title: An investigation of doubt in obsessive-compulsive disorder.
abstract: Clinicians have long considered doubt to be a fundamental characteristic of obsessive-compulsive disorder (OCD). However, the clinical relevance of doubt in OCD has not been addressed.
  
  
  
  Participants included 1182 adults with OCD who had participated in family and genetic studies of OCD. We used a clinical measure of the severity of doubt, categorized as none, mild, moderate, severe, or extreme. We evaluated the relationship between doubt and OCD clinical features, Axis I disorders, personality and personality disorder dimensions, impairment, and treatment response.
  
  
  
  The severity of doubt was inversely related to the age at onset of OCD symptoms. Doubt was strongly related to the number of checking symptoms and, to a lesser extent, to the numbers of contamination/cleaning and hoarding symptoms. Doubt also was related to the lifetime prevalence of recurrent major depression and generalized anxiety disorder; to the numbers of avoidant, dependent, and obsessive-compulsive personality disorder traits; and to neuroticism and introversion. Moreover, doubt was strongly associated with global impairment and poor response to cognitive behavioral treatment (CBT), even adjusting for OCD severity and other correlates of doubt.
  
  
  
  Doubt is associated with important clinical features of OCD, including impairment and cognitive-behavioral treatment response.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jacks@jhmi.edu.
authors.forename: Jack
authors.initials: J
authors.lastname: Samuels
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Krasnow
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Grados
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Cullen
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Goes
authors.affiliation: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Brion
authors.initials: B
authors.lastname: Maher
authors.affiliation: Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Greenberg
authors.affiliation: Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: McLaughlin
authors.affiliation: Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rasmussen
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons at Columbia University and the New York State Psychiatric Institute, New York City, New York, USA.
authors.forename: Abby J
authors.initials: AJ
authors.lastname: Fyer
authors.affiliation: Department of Psychiatry, University of Southern California School of Medicine, Los Angeles, California, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Knowles
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Nestadt
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: McCracken
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Geller
authors.affiliation: Department of Psychiatry and Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Pauls
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: S Evelyn
authors.initials: SE
authors.lastname: Stewart
authors.affiliation: Laboratory of Clinical Science, National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA.
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Murphy
authors.affiliation: Unit of Statistical Genomics, Division of Intramural Research, National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Yin-Yao
authors.initials: YY
authors.lastname: Shugart
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Kamath
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Bakker
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Riddle
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Nestadt
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003193:Compulsive Personality Disorder / Q000523:psychology; D003865:Major Depressive Disorder / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000075384:Neuroticism; D009771:Obsessive-Compulsive Disorder / Q000523:psychology*; D010554:Personality Disorders / Q000523:psychology; D055815:Young Adult