Behav. Res. Thu. Vol. 30, No. 2, pp. 103-105, Printed in Great Britain. All rights resewed
COOS-7967/92 $5.00 + 0.00
1992
Copyright 0 1992 Pergamon Press plc
WORRY AND OBSESSIONAL SYMPTOMS: A CORRELATIONAL ANALYSIS FRANK TALLIS
and PADMAL DE SILVA
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, England (Received 26 July 1991)
Summary-Several studies have suggested that worry and obsessional symptoms are systematically associated. In the present study, the relationship between worry and obsessional symptoms was confirmed. Measures included a worry content measure, a worry visual analogue scale, a modification of the everyday checking behaviours scale, and the MOCI. Worry was found to be more consistently associated with checking and doubting, than washing and slowness. It is suggested that worry and obsessional symptoms both occur in response to stress. In addition, it is suggested that worry and checking are functionally similar, and Generalised Anxiety Disorder may represent a ‘cognitive’ variant of obsessional checking.
INTRODUCTION
Worry and obsessional phenomena share a number of common features; in particular, both tend to be repetitive and difficult to control. Pruzinsky and Borkovec (1990), using a non-clinical population of Ss, found that worriers reported a greater incidence of obsessional symptoms but not obsessional traits on the Sandler and Hazari (1960) obsessionality scale. Sternberger and Burns (1990) after selecting high (n = 11) and low scorers on the Maudsley Obsessional-Compulsive Inventory (MOCI; Hodgson & Rachman, 1977) from a student sample, found that elevated measures were associated with more frequent and ‘interfering’ worry, accompanied by greater somatic change. Finally, Steketee, Grayson and Foa (1987), reported data showing that Generalised Anxiety Disorder (GAD) patients (i.e. clinical worriers), score higher on the MOCI than other clinically anxious groups, for example agoraphobics. Of specific interest is that no significant differences were found between Obsessional Compulsive Disorder (OCD) patients and GAD patients on the checking subscale of the MOCI. A major problem with the studies cited above, is small sample size. The appropriateness of some of the measures can also be questioned (cf. Orme, 1965; Reed, 1969). The purpose of the present study was twofold: firstly, to explore the relationship between worry and obsessional symptoms using appropriate measures on a large non-clinical sample; and secondly, to determine which of several obsessional behaviours are more closely associated with worry. Earlier work (Steketee et al., 1987; Tallis, Eysenck & Mathews, 1991a, b, 1992) suggests a positive and systematic association between worry and checking. METHOD
AND
RESULTS
235 Ss (72 male) completed the Worry Domains Questionnaire (WDQ; Tallis, Eysenck & Mathews, 1992) a worry Visual Analogue Scale (VAS), and the MOCI. The mean age of the sample was 33 (SD = lo), with a range from 14 to 61. Questionnaires were distributed in several locations in order to combat sampling bias. The WDQ yields a global worry score which is calculated by summing scores on five subscales: Relationships, Lack of Confidence, Aimless Future, Work Incompetence and Financial Problems. The use of a worry content measure is considered important. In DSM III-R (American Psychiatric Association, 1987), worry in GAD must be unrelated to features of another Axis 1 disorder (e.g. worry about contamination). Moreover, worry must reflect apprehension connected with general ‘life circumstances’. The WDQ items represent specific ‘life circumstance’ concerns (e.g. I worry that my future job prospects are not good). The MOCI yields a global score, and scores on four subscales labelled Checking, Washing, Slownessrepetition, and Doubting-conscientiousness. Histograms generated using the SPSS pc statistics package (Norusis-SPSS, 1988) showed data for all variables to be normally distributed. Pearson’s correlation coefficients were calculated using 103
104
FRANK TALLISand PADMALDE SILVA
the same statistical package. The worry VAS was significantly correlated with the MOCI (I = 0.30, d.f. = 233, P < 0.001) and all MOCI subscales (washing r = 0.20, P < 0.001; checking r = 0.21, P < 0.001; slowness r = 0.15, P < 0.01; doubting r = 0.25, P < 0.001). The WDQ and MOCI were significantly correlated (r = 0.20, d.f. = 233, P < 0.001). However, unlike the VAS, the WDQ was only significantly correlated with the Checking (r = 0.17, d.f. = 233, P < 0.01) and Doubting (r = 0.18, P < 0.01) MOCI subscales. The WDQ was not significantly correlated with either washing (r = 0.09) or slowness (r = 0.07) subscales. Although the suggested relationship between worry and checking is supported by these results, the coefficient might be partly attributable to item overlap. The checking subscale of the MOCI contains a few ‘cognitive’ items which might be interpreted as worry. In order to explore this possibility, a second study was conducted using an entirely behavioural measure of checking. 56 Ss, mostly female, completed the WDQ and a modified version of the Everyday Checking Behaviours Scale (ECBS; Sher, Mann & Forst, 1984). The mean age of the sample was 30 (SD = lo), with ages ranging from 21 to 64. For the purposes of the present study, it was necessary to change the wording of some of the ECBS items to a British equivalent, and reject one item completely. The rejected item concerned ‘checking over examination questions’. The 4-5 point scale was replaced by a 7 point ‘number of checks’ scale (Once, Twice etc.). Data were normally distributed and suitable for parametric analysis. Pearson’s correlation coefficients were calculated using the SPSS pc statistics package. The WDQ and the ECBS were significantly and positively correlated (r = 0.26, d.f. = 54, P < 0.05). A second correlation coefficient was then calculated, using the WDQ and the maximum number of checks reported for any item. This yielded a correlation coefficient of 0.39 (d.f. = 54, P c O.Ol), representing the highest degree of association between worry and checking found in the present study. DISCUSSION Why is there a systematic relationship between worrying-albeit about everyday problems such as debt and accommodation-and global obsessionality, as measured by the overall MOCI score? Further, if the WDQ is considered an appropriate measure of worry, why should concern over everyday problems be systematically associated with checking and doubting, but not washing and slowness? These questions are considered in turn below. It has been suggested that obsessional symptoms can be activated under stress (de Silva, 1988; Rachman & Hodgson, 1980). A number of theorists also construe worry as a response to stress (Borkovec, Shadick & Hopkins, 1990; Mathews, 1990). Everyday problems might produce the cognitive response of worry, while creating sufficient levels of stress to release obsessional action patterns. Although this account explains the significant global correlations, it does not explain the specific relationship observed between worry and checking. To explain this specific relationship, it is necessary to consider the role of temporal perspective. Washing is essentially a restorative action pattern. Contamination is assumed to have taken place, and the act of washing is reparative. Checking, on the other hand, is a preventive action pattern. The negative event has yet to take place, and checking serves the immediate function of reducing the likelihood of its occurrence (Rachman & Hodgson, 1980). Worry, like checking, is oriented towards a future threat. Given that worry is characterised by cognitions which predict a negative future event, it is more logical that preventive behaviour patterns be activated, rather than restorative behaviour patterns. Mathews (1990) suggests that through worry, “possible future events are represented within the cognitive system” ( p. 456). Moreover: “Our personal experience of worry suggests that we are rehearsing possible aversive events and outcomes, and at the same time searching for ways for avoiding them” (p. 456-457). In many respects, this description of worry is closely related to a description of checking. The act of checking can be construed as a strategy employed to avoid the occurrence of these events. The functional equivalence of worry and checking may go some way towards explaining their close relationship. Indeed, it is possible that worry represents a cortical programme, that has evolved from a sub-cortical template (Rapaport, 1990), the purpose of which is to ‘check’ the future in order to avoid imminent danger. If this is the case, then GAD might be construed as a ‘cognitive’ variant of obsessional checking.
Worry and obsessional symptoms
105
The relatively high correlation found between worry and obsessional doubt deserves a brief comment. The doubting subscale of the MOCI may represent a trait, rather than a group of obsessional complaints (Hodgson & Rachman, 1977). It is therefore possible that worry is partly determined by a personality variable captured by the doubting subscale. Doubting-or at least indecisiveness-is a feature included in several accounts of worry (e.g. Borkovec, Metzger Jz Pruzinsky, 1986; Tallis et al., 1991b). In conclusion, worry and obsessionality, as measured by the MOCI, were found to be systematically associated. Although the correlations were modest, findings were consistent across different measures and populations. Moreover, results suggest that more refined measures could produce higher levels of association. REFERENCES American Psychiatric Association (1987). Diagnosric and statistical manual of menral disorders (3rd edn-rev.). Washington D.C.: American Psychiatric Association. Borkovec, T. D., Metzger, R. L. & Pruzinsky, T. (1986). Anxiety, worry and the self. In Hartman, H. & Blankstein, K. R. (Eds), Perception of self in emotional disorder and psychotherapy. New York: Plenum Press. Borkovec, T. D., Shadick, R. & Hopkins, M. (1990). The nature of normal and pathological worry. In Rapee, R. & Barlow, D. H. (Eds), Chronic anxiety and generalised anxiety disorder. New York: Guilford Press. Hodgson, R. S. & Rachman, S. J. (1977). Obsessional-compulsive complaints. Behauiour Research and Therapy, 15,389-395. Mathews, A. (1990). Why worry? The cognitive function of anxiety. Behauiour Research and Therapy, _ . 28, 455468. Norusis-SPSS Inc. (1988). SPSS-PC+ base manual. SPSS Inc. Orme, J. E. (1965). The relationshin of obsessional traits to general emotional instabilitv. British Medical Journal. , 1., 195-198. _ ’ Pruzinsky, T. & Borkovec, T. D. (1990). Cognitive and research personality characteristics of worriers. Behauiour Research and Therapy, 28, 507-512.
Rachman, S. & Hodgson, R. (1980). Obsessions and compulsions. Englewood Cliffs: Prentice-Hall. Rapoport, J. L. (1990). Obsessive compulsive disorder and basal ganglia dysfunction. Psychological Medicine, 20,465469. Reed, G. F. (1969). Obsessionality and self-appraisal questionnaires. British Journal of Psychiatry, f15, 205-209. Sandler, J. & Hazari, A. (1960). The obsessional: On the psychological classification of obsessional character traits and symptoms. British Journal of Medical Psychology, 33, 113-122. Sher, K. J., Mann, B. & Frost, R. 0. (1984). Cognitive dysfunction in compulsive checkers: Further explorations. Behaviour Research and Therapy, 22, 493-502.
de Silva, P. (1988). Obsessive-compusive disorder. In Miller, E. & Cooper, P. (Eds), Handbook of abnormal psychology. Edinburgh: Churchill-Livingstone. Steketee, G. S., Grayson, J. B. & Foa, E. B. (1987). A comparison of characteristics of obsessive-compulsive disorder and other anxiety disorders. Journal of Anxiety Disorders, I, 325-335. Sternberger, L. G. & Burns, G. L. (1990). Maudsley Obsessional-Compulsive Inventory: Obsessions and compulsions in a nonclinal sample. Behaviour Research and Therapy, 4, 337-340. Tallis, F., Eysenck, M. W. & Mathews, A. (199la). Elevated evidence requirements and worry. Personality and Individual Differences,
12, 21-27.
Tallis, F., Eysenck, M. W. & Mathews, A. (1992). A questionnaire for the measurement of nonpathological
worry.
Personality and Individual Differences, 13, 161-168.
Tallis, F., Eysenck, M. W. & Mathews, A. (199lb). Worry: A critical analysis of some theoretical approaches. Anxiety Research, 4, 97-108.
COOS-7967/92 $5.00 + 0.00
1992
Copyright 0 1992 Pergamon Press plc
WORRY AND OBSESSIONAL SYMPTOMS: A CORRELATIONAL ANALYSIS FRANK TALLIS
and PADMAL DE SILVA
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, England (Received 26 July 1991)
Summary-Several studies have suggested that worry and obsessional symptoms are systematically associated. In the present study, the relationship between worry and obsessional symptoms was confirmed. Measures included a worry content measure, a worry visual analogue scale, a modification of the everyday checking behaviours scale, and the MOCI. Worry was found to be more consistently associated with checking and doubting, than washing and slowness. It is suggested that worry and obsessional symptoms both occur in response to stress. In addition, it is suggested that worry and checking are functionally similar, and Generalised Anxiety Disorder may represent a ‘cognitive’ variant of obsessional checking.
INTRODUCTION
Worry and obsessional phenomena share a number of common features; in particular, both tend to be repetitive and difficult to control. Pruzinsky and Borkovec (1990), using a non-clinical population of Ss, found that worriers reported a greater incidence of obsessional symptoms but not obsessional traits on the Sandler and Hazari (1960) obsessionality scale. Sternberger and Burns (1990) after selecting high (n = 11) and low scorers on the Maudsley Obsessional-Compulsive Inventory (MOCI; Hodgson & Rachman, 1977) from a student sample, found that elevated measures were associated with more frequent and ‘interfering’ worry, accompanied by greater somatic change. Finally, Steketee, Grayson and Foa (1987), reported data showing that Generalised Anxiety Disorder (GAD) patients (i.e. clinical worriers), score higher on the MOCI than other clinically anxious groups, for example agoraphobics. Of specific interest is that no significant differences were found between Obsessional Compulsive Disorder (OCD) patients and GAD patients on the checking subscale of the MOCI. A major problem with the studies cited above, is small sample size. The appropriateness of some of the measures can also be questioned (cf. Orme, 1965; Reed, 1969). The purpose of the present study was twofold: firstly, to explore the relationship between worry and obsessional symptoms using appropriate measures on a large non-clinical sample; and secondly, to determine which of several obsessional behaviours are more closely associated with worry. Earlier work (Steketee et al., 1987; Tallis, Eysenck & Mathews, 1991a, b, 1992) suggests a positive and systematic association between worry and checking. METHOD
AND
RESULTS
235 Ss (72 male) completed the Worry Domains Questionnaire (WDQ; Tallis, Eysenck & Mathews, 1992) a worry Visual Analogue Scale (VAS), and the MOCI. The mean age of the sample was 33 (SD = lo), with a range from 14 to 61. Questionnaires were distributed in several locations in order to combat sampling bias. The WDQ yields a global worry score which is calculated by summing scores on five subscales: Relationships, Lack of Confidence, Aimless Future, Work Incompetence and Financial Problems. The use of a worry content measure is considered important. In DSM III-R (American Psychiatric Association, 1987), worry in GAD must be unrelated to features of another Axis 1 disorder (e.g. worry about contamination). Moreover, worry must reflect apprehension connected with general ‘life circumstances’. The WDQ items represent specific ‘life circumstance’ concerns (e.g. I worry that my future job prospects are not good). The MOCI yields a global score, and scores on four subscales labelled Checking, Washing, Slownessrepetition, and Doubting-conscientiousness. Histograms generated using the SPSS pc statistics package (Norusis-SPSS, 1988) showed data for all variables to be normally distributed. Pearson’s correlation coefficients were calculated using 103
104
FRANK TALLISand PADMALDE SILVA
the same statistical package. The worry VAS was significantly correlated with the MOCI (I = 0.30, d.f. = 233, P < 0.001) and all MOCI subscales (washing r = 0.20, P < 0.001; checking r = 0.21, P < 0.001; slowness r = 0.15, P < 0.01; doubting r = 0.25, P < 0.001). The WDQ and MOCI were significantly correlated (r = 0.20, d.f. = 233, P < 0.001). However, unlike the VAS, the WDQ was only significantly correlated with the Checking (r = 0.17, d.f. = 233, P < 0.01) and Doubting (r = 0.18, P < 0.01) MOCI subscales. The WDQ was not significantly correlated with either washing (r = 0.09) or slowness (r = 0.07) subscales. Although the suggested relationship between worry and checking is supported by these results, the coefficient might be partly attributable to item overlap. The checking subscale of the MOCI contains a few ‘cognitive’ items which might be interpreted as worry. In order to explore this possibility, a second study was conducted using an entirely behavioural measure of checking. 56 Ss, mostly female, completed the WDQ and a modified version of the Everyday Checking Behaviours Scale (ECBS; Sher, Mann & Forst, 1984). The mean age of the sample was 30 (SD = lo), with ages ranging from 21 to 64. For the purposes of the present study, it was necessary to change the wording of some of the ECBS items to a British equivalent, and reject one item completely. The rejected item concerned ‘checking over examination questions’. The 4-5 point scale was replaced by a 7 point ‘number of checks’ scale (Once, Twice etc.). Data were normally distributed and suitable for parametric analysis. Pearson’s correlation coefficients were calculated using the SPSS pc statistics package. The WDQ and the ECBS were significantly and positively correlated (r = 0.26, d.f. = 54, P < 0.05). A second correlation coefficient was then calculated, using the WDQ and the maximum number of checks reported for any item. This yielded a correlation coefficient of 0.39 (d.f. = 54, P c O.Ol), representing the highest degree of association between worry and checking found in the present study. DISCUSSION Why is there a systematic relationship between worrying-albeit about everyday problems such as debt and accommodation-and global obsessionality, as measured by the overall MOCI score? Further, if the WDQ is considered an appropriate measure of worry, why should concern over everyday problems be systematically associated with checking and doubting, but not washing and slowness? These questions are considered in turn below. It has been suggested that obsessional symptoms can be activated under stress (de Silva, 1988; Rachman & Hodgson, 1980). A number of theorists also construe worry as a response to stress (Borkovec, Shadick & Hopkins, 1990; Mathews, 1990). Everyday problems might produce the cognitive response of worry, while creating sufficient levels of stress to release obsessional action patterns. Although this account explains the significant global correlations, it does not explain the specific relationship observed between worry and checking. To explain this specific relationship, it is necessary to consider the role of temporal perspective. Washing is essentially a restorative action pattern. Contamination is assumed to have taken place, and the act of washing is reparative. Checking, on the other hand, is a preventive action pattern. The negative event has yet to take place, and checking serves the immediate function of reducing the likelihood of its occurrence (Rachman & Hodgson, 1980). Worry, like checking, is oriented towards a future threat. Given that worry is characterised by cognitions which predict a negative future event, it is more logical that preventive behaviour patterns be activated, rather than restorative behaviour patterns. Mathews (1990) suggests that through worry, “possible future events are represented within the cognitive system” ( p. 456). Moreover: “Our personal experience of worry suggests that we are rehearsing possible aversive events and outcomes, and at the same time searching for ways for avoiding them” (p. 456-457). In many respects, this description of worry is closely related to a description of checking. The act of checking can be construed as a strategy employed to avoid the occurrence of these events. The functional equivalence of worry and checking may go some way towards explaining their close relationship. Indeed, it is possible that worry represents a cortical programme, that has evolved from a sub-cortical template (Rapaport, 1990), the purpose of which is to ‘check’ the future in order to avoid imminent danger. If this is the case, then GAD might be construed as a ‘cognitive’ variant of obsessional checking.
Worry and obsessional symptoms
105
The relatively high correlation found between worry and obsessional doubt deserves a brief comment. The doubting subscale of the MOCI may represent a trait, rather than a group of obsessional complaints (Hodgson & Rachman, 1977). It is therefore possible that worry is partly determined by a personality variable captured by the doubting subscale. Doubting-or at least indecisiveness-is a feature included in several accounts of worry (e.g. Borkovec, Metzger Jz Pruzinsky, 1986; Tallis et al., 1991b). In conclusion, worry and obsessionality, as measured by the MOCI, were found to be systematically associated. Although the correlations were modest, findings were consistent across different measures and populations. Moreover, results suggest that more refined measures could produce higher levels of association. REFERENCES American Psychiatric Association (1987). Diagnosric and statistical manual of menral disorders (3rd edn-rev.). Washington D.C.: American Psychiatric Association. Borkovec, T. D., Metzger, R. L. & Pruzinsky, T. (1986). Anxiety, worry and the self. In Hartman, H. & Blankstein, K. R. (Eds), Perception of self in emotional disorder and psychotherapy. New York: Plenum Press. Borkovec, T. D., Shadick, R. & Hopkins, M. (1990). The nature of normal and pathological worry. In Rapee, R. & Barlow, D. H. (Eds), Chronic anxiety and generalised anxiety disorder. New York: Guilford Press. Hodgson, R. S. & Rachman, S. J. (1977). Obsessional-compulsive complaints. Behauiour Research and Therapy, 15,389-395. Mathews, A. (1990). Why worry? The cognitive function of anxiety. Behauiour Research and Therapy, _ . 28, 455468. Norusis-SPSS Inc. (1988). SPSS-PC+ base manual. SPSS Inc. Orme, J. E. (1965). The relationshin of obsessional traits to general emotional instabilitv. British Medical Journal. , 1., 195-198. _ ’ Pruzinsky, T. & Borkovec, T. D. (1990). Cognitive and research personality characteristics of worriers. Behauiour Research and Therapy, 28, 507-512.
Rachman, S. & Hodgson, R. (1980). Obsessions and compulsions. Englewood Cliffs: Prentice-Hall. Rapoport, J. L. (1990). Obsessive compulsive disorder and basal ganglia dysfunction. Psychological Medicine, 20,465469. Reed, G. F. (1969). Obsessionality and self-appraisal questionnaires. British Journal of Psychiatry, f15, 205-209. Sandler, J. & Hazari, A. (1960). The obsessional: On the psychological classification of obsessional character traits and symptoms. British Journal of Medical Psychology, 33, 113-122. Sher, K. J., Mann, B. & Frost, R. 0. (1984). Cognitive dysfunction in compulsive checkers: Further explorations. Behaviour Research and Therapy, 22, 493-502.
de Silva, P. (1988). Obsessive-compusive disorder. In Miller, E. & Cooper, P. (Eds), Handbook of abnormal psychology. Edinburgh: Churchill-Livingstone. Steketee, G. S., Grayson, J. B. & Foa, E. B. (1987). A comparison of characteristics of obsessive-compulsive disorder and other anxiety disorders. Journal of Anxiety Disorders, I, 325-335. Sternberger, L. G. & Burns, G. L. (1990). Maudsley Obsessional-Compulsive Inventory: Obsessions and compulsions in a nonclinal sample. Behaviour Research and Therapy, 4, 337-340. Tallis, F., Eysenck, M. W. & Mathews, A. (199la). Elevated evidence requirements and worry. Personality and Individual Differences,
12, 21-27.
Tallis, F., Eysenck, M. W. & Mathews, A. (1992). A questionnaire for the measurement of nonpathological
worry.
Personality and Individual Differences, 13, 161-168.
Tallis, F., Eysenck, M. W. & Mathews, A. (199lb). Worry: A critical analysis of some theoretical approaches. Anxiety Research, 4, 97-108.
