-random intervals) for 14 days. Results suggest that questionnaire measures may result in underreporting of the frequency of intrusions, with most participants (80%) reporting at least one intrusion across the momentary observations, and 20% of observations indicating intrusive phenomena experienced since the previous momentary report. Baseline factors including OCD-related beliefs and feared self were related to the proportion of intrusions experienced, whereas self-concealment was not. Within the moment, state feared-self predicted intrusion-related distress, duration, perceived importance, the urge to act, and the need to control thoughts. The urge to conceal within the moment was significant but negatively related to perceived importance and the urge to act. Overall, this study provides evidence for the relevance of momentary measures of intrusions, and adds to evidence for self-beliefs in the dynamics of the disorder.

ObjectivesThe feared possible self refers to an imagined version of self that one is afraid of being or becoming. Previous evidence has shown that dysfunctional reasoning (i.e., inferential confusion) is associated with obsessive-compulsive disorder (OCD) symptoms, which is partially mediated by a feared self. However, the evidence is reliant on non-clinical samples and a general measure of the feared self.MethodsUsing a cross-sectional design, the current study attempted to replicate and extend this literature in a sample clinically diagnosed with OCD (n = 350) to assess the pathway from inferential confusion to OCD symptoms when feared self is accounted for as a mediator, particularly the individual dimensions of feared self (i.e., corrupted, culpable, and malformed feared selves). Participants completed a structured clinical interview for DSM-5, as well as measures of inferential confusion (Dysfunctional Reasoning Processes Task), obsessive beliefs, feared self, OCD symptoms, and psychological distress.ResultsInferential confusion directly, and indirectly through the feared corrupted self, affected OCD symptoms, even after adjusting for obsessive beliefs, psychological distress, and comorbidity. However, the feared culpable and malformed selves did not play a role in this pathway.ConclusionsThe study underscores that the feared corrupted self links inferential confusion to OCD symptoms, translating to the need to consider both dysfunctional reasoning processes and this specific feared self in clinical settings when treating OCD. Furthermore, the study provides more support for the inference-based approach (IBA) to OCD.

The feared possible self refers to an imagined version of self that one is afraid of being or becoming. Previous evidence has shown that dysfunctional reasoning (i.e., inferential confusion) is associated with obsessive-compulsive disorder (OCD) symptoms, which is partially mediated by a feared self. However, the evidence is reliant on non-clinical samples and a general measure of the feared self. Using a cross-sectional design, the current study attempted to replicate and extend this literature in a sample clinically diagnosed with OCD ( n  = 350) to assess the pathway from inferential confusion to OCD symptoms when feared self is accounted for as a mediator, particularly the individual dimensions of feared self (i.e., corrupted, culpable, and malformed feared selves). Participants completed a structured clinical interview for DSM-5, as well as measures of inferential confusion (Dysfunctional Reasoning Processes Task), obsessive beliefs, feared self, OCD symptoms, and psychological distress. Inferential confusion directly, and indirectly through the feared corrupted self, affected OCD symptoms, even after adjusting for obsessive beliefs, psychological distress, and comorbidity. However, the feared culpable and malformed selves did not play a role in this pathway. The study underscores that the feared corrupted self links inferential confusion to OCD symptoms, translating to the need to consider both dysfunctional reasoning processes and this specific feared self in clinical settings when treating OCD. Furthermore, the study provides more support for the inference-based approach (IBA) to OCD.

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Obsessive Compulsive Disorder (OCD) is a debilitating illness affecting 2% of the population. Psychological treatments consisting of exposure and response prevention (ERP) and cognitive behavioral based methods are efficacious for most individuals with OCD and have been found to yield long-term positive outcomes. Most research on such outcomes have focused on individual treatment and the outcomes associated with group-based treatments are less well established. Further, the mechanisms that account for outcomes of individual and group based treatments for OCD remain unclear. Cognitive theories suggest that changes in cognitive structures including self-related beliefs may account for treatment related changes, yet limited research has empirically examined such suggestions. This study examined the outcomes of a low-intensity 10-session group CBT program for OCD in real-world effectiveness. The final sample consisted of 78 participants (M = 34.9 years, 50% Males), who answered symptom and cognition measures following each session. Overall, using hierarchical linear modelling, it was found that the program was effective in reducing symptoms (modelled fall of 7.64 on the YBOCS). In addition, both OCD-relevant beliefs and self-ambivalence also reduced significantly, and both significantly related to symptom level. Implications are discussed.

Abstract This chapter discusses the cross-cultural understanding of obsessive-compulsive disorder (OCD). Epidemiological studies suggest a reasonably consistent prevalence of OCD around the world. The role of culturally influenced factors (such as religiosity and beliefs) in the presentation of OCD is also considered, with religion being considered particularly important in the presentation of OCD, although not in its prevalence per se. The influence of cultural factors on help-seeking behaviors and its role in assessment (including misdiagnosis) is considered. The importance of culture for treatment is also discussed, including the role of religious factors, along with other issues relating to working with clients from minority cultures. Limitations of the literature base are discussed, particularly the lack of non-Western studies and the lack of comparative cross-cultural studies.

OBJECTIVES:There is a significant relationship between a general feared self and contact contamination concerns in obsessive-compulsive disorder (OCD), especially when the influence of mental contamination is considered a part of this relationship. However, these associations have not been explored in a clinical OCD sample when using each dimension of the multidimensional conceptualization of the feared self as the predictor (i.e., the corrupted, culpable, and malformed feared selves).METHODS:We tested these associations using a cross-sectional design. Specifically, a sample of patients diagnosed with OCD (N = 417) completed a series of self-report measures of OCD symptoms and its related constructs. We also explored these associations with unacceptable thoughts as the outcome, rather than contamination concerns, due to unacceptable thoughts having evidenced strong associations with the feared self and mental contamination.RESULTS:After controlling for relevant cognitive (i.e., obsessive beliefs) and affective (i.e., depressive symptoms) constructs and comorbidity, the corrupted feared self was found to have a direct link, along with an indirect link through mental contamination, with symptoms of contact contamination and unacceptable thoughts.CONCLUSIONS:The fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns. The corrupted feared self and mental contamination should therefore be targeted in treatments for repugnant obsessions and contamination-related OCD.

OBJECTIVE:Dysregulated behaviors including substance use, disordered eating, and nonsuicidal self-injury (NSSI) have significant negative implications for individuals and health systems. It is therefore paramount to understand factors influencing behavioral dysregulation, to inform prevention and treatment approaches. The literature suggests that distress and rumination (brooding) prompt individuals to engage in behavioral dysregulation for distraction (Emotional Cascade Model), although these concepts have limited investigation in clinical, treatment-seeking samples, particularly alongside negative urgency. This cross-sectional study sought to examine the relationships of brooding, distress, and negative urgency with behavioral dysregulation, as well as the moderating effect of negative urgency between brooding and behavioral dysregulation, in treatment-seeking young people.METHOD:A total of 385 treatment-seeking young people completed cross-sectional, self-report measures of distress, rumination, negative urgency, and engagement in dysregulated behaviors (NSSI, alcohol use, drug use, binge eating, and purging) over the past 1-3 months.RESULTS:Structural equation modeling revealed that only negative urgency, and not brooding or distress, had a significant positive relationship with behavioral dysregulation. Negative urgency did not significantly moderate the relationship between brooding and behavioral dysregulation.CONCLUSIONS:These findings reinforce the importance of considering negative urgency in the conceptualization, prevention, and treatment of behavioral dysregulation, and contribute to the knowledge of the relationship between brooding and various dysregulated behaviors within a treatment-seeking sample.