Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-15T14:27:17.678Z Has data issue: false hasContentIssue false

Obsessional Indecision: Its Psychological Conceptualisation, Assessment, and Treatment

Published online by Cambridge University Press:  06 October 2014

Peter Dunne
Affiliation:
Sunshine Coast Adult Mental Health Service
Michael Llamas*
Affiliation:
Princess Alexandra Hospital
*
Consultation-Liaison Psychiatry Service, Princess Alexandra Hospital, Brisbane QLD 4102, Australia
Get access

Extract

This paper examines the clinical entity of obsessional indecision. It argues for its conceptualisation as a form of “pure” obsessional disorder and discusses assessment issues and proposed intervention techniques. Data gathered from four patients treated by the authors is used to substarniate the arguments and points made. The paper illustrates the nature of the problem, as well as highlighting its varying topography and elucidating a novel treatment package that appears to show promise.

Type
Articles
Copyright
Copyright © The Authors 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abel, J.L. (1993). Exposure with response prevention and serotonergic antidepressants in the treatment of obsessive-compulsive disorder: A review and implications for interdisciplinary treatment. Behaviour Research and Therapy, 31, 463478.CrossRefGoogle ScholarPubMed
Abramowitz, J.S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review. Journal of Consulting and Clinical Psychology, 65, 4452.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Asberg, M., Montgomery, S.A., Perris, C., Schalling, D., & Sedvall, G. (1978). A comprehensive psychopathological rating scale. Acta Psychiatrica Scandinavica, (Suppl. 271), 527.Google Scholar
Baer, L., Minichiello, W.E., & Jenike, M.A. (1987). Use of a portable-computer program in behavioral treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 144, 1101.Google ScholarPubMed
Ball, S.G., Baer, L., & Otto, (1996). Symptom subtypes of obsessive-compulsive disorder in behavioral treatment studies: A quantitative review. Behaviour Research and Therapy, 34, 4751.CrossRefGoogle ScholarPubMed
Barlow, D.H. (Ed.). (1985). Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford.Google Scholar
Barlow, D.H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford.Google Scholar
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.Google Scholar
Beck, A.T., & Steer, R.A. (1993). Beck Depression Inventory: Manual. San Antonio, TX: Psychological Corporation.Google Scholar
Cooper, J. (1970). The Leyton Obsessional Inventory. Psychological Medicine, 1, 4864.CrossRefGoogle ScholarPubMed
Cottraux, J., Mollard, E., Bouvard, M., Marks, I., Sluys, M., Nury, A., Douge, R., & Cialdella, P. (1990). A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. International Clinical Psychopharmacology, 5, 1730.CrossRefGoogle ScholarPubMed
Derogatis, L.R., Lipman, R.S., & Covi, L. (1973). Scl-90: An outpatient psychiatric rating scale: Preliminary report. Psychopharmacological Bulletin, 9, 1328.Google ScholarPubMed
Foa, E.B. (1979). Failure in treating obsessive-compulsives. Behaviour Research and Therapy, 17, 169176.CrossRefGoogle ScholarPubMed
Freeston, M.H., Ladouceur, R., Rheaume, J., Letarte, H., Gagnon, F., & Thibodeau, N. (1994). Self-report of obsessions and worry. Behaviour Research and Therapy, 32, 2936.CrossRefGoogle ScholarPubMed
Freund, B., Steketee, G.S., & Foa, E.B. (1987). Compulsive activity checklist (CAC): Psychometric analysis with obsessive-compulsive disorder. Behavioural Assessment, 9, 6779.Google Scholar
Frost, R.O., & Gross, R.C. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31, 367381.CrossRefGoogle ScholarPubMed
Goodall, T.A., & Halford, W.K. (1991). Self-management of diabetes mellitus: A critical review. Health Psychology, 10, 18.CrossRefGoogle ScholarPubMed
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Delgado, P., Heninger, G.R., & Charney, D.S. (1989). The Yale–Brown Obsessive Compulsive Scale: II. Validity. Archives of General Psychiatry, 46, 10121016.CrossRefGoogle ScholarPubMed
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Fleischmann, R.L., Hill, C.L., Heninger, G.R., & Charney, D.S. (1989). The Yale–Brown Obsessive Compulsive Scale: I. Development, use and reliability. Archives of General Psychiatry, 46, 10061011.CrossRefGoogle ScholarPubMed
Hodgson, R.J., & Rachman, S. (1977). Obsessional-compulsive complaints. Behaviour Research and Therapy, 15, 389395.CrossRefGoogle ScholarPubMed
Insel, T.R. (1990). Preface. Journal of Clinical Psychiatry, 51, 3.Google Scholar
Jenike, M.A. (1990). Approaches to the patient with treatment-refractory obsessive compulsive disorder. Journal of Clinical Psychiatry, 51, 1521.Google Scholar
Jenike, M.A., Baer, L., & Minichiello, W.E. (Eds.). (1986). Obsessive-compulsive disorders: Theory and management. Littleton, MA: PSG.Google Scholar
Jenike, M.A., Minichiello, W.E., & Baer, L. (1986). Management of the individual patient. In Jenike, M.A., Baer, L., & Minichiello, W.E. (Eds.), Obsessive-compulsive disorders: Theory and management (pp. 179190). Littleton, MA: PSG.Google Scholar
Lelliot, P.T., Noshirvani, M.B., Marks, I.M., & Monteiro, W.O. (1988). Obsessive-compulsive beliefs and treatment outcome. Psychological Medicine, 18, 697702.CrossRefGoogle Scholar
Marks, I.M., Lelliot, P., Basoglu, M., Noshirvani, H., Monteiro, W., Cohen, D., & Kasvikis, Y. (1988). Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522534.CrossRefGoogle ScholarPubMed
Mavissakalian, M., Turner, S.M., & Michelson, L. (Eds.). (1985). Psychological and pharmacological treatment of obsessive-compulsive disorder. New York: Plenum.CrossRefGoogle Scholar
Minichiello, W.E., Baer, L., Jenike, M.A., & Holland, A. (1990). Age of onset of major subtypes of obsessive-compulsive disorder. Journal of Anxiety Disorders, 4, 147150.CrossRefGoogle Scholar
Montgomery, B., & Evans, L. (1984). You and stress: A guide to successful living. Melbourne: Nelson.Google Scholar
Rachman, S.J., & Hodgson, R.S. (1980). Obsessions and compulsions. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Rapoport, J., Elkins, R., & Mikkelsen, E. (1980). Clinical controlled trial of clomipramine in adolescents with obsessive-compulsive disorder, Psychopharmacological Bulletin, 16(3), 6163.Google ScholarPubMed
Rasmussen, S., & Eisen, J.L. (1991). Phenomenology of OCD: Clinical subtypes, heterogeneity and coexistence. In Zohar, J., Insel, T., & Rasmussen, S. (Eds.), The psychobiology of obsessive-compulsive disorder (2nd ed., pp. 1343). New York: Springer.Google Scholar
Ricciardi, J.N., & McNally, R.J. (1995). Depressed mood is related to obsessions, but not to compulsions in obsessive-compulsive disorder. Journal of Anxiety Disorders, 9, 249256.CrossRefGoogle Scholar
Robertson, J., Wendiggensen, P., & Kaplan, I. (1983). Towards a comprehensive treatment for obsessional thoughts. Behaviour Research and Therapy, 21, 347356.CrossRefGoogle ScholarPubMed
Salkovskis, P.M. (1983). Treatment of an obsessional patient using habituation to audiotaped ruminations. British Journal of Clinical Psychology, 22, 311313.CrossRefGoogle ScholarPubMed
Salkovskis, P.M., & Kirk, J. (1990). Obsessional disorders. In Hawton, K., Salkovskis, P.M., Kirk, J., & Clark, D.M. (Eds.), Cognitive behaviour therapy for psychiatric problems: A practical approach (pp. 129168). New York: Oxford Medical.Google Scholar
Salkovskis, P.M., & Warwick, H.M.C. (1985). Cognitive therapy of obsessive-compulsive disorder: Treating treatment failures. Behavioural Psychotherapy, 13, 243255.CrossRefGoogle Scholar
Salkovskis, P.M., & Westbrook, P.M. (1989). Behaviour therapy and obsessional ruminations: Can failure be turned into success? Behaviour Research and Therapy, 27, 149160.CrossRefGoogle ScholarPubMed
Sanavio, E. (1988). Obsessions and compulsions: The Padua Inventory. Behaviour Research and Therapy, 26, 169177.CrossRefGoogle ScholarPubMed
Shillitoe, R. (1995). Diabetes mellitus. In Broome, A. & Llewelyn, S. (Eds.), Health psychology: Processes and applications (2nd ed., pp. 187204). London: Chapman & Hall.CrossRefGoogle Scholar
Silva, F. (1993). Psychometric foundations and behavioural assessment. Newbury Park: Sage.Google Scholar
Spielberger, C.D., Gorsuch, R.L., Lushene, R.E., Vagg, P.R., & Jacobs, G.A. (1983). Manual for the State—Trait Anxiety Inventory (Form-Y) (Self-Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists.Google Scholar
Steketee, G., & Foa, E.B. (1985). Obsessive-compulsive disorder. In Barlow, D.H. (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 69144). New York: Guilford.Google Scholar
Thyer, B.A. (1985). Audio-taped exposure therapy in a case of obsessional neurosis. Journal of Behaviour Therapy and Experimental Psychiatry, 16, 271273.CrossRefGoogle Scholar
Turkat, I.D., & Maisto, S.A. (1985). Personality disorders: Application of the experimental method to the formulation and modification of personality disorders. In Barlow, D.H. (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 502570). New York: Guilford.Google Scholar