Skip to main content

Obsessive Compulsive Symptom Dimensions and Suicide: The Moderating Role of Anxiety Sensitivity Cognitive Concerns

Abstract

Extant work on the relationship between obsessive–compulsive disorder (OCD) and suicide is scarce. Moreover no research has examined potential moderators that may increase risk for suicide among those with OCD. The current study examined the moderating role of anxiety sensitivity (AS) cognitive concerns. The cognitive concerns subscale of AS, which reflects fears of cognitive dyscontrol, has been found to be associated with the obsessions dimension of OCD and increased suicidality in a number of populations. The sample included 80 patients (3.8 % with a primary OCD diagnosis) recruited from the community to participate in a larger clinical trial investigating the effects of an AS intervention on suicide. Results indicated the obsessive dimension of OCD was associated with increased suicidality. Additionally, AS cognitive concerns moderated the relationship between these variables. Future research should examine the relationships between these constructs prospectively. Results of this investigation highlight the importance of assessing suicidal risk as part of a comprehensive OCD assessment.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Notes

  1. 1.

    It should be noted that due to changes in the DSM-5, OCD is no longer diagnosed as an anxiety disorder. However, OCD has a long history of being considered in the context of these disorders.

References

  1. Abramowitz, J. S., & Deacon, B. J. (2006). Psychometric properties and construct validity of the Obsessive–Compulsive Inventory—Revised: Replication and extension with a clinical sample. Journal of Anxiety Disorders, 20(8), 1016–1035.

    PubMed  Article  Google Scholar 

  2. Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., et al. (2010). Assessment of obsessive–compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive–Compulsive Scale. Psychological Assessment, 22(1), 180.

    PubMed  Article  Google Scholar 

  3. Aiken, L., & West, S. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.

    Google Scholar 

  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  5. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders identification test. Guidelines for use in primary care (2nd ed.). Geneva: World Health Organization.

  6. Balci, V., & Sevincok, L. (2010). Suicidal ideation in patients with obsessive–compulsive disorder. Psychiatry Research, 175(1), 104–108.

    PubMed  Article  Google Scholar 

  7. Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97(1), 90–113.

    CAS  PubMed  Article  Google Scholar 

  8. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988a). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893.

    CAS  PubMed  Article  Google Scholar 

  9. Beck, A. T., Steer, R. A., & Carbin, M. G. (1988b). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.

    Article  Google Scholar 

  10. Beck, A. T., Steer, R. A., Sanderson, W. C., & Skeie, T. M. (1991). Panic disorder and suicidal ideation and behavior: Discrepant findings in psychiatric outpatients. The American Journal of Psychiatry, 148(9), 1195–1199.

  11. Beck, A. T., Steer, R. A., & Trexler, L. D. (1989). Alcohol abuse and eventual suicide: A 5-to 10-year prospective study of alcohol-abusing suicide attempters. Journal of Studies on Alcohol and Drugs, 50(03), 202.

    CAS  Google Scholar 

  12. Bolton, J., & Robinson, J. (2010). Population-attributable fractions of axis I and axis II mental disorders for suicide attempts: Findings from a representative sample of the adult, noninstitutionalized US population. American Journal of Public Health, 100, 2473–2480.

    PubMed Central  PubMed  Article  Google Scholar 

  13. Capron, D. W., Blumenthal, H., Medley, A. N., Lewis, S., Feldner, M. T., Zvolensky, M. J., et al. (2012a). Anxiety sensitivity cognitive concerns predict suicidality among smokers. Journal of Affective Disorders, 138(3), 239–246.

    PubMed Central  PubMed  Article  Google Scholar 

  14. Capron, D. W., Cougle, J. R., Ribeiro, J. D., Joiner, T. E., & Schmidt, N. B. (2012b). An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation. Journal of Psychiatric Research, 46(2), 174–180.

    PubMed Central  PubMed  Article  Google Scholar 

  15. Capron, D. W., Fitch, K. E., Medley, A., Blagg, C., Mallott, M., & Joiner, T. (2012c). Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history. Depression and Anxiety, 29(3), 195–201.

    PubMed  Article  Google Scholar 

  16. Capron, D. W., Gonzalez, A., Parent, J., Zvolensky, M. J., & Schmidt, N. B. (2012d). Suicidality and anxiety sensitivity in adults with HIV. AIDS Patient Care and STDs, 26(5), 298–303.

    PubMed  Article  Google Scholar 

  17. Capron, D. W., Kotov, R., & Schmidt, N. B. (2013). A cross-cultural replication of an interactive model of anxiety sensitivity relevant to suicide. Psychiatry Research, 205(1), 74–78.

  18. Capron, D. W., Norr, A. M., Macatee, R. J., & Schmidt, N. B. (2012). Distress tolerance and anxiety sensitivity cognitive concerns: Testing the incremental contributions of affect dysregulation constructs on suicidal ideation and suicide attempt. Behavior Therapy, 44(3), 349–358.

  19. Capron, D. W., Norr, A. M., Zvolensky, M. J., & Schmidt, N. B. (2014). Prospective evaluation of the effect of an anxiety sensitivity intervention on suicidality among smokers. Cognitive Behaviour Therapy, 43(1), 72–82.

    PubMed  Article  Google Scholar 

  20. CDC. (2013). Preventing suicide retrieved 9/12/13, from http://www.cdc.gov/features/preventingsuicide/.

  21. Cooper-Patrick, L., Crum, R. M., & Ford, D. E. (1994). Identifying suicidal ideation in general medical patients. JAMA, 272(22), 1757–1762.

    CAS  PubMed  Article  Google Scholar 

  22. Cougle, J. R., Keough, M. E., Riccardi, C. J., & Sachs-Ericsson, N. (2009). Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. Journal of Psychiatric Research, 43(9), 825–829.

    PubMed  Article  Google Scholar 

  23. Cox, B. J., Direnfeld, D. M., Swinson, R. P., & Norton, G. R. (1994). Suicidal ideation and suicide attempts in panic disorder and social phobia. The American Journal of Psychiatry, 151, 882–887.

  24. Fetzner, M. G., Horswill, S. C., Boelen, P. A., & Carleton, R. N. (2013). Intolerance of uncertainty and PTSD symptoms: Exploring the construct relationship in a community sample with a heterogeneous trauma history. Cognitive Therapy and Research, 37(4), 725–734.

  25. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for DSM-IVNon-patient edition (SCID-NP, Version 1.0). American Psychiatric, Washington, DC.

  26. Foa, E. B., Huppert, J., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., et al. (2002). The Obsessive–Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485–496.

    PubMed  Article  Google Scholar 

  27. Friedman, S., Jones, J. C., Chernen, L., & Barlow, D. H. (1992). Suicidal ideation and suicide attempts among patients with panic disorder: A survey of two outpatient clinics. American Journal of Psychiatry, 149(5), 680–685.

    CAS  PubMed  Google Scholar 

  28. Fullana, M., Mataix-Cols, D., Caspi, A., Harrington, H., Grisham, J., Moffitt, T., et al. (2009). Obsessions and compulsions in the community: Prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. American Journal of Psychiatry, 166(3), 329–336.

    PubMed  Article  Google Scholar 

  29. Gibbs, N. A. (1996). Nonclinical populations in research on obsessive–compulsive disorder: A critical review. Clinical Psychology Review, 16(8), 729–773.

    Article  Google Scholar 

  30. Huppert, J. D., Walther, M. R., Hajcak, G., Yadin, E., Foa, E. B., Simpson, H. B., et al. (2007). The OCI-R: Validation of the subscales in a clinical sample. Journal of Anxiety Disorders, 21(3), 394–406.

    PubMed  Article  Google Scholar 

  31. Joiner, T. E., Brown, J. S., & Wingate, L. R. (2005). The psychology and neurobiology of suicidal behavior. Annual Review of Psychology, 56, 287–314.

    PubMed  Article  Google Scholar 

  32. Kamath, P., Janardhan Reddy, Y., & Kandavel, T. (2007). Suicidal behavior in obsessive–compulsive disorder. Journal of Clinical Psychiatry, 68(11), 1741–1750.

    PubMed  Article  Google Scholar 

  33. Katz, C., Yaseen, Z. S., Mojtabai, R., Cohen, L. J., & Galynker, I. I. (2011). Panic as an independent risk factor for suicide attempt in depressive illness: Findings from the national epidemiological survey on alcohol and related conditions (NESARC). Journal of Clinical Psychiatry, 72(12), 1628–1635.

    PubMed  Article  Google Scholar 

  34. Keough, M. E., & Schmidt, N. B. (2012). Refinement of a brief anxiety sensitivity reduction intervention. Journal of Consulting and Clinical Psychology, 80(5), 776–772.

  35. Masellis, M., Rector, N. A., & Richter, M. A. (2003). Quality of life in OCD: Differential impact of obsessions, compulsions, and depression comorbidity. Canadian Journal of Psychiatry, 48(2), 72–77.

    Google Scholar 

  36. McLeish, A. C., Zvolensky, M. J., & Bucossi, M. M. (2007). Interaction between smoking rate and anxiety sensitivity: Relation to anticipatory anxiety and panic-relevant avoidance among daily smokers. Journal of Anxiety Disorders, 21(6), 849–859.

    PubMed  Article  Google Scholar 

  37. Medina, J. L., Vujanovic, A. A., Smits, J. A., Irons, J. G., Zvolensky, M. J., & Bonn-Miller, M. O. (2011). Exercise and coping-oriented alcohol use among a trauma-exposed sample. Addictive Behaviors, 36(3), 274–277.

    PubMed Central  PubMed  Article  Google Scholar 

  38. Medley, A., Capron, D. W., Korte, K. J., & Schmidt, N. B. (2013). Anxiety sensitivity: A potential vulnerability factor for compulsive hoarding. Cognitive Behaviour Therapy, 42(1), 45–55.

    PubMed  Article  Google Scholar 

  39. Nepon, J., Belik, S.-L., Bolton, J., & Sareen, J. (2010). The relationship between anxiety disorders and suicide attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depression and Anxiety, 27(9), 791–798.

    PubMed Central  PubMed  Article  Google Scholar 

  40. Newth, S., & Rachman, S. (2001). The concealment of obsessions. Behaviour Research and Therapy, 39(4), 457–464.

    CAS  PubMed  Article  Google Scholar 

  41. Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2009). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15(8), 868–876.

    PubMed Central  PubMed  Article  Google Scholar 

  42. Olatunji, B. O., Williams, B. J., Haslam, N., Abramowitz, J. S., & Tolin, D. F. (2008). The latent structure of obsessive–compulsive symptoms: A taxometric study. Depression and Anxiety, 25(11), 956–968.

    PubMed  Article  Google Scholar 

  43. Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454.

    CAS  PubMed  Article  Google Scholar 

  44. Purdon, C. (2008). Unacceptable obsessional thoughts and covert rituals. Baltimore: Johns Hopkins University Press.

  45. Raines, A. M., Oglesby, M. E., Capron, D. W., & Schmidt, N. B. (2014). Obsessive compulsive disorder and anxiety sensitivity: Identification of specific relations among symptom dimensions. Journal of Obsessive-Compulsive and Related Disorders, 3, 71–76.

  46. Rector, N. A., Szacun-Shimizu, K., & Leybman, M. (2007). Anxiety sensitivity within the anxiety disorders: Disorder-specific sensitivities and depression comorbidity. Behaviour Research and Therapy, 45(8), 1967–1975.

    PubMed  Article  Google Scholar 

  47. Reiss, S., & McNally, R. (1985). Expectancy model of fear. In S. Reiss & R. Bootzin (Eds.), Theoretical issues in behavior therapy. San Diego, CA: Academic Press.

    Google Scholar 

  48. Rudd, M. D., Dahm, P. F., & Rajab, M. H. (1993). Diagnostic comorbidity in persons with suicidal ideation and behavior. The American Journal of Psychiatry, 150(6), 928–834.

  49. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583.

    CAS  PubMed  Article  Google Scholar 

  50. Sareen, J., Cox, B. J., Afifi, T. O., de Graaf, R., Asmundson, G., ten Have, M., et al. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry, 62(11), 1249–1257.

    PubMed  Article  Google Scholar 

  51. Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69(3), 242–248.

    PubMed  Article  Google Scholar 

  52. Saunders, J. B., Aasland, O. G., Babor, T. F., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804.

    CAS  PubMed  Article  Google Scholar 

  53. Schmidt, N. B., Capron, D. W., Raines, A. M., & Allan, N. P. (in press). Randomized clinical trial evaluating the efficacy of a brief intervention targeting anxiety sensitivity cognitive concerns. Journal of Consulting and Clinical Psychology.

  54. Schmidt, N. B., Eggleston, A. M., Woolaway-Bickel, K., Fitzpatrick, K. K., Vasey, M. W., & Richey, J. A. (2007). Anxiety Sensitivity Amelioration Training (ASAT): A longitudinal primary prevention program targeting cognitive vulnerability. Journal of Anxiety Disorders, 21(3), 302–319.

    PubMed  Article  Google Scholar 

  55. Schmidt, N. B., Woolaway-Bickel, K., & Bates, M. (2001). Evaluating panic-specific factors in the relationship between suicide and panic disorder. Behaviour Research and Therapy, 39(6), 635–649.

    CAS  PubMed  Article  Google Scholar 

  56. SPSS. (2010). SPSS for windows (Version 19.0). Chicago, IL: SPSS Inc.

  57. Stengler-Wenzke, K., Trosbach, J., Dietrich, S., & Angermeyer, M. C. (2004). Experience of stigmatization by relatives of patients with obsessive compulsive disorder. Archives of Psychiatric Nursing, 18(3), 88–96.

    PubMed  Article  Google Scholar 

  58. Suominen, K., Isometsä, E., Suokas, J., Haukka, J., Achte, K., & Lönnqvist, J. (2004). Completed suicide after a suicide attempt: A 37-year follow-up study. American Journal of Psychiatry, 161(3), 562–563.

    PubMed  Article  Google Scholar 

  59. Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176–188.

    PubMed  Article  Google Scholar 

  60. Timpano, K. R., & Schmidt, N. B. (2012). The relationship between self-control deficits and hoarding: A multimethod investigation across three samples. Journal of Abnormal Psychology, 122(1), 13–25.

    PubMed  Article  Google Scholar 

  61. Tolin, D. F., Abramowitz, J. S., Hamlin, C., Foa, E. B., & Synodi, D. (2002). Attributions for thought suppression failure in obsessive–compulsive disorder. Cognitive Therapy and Research, 26(4), 505–517.

    Article  Google Scholar 

  62. Torres, A. R., de Abreu, R.-C. A., Torresan, R. C., de Souza, D. M., Hercos, A., & Guimarães, A. (2007). Prevalence and associated factors for suicidal ideation and behaviors in obsessive–compulsive disorder. CNS Spectrums, 12(10), 771.

    PubMed  Google Scholar 

  63. Torres, A. R., Ramos-Cerqueira, A. T. A., Ferrão, Y. A., Fontenelle, L. F., do Rosário, M. C., & Miguel, E. C. (2011). Suicidality in obsessive–compulsive disorder: Prevalence and relation to symptom dimensions and comorbid conditions. Journal of Clinical Psychiatry, 72(1), 17.

    PubMed  Article  Google Scholar 

  64. Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575.

    PubMed Central  PubMed  Article  Google Scholar 

  65. Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1994). The PTSD checklist-civilian version (PCL-C). Boston, MA: National Center for PTSD.

    Google Scholar 

  66. Weissman, M. M., Klerman, G. L., Markowitz, J. S., & Ouellette, R. (1989). Suicidal ideation and suicide attempts in panic disorder and attacks. The New England Journal of Medicine, 321(18), 1209–1214.

  67. Wheaton, M. G., Mahaffey, B., Timpano, K. R., Berman, N. C., & Abramowitz, J. S. (2012). The relationship between anxiety sensitivity and obsessive–compulsive symptom dimensions. Journal of Behavior Therapy and Experimental Psychiatry, 43(3), 891–896.

    PubMed  Article  Google Scholar 

  68. Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28(7), 596–606.

    PubMed Central  PubMed  Article  Google Scholar 

Download references

Conflict of Interest

Amanda M. Raines, Daniel W. Capron, Allyson C. Bontempo, Brittney F. Dane, and Norman B. Schmidt would like to note that this work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-10-2-0181). Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the MSRC or the Department of Defense.

Informed Consent

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants before being included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Norman B. Schmidt.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Raines, A.M., Capron, D.W., Bontempo, A.C. et al. Obsessive Compulsive Symptom Dimensions and Suicide: The Moderating Role of Anxiety Sensitivity Cognitive Concerns. Cogn Ther Res 38, 660–669 (2014). https://doi.org/10.1007/s10608-014-9622-z

Download citation

Keywords

  • Comorbidity
  • Obsessive–compulsive and related disorders
  • Suicidal behavior
  • Cognitive vulnerability factors