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Obsessive-Compulsive Disorder, or OCD, is an anxiety disorder characterized by obsessions and compulsions. Obsessions are recurring and persistent thoughts, images, or impulses that are intrusive, distressing, and, at least at time, unreasonable. Compulsions are attempts to neutralize the impact of obsessions. Typically they involve repeated behaviors or mental acts that are done to counteract the effect of the obsessions, that is, to restore safety or prevent a dreaded event. The experience of having an intrusive and unwanted thought and engaging in behaviors designed to neutralize these thoughts is quite common. Most people experience unwanted intrusive thoughts, but are able to simply not pay attention to them.
My interest in OCD concerns the nature and reaction to these unwanted intrusive thoughts. Much of the experience of OCD can be described as a “Not Just Right Experience”. This is a vague and difficult to articulate sense that an experience is incomplete or not just right. Most of us have this kind of experience, but habituate to it quickly. Some of the research I do is on "Not Just Right Experiences."
Perfectionism involves setting excessively high standards for performance, accompanied by overly critical self-evaluations. My research on perfectionism has covered a variety of issues related to several important dimensions:
- Concern over mistakes
- Doubts about everyday actions
- High personal standards, and
- Perceived parental expectations and criticism
The importance of perfectionism, its relationship to psychopathology, especially OCD, and mediators of the relationship between perfectionism and psychopathology are some of my research interests in this area.
Compulsive hoarding is the acquisition of and failure to discard possessions that appear to be either useless or of limited value. This behavior is quite common, and only becomes a clinical disorder when the behavior or resulting clutter presents problems in living.
Compulsive hoarding has commonly been thought of as a symptom of obsessive-compulsive disorder, though it is also associated with other disorders like dementia, schizophrenia, and eating disorders. My research on hoarding has focused on the phenomenology, cognitive behavioral theorizing, and the development of treatments for the disorder.
Recently I have joined several colleagues from Boston University and the Institute of Living in Hartford to create the New England Hoarding Consortium, an organization of clinicians and researchers dedicated to studying hoarding. The NEHCs first newsletter can be found by going to the NEHC link on the front page of this website. Other information about hoarding can be found at the Obsessive Compulsive Foundation website listed in the “links” section of this site.
NIMH (R21 MH068539-01) / 2003-2006 (Co-Investigator)
Compulsive hoarding has proven refractory to both medication and psychosocial treatments usually effective for obsessive compulsive disorder. This project focuses on developing and testing an ecologically valid psychosocial treatment based on identified psychopathology features and a cognitive-behavioral model of this complex syndrome.
The specific aims of this proposed 2-site project are to:
- Revise and expand a cognitive-behavioral treatment manual for compulsive hoarding that has been used previously with moderate success to treat people with this syndrome. Specifically, we will:
- Complete the revision of the existing treatment manual, including additional sections on motivational enhancement and on relapse prevention;
- Treat a small sample of clients with compulsive hoarding and make appropriate modifications preparatory for a subsequent trial.
- Test the CBT treatment in a randomized trial on a larger sample of 40 clients with primary complaints of compulsive hoarding in a 2-site project (20 clients per site). For this purpose we will:
- Conduct full-scale assessments in the clinic and in clients’ homes at pretest, posttest and follow-ups;
- Conduct monthly assessments during treatment to study process aspects of the CBT;
- Determine effect size of active treatment by comparing outcomes for CBT with outcomes for the waitlist control condition;
- Conduct preliminary analyses of potential predictors of outcome on the combined treated samples if statistically appropriate.
NIMH (R01 MH068008-01), 2004-2008 (Principal Investigator)
This two-site project aims to examine the psychopathology of a common and problematic syndrome, compulsive hoarding. Three studies are proposed to examine core features of hoarding in relationship to OCD and community controls, to test portions of a cognitive behavioral model of hoarding, and to study behavioral aspects of discarding and acquiring in natural settings. All studies will be conducted simultaneously using identical procedures in two sites (Boston, Hartford/Smith) over a period of 4 years.
Dr. Gail Steketee will serve as the PI for the Boston University site where research activities will take place at the Center for Anxiety and Related Disorders, directed by Co-Investigator Dr. Tim Brown. Dr. Randy Frost of Smith College will serve as PI for studies that will take place at the Institute of Living, Hartford Hospital subcontract site where Co-Investigator Dr. David Tolin directs the Anxiety Disorders Center.
The timetable includes a 4-month start-up phase to hire and train staff, recruit participants and finalize measures and procedures. Study 1 on phenomenological and explanatory features begins immediately thereafter. Studies 2 and 3 test hypotheses about emotion, beliefs and behavior derived from a model of compulsive hoarding behavior and begin later in Year 1 after procedures have been piloted. All studies run concurrently through month 6 of Year 4, when data reduction and analyses will subsequently begin.
This research project is part of an international study on unwanted intrusive thoughts in university students from various countries around the world. The interview for this project is to obtain information on individuals’ experience of unwanted intrusive thoughts, images and impulses that might have relevance for understanding the origins of obsessive-compulsive disorder (OCD).The questions in the interview concern the experience of various types of unwanted intrusive thoughts, images or impulses that pop into your mind without too much effort on your part.
We ask about whether participants have ever experienced unwanted thoughts of contamination/illness, harm/injury/aggression, doubt, sex, religion or being a victim of aggression. We know from research as well as clinical and personal experiences that the vast majority of people (over 80%) have many different types of unwanted intrusive thoughts and these thoughts can be quite distressing at times. Because unwanted intrusive thoughts are so common, we are interested in learning more about the nature of this thinking, how people respond to the thoughts and how they try to control their unwanted mental intrusions.
So we ask questions about the frequency of these thoughts, what types of intrusive thoughts are experienced, whether the thoughts are meaningful or significant, and the participant tries to control them. The interview concludes with some specific questions about one or two of the most frequent and distressing intrusions.
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