Be/m. Rex. Thher. Vol. 28. No. 1. pp. 337-340. Pnnted in Great Britain. All nghts reserved
1990 Copyright
0005-7967 90 53.00 + 0.00 C 1990 Pergamon Press plc
CASE HISTORIES AND SHORTER COMMUNICATIONS Maudsley
Obsessional-Compulsive Inventory: obsessions and compulsions in a nonclinical sample LEE G. STERNBERGER and G. LEONARDBURNS*
Department
ofPsychology, Washington State University. Pullman. WA 991664820.
U.S.A.
(Receiced 22 February 1990) Summary-Obsessiveve‘to do things over and over. The OCD group reported sig&cantiy more compulsions than the comparison group with the average for the OCD group being 1.00 (SD = 1.18) and for the comparison group 0.18 (SD = 0.41), I (20) = 2. f7. P = 0.04. Also, 45% (n = 5) of the OCD group reported that they were bothered by the compulsions compared
CASE HISTORIES
to 9% (n = 1) of the comparison group, obsessions and/or compulsions interfered
ASD
SHORTER
339
COMMUNICATIONS
Fisher exact test, P = 0.07 (l-tail). Finally, the OCD group reported that the more with their lives than the comparison group, I (20) = 2.3 I, P = 0.03.
Generalized Anxiety Disorder A j-point rating scale was used to quantify the Ss’ verbal responses to each GAD symptom (i.e. 0 = none; I = mild: 2 = moderate; 3 = severe; and 4 = very severe, grossly disabling). For 9 of the 18 symptoms there was a significant difference with the OCD group reporting a greater frequency and severity of the particular symptom. The OCD group reported more fatigability (P = 0.023), palpitations (P = 0.016). sweating (P = 0.02), flushes (P = 0.039), lump in throat (P = 0.049), feeling keyed up (P = 0.018). easily startled (P = 0.009), difficulty concentrating (P = 0.026) and irritability (P = 0.006). There was also a tendency for the OCD group to report more restlessness (P = 0.058). dry mouth (P = 0.075) and dizziness (P = 0.096). In addition. the OCD group reported that they worried more and that their worries interfered with their lives more than the comparison group, Fisher exact test P = 0.09 (l-tail) and I (20) = 3.44, P = 0.003, respectively.* Simple phobia Seven ADIS questions inquire about simple phobias. For each item the person was asked to indicate his or her degree of fear and avoidance of the specific event (14 questions total). A S-point scale was used to quantify the Ss’ responses for their degree of fear (0 = no fear; 4 = very severe fear) and avoidance (0 = no avoidance; 4 = always avoid). Only 2 of the 14 simple phobia items revealed a significant difference between the OCD group and the comparison group. The OCD group reported a significantly greater fear (P = 0.003) as well as avoidance (P = 0.03) of the blood of others than the comparison group. Social phobia Eleven ADIS questions deal with various social phobias. The individual was asked as well as avoids the particular activity (22 questions total). A S-point scale was again to these questions. Significant differences were found on only 3 of these 22 questions. fear of eating in public (P = 0.03) as well as greater fear (P = 0.017) and avoidance (P that the comparison group.
the degree to which he or she fears used to quantify the Ss’ responses The OCD group reported greater = 0.03) of initiating a conversation
Group membership Based on the information from the interview, the interviewer was able to judge correctly the group member of 82% (n = 9) of the OCD group and 100% (n = I I) of the comparison group. Fisher exact test P < 0.0001. The two errors resulted from two members of the OCD group being judged to be in the comparison group.
DISCUSSION
Six to 7 months after the completion of the MOCI, nonclinical high MOCI scorers reported significantly more obsessions and concern about their obsessions than a comparison group in a diagnostic interview. The high scorers also reported more compulsions and that they were bothered by these compulsions. In terms of GAD symptoms, the high MOCI scorers reported significantly greater frequency and severity of 9 of 18 physiological symptoms and a trend toward significance on three additional symptoms. The nonclinical OCD group also reported that they worried more and that their worry was interfering compared to the individuals in the comparison group. While the OCD and comparison group differed in terms of GAD symptoms. the differences between the groups in regard to social and simple phobias were not greater than that expected by chance. Finally, the interviewer was able to categorize correctly 9 I % of the interviewees into their respective groups (82% correct for the OCD group and 100% for the comparison group). These results indicate that the MOCI is a valid instrument in identifying obsessions and compulsions in a nonclinical sample and that these obsessions and compulsions are stable over time. Further nonclinical high MOCI scorers are more bothered by these obsessions and compulsions than individual who score in the normal range, indicating that these two groups differ in terms of number of symptoms and degree of distress. However, the high MOCI scorers are not merely reporting a wide range of anxiety symptoms. That is, the high scorers do not report more simple and social phobias, but instead report a greater number of specific obsessions and compulsions as well as more concern about these symptoms. The MOCI is thus sensitive to differences between high and low scorers in terms of OCD symptoms and is not merely identifying individuals who report a broad range of anxiety symptoms. In addition, high nonclinical MOCI scorers report more overall worry, more interference from these concerns and more physiological symptoms when they worry. Sher and colleagues (Frost er al., 1986) found that nonclinical MOCI checkers report more general anxiety and depresson related to their checking behavior as well as specific fear symptoms related to social criticism and competence, sudden noises, and active and potential physical assault. The present study did not find a difference between high and average MOCI scorers on specific fears, but did find greater worry and interference from worry among high nonclinical scorers. It may thus be that high nonclinical MOCI scorers experience a general level of worry or distress. while specific fears may be related to a subgroup of high nonclinical scorers (e.g. checkers). Obsessive-compulsive symptoms exist in nonclinical samples and are distressing and interfering to these individuals. The validation of the MOCI using the ADIS provides further evidence that this self-report measure accurately identifies a nonclinical sample manifesting significantly more frequent and severe OCD symptoms. These results also indicate that a nonclinical analog sample is a promising avenue for studying the phenomenology of OCD. In this regard it should be noted that the mean MOCI score for our OCD group was similar to that found in obsessive patients seeking treatment (Hodgson & Rachman. 1977). Finally. research on OCD in nonclinical samples also allows for longitudinal work to study the possible development of the disorder. Such research might allow the isolation of the factors associated with the transition from normal obsessions and compulsions to obsessions and compulsions in the clinical range-that is, those that significantly interfere with social and occupational functioning. *The means and standard authors upon request.
deviations
for the GAD.
social
phobia
and simple
phobia
symptoms
are available
from the
340 ~cknow,ledgemenls-The study was supported
CASE HISTORES
AND SHORTER COMMLWCATIONS
authors would like to thank Kathy Harris for her assistance with the study. in part by funds provided the second author by Washington State University.
Preparation
of this
REFERESCES
Derogatis. L. (1983). SCL-90-R administration, scoring and procedure manual--l1 for the (R&&d cersion and other insrruments of rhe psychopathology rating scale series. Towson, Md: Clinical Psychometric Research. DiNardo. P. A., O’Brien. G. T., Barlow, D. H., Waddel, M. T. & Blanchard. E. B. (1983). Reliability of DSM-III anxiety disorders categories using a new structured interview. Archires of General Psychiafr?. 40. 1070-1074. Freund. B.. Steketee, G. & Foa, E. (1987). Compulsive Activity Checklist (CAC): Psychometric analysis with obsessiveecompulsive disorder. Behavioral Assessment, 9, 67-79. Frost. R.. Sher, K. & Green, T. (1986). Psychopathology and personality characteristics of nonclinical compulsive checkers. Behariottr Research and Therapy, 24. 133-143. Hodgson, R. J. & Rachman. S. (1977). Obsessive-compulsive complaints. Behaciour Research and Therap?. IS, 389-395. Mavissakalian. M. & Barlow, D. H. (1981). Assessment of obsessive-compulsive disorders. In Barlow. D. H. (Ed.). Behatioral assessment of adult disorders (pp. 209-238). New York: Guilford Press. Rachman, S. & de Silva. P. (1978). Abnormal and normal obsessions. Behariour Research and Therapy. 10. 233-248. Rasmussen. S. A. & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatr.v. 43, 3 17-322. Salkovskis, P. & Harrison. J. (1984). Abnormal and normal obsessions-a replication. Behariour Research and Therapy, 22, 549-552. Sanavio, E. (1988). Obsessions and compulsions: The Padua Inventory. Behariour Research and Therap),, 26, 169-177. Sher. K.. Frost. R. & Otto, R. (1983). Cognitive deficits in compulsive checkers: An exploratory study. Behariour Research and Therapy. 21, 357-363. Sher. K., Mann. B. & Frost, R. (1984). Cognitive dysfunction in compulsive checkers: Further explorations. Behaciour Research and Therapy, 22. 493-502. Sternberger, L. G. & Burns. G. L. (1990). Compulsive Activity Checklist and the Maudsley Obsessional-Compulsive Inventory: Psychometric properties of two measures of obsessive compulsive disorder. Behavior Therap?.. II. 117-127.
1990 Copyright
0005-7967 90 53.00 + 0.00 C 1990 Pergamon Press plc
CASE HISTORIES AND SHORTER COMMUNICATIONS Maudsley
Obsessional-Compulsive Inventory: obsessions and compulsions in a nonclinical sample LEE G. STERNBERGER and G. LEONARDBURNS*
Department
ofPsychology, Washington State University. Pullman. WA 991664820.
U.S.A.
(Receiced 22 February 1990) Summary-Obsessiveve‘to do things over and over. The OCD group reported sig&cantiy more compulsions than the comparison group with the average for the OCD group being 1.00 (SD = 1.18) and for the comparison group 0.18 (SD = 0.41), I (20) = 2. f7. P = 0.04. Also, 45% (n = 5) of the OCD group reported that they were bothered by the compulsions compared
CASE HISTORIES
to 9% (n = 1) of the comparison group, obsessions and/or compulsions interfered
ASD
SHORTER
339
COMMUNICATIONS
Fisher exact test, P = 0.07 (l-tail). Finally, the OCD group reported that the more with their lives than the comparison group, I (20) = 2.3 I, P = 0.03.
Generalized Anxiety Disorder A j-point rating scale was used to quantify the Ss’ verbal responses to each GAD symptom (i.e. 0 = none; I = mild: 2 = moderate; 3 = severe; and 4 = very severe, grossly disabling). For 9 of the 18 symptoms there was a significant difference with the OCD group reporting a greater frequency and severity of the particular symptom. The OCD group reported more fatigability (P = 0.023), palpitations (P = 0.016). sweating (P = 0.02), flushes (P = 0.039), lump in throat (P = 0.049), feeling keyed up (P = 0.018). easily startled (P = 0.009), difficulty concentrating (P = 0.026) and irritability (P = 0.006). There was also a tendency for the OCD group to report more restlessness (P = 0.058). dry mouth (P = 0.075) and dizziness (P = 0.096). In addition. the OCD group reported that they worried more and that their worries interfered with their lives more than the comparison group, Fisher exact test P = 0.09 (l-tail) and I (20) = 3.44, P = 0.003, respectively.* Simple phobia Seven ADIS questions inquire about simple phobias. For each item the person was asked to indicate his or her degree of fear and avoidance of the specific event (14 questions total). A S-point scale was used to quantify the Ss’ responses for their degree of fear (0 = no fear; 4 = very severe fear) and avoidance (0 = no avoidance; 4 = always avoid). Only 2 of the 14 simple phobia items revealed a significant difference between the OCD group and the comparison group. The OCD group reported a significantly greater fear (P = 0.003) as well as avoidance (P = 0.03) of the blood of others than the comparison group. Social phobia Eleven ADIS questions deal with various social phobias. The individual was asked as well as avoids the particular activity (22 questions total). A S-point scale was again to these questions. Significant differences were found on only 3 of these 22 questions. fear of eating in public (P = 0.03) as well as greater fear (P = 0.017) and avoidance (P that the comparison group.
the degree to which he or she fears used to quantify the Ss’ responses The OCD group reported greater = 0.03) of initiating a conversation
Group membership Based on the information from the interview, the interviewer was able to judge correctly the group member of 82% (n = 9) of the OCD group and 100% (n = I I) of the comparison group. Fisher exact test P < 0.0001. The two errors resulted from two members of the OCD group being judged to be in the comparison group.
DISCUSSION
Six to 7 months after the completion of the MOCI, nonclinical high MOCI scorers reported significantly more obsessions and concern about their obsessions than a comparison group in a diagnostic interview. The high scorers also reported more compulsions and that they were bothered by these compulsions. In terms of GAD symptoms, the high MOCI scorers reported significantly greater frequency and severity of 9 of 18 physiological symptoms and a trend toward significance on three additional symptoms. The nonclinical OCD group also reported that they worried more and that their worry was interfering compared to the individuals in the comparison group. While the OCD and comparison group differed in terms of GAD symptoms. the differences between the groups in regard to social and simple phobias were not greater than that expected by chance. Finally, the interviewer was able to categorize correctly 9 I % of the interviewees into their respective groups (82% correct for the OCD group and 100% for the comparison group). These results indicate that the MOCI is a valid instrument in identifying obsessions and compulsions in a nonclinical sample and that these obsessions and compulsions are stable over time. Further nonclinical high MOCI scorers are more bothered by these obsessions and compulsions than individual who score in the normal range, indicating that these two groups differ in terms of number of symptoms and degree of distress. However, the high MOCI scorers are not merely reporting a wide range of anxiety symptoms. That is, the high scorers do not report more simple and social phobias, but instead report a greater number of specific obsessions and compulsions as well as more concern about these symptoms. The MOCI is thus sensitive to differences between high and low scorers in terms of OCD symptoms and is not merely identifying individuals who report a broad range of anxiety symptoms. In addition, high nonclinical MOCI scorers report more overall worry, more interference from these concerns and more physiological symptoms when they worry. Sher and colleagues (Frost er al., 1986) found that nonclinical MOCI checkers report more general anxiety and depresson related to their checking behavior as well as specific fear symptoms related to social criticism and competence, sudden noises, and active and potential physical assault. The present study did not find a difference between high and average MOCI scorers on specific fears, but did find greater worry and interference from worry among high nonclinical scorers. It may thus be that high nonclinical MOCI scorers experience a general level of worry or distress. while specific fears may be related to a subgroup of high nonclinical scorers (e.g. checkers). Obsessive-compulsive symptoms exist in nonclinical samples and are distressing and interfering to these individuals. The validation of the MOCI using the ADIS provides further evidence that this self-report measure accurately identifies a nonclinical sample manifesting significantly more frequent and severe OCD symptoms. These results also indicate that a nonclinical analog sample is a promising avenue for studying the phenomenology of OCD. In this regard it should be noted that the mean MOCI score for our OCD group was similar to that found in obsessive patients seeking treatment (Hodgson & Rachman. 1977). Finally. research on OCD in nonclinical samples also allows for longitudinal work to study the possible development of the disorder. Such research might allow the isolation of the factors associated with the transition from normal obsessions and compulsions to obsessions and compulsions in the clinical range-that is, those that significantly interfere with social and occupational functioning. *The means and standard authors upon request.
deviations
for the GAD.
social
phobia
and simple
phobia
symptoms
are available
from the
340 ~cknow,ledgemenls-The study was supported
CASE HISTORES
AND SHORTER COMMLWCATIONS
authors would like to thank Kathy Harris for her assistance with the study. in part by funds provided the second author by Washington State University.
Preparation
of this
REFERESCES
Derogatis. L. (1983). SCL-90-R administration, scoring and procedure manual--l1 for the (R&&d cersion and other insrruments of rhe psychopathology rating scale series. Towson, Md: Clinical Psychometric Research. DiNardo. P. A., O’Brien. G. T., Barlow, D. H., Waddel, M. T. & Blanchard. E. B. (1983). Reliability of DSM-III anxiety disorders categories using a new structured interview. Archires of General Psychiafr?. 40. 1070-1074. Freund. B.. Steketee, G. & Foa, E. (1987). Compulsive Activity Checklist (CAC): Psychometric analysis with obsessiveecompulsive disorder. Behavioral Assessment, 9, 67-79. Frost. R.. Sher, K. & Green, T. (1986). Psychopathology and personality characteristics of nonclinical compulsive checkers. Behariottr Research and Therapy, 24. 133-143. Hodgson, R. J. & Rachman. S. (1977). Obsessive-compulsive complaints. Behaciour Research and Therap?. IS, 389-395. Mavissakalian. M. & Barlow, D. H. (1981). Assessment of obsessive-compulsive disorders. In Barlow. D. H. (Ed.). Behatioral assessment of adult disorders (pp. 209-238). New York: Guilford Press. Rachman, S. & de Silva. P. (1978). Abnormal and normal obsessions. Behariour Research and Therapy. 10. 233-248. Rasmussen. S. A. & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatr.v. 43, 3 17-322. Salkovskis, P. & Harrison. J. (1984). Abnormal and normal obsessions-a replication. Behariour Research and Therapy, 22, 549-552. Sanavio, E. (1988). Obsessions and compulsions: The Padua Inventory. Behariour Research and Therap),, 26, 169-177. Sher. K.. Frost. R. & Otto, R. (1983). Cognitive deficits in compulsive checkers: An exploratory study. Behariour Research and Therapy. 21, 357-363. Sher. K., Mann. B. & Frost, R. (1984). Cognitive dysfunction in compulsive checkers: Further explorations. Behaciour Research and Therapy, 22. 493-502. Sternberger, L. G. & Burns. G. L. (1990). Compulsive Activity Checklist and the Maudsley Obsessional-Compulsive Inventory: Psychometric properties of two measures of obsessive compulsive disorder. Behavior Therap?.. II. 117-127.
