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Psychiatric Quarterly

, Volume 82, Issue 2, pp 151–161 | Cite as

The Characterization of Beliefs in Obsessive–Compulsive Disorder

  • Vlasios BrakouliasEmail author
  • Vladan Starcevic
Original Paper

Abstract

Beliefs are associated with most obsessions and compulsions in obsessive–compulsive disorder (OCD). The characteristics of these beliefs can vary considerably, which has led to some of them being regarded as overvalued ideas or delusions and has contributed to confusion regarding the conceptualization and classification of OCD. This article proposes that beliefs arising in the context of OCD be assessed along the following, well-defined characteristics: conviction, fixity, fluctuation, resistance (to beliefs), insight pertaining to an awareness of the inaccuracy of one’s belief, and insight referring to the ability to attribute the belief to an illness. This approach to the assessment of OCD-related beliefs may allow a clearer distinction between non-delusional beliefs, overvalued ideas, and delusions. Although the characteristics of non-delusional beliefs may vary, especially on the dimension of awareness of the inaccuracy of belief, these beliefs can generally be distinguished from overvalued ideas and delusions in terms of lower levels of conviction and fixity and greater fluctuation, resistance and ability to attribute the belief to OCD. The development of an assessment tool using these well-defined characteristics will test the proposed model, which may lead to a more objective evaluation of OCD-related beliefs. This is likely to have implications for diagnostic conceptualization and subtyping of OCD.

Keywords

Obsessions Obsessive–compulsive disorder Beliefs Delusions Overvalued ideas 

Notes

Acknowledgments

We acknowledge the Nepean Medical Research Foundation and the Pfizer Neuroscience Grant program for funding the Nepean OCD Study.

References

  1. 1.
    Insel TR, Akiskal HS: Obsessive-compulsive disorder with psychotic features: A phenomenological analysis. American Journal of Psychiatry 143:1527–1533, 1986.PubMedGoogle Scholar
  2. 2.
    Eisen JL, Phillips KA, Rasmussen SA: Obsessions and delusions: The relationship between obsessive-compulsive disorder and the psychotic disorders. Psychiatric Annals 29:515–522, 1999Google Scholar
  3. 3.
    Sanders J, Whitty P, Murray D, Devitt P: Delusions or obsessions: The same only different? Psychopathology 39:45–48, 2006PubMedCrossRefGoogle Scholar
  4. 4.
    Eisen JL, Rasmussen SA: Obsessive-compulsive disorder with psychotic features. Journal of Clinical Psychiatry 54:373–379, 1993PubMedGoogle Scholar
  5. 5.
    Foa EB, Kozak MJ: DSM-IV field trial: Obsessive-compulsive disorder. American Journal of Psychiatry 152:90–96, 1995PubMedGoogle Scholar
  6. 6.
    Lelliot PT, Noshirvani HF, Basoglu M, Marks IM, Monteiro WO: Obsessive-compulsive beliefs and treatment outcome. Psychological Medicine 18:697–702, 1988CrossRefGoogle Scholar
  7. 7.
    Berrios GE: Obsessive-compulsive disorder: Its conceptual history in France during the 19th century. Comprehensive Psychiatry 30:283–295, 1989PubMedCrossRefGoogle Scholar
  8. 8.
    Pitman RK: Pierre Janet on obsessive-compulsive disorder (1903). Archives of General Psychiatry 44:226–232, 1987PubMedGoogle Scholar
  9. 9.
    American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV), 4th edn. Washington DC, US, American Psychiatric Press, 1994Google Scholar
  10. 10.
    Kozak MJ, Foa EB: Obsessions, overvalued ideas and delusions in obsessive-compulsive disorder. Behaviour, Research and Therapy 32:343–353, 1994CrossRefGoogle Scholar
  11. 11.
    Cambridge on-line 2009: http://dictionary.cambridge.org/define.asp?key=6825&dict=CALD. Accessed: 11.12.2009
  12. 12.
  13. 13.
    Websters on-line 2009: http://www.websters-online-dictionary.org/definition/belief. Accessed: 11.12.2009
  14. 14.
    Encyclopaedia Britannica on-line 2009: http://www.britannica.com/EBchecked/topic/59442/belief. Accessed: 11.12.2009
  15. 15.
    Hume D: Philosophical Essays Concerning Human Understanding. In: Selby-Bigge LA (Ed) Enquiries Concerning Human Understanding and Concerning the Principles of Morals, 1748, 3rd edn. Rev. by PH Nidditch, 1975Google Scholar
  16. 16.
    Basoglu M, Lax T, Kasvikis Y, Marks I: Predictors of improvement in obsessive-compulsive disorder. Journal of Anxiety Disorders 2:299–317, 1988CrossRefGoogle Scholar
  17. 17.
    Neziroglu F, Stevens KP, McKay D, Yaryura-Tobias JA: Predictive validity of the overvalued ideas scale: Outcome in obsessive-compulsive and body dysmorphic disorders. Behaviour, Research and Therapy 39:745–756, 2001CrossRefGoogle Scholar
  18. 18.
    Eisen JL, Phillips KA, Baer L, Beer DA, Atala KD, Rasmussen SA: The Brown Assessment of Beliefs Scale: Reliability and validity. American Journal of Psychiatry 155:102–108, 1998PubMedGoogle Scholar
  19. 19.
    Neziroglu F, McKay D, Yaryura-Tobias JA, Stevens KP, Todaro J: The over-valued ideas scale: Development, reliability and validity in obsessive-compulsive disorder. Behaviour, Research and Therapy 37:881–902, 1999CrossRefGoogle Scholar
  20. 20.
    Markova IS, Jaafari N, Berrios GE: Insight and obsessive-compulsive disorder: A conceptual analysis. Psychopathology 42:277–282, 2009PubMedCrossRefGoogle Scholar
  21. 21.
    Amador XF, Kronengold H: Understanding and Assessing Insight. In: Amador X, David A (Eds) Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders, 2nd edn. New York, Oxford University Press, pp. 3–30, 2004Google Scholar
  22. 22.
    Kendler KS, Glazer WM, Morgenstern H: Dimensions of delusional experience. American Journal of Psychiatry 140:466–469, 1983PubMedGoogle Scholar
  23. 23.
    Gabbard G: Mind, brain, and personality disorders. American Journal of Psychiatry 162:648–655, 2005PubMedCrossRefGoogle Scholar
  24. 24.
    Obsessive-Compulsive Cognitions Working Group: Psychometric validation of the obsessive belief questionnaire and the interpretation of intrusions inventory: Part 1. Behaviour, Research and Therapy 41:863–878, 2003Google Scholar
  25. 25.
    Salkovskis PM: Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour, Research and Therapy 27:677–682, 1989PubMedCrossRefGoogle Scholar
  26. 26.
    American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders IV, Text Revision (DSM-IV TR), 4th edn. Washington DC, US, American Psychiatric Press, 2000CrossRefGoogle Scholar
  27. 27.
    Grenier S, O’Conner KP, Belanger C: Belief in the obsessional doubt as a real probability and its relations to other obsessive-compulsive beliefs and the severity of symptomatology. British Journal of Clinical Psychology 49:67–85, 2010PubMedCrossRefGoogle Scholar
  28. 28.
    Wernicke C: Grundriss der Psychiatrie. Leipzig, Verlag Thieme, 1900Google Scholar
  29. 29.
    Jaspers K: General Psychopathology (Translated 1963 by Hoenig J and Hamilton MW). Manchester, Manchester University Press, 1959Google Scholar
  30. 30.
    Veale D: Over-valued ideas: A conceptual analysis. Behaviour Research and Therapy 40:383–400, 2002CrossRefGoogle Scholar
  31. 31.
    Hamilton M: Fish’s Clinical Psychopathology. Bristol, UK, John Wright, pp 41–47, 1985Google Scholar
  32. 32.
    Bortolotti L: Delusions and Other Irrational Beliefs. New York, Oxford University Press Inc., 2010Google Scholar
  33. 33.
    Spitzer M: On defining delusions. Comprehensive Psychiatry 31:377–397, 1990PubMedCrossRefGoogle Scholar
  34. 34.
    Jorgensen P, Jensen J: Delusional beliefs in first admitters. A clinical description. Psychopathology 27:100–112, 1994Google Scholar
  35. 35.
    Chadwick PDJ, Lowe CF: Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology 58:225–232, 1990PubMedCrossRefGoogle Scholar
  36. 36.
    Garety PA, Everitt BS, Hemsley DR: The characteristics of delusions: A cluster analysis of deluded subjects. European Archives of Psychiatry and Neurological Sciences 237:112–114, 1988PubMedCrossRefGoogle Scholar
  37. 37.
    Garety PA, Hemsley DR: Characteristics of delusional experience. European Archives of Psychiatry and Neurological Sciences 236:294–298, 1987PubMedCrossRefGoogle Scholar
  38. 38.
    Brett-Jones J, Garety P, Hemsley D: Measuring delusional experiences: A method and its application. British Journal of Clinical Psychology 26:257–265, 1987PubMedGoogle Scholar
  39. 39.
    Hurn C, Gray NS, Hughes I: Independence of “reaction to hypothetical contradiction” from other measures of delusional ideation. British Journal of Clinical Psychology 41:349–360, 2002PubMedCrossRefGoogle Scholar
  40. 40.
    Garety P, Fowler D, Kuipers E, Freeman D, Dunn G, Bebbington P, Hadley C, Jones S: London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. British Journal of Psychiatry 171:420–426, 1997PubMedCrossRefGoogle Scholar
  41. 41.
    Buchanan A, Reed A, Wessely S, Garety P, Taylor P, Grubin D, Dunn G: Acting on delusions. II: The phenomenological correlates of acting on delusions. British Journal of Psychiatry 163:77–81, 1993PubMedCrossRefGoogle Scholar
  42. 42.
    Brakoulias V, Starcevic V: A cross-sectional survey of the frequency and characteristics of delusions in acute psychiatric wards. Australasian Psychiatry 16:87–91, 2008PubMedCrossRefGoogle Scholar
  43. 43.
    Appelbaum PS, Robbins PC, Vesselinov R: Persistence and stability of delusions over time. Comprehensive Psychiatry 45:317–324, 2004PubMedCrossRefGoogle Scholar
  44. 44.
    Sharp HM, Fear CF, Williams MG, Healey D, Lowe CF, Yeadon H, Holden R: Delusional phenomenology—dimensions of change. Behaviour Research and Therapy 34:123–142, 1996CrossRefGoogle Scholar
  45. 45.
    Jones E, Watson JP: Delusion, the overvalued idea and religious beliefs: A comparative analysis of their characteristics. British Journal of Psychiatry 170:381–386, 1997PubMedCrossRefGoogle Scholar
  46. 46.
    Mullen R, Linscott RJ: A comparison of delusions and overvalued ideas. Journal of Nervous and Mental Disease 198:35–38, 2010PubMedCrossRefGoogle Scholar
  47. 47.
    Leckman JF, Denys D, Simpson HB, et al.: Obsessive-compulsive disorder: A review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depression and Anxiety 27:507–527, 2010PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Discipline of PsychiatrySydney Medical School—Nepean, University of Sydney, Nepean HospitalPenrith, SydneyAustralia

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