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Maudsley obsessional-compulsive inventory: obsessions and compulsions in a nonclinical sample
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-Obsessive
The development of a variety of measurement procedures for obsessive-compulsive disorder (OCD) (Mavissakalian & Barlow. 1981) has resulted in the study of OCD symptoms in both clinical and nonclinical samples (e.g. Salkovskis & Harrison, 1984: Sher, Frost & Otto. 1983). While OCD appears to have a 2-3% lifetime prevalence rate (Rasmussen & Tsuang, 1986). the research also suggests a significant percentage of the general population experiences obsessive thoughts and performs compulsive behavior. For example, Rachman and de Silva (1978) found normal obsessions to be similar to abnormal obsessions in meaningfulness to the individual, in form, and to some extent content when comparing OCD patients to nonclinical individuals. Normal obsessions were, however, more easily dismissed, shorter, less frequent. less intense, and produced less discomfort. In a replicaton of this study, Salkovskis and Harrison (1984) found 88% of their nonclinical sample experienced intrusive cognitions. These researchers also found higher levels of discomfort were significantly associated with more difficulty in dismissing the obsession in their nonclinical sample. Sher and colleagues (Sher et al., 1983; Sher, Mann & Frost, 1984) found college students who scored high on the Maudsley Obsessive-Compulsive Inventory (MOCI) checking subscale reported a greater frequency of everyday checking behaviors than students low on the checking subscale. These researchers also reported that nonclinical checkers experience more problems (e.g. depression, general anxiety. fears relating to social and interpersonal situations and fears of harm or danger) and manifest certain memory deficits, including poor memory for prior actions (Frost. Sher & Green. 1986; Sher et al., 1983. 1984). While there is evidence that nonclinical samples show aspects of OCD, no study to our knowledge has examined the phenomenology of OCD in nonclinical samples through the use of a diagnostic interview. All of the studies have employed self-report inventories such as the MOCI to select individuals high on the inventory for subsequent study. Though the results from these studies are promising, it is nonetheless important to examine further the validity of these various self-report inventories of OCD through the use of a diagnostic interview. Such a study would provide additional evidence on the appropriateness of the MOCI in the selection of nonclinical samples to study OCD. The Anxiety Disorders Interview Schedule (ADIS) (DiNardo, O’Brien, Barlow, Waddel & Blanchard. 1983) is the only available interview schedule specific to DSM-III anxiety disorders. This 90min semi-structured interview schedule was developed to provide a differential diagnosis among the anxiety disorders, to rule out other mental disorders, and to collect additional information. DiNardo et al. (1983) examined the discriminative power and accuracy of the ADIS with 60 anxiety disorder outpatients and found good agreement among raters for specific anxiety disorders. The ADIS accordingly allows differential diagnosis of the anxiety disorders from other mental disorders and distinguishes between specific anxiety disorders. The purpose of this study was therefore to examine the predictive validity of the MOCI in the nonclinical population through the use of the ADIS. Four sections of the ADIS were administered to individuals who scored high on MOCI (> 2 SD above the mean) and individuals who scored in the normal range. These four sections were the obsessive-compulsive disorder, the generalized anxiety disorder, the simple phobia and the social phobia sections. The generalized anxiety disorder section was administered to examine general anxiety and associated physiological symptoms while the simple and social
*To whom
all correspondence
should
be addressed. 337
338
CASE
HISTORIES
AND
SHORTER
COMMUNICATIONS
phobia sections were given to ascertain the specificity of the MOCI. That is, high scorers on the MOCI were expected to report moreOCD symptoms than the comparison group while the two groups were not expected to differ in terms of simple and social phobias. Prior research with clinical and nonclinicat samples (Frost et nl., 1986) also suggested that the OCD group would report more symptoms of GAD than the comparison group. The purpose of the study was thus to determine the predictive validity of the MOCI through the use of the ADIS and therefore to provide information on the differences between high and low MOCI scorers in terms of OCD symptoms, general anxiety and physiological symptoms as well as the specificity of the response pattern. Moreover, the study sought to determine if such differences would be found over a 67 month interval.
METHOD
Subjecrs The Ss were recruited from introductory psychology classes at Washington State University as part of an earlier study (Sternberger & Burns, 1990). For the earlier study the 579 Ss were administered the MOCI (Hodgson & Rachman, 1977). Compulsive Activity Checklist (Freund, Steketee & Foa, 1987) and the Symptom Checklist-90-Revised (Derogatis, 1983). Individuals with MOCI scores in the top 2% and individuals with MOCI scores at the 50th percentile were selected to complete the ADIS interview 6-7 months after the original administration of the questionnaires. A total of I4 people scored in the top 2% of the MOCI distribution. Of these 14 people, 13 were Caucasian and 12 of these 13 had given their permission earlier to be contacted for the second study. When contacted 6-7 months later, I I of these 12 people agreed to take part in the second study. The comparison group was matched to the OCD group by age and gender. There were thus 11 individuals in the OCD group and II in the comparison group with 64% of both groups being female. The mean age for both groups was 18.36 (SD = 0.51). Measures Ansiery Disorders Inrewiew ~c~eda~e. For the present study we chose to administer four parts of the ADIS: (I) Generalized Anxiety Disorder (GAD); (2) Simple Phobia; (3) Social Phobia; and (4) Obsessive-Compulsive Disorder. Each section reviews the diagnostic criteria for the particular anxiety disorder. The GAD, simple and social phobia sections were administered first to provide time for the participants to become comfortable before the completion of the OCD section. Maudsley Obsessiona/-Compulsir’e inrenror.v. The MOCI (Hodgson & Rachman, 1977) is a 30-item true-false scale. A total score as well as washing (1 I items), checking (9 items), slowness (7 items) and doubting (7 items) subscale scores may be determined. The MOCI is considered to provide a self-report measure of the number of obsessive+zompulsive behaviors. Procedwrs
The Ss were administered the four sections of the ADIS-GAD. simple phobia, social phobia and OCD interview lasting 25113 min. The interviewer was unaware of the group membership of the student. The students debriefed. paid S10.00 and thanked for their time.
with each were then
RESULTS
Reliability of .ADIS A second individual scored 36% of the ADIS interviews from the audiotape recordings (4 randomly selected from the OCD group and 4 from the comparison group). There were a total of 61 questions on the ADIS interview relevant to the current study (5 from the OCD section, 20 from the GAD section, 14 from the simple phobia section and 22 from the social phobia section). A total of 58 of the questions were judged on a quantitative scale (j-point scale) with the other 3 being on a qualitative scale (i.e. ‘yes’ or ‘no’). The calculation of the percent agreement score between the two judges required an exact match to count as an agreement. The average percent agreement for the 61 questions was 97% (range 75-1009/o), indicating adequate agreement between the interviewer and second individual.
The mean MOCI score The MOCI mean for the N = 579). while the mean group was similar to the 1130 obsessional patients. Obsessions
for the OCD was 18.55 (SD = 1.51; range 18-22) and for the comparison group 5.00 (SD = 0.00). OCD group was 2.56 standard deviations above the total sample mean (M = 7.58, SD = 4.28, for the comparison group was at the 50th percentile. The MOCI mean of 18.55 for our OCD MOCI mean of 18.86 (SD = 4.92) which Hodgson and Rachman (1977) reported for a group of
and compulsions
There were seven types of obsessions which the individual was specifically asked about during the obsessive-compulsive section of the ADfS interview. These were: (I) unpleasant thoughts that will not go away; (2) concern about being clean or feeling contaminated; (3) doubts about things you do; (4) worrying if you have done things right; (5) worrying about germs or disease; (6) strict conscience; and (7) attention to detail. The OCD group reported significantly more obsessions than the comparison group, I (20) = 5.60, P = 0.00002. The OCD group reported an average of 3.90 (SD = 1.45) obsessions and the comparison group an average of 1.09 (SD = 0.83). In addition, 91% (n = to) of the OCD group reported that they were bothered by the obsessions while only 9% (n = I) of the comparison group responded affirmatively to this question, Fisher exact test P < 0.0001. The ADIS interview asked specifically about five different types of compulsions. These were: (I) spending a great deal of time checking things (e.g. stove. lights); (2) spending a great deal of time dressing: (3) spending a great deal of time countine thinas; (4) washing hands over and over because they are never quite clean enough; and (5) being late or behind becausevou h>ve‘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-Obsessive
The development of a variety of measurement procedures for obsessive-compulsive disorder (OCD) (Mavissakalian & Barlow. 1981) has resulted in the study of OCD symptoms in both clinical and nonclinical samples (e.g. Salkovskis & Harrison, 1984: Sher, Frost & Otto. 1983). While OCD appears to have a 2-3% lifetime prevalence rate (Rasmussen & Tsuang, 1986). the research also suggests a significant percentage of the general population experiences obsessive thoughts and performs compulsive behavior. For example, Rachman and de Silva (1978) found normal obsessions to be similar to abnormal obsessions in meaningfulness to the individual, in form, and to some extent content when comparing OCD patients to nonclinical individuals. Normal obsessions were, however, more easily dismissed, shorter, less frequent. less intense, and produced less discomfort. In a replicaton of this study, Salkovskis and Harrison (1984) found 88% of their nonclinical sample experienced intrusive cognitions. These researchers also found higher levels of discomfort were significantly associated with more difficulty in dismissing the obsession in their nonclinical sample. Sher and colleagues (Sher et al., 1983; Sher, Mann & Frost, 1984) found college students who scored high on the Maudsley Obsessive-Compulsive Inventory (MOCI) checking subscale reported a greater frequency of everyday checking behaviors than students low on the checking subscale. These researchers also reported that nonclinical checkers experience more problems (e.g. depression, general anxiety. fears relating to social and interpersonal situations and fears of harm or danger) and manifest certain memory deficits, including poor memory for prior actions (Frost. Sher & Green. 1986; Sher et al., 1983. 1984). While there is evidence that nonclinical samples show aspects of OCD, no study to our knowledge has examined the phenomenology of OCD in nonclinical samples through the use of a diagnostic interview. All of the studies have employed self-report inventories such as the MOCI to select individuals high on the inventory for subsequent study. Though the results from these studies are promising, it is nonetheless important to examine further the validity of these various self-report inventories of OCD through the use of a diagnostic interview. Such a study would provide additional evidence on the appropriateness of the MOCI in the selection of nonclinical samples to study OCD. The Anxiety Disorders Interview Schedule (ADIS) (DiNardo, O’Brien, Barlow, Waddel & Blanchard. 1983) is the only available interview schedule specific to DSM-III anxiety disorders. This 90min semi-structured interview schedule was developed to provide a differential diagnosis among the anxiety disorders, to rule out other mental disorders, and to collect additional information. DiNardo et al. (1983) examined the discriminative power and accuracy of the ADIS with 60 anxiety disorder outpatients and found good agreement among raters for specific anxiety disorders. The ADIS accordingly allows differential diagnosis of the anxiety disorders from other mental disorders and distinguishes between specific anxiety disorders. The purpose of this study was therefore to examine the predictive validity of the MOCI in the nonclinical population through the use of the ADIS. Four sections of the ADIS were administered to individuals who scored high on MOCI (> 2 SD above the mean) and individuals who scored in the normal range. These four sections were the obsessive-compulsive disorder, the generalized anxiety disorder, the simple phobia and the social phobia sections. The generalized anxiety disorder section was administered to examine general anxiety and associated physiological symptoms while the simple and social
*To whom
all correspondence
should
be addressed. 337
338
CASE
HISTORIES
AND
SHORTER
COMMUNICATIONS
phobia sections were given to ascertain the specificity of the MOCI. That is, high scorers on the MOCI were expected to report moreOCD symptoms than the comparison group while the two groups were not expected to differ in terms of simple and social phobias. Prior research with clinical and nonclinicat samples (Frost et nl., 1986) also suggested that the OCD group would report more symptoms of GAD than the comparison group. The purpose of the study was thus to determine the predictive validity of the MOCI through the use of the ADIS and therefore to provide information on the differences between high and low MOCI scorers in terms of OCD symptoms, general anxiety and physiological symptoms as well as the specificity of the response pattern. Moreover, the study sought to determine if such differences would be found over a 67 month interval.
METHOD
Subjecrs The Ss were recruited from introductory psychology classes at Washington State University as part of an earlier study (Sternberger & Burns, 1990). For the earlier study the 579 Ss were administered the MOCI (Hodgson & Rachman, 1977). Compulsive Activity Checklist (Freund, Steketee & Foa, 1987) and the Symptom Checklist-90-Revised (Derogatis, 1983). Individuals with MOCI scores in the top 2% and individuals with MOCI scores at the 50th percentile were selected to complete the ADIS interview 6-7 months after the original administration of the questionnaires. A total of I4 people scored in the top 2% of the MOCI distribution. Of these 14 people, 13 were Caucasian and 12 of these 13 had given their permission earlier to be contacted for the second study. When contacted 6-7 months later, I I of these 12 people agreed to take part in the second study. The comparison group was matched to the OCD group by age and gender. There were thus 11 individuals in the OCD group and II in the comparison group with 64% of both groups being female. The mean age for both groups was 18.36 (SD = 0.51). Measures Ansiery Disorders Inrewiew ~c~eda~e. For the present study we chose to administer four parts of the ADIS: (I) Generalized Anxiety Disorder (GAD); (2) Simple Phobia; (3) Social Phobia; and (4) Obsessive-Compulsive Disorder. Each section reviews the diagnostic criteria for the particular anxiety disorder. The GAD, simple and social phobia sections were administered first to provide time for the participants to become comfortable before the completion of the OCD section. Maudsley Obsessiona/-Compulsir’e inrenror.v. The MOCI (Hodgson & Rachman, 1977) is a 30-item true-false scale. A total score as well as washing (1 I items), checking (9 items), slowness (7 items) and doubting (7 items) subscale scores may be determined. The MOCI is considered to provide a self-report measure of the number of obsessive+zompulsive behaviors. Procedwrs
The Ss were administered the four sections of the ADIS-GAD. simple phobia, social phobia and OCD interview lasting 25113 min. The interviewer was unaware of the group membership of the student. The students debriefed. paid S10.00 and thanked for their time.
with each were then
RESULTS
Reliability of .ADIS A second individual scored 36% of the ADIS interviews from the audiotape recordings (4 randomly selected from the OCD group and 4 from the comparison group). There were a total of 61 questions on the ADIS interview relevant to the current study (5 from the OCD section, 20 from the GAD section, 14 from the simple phobia section and 22 from the social phobia section). A total of 58 of the questions were judged on a quantitative scale (j-point scale) with the other 3 being on a qualitative scale (i.e. ‘yes’ or ‘no’). The calculation of the percent agreement score between the two judges required an exact match to count as an agreement. The average percent agreement for the 61 questions was 97% (range 75-1009/o), indicating adequate agreement between the interviewer and second individual.
The mean MOCI score The MOCI mean for the N = 579). while the mean group was similar to the 1130 obsessional patients. Obsessions
for the OCD was 18.55 (SD = 1.51; range 18-22) and for the comparison group 5.00 (SD = 0.00). OCD group was 2.56 standard deviations above the total sample mean (M = 7.58, SD = 4.28, for the comparison group was at the 50th percentile. The MOCI mean of 18.55 for our OCD MOCI mean of 18.86 (SD = 4.92) which Hodgson and Rachman (1977) reported for a group of
and compulsions
There were seven types of obsessions which the individual was specifically asked about during the obsessive-compulsive section of the ADfS interview. These were: (I) unpleasant thoughts that will not go away; (2) concern about being clean or feeling contaminated; (3) doubts about things you do; (4) worrying if you have done things right; (5) worrying about germs or disease; (6) strict conscience; and (7) attention to detail. The OCD group reported significantly more obsessions than the comparison group, I (20) = 5.60, P = 0.00002. The OCD group reported an average of 3.90 (SD = 1.45) obsessions and the comparison group an average of 1.09 (SD = 0.83). In addition, 91% (n = to) of the OCD group reported that they were bothered by the obsessions while only 9% (n = I) of the comparison group responded affirmatively to this question, Fisher exact test P < 0.0001. The ADIS interview asked specifically about five different types of compulsions. These were: (I) spending a great deal of time checking things (e.g. stove. lights); (2) spending a great deal of time dressing: (3) spending a great deal of time countine thinas; (4) washing hands over and over because they are never quite clean enough; and (5) being late or behind becausevou h>ve‘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.