Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Overvalued ideation in adolescents with obsessive-compulsive disorder Tania Borda a , Fugen Neziroglu b, ⁎ , William Taboas c , Dean McKay c , Leah Frenkiel b a Bio-Behavioral Institute, Buenos Aires, Argentina, and Pontificia Universidad Catolica Argentina (UCA), Psychology School, Buenos Aires, Argentina b Bio-Behavioral Institute, Great Neck, NY, USA c Department of Psychology, Fordham University, Bronx, NY, USA ARTICLE INFO Keywords: Obsessive-compulsive beliefs ABSTRACT In Obsessive Compulsive Disorder (OCD), overvalued ideas (OVI) are considered poor prognostic indicators in adults. To date, OVI has not been studied in an adolescent population with OCD, nor has it been examined in relation to obsessive-compulsive beliefs. To investigate the relationship between OVI and specific cognitions, fifty-five adolescents with OCD (35 male; 20 female; age range 13–17 years; M = 14.05 years, SD = 1.75 years) participated. It was predicted that OVI would be associated with symptom severity and would moderate obsessive-compulsive beliefs and functional disability. Results showed that OVI was associated with symptom severity, but did not moderate the relationship with any OC beliefs or functional domains. To evaluate the role of OVI in treatment outcome, thirteen adolescents completed a cognitive-behavioral treatment program. Severity of their OCD symptoms, OVI, degree of functional impairment and quality of life were assessed. It was expected that all variables would change in response to treatment. Further, it was expected that OVI would mediate treatment outcome for all measures of obsessive-compulsive symptom and belief assessments. Results indicated that there was clinically significant change in symptom severity and functional disability, as well as beliefs regarding responsibility/overestimation of threat. Treatment, assessment, and methodological recommendations for this population are offered. 1. Introduction Obsessive Compulsive Disorder (OCD) is principally characterized by obsessions, negative feelings, and compulsions. Obsessions are thoughts, images, or impulses that are repetitive, intrusive, and difficult to suppress. The five core features of obsessions are discussed in greater detail in Clark (2004) and are based on the criteria for diagnosing OCD in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). A compulsion, ritual, or neutralizing strategy has four main characteristics: the response is intentional, repetitive, excessive, and the person feels an urge to perform it. The prevalence of OCD has been well studied in popula- tion-wide surveys across the globe. These studies show that OCD occurs in 1 – 3% of adults (Fireman et al., 2001; Weissman et al., 1994) and 1.9 – 4% in children (Douglass et al., 1995; Karno et al., 1988; Zohar, 1999). OCD is considered responsive to treatment, with two approaches shown to be efficacious: cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) and psychopharmacologic interventions, including selective serotonin reuptake inhibitors (SSRIs) (Franklin et al. (2015); Pediatric OCD Treatment Study (POTS) Team, 2004). As OCD continues to be studied by researchers, cognitive-behavioral etiology models are becoming promising approaches to conceptualizing OCD (Clark, 2004; Frost and Steketee, 2002; Salkovskis, 1999). These models propose that OCD develops from a certain set of dysfunctional beliefs, leading the person to misinterpret or overestimate the signifi- cance of their unwanted and intrusive thoughts. When an individual attributes unwarranted significance to such thoughts, mental events can become transformed into obsessions and lead to compulsions. A diagnosis of OCD presumes that, at some point, the patient has recognized the obsessions as excessive or unreasonable. However, some OCD patients believe their obsessions are logical and are unable to perceive their obsessions as being irrational. Thus, their obsessions are said to be overvalued. An overvalued idea (OVI) is “an unreasonable and sustained belief that is maintained with less than delusional intensity,” (5th ed.; DSM-V; American Psychiatric Association, 2013). A number of authors (Hollander, 1993; Kozak and Foa, 1994; Neziroglu et al., 1999) consider the strength of a belief as one of the prominent features characterizing overvalued ideas. Overvalued ideas are irra- tional, unreasonable beliefs that are held with strong conviction, and the person lacks insight or the ability to attribute the belief to the disorder (i.e. OCD; Neziroglu and Stevens, 2002). Conceptually, over- http://dx.doi.org/10.1016/j.psychres.2017.05.001 Received 1 June 2016; Accepted 2 May 2017 ⁎ Correspondence to: Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY 11021, USA. E-mail address: neziroglu@gmail.com (F. Neziroglu). Psychiatry Research 255 (2017) 66–71 Available online 03 May 2017 0165-1781/ Published by Elsevier Ireland Ltd. MARK