Assessing Sexual Orientation–Related Obsessions and Compulsions in Italian Heterosexual Individuals: Development and Validation of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS)

doi:10.1016/j.beth.2016.03.004

Behavior Therapy

Volume 47, Issue 4, July 2016, Pages 431-443

https://doi.org/10.1016/j.beth.2016.03.004 Get rights and content

Highlights

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The study developed and validated the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS)
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The SO-OCS was refined through item analysis and exploratory factor analysis in a large non-clinical sample
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Factor structure, reliability, validity and diagnostic sensitivity were then investigated in non-clinical and clinical samples
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Evidence of an unidimensional structure and adequate reliability and validity was found
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In particular, the SO-OCS had excellent criterion validity and diagnostic sensitivity

Abstract

Sexual Orientation–Obsessive-Compulsive Disorder (SO-OCD) is characterized by intrusive thoughts, images, and urges related to one’s sexual orientation, and by consequent avoidance, reassurance seeking, and overt and covert compulsions. Currently there is no short self-report measure that assesses SO-OCD symptoms. The current article describes two studies that develop and evaluate the first version of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS), a 14-item Italian self-report measure targeted towards heterosexual individuals. In Study 1, the SO-OCS was developed and refined through item analysis and exploratory factor analysis from an initial pool of 33 items administered to 732 Italian nonclinical participants. The SO-OCS showed a unidimensional structure and an acceptable internal consistency. In Study 2, the factor structure, internal consistency, temporal stability, construct and criterion validity, and diagnostic sensitivity of the SO-OCS were investigated in three samples of Italian participants (294 from the general population, 52 OCD patients who reported sexual orientation-related symptoms or concerns as a primary complaint, and 51 OCD patients who did not report these symptoms as primary complaint). The SO-OCS was again found to have a unidimensional structure and good internal consistency, as well as to exhibit strong construct validity. Specifically, the SO-OCS showed an excellent criterion validity and diagnostic sensitivity, as it successfully discriminated between those with SO-OCD and all other groups of participants. Finally, evidence of temporal stability of the SO-OCS in a nonclinical subsample was found. The SO-OCS holds promise as a measure of SO-OCD symptoms in heterosexual individuals.

Section snippets

Study 1

Study 1 was geared towards initial development of the SO-OCS scale, examining an initial pool of draft items within a large community sample. The aim was to develop an adequate and psychometrically sound measure of sexual orientation obsessions, which could then be further examined in clinical populations.

Study 2

In Study 1, we developed a measure of SO-OCD, that both had adequate psychometric properties and was short enough for routine clinical and research use. However, as clinical populations differ from nonclinical populations, it was important to assess the psychometric properties of the questionnaire within clinical samples. This was the aim of Study 2. We also examined whether the measure exhibited convergent validity with general obsessional symptoms as opposed to other OCD and non-OCD symptoms

Discussion

Sexual orientation obsessions are an important yet, to date, understudied symptom dimension of OCD. One factor contributing to this dearth of research is the lack of tools for assessing SO-OCD: While other measurement tools exist, they are either too long for routine use or they do not specifically assess SO-OCD. As such, the present study aimed to develop a measure—the Sexual Orientation Obsessive-Compulsive Scale—and to evaluate its psychometric properties, using both a large community sample

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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Feared self and dimensions of obsessive compulsive symptoms: Sexual orientation-obsessions, relationship obsessions, and general OCD symptoms
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Citation Excerpt :
Items are rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The SO-OCS has demonstrated adequate construct and criterion validity, and very good internal consistency (αs = 0.85–0.90; Melli, Moulding, et al., 2016). In this study, the English language translation was used (Melli, Moulding, et al., 2016).
Feared self beliefs have been found to relate with OCD, whereby fears of who one is or might become have had implications for the experience of obsessive-compulsive symptoms. The present study aimed to further the investigation of the fear of self to different OCD-symptom dimensions, including the understudied dimensions of relationship OCD and sexual orientation OCD, and compare this to prediction by other specific and general OCD-relevant beliefs. The final sample comprised 264 non-clinical participants (48.9% males) with a mean age of 34.65 years (SD = 12.01), who completed a battery of self-report measures. We found that different cognitions may contribute to OCD symptom presentations. General maladaptive beliefs were predictive of general OCD symptoms, while specific sexual-orientation beliefs were predictive of SO-OCD, over-and-above the more general beliefs noted in the cognitive appraisal model of OCD. The “feared self” was found to relate significantly to all OC symptoms dimensions including relationship OCD and sexual orientation OCD, and predicted significant additional variance in all symptom dimensions except for contamination and partner-focussed obsessions. The findings suggest that beliefs centred on feared self-perceptions and inner-self concerns may be important in understanding the appraisal process of intrusions.
Ego-dystonic stance-taking in sexual orientation obsessive-compulsive disorder (SO-OCD)
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Quantitative studies have demonstrated the relevance of a “feared self” in the maintenance and development of sexual orientation obsessive-compulsive disorder (SO-OCD). The current pilot study demonstrates how the “feared self” – i.e., a set of qualities one fears to have or become – can systematically be traced in language by operationalizing it as evaluative stance-taking. Online sexual doubt narratives written by self-diagnosed sexual orientation OCD men (n = 299) and “questioning men” who doubt their sexuality without referring to OCD (n = 105) were compared with the mixed method corpus-assisted discourse analysis. The analysis focused on the co-occurrence of adjectives and determiners with the noun “thought(s)”. Self-diagnosed men used significantly more adjectives than questioning men. Qualitative results showed that the evaluative polarity of “thought(s)” was negative for both groups of men. While self-diagnosed men always avoided the feared gay self, few questioning men ambiguously embraced a gay/bisexual identification. Moreover, while both groups tended to deny ownership of “thought(s)” by doubling the usual use of any other determiners over the pronoun “my”, more self-diagnosed men followed this tendency. Potential therapeutic applications of these findings, and future interdisciplinary research avenues are discussed.
Assessing Sexual Orientation Symptoms in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT)
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Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one’s sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current paper details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure’s 12 items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears; Factor 2: Somatic Checking) and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.
The relationship of inferential confusion and obsessive beliefs with specific obsessive-compulsive symptoms
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This study aimed to investigate the specificity of inferential confusion and obsessive beliefs to symptoms of obsessive-compulsive disorder (OCD). The construct of inferential confusion is grounded in an Inference-Based Approach (IBA) to the study of OCD, which maintains that dysfunctional reasoning plays a central role in its development, whereas other cognitive models have emphasized the role of obsessive beliefs in the escalation of intrusive thoughts into obsessions. To investigate the role of inferential confusion and obsessive beliefs, a group of individuals diagnosed with OCD (N = 296) completed the Inferential Confusion Questionnaire (ICQ-EV) and the Obsessive Beliefs Questionnaire (OBQ-44). As expected, inferential confusion and obsessive beliefs uniquely predicted OCD symptoms. Specifically, importance and control of thoughts was particularly relevant to obsessions, perfectionism and certainty to precision, and just right and inferential confusion to indecision and rumination. Beliefs about responsibility and threat did not uniquely predict any symptoms of OCD. Results are discussed in terms of future avenues for research, and how an investigation of cognitive constructs that are not explicitly represented in the OBQ-44 may help to further inform and refine cognitive models of OCD.
Specific and general cognitive predictors of Sexual Orientation-Obsessive Compulsive Disorder
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Citation Excerpt :
Mark the number that best corresponds to your way of thinking, according to the following scale: 0 = Strongly disagree; 1 = Somewhat agree; 2 = Moderately agree; 3 = Strongly agree; 4 = Fully agree.” Sexual Orientation Obsessive-Compulsive Scale (SO-OCS; Melli, Moulding et al., 2016). The SO-OCS is a 14-item unidimensional scale recently developed to assess SO-OCS symptoms in Italian heterosexual individuals, measured on a 5-point Likert scale from 0 (‘not at all’) to 4 (‘extremely’).
Sexual Orientation-Obsessive Compulsive Disorder (SO-OCD) is yet understudied in the literature. The current study was prompted to test the role of specific and general beliefs potentially involved in the genesis and maintenance of SO-OCD. As such, 263 patients with SO-OCD, 42 patients with OCD (NSO-OCD) and 116 non-clinical participants (NCP) were administered the Sexual Orientation-Obsessive Beliefs Scale (SO-OBS), which was designed to evaluate specific beliefs hypothesized to relate to SO-OCD, together with other measures assessing SO-OCD symptoms, general obsessive beliefs, depression and anxiety. The final SO-OBS consisted of 12 items and showed a four-factor structure and a very good internal consistency. Regression analysis and multivariate analysis of covariance (MANCOVA) highlighted the significant role of beliefs regarding the negative impact of homosexuality on one's identity and beliefs about the meaning of sexual problems in heterosexual intercourse as well as a more marginal role of black/white beliefs regarding what it is “right” to feel in heterosexual sexuality. There were no significant differences between SO-OCD and NSO-OCD patients on homophobic beliefs. Despite some limitations of the study, including the limitation to heterosexual individuals with SO-OCD, the identification of these specific cognitive factors has important implications for the prevention and treatment of SO-OCD.
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View all citing articles on Scopus

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Assessing Sexual Orientation–Related Obsessions and Compulsions in Italian Heterosexual Individuals: Development and Validation of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS)

Highlights

Abstract

Section snippets

Study 1

Study 2

Discussion

Conflict of Interest Statement

Journal of Obsessive–Compulsive and Related Disorders

Behaviour Research and Therapy

Journal of Obsessive-Compulsive and Related Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Comprehensive Psychiatry

Comprehensive Psychiatry

Behaviour Research and Therapy

Journal of Obsessive-Compulsive and Related Disorders

Psychiatry Research

Behaviour Research and Therapy

Journal of Obsessive Compulsive and Related Disorders

Journal of Anxiety Disorders

Behavior Therapy

Psychiatry Research

Diagnostic and statistical manual of mental disorders, (DSM-5)

Ethical principles of psychologists and code of conduct

Manual for the Beck Anxiety Inventory

Manual for the beck depression inventory-II

Meta-analysis of the symptom structure of obsessive-compulsive disorder

The American Journal of Psychiatry

The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples

Comprehensive Psychiatry

Anxiety Disorders Interview Schedule Adult Version: Client interview schedule

Remarks on parallel analysis

Multivariate Behavioral Research

Exploratory factor analysis with small sample sizes

Multivariate behavioral research

The Obsessive-Compulsive Inventory: Development and validation of a short version

Psychological Assessment

Scale construction and psychometrics for social and personality psychology

Heterosexual panic

The American Journal of Psychoanalysis

Sexual obsessions and OCD

Sexual and Relationship Therapy