Obsessive– Compulsive Disorder 469
nitive literature on OCD. In a 3-month prospective study of 85 new fathers and mothers
OC-relevant beliefs as assessed at Time 1 (i.e., prenatal) was a significant predictor of
postpartum subclinical OCD but not depressive or anxious symptomatology. More-
over, the majority of parents reported distressing intrusive thoughts of harm to their
infant and utilized a variety of neutralization strategies in response to the intrusions
(Abramowitz et al., 2006). In a 6-week prospective study involving 377 undergraduates,
Coles and Horng (2006) found that Time 1 Obsessive Beliefs Questionnaire (OBQ) and
number of negative life events independently predicted Time 2 OCD symptoms as deter-
mined by the Obsessive Compulsive Inventory Total Score. However, there was only
weak support for these results in a more recent study involving a 6-month follow-up of
an undergraduate sample and no evidence of a diathesis– stress interaction between OC
beliefs and negative life events (Coles et al., 2008).
Although no prospective studies have yet investigated whether certain self- structure
concepts may constitute an enduring vulnerability to OCD, there are some relevant
findings that bear on this issue. Bhar and Kyrios (2007) found that self-worth ambiva-
lence (i.e., uncertainty about the self) was significantly associated with self- reported
OC symptoms and control, importance, and responsibility beliefs. However, both the
OCD and the nonobsessional anxious groups scored significantly higher on self-worth
ambivalence than the student control group. In a different study based exclusively on a
nonclinical sample Doron, Kyrios, and Moulding (2007) reported that self-worth sen-
sitivity in either the morality or job- competence domains was related to higher levels
of OC symptoms. Two studies found that both nonclinical and OCD individuals rated
their most upsetting intrusive thought as more meaningful and contradicted important
and valued aspects of the self to a greater extent than less upsetting thoughts (Rowa &
Purdon, 2003; Rowa et al., 2005). Given their appraised significance for self- concerns,
it is little wonder that these upsetting intrusions were associated with appraisals of
control and importance of thought. Likewise Ferrier and Brewin (2005) found that indi-
viduals with OCD generated more negative self- inferences from their intrusive thoughts
than a nonobsessional anxious group and their “feared self” contained more immoral
and bad trait attributes. Although only suggestive at this time, these studies indicate
that self-worth concerns may play an important role in how individuals evaluate the
meaning of intrusive thoughts and so might be a fruitful avenue to explore for vulner-
ability to OCD.
Cognitive assessment anD Case formulationDiagnostic and Symptom Measures
The SCID-IV (First et al., 1997) or the ADIS-IV (Brown, Di Nardo, & Barlow, 1994)
can be used for diagnostic assessment of OCD. The ADIS-IV is more highly recom-
mended because the lifetime version has excellent interrater reliability for OCD (kappa
= .85; Brown, Di Nardo, et al., 2001) and it provides a more complete symptom assess-
ment by inquiring into the specific content of obsessions and compulsions, their severity,
degree of insight, resistance, and avoidance patterns. The drawback to the ADIS-IV is
the length of interview time (2–4 hours) often required for OCD patients to complete
the interview (Taylor, 1998; Summerfeldt & Antony, 2002).