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. 2017 May:75:117-124.
doi: 10.1016/j.comppsych.2017.03.004. Epub 2017 Mar 12.

An investigation of doubt in obsessive-compulsive disorder

Jack Samuels  1 , O Joseph Bienvenu  2 , Janice Krasnow  2 , Ying Wang  2 , Marco A Grados  2 , Bernadette Cullen  2 , Fernando S Goes  2 , Brion Maher  3 , Benjamin D Greenberg  4 , Nicole C McLaughlin  4 , Steven A Rasmussen  4 , Abby J Fyer  5 , James A Knowles  6 , Paul Nestadt  2 , James T McCracken  7 , John Piacentini  7 , Dan Geller  8 , David L Pauls  9 , S Evelyn Stewart  10 , Dennis L Murphy  11 , Yin-Yao Shugart  12 , Vidya Kamath  2 , Arnold Bakker  2 , Mark A Riddle  2 , Gerald Nestadt  2
Affiliations

An investigation of doubt in obsessive-compulsive disorder

Jack Samuels et al. Compr Psychiatry. 2017 May.

Abstract

Background: Clinicians have long considered doubt to be a fundamental characteristic of obsessive-compulsive disorder (OCD). However, the clinical relevance of doubt in OCD has not been addressed.

Methods: Participants included 1182 adults with OCD who had participated in family and genetic studies of OCD. We used a clinical measure of the severity of doubt, categorized as none, mild, moderate, severe, or extreme. We evaluated the relationship between doubt and OCD clinical features, Axis I disorders, personality and personality disorder dimensions, impairment, and treatment response.

Results: The severity of doubt was inversely related to the age at onset of OCD symptoms. Doubt was strongly related to the number of checking symptoms and, to a lesser extent, to the numbers of contamination/cleaning and hoarding symptoms. Doubt also was related to the lifetime prevalence of recurrent major depression and generalized anxiety disorder; to the numbers of avoidant, dependent, and obsessive-compulsive personality disorder traits; and to neuroticism and introversion. Moreover, doubt was strongly associated with global impairment and poor response to cognitive behavioral treatment (CBT), even adjusting for OCD severity and other correlates of doubt.

Conclusions: Doubt is associated with important clinical features of OCD, including impairment and cognitive-behavioral treatment response.

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Conflict of interest statement

Author Disclosure–Declaration of Interests

The authors of this manuscript do not have any actual or potential conflicts of interest to report or disclose.

Figures

Figure 1
Figure 1
Numbers of obsessive-compulsive symptoms, by doubt severity. Contamination/cleaning (F4;1177 = 18.6, p<0.001); Taboo thoughts (F4;1177 = 6.3, p<0.001); Checking (F4;1177 = 37.3, p<0.001); Symmetry/ordering (F4;1177 = 4.5, p=0.001); Hording (F4;1177 = 6.5, p<0.001).
Figure 2
Figure 2
Number of DSM-IV personality disorder traits, by doubt severity. Obsessive-compulsive (F4;1177 = 17.2, p<0.001); Dependent (F4;1177 = 22.5, p<0.001); Avoidant (F4;1177 = 9.6, p<0.001).
Figure 3
Figure 3
Proportion with impairment (marked or extreme) and proportion responding to treatment (moderate improvement or total remission), by doubt severity. Impairment (χ21 trend = 60.1, p<0.001); CBT, Cognitive behavioral therapy (χ21 trend = 8.4, p<0.001); SRI, Serotonin reuptake inhibitors (χ21 trend = 3.1, p=0.08).
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