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Obsessions and compulsions: The Padua inventory
BPhm. Rex. The?. Vol. 26. No. 2. pp. 169-177.
00057967 88 S3.00 + 0.00 Pergamon Press plc
1988
Printed in Great Britain
OBSESSIONS AND COMPULSIONS: THE PADUA INVENTORY EZIO SANAVIO Department
of General
Psychology,
University (Received
of Padova, 6 Augusr
Piazza
Capitaniato
3, 35100 Padova,
Italy
1987)
Summary-The Padua Inventory (PI) consists of 60 items describing common obsessional and compulsive behavior and allows investigation of the topography of such problems in normal and clinical Ss. It was administered to 967 normal Italian Ss, ranging in age from I6 to 70yr. Inventoryconsistencyand I-month reliability were satisfactory. Females reported more complaints. more intensely than males. Ss aged from I6 to 20yr and Ss aged from 46 to 70 complain of more obsessions and compulsions than Ss of intermediate ages. Four factors were identified: impaired control of mental activities, becoming contaminated, checking behaviors, urges and worries of losing control over motor behaviors. The PI correlates with the Maudsley Obsessional-Compulsive Questionnaire (0.70). Leyton ObsessionalCompulsive Inventory (0.71 with Symptom and 0.66 with Trait scales) and Self-rating Obsessional Scale (0.61). Furthermore, it allows discrimination between a group of 75 outpatients with obsessive-compulsive disorders and a similar group of outpatients with other neurotic disorders. Relationships with fears and neuroticism traits were also found, reflected in moderately high correlations with rhe Fear Survey Schedule and the Neuroticism scale of the Eysenck Personality Questionnaire.
INTRODUCTION Obsessions and compulsions are essential features of the obsessive
170
Ezra
SANAVIO
repetitive thinking about low-probability dangers, recurrent repugnant images etc. This paper describes an inventory which was developed from interviews of obsessional patients and studies with normals as well as neurotic and obsessive-compulsive patients. It lists obsessions and compulsions that may constitute significant sources of distress to the individual and produce some impairment in several areas of routine daily functioning, such as work, social relations and self-care.
METHOD
Development and Description of the Padua Intlentory
After analyzing the tapes of the initial interviews of 28 patients who met the DSM-III diagnostic criteria for obsessive compulsive disorders, we assembled about 200 statements describing patients’ complaints. Statements were first selected on the basis of content dissimilarity and representativeness of the described situations; statements describing emotional states or personality traits were not considered. A list of the selected statements was submitted to small groups of anxious, depressive and psychosomatic patients in order to check discriminativity. From this pool 76 items were selected and presented to a group of 1200 normal Ss. After item and factor analyses 16 items were excluded, while some of the remainder were sometimes lexically modified in order to facilitate understanding. The final version the Padua Inventory (PI) consists of 60 items. Each item is rated on a O-4 scale regarding degree of disturbance: 0 indicates that the item is not at all disturbing, while 4 indicates that it is very much disturbing. Subjects and Procedure
The PI was given to 967 normal Ss ranging in age from 16 to 70 yr, all residing in north-eastern Italy; 489 were males, 478 females. A second group of 100 males and 100 females aged between 16 and 19 yr, attending highereducation institutes, was given the same inventory and the Italian versions of the Sandier and Hazari SOS, LOI, MOCQ, Eysenck Personality Questionnaire (EPQ) and Fear Survey Schedule (FSS). A further group of 98 male and 92 female students, attending higher-education institutes and ranging in age from 16 to 18 yr, filled out the inventory twice at an interval of 30 days. All Ss were asked to participate on a voluntary basis, and anonymity was guaranteed.
RESULTS Subjects were divided into six age groups: 16-20, 21-25, 2635, 36-45, 4655, 56-70 yr; means and standard deviations of total scores are presented in Table 1. A two-way ANOVA, considering sex and age groups, shows that females obtain higher scores than males: F(1,955) = 22.5, P < 0.001. The age effect is also significant: F(5,955) = 8.2, P < 0.0001. Post hoc comparisons show that Ss of 16-20 and 46-70 yr score higher than Ss of 21-45 yr. The sex x age interaction was not significant: F(5,955) = 1.5, NS. In order to compare male and female responses, separate ANOVAs were carried out on the responses to each item of the inventory. Females had higher scores on Items 1, 3, 5, 6, 7, 8, 10, 11, 15, 16, 20, 21, 26, 27, 28, 29, 31, 32, 33, 35, 36, 38, 50, 51, 58, 59 and males on Items 49, 54, 55, 56; no difference was found in the remaining items. For each S the number of items rated 4 (i.e. very much disturbing) was calculated (cf. Fig. 1): 10% of male and 20% of female Ss complained of 8 or more obsessions/compulsions. The ANOVA, considering as factors sex and age groups, indicates sex [F(1,955) = 14.0, P < O.OOl]and age [F(5,955) = 4.8, P < O.OOl] effects; the interaction was not significant. Post hoc comparisons indicate that Ss of 46-70yr have more obsessions and compulsions than Ss of lower ages. Correlations between the PI total scores and scores of the other questionaires filled out by the 200 students are reported in Table 2.
ObsessIons
and compulsions:
the Padua
Table I. PI scores: means and standard
deviations
Males
Females
Age or)
,V
.Y
I&X
60
55.4
21-25 2635 3-55 46-55
90 61 84 99 95
46.8 47.9 47.0 55. I 66.6
S&i0
171
SD
.V
.v
SD
29.8
60
26.2 23.5 24.3 29.8 31.2
86 42 95 96 99
70. I 59.2 57.4 55. I 66.5 66.0
26.6 27.7 32.9 27.3 29.4 33.3
5\
Inventory
FEMALES \
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xx MALES
:
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I-
I 16-20
I 21-25
I 26-35
-I 36-45
I 46-55
I 56-70
AGE Fig.
I. Mean
number
of items rated ‘very much disturbing’
in the various
age groups.
Reliability
The cc-coefficient was calculated as an index of consistency and turned out to be 0.90 in male and 0.94 in female Ss. Test-retest correlations were 0.78 for the males and 0.83 for the females who filled out the inventory twice at a 30-day interval. Factor analysis
To derive a factor structure which could be accepted with confidence, separate factor analyses were performed on the responses of the following: (a) male subgroup; (b) female subgroup; (c) Ss of 16-35 yr; (d) Ss of 36-70 yr; (e) the whole group. Subject/variable ratios were 8.1, 8.0. 6.6, 9.5 and 16.1. The principal-components method with iterations was used, followed by Varimax rotation using the SPSS statistical program. From the five groups, extraction procedures gave respectively 15, 14, 15, 14 and 13 factors with eigenvalues > 1. The plot of the eigenvalues, however, showed clear breaks after the first four factors, and continued extraction in each group gave factors loaded by pairs of similar items or
Table 2. Correlations between PI scores and other questionnaires (.V = 200) SOS LOI (Symptoms) LOI (Traits) MOCQ EPQ (Neuroticism) EPQ (Extraversion) EPQ (Psychoticism)
0.61 0.71 0.66 0.70 0.5 I -0.10 0.09
-0.08 0.42
172
EZIOSANAVIO Table
3. Items
which
load
on the four
Facror I: impaired conrrol owr mental ocrniries 32. When I startthinking of certain things, I become obsessed with 33.
Unpleasant
thoughts
36.
I I
35.
My
26.
I find it difficult
28.
I have
31.
invent
doubts
imagine
I think
Sometimes
29.
After
38.
When
43.
I worry
59.
When
I
When
doubts
I.
When
I will
hear
about
and
having
carefully,
a disaster,
about
or dirty
words
a thought
If
3.
I find
IO.
I
come
more
something
If an animal
into
I
using
public
2.
I think
even
slight
harm
I find it difficult
6.
I avoid
I.
I feel my hands
0.63
is happening
round
me
when
about
important
0.5-t
especially
talking
matters
0.51
my
for
I cannot
mind
and
it
0.50
I have done
I have either
things
I amupset
done
0.49 it badly
or not
timshed
it
0.49 0.47
and make
a long
time
rest until
I cannot
my mind.
knowing
I know
my fault
unimportant
into
keep on doing
and
an effort and
I have
find talked
not
to forget
it difficult them
them
to stop
over
with
0.46
thinking
a reassuring
about
it
0.45
person
0.44
get rid of them
I have to examine
0.4-l
it from
all points
of view
and cannot
stop
until
I
to touch
public
with
because
bodily
more
often
I thmk
are dirty
22.
I keep on checking
20.
I check
19.
I
25.
I check
23.
I keep on going
24.
When
18.
I have to do things
than
I may
necessary
be dirty
0.42
or ‘contaminated‘
0.67
have to uash
it has been touched have to wash
of disease
secretions
or clean
by strangers mvsclf
myself
0.65
or by certain
or change
people
0.64
my clothing
0.6-l
and contamination
(perspiration,
saliva.
0.61
urine
etc.)
may
contammatr
my
clothes
or
when about
forms,
recheck
gas and
carefully
When
I handle
I look
back money
down
57.
I feel I have
47.
When
54.
I sometimes
55.
I am sometimes
49.
While
money
and
water
taps and
times
I count
0.56
before
etc.,
light
to make
switches
than
posting
after
are properly
sure I have filled
turning
them
shut them
0.69 in correctly
off
from
a bridge
special
gestures
approaching
have an impulse almost
0.63 0.59
etc. are properly
extinguished
0.52
times
0.52
they are properly
to steal
high
or walk
I sometimes
irresistibly
I sometimes
or a very
other
tempted
feel an impulse
window,
in a certain think
people’s
I could
I
done
0.49
0.62
feel an impulse
to throw
myself
into
space
way
belongings, the car into
0.57 0.48
throw
to steal something to drive
0.65 0.65
them
it several
I think
sure they
to make
necessary
cigarettes
recount
before
0.43
etc. in detail,
often
matches,
and
times
and disease
0.52
drawers checks
more
of contagion
diseases
windows.
to see that
several
to make
I see a train
driving
0.59 0.57
I touch germs
things
many
things
I am afraid
documents.
to keep on checking letters
or dirty
because
Factor IV: urges and worries of losing conirol over motor behaviors 53. I sometimes feel the need to break or damage things for no reason 46.
0.43
0.66
immediately
immediately
I amafraid
garbage
telephones
useless worries
and
I know
and
things
necessary
I
when
because
contact
than
is ‘contaminated’
me, I feel dirty toilets
certain
simply
longer
an object
Factor III: checking behoriors 21. I return home to check doors,
tend
I make
me
4.
using
often
I think
touches
I avoid
I invent
to what
which
0.5 I
clearly.
without
the impression
to my mind,
comes
to touch
5.
60.
errors
matters
in fact
it is somehow
or a crime,
late because
it difficult
somehow
0 68
so
my hands
touch
or minor
to attend
things
someone which
have
completely come
or doubt
hurt
I still I think
a suicide
and worries
I am sometimes
9.
0.72 get rid of them
0.65
it difficult
unimportant
things
Facror II: becoming conramrnored 8. I sometimes have to wash or clean myself I wash
them
I cannot
of absent-mindedness
I find
even about
and
loadings
I do
never be able to explain
about
remembering
hear
have done
7.
my will
of the things
as a result
not sure I have done
something
about
Obscene
most
way
decisions.
that
at length
I am
doing
34.
30.
goes its own
to take
or worry
44.
about
against
with
me
37.
I
my mind
consequences
the impression
involve
into
problems
constantly
27.
I
and
catastrophic
brain
that
come
factors.
myself
under
even if they from
its wheels
are of no use to me
the supermarket
someone
or something
0.4s 0.47 0.44 0.42
by single items. We therefore retained only four factors for rotation. Factor loadings from the analysis on the responses of the whole group (N = 967) are presented in Table 3. This solution resulted in the same clearest and most interpretable factor structure across the five analyses. The four factors can fairly clearly be interpreted in the following: Factor
I:
Factor
II:
Factor
III:
Factor
IV:
impaired control over mental activities, i.e. lower ability to remove undesirable thoughts, difficulties in coping with simple decisions and doubts, uncertainty about one’s own responsibility in occasional accidents, ruminative thinking about low-probability dangers etc. becoming contaminated, i.e. excessive hand-washing, stereotyped cleaning activities, overconcern with dirt, worries about unrealistic contaminations etc. checking behavior i.e. checking doors, gas and water taps, letters, money, numbers etc. over and over again. urges and worries of loss of control of motor behavior, i.e. urges of violence against animals or things, impulses to kill oneself or others without reason, fear of losing control over antisocial or sexual impulses etc.
Obsessions Table
and compulsions:
the Padua
Inventory
173
4. PI scores (‘score‘) and number of Items rated ‘very much disturbing‘ (‘obsessions’) obsessivcxompulsive and ‘neurotic’ patients: means and standard deviations (in parentheses)
of
Females
Males IV
Score
Obsessions
,A’
Score
Obsessions
Obsessive-zompulwes
35 35
7.5 (7.6) 1.8 (2.9)
40
‘Neurotics’
53.6 (34.8) 50.2 (28.9)
98.6 (32.3) 66.5 02.4)
Il.3 (9.2) 3.6 (4.6)
40
Obsessional cs Neurotic Group
Seventy-five outpatients suffering from obsessive-compulsive disorders and requesting behavioural treatment filled out the inventory. They all satisfied DSM-III criteria for obsessivecompulsive disorder (code 300.30) and were concordantly evaluated in separate interviews by both a psychiatrist and a behavioral therapist. Patients’ ages ranged between 26 and 45 yr; 35 were males and 40 females. The PI was given to a group of 75 outpatients requesting treatment for other neurotic disorders. The group was paired for sex and age with the obsessional group. Diagnoses were agoraphobia, social phobia, depression and psychosexual dysfunction. Scores are presented in Table 4. An ANOVA, considering group and sex, shows that the obsessional group had higher scores than the neurotic group [F( 1,146) = 38.6, P c O.OOl].Females also obtained higher scores than males [F(1,146) = 8.8, P = 0.0031; an interaction effect between sex and diagnostic group was not found [F( 1,146) = 0.02, NS]. Seven items failed to differentiate between groups. In fact a series of one-way ANOVAs showed that obsessionals did not score significantly higher than neurotics on Items 17, 34, 39, 40, 41, 56 and 60. DISCUsSION Our data shows the high incidence of unwanted intrusive cognitions and urges in the non-clinical population and support previous findings regarding similarity between ‘normal’ and ‘pathological’ obsessions (Rachman and de Silva, 1978; Salkovskis and Harrison, 1984). A number of important additional results emerge. Females report more obsessional thoughts and impulses than males. The difference was found in 26 of the 60 items of the inventory, but men scored significantly higher than women on items referring to violent impulses in driving (Item 49) and against animals (Item 56) and property (Items 54 and 55). The interpretation of these sex differences is quite intriguing. Epidemiological studies in obsessive-compulsive disorders do not report differences in sex ratio apart from the higher incidence of washing/cleaning rituals in women. Further difficulty in interpretation comes from the results of a recent research on Italians (Sanavio, Bertolotti, Michielin, Vidotto and Zotti, 1986): 720 normal Ss ranging in age from 16 to 80 yr, filled out a large battery of questionnaires, including a revised version of the MOCQ. No sex difference appears in total scores or Cleaning or Doubting/Ruminating subscales, but men scored higher than women in Checking subscale items. Females’ complaints in the present inventory may also be considered in the light of results on research on fears, in which females systematically report more fears than males in fear inventories (Arrindell, Emmelkamp and van der Ende, 1984; Sanavio, 1987). The usual interpretation is that women do not differ so much in experiencing fears, as in admitting that they do. As a tentative interpretation of the sex differences found in ‘normal’ obsessional behaviors, we may again hypothesize that females do not differ so much in experiencing obsessions and compulsions, as in admitting that they do. According to sexual stereotypes, males may be prone to admitting antisocial and violent impulses, but not irrational and often ridiculous worries and behavior. Some argument against this interpretation comes from the lack of relationship between obsessional complaints and the EPQ Lie scale. Since this scale measures Ss’ tendency to present themselves in a favorable light and conform to social expectations, we may expect to find a relevant and negative correlation with admitted obsessions and compulsions. However, the obtained correlation turned out to be practically nil (- 0.08) and we may argue that sex differences reflect effective differences in Ss’ beliefs and perceptions rather than artifacts in response sincerity.
EZIO SAXAWO
174
A further finding to be considered is the U-shaped evolution of obsessions and compulsions along ages-a finding suggesting that both early adulthood and old age must be considered as ‘windows of vulnerability’ for obsessions and compulsions. The higher incidence of such behavior in young adults is consistent with data from epidemiological researches. Ingram (1961) and Pollit (1957) reported that the mean age of onset of obsessive-compulsive disorders is in the early twenties. Black (1974) reported that 50% of obsessive-compulsive patients had developed their symptomatology by the age of 25 yr. With regard to higher scores of older Ss, a tentative hypothesis is that obsessional and compulsive complaints increase with depression. Obsessions and compulsions have been clinically and theoretically linked to depression (Rachman and Hodgson, 1980) and a number of clinical studies illustrate the usefulness of antidepressant drugs in treating obsessive~ompuIs~ve disorders (Turner, Beidel and Nathan, 1985). The above-mentioned Italian study (Sanavio et al.. 1986) indicated a significant increase in old age in both depressive and obsessional complaints. As Fig. 2 shows. noticeable increases have been found in Ss aged 61-80 yr using a different measure of obsessional complaints, i.e. the MOCQ, and a measure of depression, i.e. the Depression Questionnaire, a reliable and valid Italian questionnaire, Since depression increases in old age, we may argue one of the following: (1) depression acts as an intermediate variable linking old age with enhanced vulnerability to obsessions and compulsions; (2) the well-known attitude of depressed persons towards emphasizing cognitive and behavioral impairments lead to overevaIuation of the severity of norma obsessional and compulsive behaviors; (3) a higher-order mechanism, varying with age, could be identified as responsible for increases in both depressive and obsessional~ompulsive complaints in old age. According to the Eysenckian model of personality, introversion and neuroticism contribute to the development of obsessional-compulsive compfaints and, in turn, are increased bl; them. Both
44-
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39-
303736-
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-
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Fig. 2. Mean scores of 720 normal Italian Ss on the MOCQ, the Trait scale of the Spielberger Stats-Trait Anxiety Inventory and Depression Questionnaire [adapted from Sanavio et ai. (1936)I.
Obsessions and compulsions: the Padua Inventory
175
associations were confirmed by Kendell and DiScipio (1970) in a study using the LOI in a group of patients recovering from depression and by Hodgson and Rachman (1977) in a study using the MOCQ in a group of patients being treated for obsessional-compulsive disorders. Our results only support the association between obsessional complaints and the neuroticism dimension as measured by the EPQ. A 0.51 correlation was found with the EPQ Neuroticism scale, while correlation with the Introversion’Extraversion and Psychoticism scales were nil. A relationship between fears and obsessional complaints was also found, reflected in a positive and moderately high correlation with the FSS. Therefore, in normal people, high obsessionalcompulsive complaints are associated with neuroticism traits and greater fears, but are independent of introversion/extraversion and psychoticism traits. Four main types of obsessions and compulsions emerge from our factorial analyses. The first factor refers to a sense of impaired control over thoughts and mental imagery and mainly describes exaggerated doubts and ruminations. It clearly corresponds to the ‘doubting’ and ‘ruminating’ components identified in the MOCQ and to the ‘feeling of incompleteness’ component of the LOI. The second factor may be named ‘becoming contaminated’ and refers to overconcern with dirt and improbable/impossible contaminations. It corresponds to the MOCQ ‘cleaning’ component and the LO1 ‘clean and tidy’ component. The third factor describes repeated checking behaviors and is almost identical to the MOCQ ‘checking’ and the LO1 ‘checking and repetition’ components. The fourth factor refers to urges of violent and antisocial nature and worries of losing control over motor behavior, such as killing one’s child, damaging or stealing something without reason or throwing oneself out of a high window. There is no clear correspondence, in this case, with the components identified in the other obsessional questionnaires. The presence of such a type of obsessions in normal Ss is, in our opinion, an interesting finding and may suggest further research in the area of ‘normal obsessions and compulsions. Moreover, an inventory including items investigating obsessions and urges different frem checking and cleaning urges could be a useful tool for researchers and clinicians too. The reliability of the inventory is clearly satisfactory. The internal consistency is high (z = 0.90 in males, a = 0.94 in females), as well as stability over a months’ interval (test-retest correlations were 0.78 for the male and 0.83 for the female groups). The inventory clearly correlates with the currently existing measures of obsessional complaints, i.e. the MOCQ (0.70), the LO1 (0.71 with Symptom and 0.66 with Trait scales) and the SOS (0.61). Furthermore, it allows discrimination between patients with obsessive-compulsive disorders and patients with other types of neurotic disturbance. We therefore hope that the PI may be useful in investigating the topography of obsessions and compulsions in both normal and clinical Ss and in providing more detailed information for clinical assessment. Furthermore, this inventory, together with other obsessional questionnaires, could be used in research to evaluate changes resulting from treatment.
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EZIO SANAVlO
Sanavio E. (1987) The fears of Utahan children and adolescents. In indiriduai Dtfirences in Children and Rdoiescenrs (Edited by Eysenck S. B. G. and Saklofske D. H.). Hodder & Stoughton. Sevenoaks, Kent. Sanavio E. and Vidotto G. (1985) The components of the Maudsley Obsessional~ompulsive Questionnaire. Behm. Res. Ther. 23, 659-662. Sanavio E., Bertolotti G., ~ichielin P., Vidotto G. and Zotti A. M. (1986) CBA-Z.0 Scale Primnrie: C’nn Botteria P Vusro Spetrro per I’Assessmeffi Psicofogico. Organiuazioni Speciali. Firenze. Sandier J. and Hazari A. (1960) The obsessional: on the psychological classification of obsessionai character traits and symptoms. Br. J. med. Psychoi. 33, 113-122. Snaith R., McGuire R. and Fox K. (1971) Aspects of personality and depression. Psychol. Med. 1, 239-216. Turner S. M., Beidel D. C. and Nathan R. S. (1985) Biological factors in obwssive+ompulsive disorders. Psycho/. Bull. 97, 430-450.
APPENDIX INSTRUCTIONS: The following statements refer to thoughts and behaviors which may occur to everyone in everyday life. For each statement, choose the reply which best seems to tit you and the degree of disturbance which such thoughts or behaviors may create. Rate your replies as follows: O-not at all i-a little Z-quite a lot 3-a lot 4-very much I. I feel my hands are dirty when I touch money. 2. 1 think even slight contact with bodily secretions (perspiration, saliva. urine etc.) may contaminate my clothes or somehow harm me. 3. I find it difficult to touch an object when I know it has been touched by strangers or by certain people. 4. I find it difficult to touch garbage or dirty things. 5. I avoid using public toilets because I am afraid of disease and contamination. 6. I avoid using public telephones because I am afraid of contagion and disease. 7. I wash my hands more often and longer than necessary. 8. I sometimes have to wash or clean myself simply because I think 1 may be dirty or ‘contaminated’. 9. If I touch something I think is ‘contaminated’ I immediately have to wash or clean myself. 10. If an animal touches me, I feel dirty and immediately have to wash myself or change my clothing. I I. When doubts and worries come to my mind, I cannot rest until I have talked them over with a reassuring person. 12. When I talk I tend to repeat the same things and the same sentences several times. 13. I tend to ask people to repeat the same things to me several times consecutively, even though I did understand what they said the first time. 14. I feel obliged to follow a particular order in dressing, undressing and washing myself. IS. Before going to sleep I have to do certain things in a certain order. 16. Before going to bed I have to hang up or fold my clothes in a special way. 17. I feel I have to repeat certain numbers for no reason. 18. I have to do things several times before I think they are properly done. 19. I tend to keep on checking things more often than necessary. 20. I check and recheck gas and water taps and light switches after turning them off. 21. I return home to check doors, windows, drawers etc., to make sure they are properly shut. 22. I keep on checking forms, documents, checks etc. in detail, to make sure I have filled them in correctly. 23. I keep on going back to see that matches. cigarettes etc. are properly extinguished. 24. When I handle money I count and recount it several times. 25. I check letters carefully many times before posting them. 26. I find it difficult to take decisions, even about unimportant matters. 27. Sometimes I am not sure I have done things which in fact I know I have done. 28. I have the impression that I will never be able to explain things clearly, especially when talking about important matters that involve me. 29. After doing something carefully, I still have the impression I have either done it badly or not finished it. 30. I am sometimes late because I keep on doing certain things more often than necessary. 31. I invent doubts and problems about most of the things I do. 32. When I start thinking of certain things, I become obsessed with them. 33. Unpleasant thoughts come into my mind against my will and I cannot get rid of them. 34. Obscene or dirty words come into my mind and I cannot get rid of them. 35. My brain constantly goes its own way and I find it difficult to attend to what is happening round me. 36. I imagine catastrophic consequences as a result of absent-mindedness or minor errors which I make. 37. I think or worry at length about having hurt someone without knowing it. 38. When I hear about a disaster, I think it is somehow my fault. 39. I sometimes worry at length for no reason that I have hurt myself or have some disease. 40. I sometimes start counting objects for no reason. 41. I feel I have to remember completely unimportant numbers. 42. When I read I have the impression I have missed something important and must go back and reread the passage at least two or three times. 43. I worry about remembering completely unimportant things and make an effort not to forget them. 44. When a thought or doubt comes into my mind, I have to examine it from all points of view and cannot stop until I have done so. 45.
In certain situations I am afraid of losing my self-controi and doing embarassing things.
Obsessions 46. 47. 48. 49. 50. 51. 52.
and compulsions:
the Padua
Inventory
177
When I look down from a bridge or a very high window, I feel an impulse to throw myself into space. When I see a train approaching I sometimes think I could throw myself under its wheels. At certain moments I am tempted to tear off my clothes in public. While driving I sometimes feel an impulse to drive the car into someone or something. Seeing weapons excites me and makes me think violent thoughts. I get upset and worried at the sight of knives, daggers and other pointed objects. I sometimes feel something inside me which makes me do things which are really senseless and which I do not want to do. 53. I sometimes feel the need to break or damage things for no reason. 5-t. I sometimes have an impulse to steal other people’s belongings, even if they are of no use to me. 55. I am sometimes almost irresistibly tempted to steal something from the supermarket. 56. I sometimes have an impulse to hurt defenseless children or animals. 57. I feel I have to make special gestures or walk in a certain way. 58. In certain situations I feel an impulse to eat too much. even if I am then ill. 59. When I hear about a suicide or a crime, I am upset for a long time and find it difficult to stop thinking about it. 60. I invent useless worries about germs and diseases.
00057967 88 S3.00 + 0.00 Pergamon Press plc
1988
Printed in Great Britain
OBSESSIONS AND COMPULSIONS: THE PADUA INVENTORY EZIO SANAVIO Department
of General
Psychology,
University (Received
of Padova, 6 Augusr
Piazza
Capitaniato
3, 35100 Padova,
Italy
1987)
Summary-The Padua Inventory (PI) consists of 60 items describing common obsessional and compulsive behavior and allows investigation of the topography of such problems in normal and clinical Ss. It was administered to 967 normal Italian Ss, ranging in age from I6 to 70yr. Inventoryconsistencyand I-month reliability were satisfactory. Females reported more complaints. more intensely than males. Ss aged from I6 to 20yr and Ss aged from 46 to 70 complain of more obsessions and compulsions than Ss of intermediate ages. Four factors were identified: impaired control of mental activities, becoming contaminated, checking behaviors, urges and worries of losing control over motor behaviors. The PI correlates with the Maudsley Obsessional-Compulsive Questionnaire (0.70). Leyton ObsessionalCompulsive Inventory (0.71 with Symptom and 0.66 with Trait scales) and Self-rating Obsessional Scale (0.61). Furthermore, it allows discrimination between a group of 75 outpatients with obsessive-compulsive disorders and a similar group of outpatients with other neurotic disorders. Relationships with fears and neuroticism traits were also found, reflected in moderately high correlations with rhe Fear Survey Schedule and the Neuroticism scale of the Eysenck Personality Questionnaire.
INTRODUCTION Obsessions and compulsions are essential features of the obsessive
170
Ezra
SANAVIO
repetitive thinking about low-probability dangers, recurrent repugnant images etc. This paper describes an inventory which was developed from interviews of obsessional patients and studies with normals as well as neurotic and obsessive-compulsive patients. It lists obsessions and compulsions that may constitute significant sources of distress to the individual and produce some impairment in several areas of routine daily functioning, such as work, social relations and self-care.
METHOD
Development and Description of the Padua Intlentory
After analyzing the tapes of the initial interviews of 28 patients who met the DSM-III diagnostic criteria for obsessive compulsive disorders, we assembled about 200 statements describing patients’ complaints. Statements were first selected on the basis of content dissimilarity and representativeness of the described situations; statements describing emotional states or personality traits were not considered. A list of the selected statements was submitted to small groups of anxious, depressive and psychosomatic patients in order to check discriminativity. From this pool 76 items were selected and presented to a group of 1200 normal Ss. After item and factor analyses 16 items were excluded, while some of the remainder were sometimes lexically modified in order to facilitate understanding. The final version the Padua Inventory (PI) consists of 60 items. Each item is rated on a O-4 scale regarding degree of disturbance: 0 indicates that the item is not at all disturbing, while 4 indicates that it is very much disturbing. Subjects and Procedure
The PI was given to 967 normal Ss ranging in age from 16 to 70 yr, all residing in north-eastern Italy; 489 were males, 478 females. A second group of 100 males and 100 females aged between 16 and 19 yr, attending highereducation institutes, was given the same inventory and the Italian versions of the Sandier and Hazari SOS, LOI, MOCQ, Eysenck Personality Questionnaire (EPQ) and Fear Survey Schedule (FSS). A further group of 98 male and 92 female students, attending higher-education institutes and ranging in age from 16 to 18 yr, filled out the inventory twice at an interval of 30 days. All Ss were asked to participate on a voluntary basis, and anonymity was guaranteed.
RESULTS Subjects were divided into six age groups: 16-20, 21-25, 2635, 36-45, 4655, 56-70 yr; means and standard deviations of total scores are presented in Table 1. A two-way ANOVA, considering sex and age groups, shows that females obtain higher scores than males: F(1,955) = 22.5, P < 0.001. The age effect is also significant: F(5,955) = 8.2, P < 0.0001. Post hoc comparisons show that Ss of 16-20 and 46-70 yr score higher than Ss of 21-45 yr. The sex x age interaction was not significant: F(5,955) = 1.5, NS. In order to compare male and female responses, separate ANOVAs were carried out on the responses to each item of the inventory. Females had higher scores on Items 1, 3, 5, 6, 7, 8, 10, 11, 15, 16, 20, 21, 26, 27, 28, 29, 31, 32, 33, 35, 36, 38, 50, 51, 58, 59 and males on Items 49, 54, 55, 56; no difference was found in the remaining items. For each S the number of items rated 4 (i.e. very much disturbing) was calculated (cf. Fig. 1): 10% of male and 20% of female Ss complained of 8 or more obsessions/compulsions. The ANOVA, considering as factors sex and age groups, indicates sex [F(1,955) = 14.0, P < O.OOl]and age [F(5,955) = 4.8, P < O.OOl] effects; the interaction was not significant. Post hoc comparisons indicate that Ss of 46-70yr have more obsessions and compulsions than Ss of lower ages. Correlations between the PI total scores and scores of the other questionaires filled out by the 200 students are reported in Table 2.
ObsessIons
and compulsions:
the Padua
Table I. PI scores: means and standard
deviations
Males
Females
Age or)
,V
.Y
I&X
60
55.4
21-25 2635 3-55 46-55
90 61 84 99 95
46.8 47.9 47.0 55. I 66.6
S&i0
171
SD
.V
.v
SD
29.8
60
26.2 23.5 24.3 29.8 31.2
86 42 95 96 99
70. I 59.2 57.4 55. I 66.5 66.0
26.6 27.7 32.9 27.3 29.4 33.3
5\
Inventory
FEMALES \
\
b-
\
\
’
\
/
/
I 2-
1
r
I
. .
*+ + * +*
.
.
‘
xx MALES
:
‘&____,J 3-
/ -c-*.
,
‘
*=
l++**
I-
I 16-20
I 21-25
I 26-35
-I 36-45
I 46-55
I 56-70
AGE Fig.
I. Mean
number
of items rated ‘very much disturbing’
in the various
age groups.
Reliability
The cc-coefficient was calculated as an index of consistency and turned out to be 0.90 in male and 0.94 in female Ss. Test-retest correlations were 0.78 for the males and 0.83 for the females who filled out the inventory twice at a 30-day interval. Factor analysis
To derive a factor structure which could be accepted with confidence, separate factor analyses were performed on the responses of the following: (a) male subgroup; (b) female subgroup; (c) Ss of 16-35 yr; (d) Ss of 36-70 yr; (e) the whole group. Subject/variable ratios were 8.1, 8.0. 6.6, 9.5 and 16.1. The principal-components method with iterations was used, followed by Varimax rotation using the SPSS statistical program. From the five groups, extraction procedures gave respectively 15, 14, 15, 14 and 13 factors with eigenvalues > 1. The plot of the eigenvalues, however, showed clear breaks after the first four factors, and continued extraction in each group gave factors loaded by pairs of similar items or
Table 2. Correlations between PI scores and other questionnaires (.V = 200) SOS LOI (Symptoms) LOI (Traits) MOCQ EPQ (Neuroticism) EPQ (Extraversion) EPQ (Psychoticism)
0.61 0.71 0.66 0.70 0.5 I -0.10 0.09
-0.08 0.42
172
EZIOSANAVIO Table
3. Items
which
load
on the four
Facror I: impaired conrrol owr mental ocrniries 32. When I startthinking of certain things, I become obsessed with 33.
Unpleasant
thoughts
36.
I I
35.
My
26.
I find it difficult
28.
I have
31.
invent
doubts
imagine
I think
Sometimes
29.
After
38.
When
43.
I worry
59.
When
I
When
doubts
I.
When
I will
hear
about
and
having
carefully,
a disaster,
about
or dirty
words
a thought
If
3.
I find
IO.
I
come
more
something
If an animal
into
I
using
public
2.
I think
even
slight
harm
I find it difficult
6.
I avoid
I.
I feel my hands
0.63
is happening
round
me
when
about
important
0.5-t
especially
talking
matters
0.51
my
for
I cannot
mind
and
it
0.50
I have done
I have either
things
I amupset
done
0.49 it badly
or not
timshed
it
0.49 0.47
and make
a long
time
rest until
I cannot
my mind.
knowing
I know
my fault
unimportant
into
keep on doing
and
an effort and
I have
find talked
not
to forget
it difficult them
them
to stop
over
with
0.46
thinking
a reassuring
about
it
0.45
person
0.44
get rid of them
I have to examine
0.4-l
it from
all points
of view
and cannot
stop
until
I
to touch
public
with
because
bodily
more
often
I thmk
are dirty
22.
I keep on checking
20.
I check
19.
I
25.
I check
23.
I keep on going
24.
When
18.
I have to do things
than
I may
necessary
be dirty
0.42
or ‘contaminated‘
0.67
have to uash
it has been touched have to wash
of disease
secretions
or clean
by strangers mvsclf
myself
0.65
or by certain
or change
people
0.64
my clothing
0.6-l
and contamination
(perspiration,
saliva.
0.61
urine
etc.)
may
contammatr
my
clothes
or
when about
forms,
recheck
gas and
carefully
When
I handle
I look
back money
down
57.
I feel I have
47.
When
54.
I sometimes
55.
I am sometimes
49.
While
money
and
water
taps and
times
I count
0.56
before
etc.,
light
to make
switches
than
posting
after
are properly
sure I have filled
turning
them
shut them
0.69 in correctly
off
from
a bridge
special
gestures
approaching
have an impulse almost
0.63 0.59
etc. are properly
extinguished
0.52
times
0.52
they are properly
to steal
high
or walk
I sometimes
irresistibly
I sometimes
or a very
other
tempted
feel an impulse
window,
in a certain think
people’s
I could
I
done
0.49
0.62
feel an impulse
to throw
myself
into
space
way
belongings, the car into
0.57 0.48
throw
to steal something to drive
0.65 0.65
them
it several
I think
sure they
to make
necessary
cigarettes
recount
before
0.43
etc. in detail,
often
matches,
and
times
and disease
0.52
drawers checks
more
of contagion
diseases
windows.
to see that
several
to make
I see a train
driving
0.59 0.57
I touch germs
things
many
things
I am afraid
documents.
to keep on checking letters
or dirty
because
Factor IV: urges and worries of losing conirol over motor behaviors 53. I sometimes feel the need to break or damage things for no reason 46.
0.43
0.66
immediately
immediately
I amafraid
garbage
telephones
useless worries
and
I know
and
things
necessary
I
when
because
contact
than
is ‘contaminated’
me, I feel dirty toilets
certain
simply
longer
an object
Factor III: checking behoriors 21. I return home to check doors,
tend
I make
me
4.
using
often
I think
touches
I avoid
I invent
to what
which
0.5 I
clearly.
without
the impression
to my mind,
comes
to touch
5.
60.
errors
matters
in fact
it is somehow
or a crime,
late because
it difficult
somehow
0 68
so
my hands
touch
or minor
to attend
things
someone which
have
completely come
or doubt
hurt
I still I think
a suicide
and worries
I am sometimes
9.
0.72 get rid of them
0.65
it difficult
unimportant
things
Facror II: becoming conramrnored 8. I sometimes have to wash or clean myself I wash
them
I cannot
of absent-mindedness
I find
even about
and
loadings
I do
never be able to explain
about
remembering
hear
have done
7.
my will
of the things
as a result
not sure I have done
something
about
Obscene
most
way
decisions.
that
at length
I am
doing
34.
30.
goes its own
to take
or worry
44.
about
against
with
me
37.
I
my mind
consequences
the impression
involve
into
problems
constantly
27.
I
and
catastrophic
brain
that
come
factors.
myself
under
even if they from
its wheels
are of no use to me
the supermarket
someone
or something
0.4s 0.47 0.44 0.42
by single items. We therefore retained only four factors for rotation. Factor loadings from the analysis on the responses of the whole group (N = 967) are presented in Table 3. This solution resulted in the same clearest and most interpretable factor structure across the five analyses. The four factors can fairly clearly be interpreted in the following: Factor
I:
Factor
II:
Factor
III:
Factor
IV:
impaired control over mental activities, i.e. lower ability to remove undesirable thoughts, difficulties in coping with simple decisions and doubts, uncertainty about one’s own responsibility in occasional accidents, ruminative thinking about low-probability dangers etc. becoming contaminated, i.e. excessive hand-washing, stereotyped cleaning activities, overconcern with dirt, worries about unrealistic contaminations etc. checking behavior i.e. checking doors, gas and water taps, letters, money, numbers etc. over and over again. urges and worries of loss of control of motor behavior, i.e. urges of violence against animals or things, impulses to kill oneself or others without reason, fear of losing control over antisocial or sexual impulses etc.
Obsessions Table
and compulsions:
the Padua
Inventory
173
4. PI scores (‘score‘) and number of Items rated ‘very much disturbing‘ (‘obsessions’) obsessivcxompulsive and ‘neurotic’ patients: means and standard deviations (in parentheses)
of
Females
Males IV
Score
Obsessions
,A’
Score
Obsessions
Obsessive-zompulwes
35 35
7.5 (7.6) 1.8 (2.9)
40
‘Neurotics’
53.6 (34.8) 50.2 (28.9)
98.6 (32.3) 66.5 02.4)
Il.3 (9.2) 3.6 (4.6)
40
Obsessional cs Neurotic Group
Seventy-five outpatients suffering from obsessive-compulsive disorders and requesting behavioural treatment filled out the inventory. They all satisfied DSM-III criteria for obsessivecompulsive disorder (code 300.30) and were concordantly evaluated in separate interviews by both a psychiatrist and a behavioral therapist. Patients’ ages ranged between 26 and 45 yr; 35 were males and 40 females. The PI was given to a group of 75 outpatients requesting treatment for other neurotic disorders. The group was paired for sex and age with the obsessional group. Diagnoses were agoraphobia, social phobia, depression and psychosexual dysfunction. Scores are presented in Table 4. An ANOVA, considering group and sex, shows that the obsessional group had higher scores than the neurotic group [F( 1,146) = 38.6, P c O.OOl].Females also obtained higher scores than males [F(1,146) = 8.8, P = 0.0031; an interaction effect between sex and diagnostic group was not found [F( 1,146) = 0.02, NS]. Seven items failed to differentiate between groups. In fact a series of one-way ANOVAs showed that obsessionals did not score significantly higher than neurotics on Items 17, 34, 39, 40, 41, 56 and 60. DISCUsSION Our data shows the high incidence of unwanted intrusive cognitions and urges in the non-clinical population and support previous findings regarding similarity between ‘normal’ and ‘pathological’ obsessions (Rachman and de Silva, 1978; Salkovskis and Harrison, 1984). A number of important additional results emerge. Females report more obsessional thoughts and impulses than males. The difference was found in 26 of the 60 items of the inventory, but men scored significantly higher than women on items referring to violent impulses in driving (Item 49) and against animals (Item 56) and property (Items 54 and 55). The interpretation of these sex differences is quite intriguing. Epidemiological studies in obsessive-compulsive disorders do not report differences in sex ratio apart from the higher incidence of washing/cleaning rituals in women. Further difficulty in interpretation comes from the results of a recent research on Italians (Sanavio, Bertolotti, Michielin, Vidotto and Zotti, 1986): 720 normal Ss ranging in age from 16 to 80 yr, filled out a large battery of questionnaires, including a revised version of the MOCQ. No sex difference appears in total scores or Cleaning or Doubting/Ruminating subscales, but men scored higher than women in Checking subscale items. Females’ complaints in the present inventory may also be considered in the light of results on research on fears, in which females systematically report more fears than males in fear inventories (Arrindell, Emmelkamp and van der Ende, 1984; Sanavio, 1987). The usual interpretation is that women do not differ so much in experiencing fears, as in admitting that they do. As a tentative interpretation of the sex differences found in ‘normal’ obsessional behaviors, we may again hypothesize that females do not differ so much in experiencing obsessions and compulsions, as in admitting that they do. According to sexual stereotypes, males may be prone to admitting antisocial and violent impulses, but not irrational and often ridiculous worries and behavior. Some argument against this interpretation comes from the lack of relationship between obsessional complaints and the EPQ Lie scale. Since this scale measures Ss’ tendency to present themselves in a favorable light and conform to social expectations, we may expect to find a relevant and negative correlation with admitted obsessions and compulsions. However, the obtained correlation turned out to be practically nil (- 0.08) and we may argue that sex differences reflect effective differences in Ss’ beliefs and perceptions rather than artifacts in response sincerity.
EZIO SAXAWO
174
A further finding to be considered is the U-shaped evolution of obsessions and compulsions along ages-a finding suggesting that both early adulthood and old age must be considered as ‘windows of vulnerability’ for obsessions and compulsions. The higher incidence of such behavior in young adults is consistent with data from epidemiological researches. Ingram (1961) and Pollit (1957) reported that the mean age of onset of obsessive-compulsive disorders is in the early twenties. Black (1974) reported that 50% of obsessive-compulsive patients had developed their symptomatology by the age of 25 yr. With regard to higher scores of older Ss, a tentative hypothesis is that obsessional and compulsive complaints increase with depression. Obsessions and compulsions have been clinically and theoretically linked to depression (Rachman and Hodgson, 1980) and a number of clinical studies illustrate the usefulness of antidepressant drugs in treating obsessive~ompuIs~ve disorders (Turner, Beidel and Nathan, 1985). The above-mentioned Italian study (Sanavio et al.. 1986) indicated a significant increase in old age in both depressive and obsessional complaints. As Fig. 2 shows. noticeable increases have been found in Ss aged 61-80 yr using a different measure of obsessional complaints, i.e. the MOCQ, and a measure of depression, i.e. the Depression Questionnaire, a reliable and valid Italian questionnaire, Since depression increases in old age, we may argue one of the following: (1) depression acts as an intermediate variable linking old age with enhanced vulnerability to obsessions and compulsions; (2) the well-known attitude of depressed persons towards emphasizing cognitive and behavioral impairments lead to overevaIuation of the severity of norma obsessional and compulsive behaviors; (3) a higher-order mechanism, varying with age, could be identified as responsible for increases in both depressive and obsessional~ompulsive complaints in old age. According to the Eysenckian model of personality, introversion and neuroticism contribute to the development of obsessional-compulsive compfaints and, in turn, are increased bl; them. Both
44-
43b241-
doI
39-
303736-
,-
\ \
,
.z
?
-
. ..
_
---STAlb
I’
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.I
Fig. 2. Mean scores of 720 normal Italian Ss on the MOCQ, the Trait scale of the Spielberger Stats-Trait Anxiety Inventory and Depression Questionnaire [adapted from Sanavio et ai. (1936)I.
Obsessions and compulsions: the Padua Inventory
175
associations were confirmed by Kendell and DiScipio (1970) in a study using the LOI in a group of patients recovering from depression and by Hodgson and Rachman (1977) in a study using the MOCQ in a group of patients being treated for obsessional-compulsive disorders. Our results only support the association between obsessional complaints and the neuroticism dimension as measured by the EPQ. A 0.51 correlation was found with the EPQ Neuroticism scale, while correlation with the Introversion’Extraversion and Psychoticism scales were nil. A relationship between fears and obsessional complaints was also found, reflected in a positive and moderately high correlation with the FSS. Therefore, in normal people, high obsessionalcompulsive complaints are associated with neuroticism traits and greater fears, but are independent of introversion/extraversion and psychoticism traits. Four main types of obsessions and compulsions emerge from our factorial analyses. The first factor refers to a sense of impaired control over thoughts and mental imagery and mainly describes exaggerated doubts and ruminations. It clearly corresponds to the ‘doubting’ and ‘ruminating’ components identified in the MOCQ and to the ‘feeling of incompleteness’ component of the LOI. The second factor may be named ‘becoming contaminated’ and refers to overconcern with dirt and improbable/impossible contaminations. It corresponds to the MOCQ ‘cleaning’ component and the LO1 ‘clean and tidy’ component. The third factor describes repeated checking behaviors and is almost identical to the MOCQ ‘checking’ and the LO1 ‘checking and repetition’ components. The fourth factor refers to urges of violent and antisocial nature and worries of losing control over motor behavior, such as killing one’s child, damaging or stealing something without reason or throwing oneself out of a high window. There is no clear correspondence, in this case, with the components identified in the other obsessional questionnaires. The presence of such a type of obsessions in normal Ss is, in our opinion, an interesting finding and may suggest further research in the area of ‘normal obsessions and compulsions. Moreover, an inventory including items investigating obsessions and urges different frem checking and cleaning urges could be a useful tool for researchers and clinicians too. The reliability of the inventory is clearly satisfactory. The internal consistency is high (z = 0.90 in males, a = 0.94 in females), as well as stability over a months’ interval (test-retest correlations were 0.78 for the male and 0.83 for the female groups). The inventory clearly correlates with the currently existing measures of obsessional complaints, i.e. the MOCQ (0.70), the LO1 (0.71 with Symptom and 0.66 with Trait scales) and the SOS (0.61). Furthermore, it allows discrimination between patients with obsessive-compulsive disorders and patients with other types of neurotic disturbance. We therefore hope that the PI may be useful in investigating the topography of obsessions and compulsions in both normal and clinical Ss and in providing more detailed information for clinical assessment. Furthermore, this inventory, together with other obsessional questionnaires, could be used in research to evaluate changes resulting from treatment.
REFERENCES APA; American Psychiatric Association (1980) Diagnostic and Statistical Manaai of Mental Disorders, 3rd edn. APA, Washington, D.C. Arrindell W. A., Emmelkamp P. M. G. and van der Ende J. (1984) Phobic dimensions: I. Reliability and general&ability across samples, gender and nations. A&. Behau. Res. Ther. 6, 207-254. Black A. (1974) The natural history of obsessional neurosis. In ~~sessjonaf Srares (Edited by Beech H. R.). Methuen, London. Cooper J. (1970) The Leyton Obsessional Inventory. Psychof. Med. 1, 48-64. Cooper J. E. and Kelleher M. Y. (1973) The Leyton Obsessional inventory: a principal components analysis on normal subjects. Psychof. Med. 3, 204-208. Hodgson R. J. and Rachman S. (1977) Obsessional~ompulsive compiaints. Be!zac. Rex Ther. 15, 389-395. Ingram 1. M. (1961) Obsessional illness in mental hospitat patients. J. ment. Sci. 197, 382-402. Kendell R. E. and DiScipio W. J. (1970) Obsessional symptoms and obsessional personality traits in patients with depressive illnesses. Psychol. Med. 1, 65-72. Omtt J. E. (1965) The relationship of obsessional traits to genera1 emotional instability. Er. J. med. Ps&~of. 38, 269-270. Pollitt J. (1957) Natural history of obsessional states. Br. med. J. I, 195-198. Rachman S. J. and Hodgson R. J. (1980) Obsessions and Compulsions. Prentice-Hall, Englewood Cliffs. N.J. Rachman S. J. and de Silva P. (1978) Abnorrnai and normal obsessions. Be/xx. Res. ?%er. 16, 233-248. Reed G. F. (1969) Obsessionality and self-appraisal questionnaires. Br. J. Psychiar. 115. 205-209. Salkovskis P. M. and Harrison J. (1984) Abnormal and normal obsessions -a replication. Behav. Res. Ther. 22, 549-552.
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Sanavio E. (1987) The fears of Utahan children and adolescents. In indiriduai Dtfirences in Children and Rdoiescenrs (Edited by Eysenck S. B. G. and Saklofske D. H.). Hodder & Stoughton. Sevenoaks, Kent. Sanavio E. and Vidotto G. (1985) The components of the Maudsley Obsessional~ompulsive Questionnaire. Behm. Res. Ther. 23, 659-662. Sanavio E., Bertolotti G., ~ichielin P., Vidotto G. and Zotti A. M. (1986) CBA-Z.0 Scale Primnrie: C’nn Botteria P Vusro Spetrro per I’Assessmeffi Psicofogico. Organiuazioni Speciali. Firenze. Sandier J. and Hazari A. (1960) The obsessional: on the psychological classification of obsessionai character traits and symptoms. Br. J. med. Psychoi. 33, 113-122. Snaith R., McGuire R. and Fox K. (1971) Aspects of personality and depression. Psychol. Med. 1, 239-216. Turner S. M., Beidel D. C. and Nathan R. S. (1985) Biological factors in obwssive+ompulsive disorders. Psycho/. Bull. 97, 430-450.
APPENDIX INSTRUCTIONS: The following statements refer to thoughts and behaviors which may occur to everyone in everyday life. For each statement, choose the reply which best seems to tit you and the degree of disturbance which such thoughts or behaviors may create. Rate your replies as follows: O-not at all i-a little Z-quite a lot 3-a lot 4-very much I. I feel my hands are dirty when I touch money. 2. 1 think even slight contact with bodily secretions (perspiration, saliva. urine etc.) may contaminate my clothes or somehow harm me. 3. I find it difficult to touch an object when I know it has been touched by strangers or by certain people. 4. I find it difficult to touch garbage or dirty things. 5. I avoid using public toilets because I am afraid of disease and contamination. 6. I avoid using public telephones because I am afraid of contagion and disease. 7. I wash my hands more often and longer than necessary. 8. I sometimes have to wash or clean myself simply because I think 1 may be dirty or ‘contaminated’. 9. If I touch something I think is ‘contaminated’ I immediately have to wash or clean myself. 10. If an animal touches me, I feel dirty and immediately have to wash myself or change my clothing. I I. When doubts and worries come to my mind, I cannot rest until I have talked them over with a reassuring person. 12. When I talk I tend to repeat the same things and the same sentences several times. 13. I tend to ask people to repeat the same things to me several times consecutively, even though I did understand what they said the first time. 14. I feel obliged to follow a particular order in dressing, undressing and washing myself. IS. Before going to sleep I have to do certain things in a certain order. 16. Before going to bed I have to hang up or fold my clothes in a special way. 17. I feel I have to repeat certain numbers for no reason. 18. I have to do things several times before I think they are properly done. 19. I tend to keep on checking things more often than necessary. 20. I check and recheck gas and water taps and light switches after turning them off. 21. I return home to check doors, windows, drawers etc., to make sure they are properly shut. 22. I keep on checking forms, documents, checks etc. in detail, to make sure I have filled them in correctly. 23. I keep on going back to see that matches. cigarettes etc. are properly extinguished. 24. When I handle money I count and recount it several times. 25. I check letters carefully many times before posting them. 26. I find it difficult to take decisions, even about unimportant matters. 27. Sometimes I am not sure I have done things which in fact I know I have done. 28. I have the impression that I will never be able to explain things clearly, especially when talking about important matters that involve me. 29. After doing something carefully, I still have the impression I have either done it badly or not finished it. 30. I am sometimes late because I keep on doing certain things more often than necessary. 31. I invent doubts and problems about most of the things I do. 32. When I start thinking of certain things, I become obsessed with them. 33. Unpleasant thoughts come into my mind against my will and I cannot get rid of them. 34. Obscene or dirty words come into my mind and I cannot get rid of them. 35. My brain constantly goes its own way and I find it difficult to attend to what is happening round me. 36. I imagine catastrophic consequences as a result of absent-mindedness or minor errors which I make. 37. I think or worry at length about having hurt someone without knowing it. 38. When I hear about a disaster, I think it is somehow my fault. 39. I sometimes worry at length for no reason that I have hurt myself or have some disease. 40. I sometimes start counting objects for no reason. 41. I feel I have to remember completely unimportant numbers. 42. When I read I have the impression I have missed something important and must go back and reread the passage at least two or three times. 43. I worry about remembering completely unimportant things and make an effort not to forget them. 44. When a thought or doubt comes into my mind, I have to examine it from all points of view and cannot stop until I have done so. 45.
In certain situations I am afraid of losing my self-controi and doing embarassing things.
Obsessions 46. 47. 48. 49. 50. 51. 52.
and compulsions:
the Padua
Inventory
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When I look down from a bridge or a very high window, I feel an impulse to throw myself into space. When I see a train approaching I sometimes think I could throw myself under its wheels. At certain moments I am tempted to tear off my clothes in public. While driving I sometimes feel an impulse to drive the car into someone or something. Seeing weapons excites me and makes me think violent thoughts. I get upset and worried at the sight of knives, daggers and other pointed objects. I sometimes feel something inside me which makes me do things which are really senseless and which I do not want to do. 53. I sometimes feel the need to break or damage things for no reason. 5-t. I sometimes have an impulse to steal other people’s belongings, even if they are of no use to me. 55. I am sometimes almost irresistibly tempted to steal something from the supermarket. 56. I sometimes have an impulse to hurt defenseless children or animals. 57. I feel I have to make special gestures or walk in a certain way. 58. In certain situations I feel an impulse to eat too much. even if I am then ill. 59. When I hear about a suicide or a crime, I am upset for a long time and find it difficult to stop thinking about it. 60. I invent useless worries about germs and diseases.