A behavioral comparison of male and female adults with high functioning autism spectrum conditions

Autism spectrum conditions (ASC) affect more males than females in the general population. However, within ASC it is unclear if there are phenotypic sex differences. Testing for similarities and differences between the sexes is important not only for clinical assessment but also has implications for theories of typical sex differences and of autism. Using cognitive and behavioral measures, we investigated similarities and differences between the sexes in age- and IQ-matched adults with ASC (high-functioning autism or Asperger syndrome). Of the 83 (45 males and 38 females) participants, 62 (33 males and 29 females) met Autism Diagnostic Interview-Revised (ADI-R) cut-off criteria for autism in childhood and were included in all subsequent analyses. The severity of childhood core autism symptoms did not differ between the sexes. Males and females also did not differ in self-reported empathy, systemizing, anxiety, depression, and obsessive-compulsive traits/symptoms or mentalizing performance. However, adult females with ASC showed more lifetime sensory symptoms (p = 0.036), fewer current socio-communication difficulties (p = 0.001), and more self-reported autistic traits (p = 0.012) than males. In addition, females with ASC who also had developmental language delay had lower current performance IQ than those without developmental language delay (p<0.001), a pattern not seen in males. The absence of typical sex differences in empathizing-systemizing profiles within the autism spectrum confirms a prediction from the extreme male brain theory. Behavioral sex differences within ASC may also reflect different developmental mechanisms between males and females with ASC. We discuss the importance of the superficially better socio-communication ability in adult females with ASC in terms of why females with ASC may more often go under-recognized, and receive their diagnosis later, than males.

The treatment of mental contamination: a case series

The recommended treatment for obsessive-compulsive disorder (OCD) is cognitive behavior therapy (CBT) incorporating exposure and response prevention (ERP), which is effective for approximately 50% of patients. However, there has been little advance in treatment outcomes since the introduction of ERP in 1979. It has been suggested that some progress can be made in treating contamination obsessions and washing compulsions by addressing feelings of dirtiness and contamination that arise without physical contact with a tangible contaminant. To date, the treatment of these “mental contamination” fears in OCD has not been systematically explored. This paper reports on a case series of 12 participants with OCD who received 10 to 20 sessions of a CBT-based treatment for mental contamination. At the end of treatment, 7 participants no longer met the diagnostic criteria for OCD and mental contamination and these gains were maintained at 6-month follow-up. The clinical implications of these findings are discussed.

Mental contamination in obsessive–compulsive disorder

It was recently proposed that feelings of contamination can arise in the absence of physical contact with a contaminant. Currently, there are limited data regarding this construct of ‘mental contamination’ although it is hypothesised to be relevant to obsessive compulsive disorder(OCD) where compulsive washing in response to contamination fear is a common presentation (Rachman,2006). This research examined the presence of mental contamination in OCD. Participants (N=177) with obsessive compulsive symptoms completed questionnaires to assess mental contamination, OCD symptoms and thought-action fusion (TAF). Findings indicated that 46% of participants experienced mental contamination, and severity was associated with severity of OCD symptoms and TAF. Mental contamination in the absence of contact contamination was reported by 10.2% of participants. Similar findings were reported in a sub-sample of participants who had received a formal diagnosis of OCD (N=54). These findings suggest that mental contamination is a distinct construct that overlaps with, but is separate from, contact contamination, and provide preliminary empirical support for the construct.

The induction of mental and contact contamination

Background: Extreme fear of contamination within Obsessive Compulsive Disorder is traditionally conceptualised as a physical phenomenon. More recent research has supported the notion of ‘mental’ contamination, in which people feel contaminated in the absence of physical contact. The current research sought to determine whether feelings of contact and mental contamination could be induced within a non-clinical sample, whether the impact of mental and contact contamination was comparable in terms of associated feelings and behaviour and whether related psychopathology related to the impact of the tasks. Methods: Undergraduate students (n=60) completed OCD relevant measures and were randomly assigned to either a contact contamination condition (CC: moving a bucket of fake vomit) or a mental contamination condition (MC: thinking about a bucket of vomit). Results: Both manipulations induced feelings of contamination. Participants in the contact condition had significantly greater urges to wash than those in the mental condition. Neutralising behaviour did not differ across conditions. Conclusions: Feelings of contamination can be induced in the absence of physical contact and for those in the MC group, some aspects of OCD-relevant psychopathology were related to the impact of the manipulation. These findings have implications for the understanding and treatment of contamination-related fears in OCD.

Biased interpretation in perfectionism and its modification

Perfectionism is a transdiagnostic construct associated with a range of diagnoses, including depression, eating disorders and obsessive compulsive disorder. Treatments that directly target perfectionist cognitions have been shown to successfully reduce associated pathologies. However, the way in which they do this is not clear. We set out to assess the role of one candidate mechanism of action, namely the cognitive process of interpretation of ambiguity. In one experiment we looked for associations between biased interpretation and perfectionism. In a second, we manipulated interpretations, thereby providing a strong test of their aetiological significance. Results from the first experiment confirmed the presence of biased interpretation in perfectionism and demonstrated that these are highly specific to perfection relevant information, rather than reflecting general negativity. The second experiment succeeded in manipulating these perfection relevant interpretations and demonstrated that one consequence of doing so is a change in perfectionist behaviour. Together, these data experimentally demonstrate that biased interpretation of perfection relevant ambiguity contributes to the maintenance of perfectionism, but that it is also possible to reverse this. Clinical implications include the identification of one likely mechanism of therapeutic change within existing treatments, as well as identification of an appropriate evidence based focus for future treatment development. Targeting underlying functional mechanisms, such as biased interpretation, has the potential to offer transdiagnostic benefits.

Development and validation of the Morphing Fear Questionnaire (MFQ)

Morphing fears (also called transformation obsessions) involve concerns that a person may become contaminated by and acquire undesirable characteristics of others. These symptoms are found in patients with OCD and are thought to be related to mental contamination. Given the high levels of distress and interference morphing fears can cause, a reliable and valid assessment measure is needed. This article describes the development and evaluation of the Morphing Fear Questionnaire (MFQ), a 13-item measure designed to assess for the presence and severity of morphing fears. A sample of 900 participants took part in the research. Of these, 140 reported having a current diagnosis of OCD (SR-OCD) and 760 reported never having had OCD (N-OCD; of whom 24 reported a diagnosis of an anxiety disorder and 23 reported a diagnosis of depression). Factor structure, reliability, and construct and criterion related validity were investigated. Exploratory and confirmatory factor analyses supported a one-factor structure replicable across the N-OCD and SR-OCD group. The MFQ was found to have high internal consistency and good temporal stability, and showed significantly greater associations with convergent measures (assessing obsessive-compulsive symptoms, mental contamination, thought-action fusion and magical thinking) than with divergent measures (assessing depression and anxiety). Moreover, the MFQ successfully discriminated between the SR-OCD sample and the N-OCD group, anxiety disorder sample, and depression sample. These findings suggest that the MFQ has sound psychometric properties and that it can be used to assess morphing fear. Clinical implications are discussed.

Emetofobia: revisão crítica sobre um transtorno pouco estudado

INTRODUÇÃO: A emetofobia ou fobia de vômitos - que inclui o medo excessivo de vomitar ou de ver outras pessoas vomitando e pode ser desencadeado por estímulos internos e externos - é um transtorno mental complexo e pouco conhecido. OBJETIVO: Este estudo teve como objetivo levantar os conhecimentos disponíveis sobre diversos aspectos do quadro. MÉTODO: Revisão convencional da literatura dos últimos 30 anos utilizando como estratégia de busca as seguintes palavras-chave: emetofobia, emetofóbico, medo de vomitar, fobia de vomitar efobia de vômito. Foram incluídos artigos sobre epidemiologia, fenomenologia, diagnóstico diferencial e tratamento da emetofobia, assim como artigos referidos nestes. RESULTADOS: Não há dados de prevalência na população geral e pouco se sabe sobre a etiologia da emetofobia. A maioria dos estudos aponta predominância no sexo feminino, início precoce e curso crônico. Os comportamentos de esquiva podem impactar negativamente a vida ocupacional, social e familiar. Os principais diagnósticos diferenciais são: transtorno de pânico com agorafobia, fobia social, anorexia nervosa e transtorno obsessivo-compulsivo. Estudos de tratamento se resumem a relatos de casos e não há ensaios clínicos controlados, mas intervenções cognitivo-comportamentais parecem ser promissoras. CONCLUSÃO: Mais estudos são necessários para melhor compreensão sobre a epidemiologia, o quadro clínico, a etiologia, a classificação e o tratamento da emetofobia.

Qualidade de vida no transtorno obsessivo-compulsivo: uma revisão

CONTEXTO: O transtorno obsessivo-compulsivo (TOC) foi considerado pela Organização Mundial da Saúde como a 10ª causa de anos vividos com incapacidade, mas pesquisas sobre qualidade de vida (QV) nesse transtorno ainda são relativamente raras. OBJETIVOS: O objetivo deste trabalho foi fazer uma revisão convencional da literatura a respeito de estudos sobre qualidade de vida no TOC, publicados em português e inglês. MÉTODOS: A busca de artigos foi feita pelos sistemas MEDLINE, PsicoInfo e LILACS, cobrindo o período de 1980 a 2007, utilizando-se como palavras-chave: qualidade de vida, transtorno obsessivo-compulsivo, prejuízo funcional e incapacidade. RESULTADOS: Estudos populacionais apresentam indicadores indiretos de comprometimento na QV em pessoas com TOC, como mais desemprego, menor renda e menor índice de união conjugal estável, além de taxas relativamente altas de ideação e tentativas de suicídio. Estudos clínicos encontraram mais comprometimento na QV no TOC em comparação com algumas doenças clínicas crônicas, outros transtornos de ansiedade, quadros depressivos e mesmo esquizofrenia, em alguns aspectos. CONCLUSÃO: O impacto negativo do TOC sobre a QV de seus portadores pode ser grande, afetando vários domínios da vida e repercutindo também nos familiares. A reabilitação psicossocial deve ser vista como parte integrante essencial do tratamento e é preciso aumentar a conscientização da população sobre o problema, assim como o acesso a tratamentos adequados, para minimizar tal impacto, por vezes devastador.

Quadro clínico do transtorno obsessivo-compulsivo

Obsessive-compulsive disorder is a very heterogeneous condition, not always easy to be identified. Obsessions are intrusive thoughts, impulses or images that cause anxiety or other emotional discomfort, whereas compulsions are repetitive behaviors or mental acts voluntarily performed to counterbalance or minimize the discomfort, or magically prevent any feared events. The most common symptoms are contamination, aggressive, somatic and sexual obsessions and washing, checking, repeating, counting and ordering compulsions. Patients usually have multiple symptoms simultaneously, which often change over time. Although the insight is typically preserved, it varies among patients and also fluctuates in the same patient in different ocasions. The main features are: exacerbated appraisal of risks, pathological doubts and incompleteness, as well as excessive sense of responsibility and guilt and thought/action fusion. As patients frequently feel ashamed of their symptoms, they can be reticent about them. Consequently, it usually takes time till they get adequate treatment.

Diagnóstico diferencial do transtorno obsessivo-compulsivo

Obsessive-compulsive disorder (OCD) has clinical features that overlap in various degrees with many other mental disorders. As a result, the differential diagnosis sometimes can be difficult. This review briefly summarizes the phenomenologic similarities and differences between OCD and the following disorders: depression, phobias, hypochondriasis and body dysmorphic disorder, Tourette syndrome and tic disorder, obsessive-compulsive personality disorder, impulse control and eating disorders, generalized anxiety, panic and post-traumatic stress disorders, and delusional and schizophrenic disorders. The accurate diagnosis is essential for adequate treatment planning and management.

Effects of the essential oil from Citrus aurantium L. in experimental anxiety models in mice

Citrus aurantium L. is popularly used to treat anxiety, among other indications suggesting central nervous system action. Previous studies showed anxiolytic effect in the essential oil from peel in mice evaluated on the elevated plus maze [Carvalho-Freitas, M.I.R., Costa, M., 2002. Anxiolytic and sedative effects of extracts and essential oil from Citrus aurantium L. Biological and Pharmaceutical Bulletin 25, 1629-1633.]. In order to better characterize the activity of the essential oil, it was evaluated in two other experimental models: the light-dark box and the marble-burying test, respectively related to generalized anxiety disorder and to obsessive compulsive disorder. Mice were treated acutely by oral route 30 min (single dose) or once a day for 15 days (repeated doses) before experimental procedures. In light-dark box test, single treatment with essential oil augmented the time spent by mice in the light chamber and the number of transitions between the two compartments. There were no observed alterations in the parameters evaluated in light-dark box after repeated treatment. Otherwise, single and repeated treatments with essential oil were able to suppress marble-burying behavior. At effective doses in the behavioral tests, mice showed no impairment on rotarod procedure after both single and repeated treatments with essential oil, denoting absence of motor deficit. Results observed in marble-burying test, related to obsessive compulsive disorder, appear more consistent than those observed in light-dark box. (c) 2005 Elsevier B.V. All rights reserved.

Tricotilomania: dificuldades diagnósticas e relato de dois casos

OBJETIVO: Relatar dois casos de tricotilomania, um transtorno psiquiátrico ainda subdiagnosticado e que pode estar associado a problemas sociais e clínicos relevantes. Pretende-se destacar as características clínicas, discutindo as implicações do diagnóstico precoce para a evolução dos pacientes. DESCRIÇÃO do CASO: Uma adolescente com diagnóstico de tricotilomania pura e outra menina cujo quadro estava associado ao transtorno obsessivo-compulsivo. Embora com o tratamento, a evolução de ambas tenha sido favorável, houve demora significativa para estabelecer o diagnóstico e encaminhá-las a um serviço de saúde mental, com prejuízos escolares e sociais. COMENTÁRIOS: A tricotilomania difere dos quadros benignos e transitórios de arrancar cabelos observados nos primeiros anos de vida e ainda é subdiagnosticada. A vergonha dos sintomas observada nos portadores e o desconhecimento por parte dos profissionais de saúde contribuem para essa situação. O quadro pode ser grave, particularmente se acompanhado de tricofagia. Profissionais da saúde precisam identificar o transtorno precocemente e encaminhar as crianças para tratamento especializado antes das possíveis complicações clínicas e repercussões psicossociais

Epidemiologia do transtorno obsessivo-compulsivo: uma revisão

Os inquéritos populacionais são importantes, pois amostras clínicas tendem a apresentar vieses de seleção. Aspectos sociodemográficos e relacionados à própria condição mórbida podem interferir na procura por tratamento. Pela natureza egodistônica do transtorno obsessivo-compulsivo, seus portadores tendem a ocultar o problema, podendo não procurar ou demorar a procurar tratamento. Porém, a maior parte do conhecimento atual sobre o transtorno obsessivo-compulsivo advém de amostras clínicas, que não representam a totalidade dos casos. Foi feita uma revisão convencional da literatura através do Medline, PsicoInfo e Lilacs de inquéritos populacionais sobre o transtorno obsessivo-compulsivo, cobrindo o período de 1980 a 2004, utilizando-se como palavras-chave epidemiologia, transtorno obsessivo-compulsivo, inquéritos populacionais e prevalência. Estudos realizados em diferentes países indicam para o transtorno obsessivo-compulsivo uma prevalência atual em torno de 1,0% e ao longo da vida de 2,0 a 2,5%. Diferentemente de amostras clínicas, em quase todas as amostras populacionais há predomínio de mulheres e portadores que têm apenas obsessões. A freqüente comorbidade com outros transtornos mentais, particularmente depressão e outros transtornos ansiosos, repete-se em casos da população geral, que apresentam ainda uma associação com abuso de substâncias. Muitos portadores não estão em tratamento, particularmente os casos puros. Indicadores de incapacitação funcional demonstram um considerável impacto negativo do transtorno obsessivo-compulsivo. É preciso melhorar o conhecimento da população e dos profissionais de saúde sobre os sintomas do transtorno obsessivo-compulsivo para aumentar a procura de atendimento, assim como a correta identificação e abordagem terapêutica deste grave problema de saúde.

DISTURBIO OBSESSIVO-COMPULSIVO E QUADROS CORRELATOS NA CLINICA DERMATOLOGICA

The article describes the obsessive-compulsive disorder (OCD), a not uncommon mental illness, of an unknown origin, for the most part, which can cause important dermatoses. Some OCD-related disorders of importance in dermatologic practice are also described, such as: body dysmorphic disorder, trichotillomania, onychophagia and factitial dermatitis. The importance of the proper identification of these disorders is stressed for the application for adequate therapy.