Sofia 3 Hall - Marinela

Risk and vulnerability factors of OCD and predictors of outcome: Recent findings from experimental and longitudinal studies

Andrea Ertle, Patrizia Hofer, Lee Tibi Speaker

Convenor: Karina Wahl

Chair: Andrea Ertle

Presenters: Karina Wahl, Patrizia Hofer, Lee Tibi

Discussant: tba

Subject tracks: Adult mental health


Several risk and vulnerability factors of obsessive-compulsive disorder (OCD) have been discussed, including cognitive factors as well as temperamental factors, parental rearing, and adverse life events. The symposium gathers recent studies of risk and vulnerability factors of OCD and also predictors of outcome in OCD. Two experimental studies investigate the role of cognitive factors. The first one shows that the performance of approach avoidance reversal learning is reduced in individuals diagnosed with OCD, which might pose a particular problem during exposure exercises. The second experimental study investigates the effects of rumination about unwanted intrusive thoughts on the frequency of theses thoughts, the urge to neutralize them and on depressive mood. A longitudinal, community based study in young adults found evidence that the interaction of temperamental factors (behavioural inhibition) and environmental factors (adverse life events and parental rearing style) predicts incident OCD. Finally, the last study investigates the prognostic role of interpersonal determinants (expressed emotion, social support and attachment style) as well as intrapersonal factors (severity, age of onset and chronicity) of the four-year outcome of OCD.


1st presenation

Rumination on unwanted intrusive thoughts affects the urge to neutralize in nonclinical individuals

Karina Wahl1

Marcel van den Hout2

Roselind Lieb1

1 University of Basel, Department of Psychology, Clinical Psychology and Epidemiology, Missionsstr. 62a, 4055 Basel, Switzerland

2 University of Utrecht, Heidelberglaan1, 3584 CS Utrecht, The Netherlands

Rumination on symptoms of mental disorders is involved in the onset and maintenance of these symptoms across a range of mental disorders. The purpose of the study was to investigate whether rumination on unwanted intrusive thoughts (UITs) has an immediate causal effect on discomfort, urge to do something about the UITs (i.e., to neutralize) and frequency of the UITs, as well as on depressed mood. A UIT was activated by asking nonclinical participants to write down a sentence stating that they wished a loved one would die in a horrible car accident. During the experimental manipulation, they were instructed to ruminate on their UIT, to ruminate on negative mood, or to distract themselves by thinking about everyday objects and situations. Individuals who had previously ruminated on the UIT had an attenuated reduction of the urge to neutralize compared to individuals who had previously engaged in rumination on negative mood or those who were distracted. Results indicate that thinking repetitively about a UIT prevents decay of the urge to engage in behaviors to undo it but does not influence discomfort or depressed mood associated with it. This phenomenon may be involved in the maintenance of UITs, for example, in obsessive-compulsive disorder.

2nd presentation

The role of behavioral inhibition, perceived parental rearing and traumatic events for the subsequent onset of OCD in adolescents and young adults

Hofer, Patrizia, D., University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Missionsstrasse 60/62, CH-4055 Basel, +0041 61 207 35 67,

Patrizia D. Hofer1, Karina Wahl1, Andrea H. Meyer,1 Marcel Miché1, Katja Beesdo-Baum2,3, H.-U. Wittchen2,4, Roselind Lieb1,5

1 Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland

2 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany

3 Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany

4 Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig Maximilians Universitaet Munich, Munich, Germany 5 Max Planck Institute of Psychiatry, Munich, Germany


We prospectively examined if BI and perceived parental rearing predicted incident OCD. Consistent with a diathesis-stress model, we investigated whether BI moderated the association between perceived parental rearing / adverse life events and incident OCD.


Data stem from the Early Developmental Stages of Psychopathology Study, a prospective-longitudinal study among a community sample of adolescents and young adults (aged 14-24) that were followed up over 10 years (N=2210). OCD and adverse life events were assessed with the DSM-IV/M-CIDI. BI and parental rearing were assessed using the Retrospective Self-Report of Inhibition and the Questionnaire of Recalled Parenting Rearing Behavior.


In logistic regressions adjusted for gender and age, BI, both the social and the non-social component, and paternal rejection but none of the other rearing styles predicted incident OCD. Social BI interacted with any adverse life event (RR=11.98) and paternal overprotection (RR=5.54), i.e., adverse life events and paternal overprotection only predicted incident OCD among individuals with high but not low social behavioral inhibition. Non-social fear BI interacted with emotional warmth (RR=0.34) in predicting incident OCD in that paternal emotional warmth seemed to be associated with OCD in individuals with high but not low non-social fear BI. We found no evidence of other interactive effects.


Findings suggest that BI, paternal rejection and traumatic life events predict the subsequent onset of OCD. Especially individuals with high social BI who experienced parental rejection or adverse life events or with high non-social fear who experienced a lack of paternal emotional warmth may profit from early, targeted preventive interventions.

3rd presentation:

Lee Tibi1*, Patricia van Oppen2 Anton J. L. M. van Balkom2, Merijn Eikelenboom2, Gert-Jan Hendriks3,4,5, Gideon E. Anholt1


1 Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

2 Department of Psychiatry and EMGO institute for health and care research, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands.

3Institute of Integrated Mental Health Care “Pro Persona,” Centre for Anxiety Disorders “Overwaal,” Lent, the Netherlands. 

4University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

5Department of Psychiatry, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen, the Netherlands

Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Several predictors associated with improved outcome of OCD were previously identified. However, information on interpersonal determinants as predictors of remission in OCD is lacking. We used the baseline, two and four year data of 180 adult OCD patients participating in the multicenter, naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Both intrapersonal and interpersonal predictors of the four-year outcome were assessed at baseline, using clinician rated and self-report instruments. Using regression analyses, we examined the unique predictors of the outcome of OCD. Approximately 57% of the patients did not remit two years from intake. Among remitters, partial remission was more common than full remission (30.6% vs. 12.4%, respectively). After four years, 60% of the patients failed to remit as compared to 24.6% and 15.3% who exhibited partial and full remission. A total of 87 (48.3%) patients remained diagnosed through the entire four-year follow-up, compared to 52 (28.9%) that maintained partial or full remission during the observation period. Baseline chronicity and OCD severity predicted increased odds for poor outcome and secure attachment style emerged as the only predictor of good outcome. Results coincide with previous prediction research and stretch the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed.

4th presentation to be announced