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An experimental analysis of compulsive ordering and arranging Radomsky, Adam Scott 2001

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AN E X P E R I M E N T A L ANALYSIS O F COMPULSIVE ORDERING AND ARRANGING by ADAM SCOTT RADOMSKY B . S c , The University of Toronto, 1994 M . A . , The University of B r i t i s h C o l u m b i a , 1998  A T H E S I S S U B M I T T E D IN PARTIAL F U L F I L M E N T O F T H E REQUIREMENTS FOR T H E D E G R E E O F  D O C T O R O F PHILOSOPHY in T H E FACULTY O F GRADUATE STUDIES (Department of Psychology) We accept this thesis as conforming^t0'tn^ required s t a n d a r d >  T H E U N I V E R S I T Y O F BRITISH C O L U M B I A J a n u a r y , 2001 © A d a m Scott Radomsky, 2001  In presenting this thesis in partial fulfilment o f the requirements for a n advanced degree at the University o f British Columbia, I agree that the Library shall m a k e it freely available for reference a n d study. I further agree that permission for extensive copying o f this thesis for scholarly purposes m a y be granted b y the h e a d of m y department or b y his or her representatives. It is understood that copying or publication o f this thesis for financial gain shall not be allowed without m y written permission.  Department T h e University o f British Columbia Vancouver, C a n a d a  DE-6 (2/88)  Abstract  Compulsive ordering and arranging, and a preoccupation with symmetry have been documented within the context of obsessive-compulsive disorder (OCD) symptomatology, but have not been examined experimentally. Three connected studies were conducted to examine this phenomenon, including the development of a self-report measure of this behaviour, the validation of this scale, and a test of anxiety provocation and memory in association with compulsive ordering and arranging. Results indicated that the self-report measure had good psychometric properties, and external validity. Also, participants who had a strong preference for order were made more anxious by having to complete a difficult task in a disorganized environment. Hypotheses about memory bias in association with this behaviour were not confirmed. Like other types of abnormal behaviour, these symptoms are likely extensions of normal and adaptive ordering and arranging behaviour. They are consistent with cognitive-behavioural conceptualizations of the disorder, however some aspects of this behaviour may not necessarily be reflected by current theory. Results are discussed in terms of the phenomenology of compulsive ordering and arranging, and its relationship to both OCD and normal human behaviour.  TABLE OF CONTENTS  Abstract List of Tables  ii .<  iv  List of Figures  v  Acknowledgements  vi  Introduction  1  Study 1  13  Study 2  37  Study 3  46  Overall Discussion  64  References  72  Appendix I  78  Appendix II  81  iv List of Tables  Table 1 - Participant characteristics, Study 1, Phase 1  16  Table 2 - Principal components analysis, Study 1, Phase 1  18  Table 3 - Factor loadings, item means and standard deviations, Study 1, Phase 1 Table 4 - Participant characteristics, Study 1, Phase 2  20 26  Table 5 - Principal components analysis of the SOAQ, Study 1, Phase 2  28  Table 6 - Factor loadings, item means and standard deviations for the SOAQ, Study 1, Phase 2  29  Table 7 - Hotelling's t-tests for differences between dependant correlations, Study 1, Phase 2  32  Table 8 - Participant characteristics, Study 2  39  Table 9 - Participant characteristics, Study 3  51  Table 10 - Baseline SUDS ratings, Study 3  52  Table 11 - Post-provocation SUDS ratings, Study 3  53  List of Figures  Figure 1 - Scatterplot of degree of preference of ordered target items over disordered target items a n d S O A Q scores, S t u d y 2 ...  42  Figure 2 - Post provocation S U D S ratings, Study 3  54  Figure 3 - Target item recall scores by group a n d condition, S t u d y 3  57  vi Acknowledgements  I would like to t h a n k Doreen R a d o m s k y , Nikolas Dixon, members of the Fear a n d Anxiety Disorders Laboratory at U B C (including D a n a T h o r d a r s o n , D a v i d H a m m o n d , a n d Michael Morris), m y dissertation committee a n d especially J a c k R a c h m a n for their support a n d assistance d u r i n g this seemingly u n e n d i n g process.  Portions of this research were presented at the 2000 Association for the Advancement of Behavior Therapy Conference i n New Orleans, a n d at invited addresses at the University of M i a m i a n d C o n c o r d i a University.  T h i s research was supported in part by a n N S E R C P G S - B scholarship #207769-1998.  1 Introduction  Obsessive compulsive disorder (OCD) is characterized by the presence of either obsessions or compulsions, which produce either interference with daily functioning or significant distress (American Psychiatric Association, 1994). While certain examples are provided, the content of these obsessions and compulsions is not specified i n the Diagnostic and Statistical M a n u a l of Mental Disorders (4 Edition). However, for both obsessions and th  compulsions, the content of these thoughts and behaviours is not random it appears to commonly occur i n one of several different categories (Pigott, 1998; Rachman & Hodgson, 1980). More recently, this observation has been supported by empirical data from the factor analyses of O C D symptoms (e.g., Baer, 1994; Foa et al., 1998; Leckman et al., 1997; Rasmussen & Eisen, 1992; Summerfeldt et al., 1999; Thordarson et al., 1993). Within obsessions, thoughts often tend to encompass one or more of aggressive, blasphemous, or inappropriate sexual thoughts.  Similarly,  compulsions tend to include washing, checking, ordering/arranging, ritualistic tapping/touching, and mental compulsions such as counting or praying (de Silva 85 Rachman, 1998, Rachman & Hodgson, 1980). There are of course, other types of obsessions and compulsions that occasionally occur, but these have rarely been documented.  2 Initially, the content of obsessions a n d / o r c o m p u l s i o n s w a s not essential to the u n d e r s t a n d i n g of O C D theory or treatment (Wolpe, 1958). Repetitive b e h a v i o u r was treated t h r o u g h the a p p l i c a t i o n of r e c i p r o c a l i n h i b i t i o n treatment strategies (Wolpe, 1958) a n d later by exposure a n d response prevention (Meyer, 1966). (Incidentally, this treatment m o d a l i t y r e m a i n s the m o s t s u p p o r t e d a n d a p p l i e d p s y c h o t h e r a p e u t i c i n t e r v e n t i o n for O C D to t h i s day.) However, as o u r u n d e r s t a n d i n g of O C D theory a n d treatment h a s increased, there h a s also been a n i n c r e a s i n g e m p h a s i s o n different theoretical a n d a p p l i e d c o n c e p t u a l i z a t i o n s of O C D subtypes, i n a d d i t i o n to c o n c e p t u a l i z i n g O C D p r o b l e m s as o c c u r r i n g w i t h i n a " s p e c t r u m " (Hollander, 1993). E a r l y cognitive-behavioural theories of O C D (e.g., S a l k o v s k i s , 1985) tended to e x p l a i n the complete phenomenology of O C D w i t h one set of p s y c h o l o g i c a l factors. In the case of P a u l S a l k o v s k i s ' s theory of O C D (1985), the major p s y c h o l o g i c a l factor involved is proposed to be inflated responsibility. T h a t is,, m o s t O C D symptomatology c a n be a c c o u n t e d for by a n i n c r e a s e d perception of one's r e s p o n s i b i l i t y for the safety a n d w e l l - b e i n g of oneself a n d / o r of one's friends a n d family m e m b e r s .  F o r example, a  p e r s o n w i t h O C D c h e c k s h o u s e h o l d a p p l i a n c e s repeatedly b e c a u s e they feel responsible for the safety a n d security of the h o u s e h o l d a n d its contents; a p e r s o n w h o w a s h e s repeatedly does so because they feel responsible for the h e a l t h of themselves or those a r o u n d t h e m ; a p e r s o n w h o p r a y s excessively  3 does so because they feel responsible for n e u t r a l i z i n g or u n d o i n g the effects of their o w n i n t r u s i v e b l a s p h e m o u s thoughts, etc. A s this theory h a s developed a n d been increasingly a p p l i e d (through the a p p l i c a t i o n of r e s p o n s i b i l i t y r e d u c t i o n strategies), it h a s become debatable the extent to w h i c h r e s p o n s i b i l i t y , as a n o v e r a r c h i n g p s y c h o l o g i c a l factor, plays the same role i n e a c h O C D subtype.  It appears that r e s p o n s i b i l i t y i s c e r t a i n l y a core  factor i n the n a t u r e of c o m p u l s i v e c h e c k i n g ; however the i m p o r t a n c e of r e s p o n s i b i l i t y m i g h t well be d i m i n i s h e d i n someone w h o w a s h e s c o m p u l s i v e l y - a n d p o s s i b l y be even further d i m i n i s h e d i n someone w i t h u n w a n t e d , i n t r u s i v e t h o u g h t s - w h e n c o m p a r e d w i t h the perceived r e s p o n s i b i l i t y of those w h o c h e c k c o m p u l s i v e l y . B e c a u s e of the u n c e r t a i n t y a b o u t the degree to w h i c h r e s p o n s i b i l i t y plays a role i n a l l cases a n d subtypes of O C D , other cognitive b e h a v i o u r a l theories of the disorder have been proposed - p a r t i c u l a r l y for those subtypes w h i c h do n o t l e n d themselves well to being completely e x p l a i n e d b y inflated responsibility. A p r i m e example of this i s the cognitive-behavioural theory of obsessions b y R a c h m a n (1997, 1998), i n w h i c h personal significance is h y p o t h e s i z e d to be the p s y c h o l o g i c a l factor of foremost i m p o r t a n c e .  While  the concept of inflated r e s p o n s i b i l i t y is n o t i n c o m p a t i b l e w i t h t h i s newer f o r m u l a t i o n a n d c o n c e p t u a l i z a t i o n of obsessions, it doesn't a p p e a r to e x p l a i n as m u c h of the phenomenology as a f o r m u l a t i o n t h a t centralizes the role of p e r s o n a l significance. S i m i l a r l y , one w o u l d expect t h a t other  4 subtypes might benefit from revised and more specific cognitive-behavioural explanations. One subtype that has received very little attention i n the literature is a compulsion to order and arrange one's surroundings, to avoid disorderly surroundings, and to ensure that objects are arranged i n "exactly the right way". This may often include an increased preference for symmetry, either generally, or with respect to a few select possessions. Patients within this subtype of O C D will often report that they need to ensure that their belongings are "just right" before they can proceed with their day, often spending several hours i n front of a shelf or table, repositioning objects until their anxiety decreases to a tolerable level. It is surprising that this subtype of OCD has been so neglected i n the literature, particularly given the results of epidemiological data, which indicate that ordering and arranging is one of the more common presentations of OCD generally (e.g., Rasmussen & Eisen, 1992; Sasson et al., 1997), i n adults (e.g., Leckman et al., 1997; Summerfeldt et al., 1999), and i n children (e.g., Flament et al., 1988; Valleni-Bassile et al., 1994). While studies like these document the presence of this subtype of O C D , there is a notable absence of both critical experimental analyses of ordering and arranging, and of theoretical explanations of this behaviour. As such, little is known about the specific phenomenology of ordering and arranging apart from the experiences of those who treat the problem clinically. This  5  investigation will hopefully provide the basis for future investigations of the prevalence of ordering and arranging within populations of people who suffer from OCD (something which has not been well documented i n the literature). We would expect that this compulsion serves the same functional purpose as other compulsions - to reduce anxiety. One might hypothesize that people with ordering and arranging compulsions feel that by obtaining control over a small part of their external environment (which may also include an internal sense of being "just right"), they can feel safe and/or more i n control of the rest of their environment. This is similar to some conceptualizations of eating disorders, i n which it is hypothesized that one of the reasons these patients restrict their diets is because they feel that weight is one of the few things they can control - and this limited control provides some relief from a perceived chaotic world (Fairburn, Shafran 85 Cooper, 1999; Rodin, 1977). This similar formulation may account for the strong overlap between eating disorders and the specific subtype of ordering and arranging within O C D found by Matsunaga and colleagues (1999). One obvious overlap with ordering and arranging behaviour occurs within obsessive-compulsive personality disorder (OCPD). This personality disorder is characterized by a "preoccupation with orderliness, perfectionism, and mental and interpersonal control" (American Psychiatric  6 A s s o c i a t i o n , 1994, p.669). There is no reason to a s s u m e t h a t o r d e r i n g a n d a r r a n g i n g b e h a v i o u r i n O C D s h o u l d be a n y different from the same b e h a v i o u r i n O C P D . In fact, the c o n c e p t u a l i z a t i o n of t h i s b e h a v i o u r as a n attempt at g a i n i n g more c o n t r o l is consistent across b o t h disorders. We w o u l d expect however, that O C D ordering a n d a r r a n g i n g s h o u l d serve a different function  - as anxiety r e d u c i n g behaviour; whereas O C P D o r d e r i n g  a n d a r r a n g i n g is likely c a r r i e d out because of a simple preference for orderly environments.  The better p s y c h o m e t r i c properties of A x i s I diagnoses w h e n  c o m p a r e d w i t h personality or A x i s II disorders w i l l lead u s to e x a m i n e a n d conceptualize o r d e r i n g a n d a r r a n g i n g b e h a v i o u r w i t h i n the context of O C D rather t h a n O C P D ; however it is not argued that the two types of b e h a v i o u r are f u n d a m e n t a l l y different. A n o t h e r i m p o r t a n t p s y c h o l o g i c a l factor i n c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g is likely to be inflated responsibility. If these patients d i d not feel responsible for the stability or c o n t r o l of their environment, they m i g h t not be so c o n s u m e d by this b e h a v i o u r - or by the desire to achieve the i n t e r n a l a n d external state of things being "just right". T h i s f o r m u l a t i o n is consistent w i t h S a l k o v s k i s ' s (1985) theory of O C D b u t also enables more detailed cognitive analyses of concepts like perceived c o n t r o l , a n d feeling "just right". The concept of inflated r e s p o n s i b i l i t y alone w o u l d not necessarily i m p l i c a t e these ideas i n the development or m a i n t e n a n c e of this disordered behaviour.  7 M u c h like other symptoms of OCD, we would expect that ordering and arranging behaviour lies on a continuum from normal, adaptive, everyday ordering and arranging behaviour to more significant, clinically impairing compulsive ordering and arranging. Certainly, we all need some degree of order i n our lives. We tend to sort things naturally - both for convenience (e.g., plates, glasses, pots etc., are all kept in groups/piles i n the kitchen) and for aesthetics (e.g., pictures tend to hang on our walls level with the floor/ceiling, organized rooms are more appealing, etc.). Without any ordering and arranging, it would be more difficult to find the things we need, to manoeuvre safely through our homes, and to live i n our complicated physical and social environments. Some of us tend to prefer more order than others and many people feel as if some of the objects i n their home (e.g., trophies, prized posessions, etc.) have an exact and proper place. Obsessions and compulsions do occur in normal people (Gibbs, 1996). We know that normal individuals experience the same types of thoughts as obsessionals (de Silva & Rachman, 1978; Salkovskis & Harrison, 1984). We also know that behaviour almost identical to compulsions is commonly found i n normal individuals (Muris, Merkelbach & Clavan, 1997). It is reasonable to expect then, that a preference for order and some amount of arranging behaviour is prevalent i n a majority of people. This hypothesis needs to be tested however, and evidence from other studies of normal undergraduates and  8 community adults suggests that, if it is present, it can be easily detected (Gibbs, 1996). In order to assess the degree to which this behaviour exists in normal populations, there is a need for a tool that measures ordering and arranging behaviour. One of the most popular pencil and paper measures of OCD symptomatology has been the Maudsley Obsessional Compulsive Scale (MOCI - Rachman 85 Hodgson, 1980). Of the thirty true/false items i n the scale, none of them assesses ordering or arranging behaviour or a desire for symmetry. The revision of the MOCI, the Vancouver Obsessive Compulsive Scale (VOCI - Thordarson, Radomsky, Rachman, Sawchuk 8B Shafran, 1993), contains one item within its Routine/Counting/Slowness subscale, "I feel upset if my furniture or other possessions are not always i n exactly the same position". This item does not adequately assess the full range of ordering and arranging behaviour hypothesized to occur among compulsive orderers and arrangers. There is currently no well-validated scale available which assesses this behaviour. Another good argument for the development of a psychometric assessment tool is that it would provide an excellent opportunity to determine if ordering and arranging behaviour is a singular construct or if it comprises more than one set of beliefs and/or behaviours. Unlike claustrophobia, which is comprised of both a fear of restriction and a fear of suffocation (Rachman 8B Taylor, 1993; Radomsky et al., i n press), there is no  reason to hypothesize that ordering and arranging behaviour is made up of separate fears. The assumption that we would not expect people to be arranging their objects according to multiple sets of rules or with separate goals in mind, primarily results from the phenomenology of ordering and arranging behaviour seen in the clinic. Our experience indicates that some anxiety disorders appear to fall into several classes (e.g., claustrophobic patients seem to be primarily concerned with either an inability to breathe in or an inability to escape from enclosed places). Compulsive ordering and arranging concerns however, appear to present as a simple distress in the presence of disorder and a calmness in the presence of order. While there are the occasional cases that present with concerns about only symmetry, for example, the overwhelming majority appear to have general preferences for order over disorder. There will certainly be idiosyncratic cognitions underlying this behaviour (e.g., "if my belongings are not properly arranged, my husband will be in an accident" or "if my belongings are not just right, I will have bad luck") - as there appears to be in association with other compulsive behaviour. However, clinicians have reported that ordering and arranging compulsions often occur in the absence of traditional fear-related cognitions (Wilhelm, 2000). The demonstration of a unitary factor structure within a self-report measure of ordering and arranging behaviour would lend support to this hypothesis.  It may be revealed that this type of compulsive  10  behaviour is motivated by a basic prepared calming response associated with orderly surroundings. In addition to a psychometric test of the structure of the behaviour, and its prevalence in normal populations, an experiment in which participants are asked to indicate their preference for both orderly and disorderly environments would provide a slightly more ecologically valid indication of the degree to which this behaviour is prevalent. Also, provoking individuals who do have a preference for orderly surroundings, by having them complete a difficult task in a disorderly and disorganized environment, should provide an excellent opportunity to examine the beliefs and cognitions operating in these individuals in vivo, as well as to test the hypothesis that these people are more anxious when their surroundings are disorganized. This will obviously need to be contrasted with participants without this preference, as well as with participants placed in an orderly and organized environment. Should we find elevated anxiety among participants who have a preference for order, who are then placed in disorderly surroundings, it would provide some indication of how these preferences lead to distress and interference in daily functioning. A set of well developed psychometric, experimental, and ecologically valid studies will enable us to test if the clinically observed phenomenology of ordering and arranging is consistent with current cognitive behavioural theories of OCD.  11  Memory bias i n compulsive ordering and arranging  This research grew out of some observations made during a study of memory bias i n compulsive washing (Radomsky & Rachman, 1999). This study required participants who washed compulsively to watch as each of a set of 50 objects was either contaminated, or touched but not contaminated. After watching this procedure and completing a neuropsychological memory assessment, participants were given several memory tests. Results indicated that participants with OCD and a fear of contamination had a biased recall of contaminated items, whereas a clinically anxious control group, and an undergraduate student group did not. One of the clinical experimental group participants who was excluded from the Radomsky & Rachman (1999) study was someone who did not have a fear of contamination but instead ordered and arranged many of her belongings at home. This participant was r u n through the experimental protocol accidentally (only compulsive washers were to be included i n the experimental group - and a diagnosis of OCD was an exclusionary criteria for the clinical control group), resulting from a miscommunication between the assessor and the experimenter. During the recall task, this participant recalled all of the objects that were "not put right" on the table "because  12 they stood out - like they needed to be moved a bit", and had trouble recalling the objects that had been 'properly placed'. J u s t as memory biases in favour of threatening information have been demonstrated i n compulsive washers (Radomsky & Rachman, 1999) and among compulsive checkers (Radomsky, Rachman 8& Hammond, i n press), we would expect that compulsive orderers and arrangers will have a biased recall for objects which are out of place or disorderly. A n experimental analysis of compulsive ordering and arranging therefore provides an excellent opportunity to test for the presence of this bias.  Summary  Increasingly, researchers are paying more and more attention to O C D subtypes. While some of these (especially washing, checking, and more recently, obsessions without overt compulsions) have been receiving particular attention i n the literature, there is a great need for an experimental analysis of ordering and arranging. This behaviour can be explained somewhat by current cognitive behavioural theories of O C D but might well benefit from a more precise conceptualization. There is therefore a need to develop a scale which measures this phenomenon, to assess whether it (like other OCD symptoms) occurs on a continuum from normal everyday behaviour to more significant clinically impairing behaviour, and'  13 to test if people who do compulsively order and arrange their surroundings are indeed upset by disorder and disarray. Finally, these studies provide an excellent opportunity to test for the presence of memory bias among compulsive orderers and arrangers - which would be consistent with memory biases that have been found i n association with other subtypes of OCD.  Study 1  Aim: The aim of this study is to develop a psychometric scale (The Symmetry, Ordering and Arranging Questionnaire - SOAQ) to assess beliefs and behaviour associated with compulsive ordering and arranging.  Predictions: 1. The SOAQ will have sufficient psychometric properties to be used as a self-report measure for ordering and arranging behaviour within a sample of undergraduate students. 2. The SOAQ will measure a single factor. 3. The SOAQ will have a stable factor structure.  14  Method - Phase I  Thirty-four items pertaining to compulsive ordering, arranging a n d a desire for symmetry were formulated by the U B C Fear a n d Anxiety Disorders Laboratory from both theoretical conceptualizations a n d clinical presentations of ordering a n d arranging in O C D . T h e working group i n the lab i n c l u d e d a professor with international authority on the research a n d treatment of obsessive compulsive disorder, a post-doctoral fellow with several years of senior experience i n the research a n d treatment of O C D , several doctoral level graduate students, all of w h o m h a d c o n d u c t e d research a n d treatment with O C D patients, a n d one of w h o m does a great deal of ordering a n d arranging i n her private life. Items were based on clinical reports, on logical extensions of items developed for the V a n c o u v e r Obsessional Compulsive Inventory (VOCI - T h o r d a r s o n et al., 1993), a n d on extensions of current cognitive behavioural conceptions of O C D . T h i s scale (see A p p e n d i x I) was distributed to 250 undergraduate psychology students, who were asked to rate each item on a 0 to 4 scale to indicate how strongly they agree with each statement. Participants were also asked to complete scales that assess related p h e n o m e n a - e.g., the M a u d s l e y Obsessional-Compulsive Inventory - M O C I (Rachman & Hodgson, 1980), the V a n c o u v e r Obsessive Compulsive Inventory - V O C I (Thordarson, Radomsky, R a c h m a n , S a w c h u k 8B Shafran, 1993), the B e c k Anxiety  15 Inventory - BAI (Beck et al., 1990), and the Beck Depression Inventory II BDI (Beck, Steer, 85 Garbin, 1996). Participants responded to announcements in undergraduate psychology lectures and to signs i n the psychology department building indicating where they could obtain questionnaire packages. Participants were offered course credit for completing the questionnaires.  Participants  We received 211 completed questionnaire packages (a return rate of 84.4%). 74.3% of participants who completed the questionnaires were female. Other participant characteristics are displayed in Table 1.  16 Table 1 - Participant characteristics, Study 1, Phase I  Mean  SD  Minimum  Maximum  Maximum possible  Age  19.34  1.48  16.00  30.00  BDI  1  12.74  9.12  0.00  52.00  63.00  BAI  2  12.11  9.39  0.00  43.00  63.00  8.64  5.85  0.00  25.00  30.00  0.83  0.56  0.02  2.69  4.00  MOCI  3  Total VOCI  4  Total  1 - Beck Depression Inventory 2 - Beck Anxiety Inventory 3 - Maudsley Obsessional Compulsive Inventory 4 - Vancouver Obsessional Compulsive Inventory  17 Results - Phase 1  Inter-item reliability  The inter-item reliability of the 34 items was extremely high, Cronbach's oc=0.98.  Factor Structure  Items were subjected to a principal components analysis and resulting Eigenvalues are displayed in Table 2. The best solution (both statistically and conceptually) was a one-factor solution that accounted for 56.7% of the variance. Factor loadings, item means and standard deviations are displayed i n Table 3.  18 Table 2 -Principal components analysis, Study 1, Phase 1  Component 1 2 3 4 5 6  Total 19.287 1.566 1.243 1.042 0.876 0.796  7 8 9 10 11 12 13 14 15 16 17  0.674 0.625 0.606 0.576 0.539 0.532 0.472 0.451 0.427 • 0.414  18 19 20  0.346 0.318 0.300  21 22  0.289 0.265 0.247  23 24 25 26 27 28 29 30  0.354  0.238 0.211 0.205 0.175 0.168 0.156 0.149  Initial Eigenvalues % of variance Cumulative % 56.73 56.73 4.60 61.33 3.66 64.99 3.06 68.05 2.58 70.63 2.34 72.97 1.98 74.95 1.84 76.79 1.78 78.57 1.69 80.27 1.58 81.85 1.57 83.41 1.39 84.80 1.33 86.13 1.26 87.39 1.22 88.60 1.04 89.65 1.02 0.94  90.66 91.60  0.88 0.85 0.78  92.48 93.33 94.11  0.73  94.84  0.70 0.62 0.60  95.54  0.51 0.50  97.28 97.77  0.46 0.44  98.23 98.67  96.16 96.76  31  0.143  0.42  99.09  32  0.115  0.34  99.43  33  0.100  0.29  99.72  34  0.096  0.28  100.00  20 Table 3 -Factor loadings, item means and standard deviations, Study 1, Phase 1  Item  Factor Loading 0.760  Item Mean 0.670  Standard deviation 0.931  0.735  0.609  0.955  0.727  0.868  1.102  0.720  1.308  1.058  0.748  0.528*  0.931  0.751  0.821  1.000  7. Ordering and arranging take up so much time that I am prevented from doing important activities in my daily life.  0.740  0.420*  0.747  8. It is important that my belongings are placed i n a symmetrical and evenly  0.770  0.623  0.892  9. When I am anxious, I find myself arranging and ordering my surroundings much more than usual.  0.676*  0.835  1.019  10. The wall hangings (pictures, posters, etc.) in my home must be exactly even or straight.  0.624*  1.283  1.150  1. I feel upset if my furniture is not always in exactly the same position. 2. Other people think I spend too much time ordering and arranging my belongings. 3. It is essential that I arrange my clothing i n a particular and specific way. 4. I am more at ease when my belongings are "just right". 5. I cannot go to sleep unless my belongings have been arranged properly. 6. I must keep my papers, receipts, documents, etc. organized according to a specific set of rules.  distributed way.  21 11. If someone accidentally disturbs my belongings - however slightly, I become bothered or upset. 12.1 feel compelled to arrange my possessions until it feels "just right". 13. When I think that my belongings are out of place, I am uncomfortable or anxious. 14. I cannot leave my desk or workspace until it has been arranged so that it is "just right". 15. When I put things away, I feel compelled to do it carefully and precisely. 16. My main problem is that I spend too much time arranging my belongings 17. Putting objects in order helps to calm me down. 18. The furniture in my home must be in exactly the "right" spot. 19.1 feel calm and relaxed only when objects around me are organized and placed correctly. 20.1 feel compelled to arrange cans or boxes of food on my kitchen shelves in a specific way. 21. When I see that my belongings are out of place, I become anxious until I can arrange them properly. 22.1 feel compelled to arrange objects so that they are balanced and evenly spaced. 23. Ordering and arranging take up so much of my time that I am often late for appointments, events, etc. 24.1 am much more concerned about  0.779  0.844  1.028  0.846  0.829  1.037  0.843  0.733  0.995  0.847  0.564*  0.883  0.757  0.844  0.925  0.801  0.415*  0.765  0.685*  0.835  1.024  0.855  0.706  0.941  0.779  0.807  0.991  0.759  0.611  0.957  0.867  0.632  0.912  0.800  0.687  0.950  0.671*  0.332*  0.752  0.812  0.514*  0.857  22 ordering and arranging than is necessary. 25.1 insist that people not touch,my belongings because they might move them out of place. 26.1 feel calm/at ease only when my surroundings are neat and tidy. 27. Even when my home is messy, I keep things organized according to a specific set of rules. 28. Things i n my home have a proper and exact place. 29. If I cannot have all of my belongings i n a properly arranged manner, I feel that something awful might happen. 30.1 cannot concentrate unless things are in the right place. 31. It is sometimes difficult to tell whether or not I have arranged things properly. 32.1 don't like to disturb objects once they are properly arranged. 33. Messiness i n my home always makes me uncomfortable or anxious. 34. Cooking items in my kitchen (e.g. pots, pans, measuring cups) must be arranged i n a particular way.  0.784  0.597*  0.943  0.704  1.000  0.993  0.735  0.925  1.116  0.744  1.142  1.073  0.686*  0.311*  0.707  0.771  0.678  0.838  0.607*  0.613  0.898  0.775  0.807  0.991  0.672*  0.920  0.943  0.687*  0.811  1.041  Items from the original pool with factor loadings of less than 0.7 (items 9, 10, 17, 23, 29, 31, 33 and 34) were removed. Additionally, items with means at or less than 0.6 (items 5, 7, 14, 16, 24 and 25) were deleted  23 in order to produce a scale that will better discriminate between normal and excessive orderers/arrangers.  Convergent and divergent validity  A preliminary analysis of convergent validity was conducted by computing correlations between this new 20-item scale, the MOCI, the VOCI, the "just right" subscale of the VOCI, as well as with the BAI and BDI. Hotelling's t-tests for testing differences between dependant correlations (Hotelling, 1940) indicated that the correlation between the ordering and arranging scale and the MOCI total score (r=0.63, p_<0.001) was greater than the correlation between the ordering scale and the BDI (r=0.40, p<0.001), t(208)=6.24, p_<0.001, and than the correlation between the ordering scale and the BAI (r=0.46, p<0.001), t(208)=3.07, p<0.005. Similarly, the correlation between the ordering scale and the VOCI total score (r=0.74, P<0.001) was significantly greater than the correlation between the ordering scale and the BDI, t(208)=7.40, p<0.001, and than the correlation between the ordering scale and the BAI, t(208)=6.19, p<0.001 . Additionally, the correlation between the ordering scale and the VOCI "just right" subscale score (r=0.77, p<0.001) was significantly greater than the correlation between the ordering scale and the BDI, t(208)=7.95, p<0.001, and than the correlation between the ordering scale and the BAI, t(208)=6.81, p<0.001.  24  Method - Phase 2  The SOAQ (Appendix 2) was distributed to approximately 250 undergraduate psychology students, along with other related questionnaires (MOCI, VOCI). Questionnaires which assess problems that are NOT hypothesized to be related to compulsive ordering and arranging, such as the BDI, the BAI, the Claustrophobia Questionnaire - CLQ (Radomsky et al., in press), the Agoraphobic Cognitions Questionnaire - ACQ (Chambless et al., 1984), and the Body Sensations Questionnaire - BSQ (Chambless et al., 1984) were included in the package. Participants responded to announcements in undergraduate psychology lectures and to signs in the psychology department building indicating where they could obtain questionnaire packages. Participants received course credit for completing the questionnaires.  Participants  There were 190 questionnaire packages returned by psychology undergraduate students (a return rate of 76.0%). 72.3% of the participants  25 who completed the questionnaire packages were female. characteristics are displayed i n Table 4.  Other participant  26 Table 4 -Participant characteristics, Study 1, Phase 2  Mean  SD  Minimum  Maximum  Maximum possible  Age  19.1  1.81  17.0  31.0  BDI  1  11.4  9.00  0.0  49.0  63.0  BAI  2  14.7  10.42  0.0  49.0  63.0  9.8  10.13  0.0  26.0  30.0  0.78  0.56  0.02  2.84  4.00  MOCI  3  Total VOCI  4  Total ACQ  5  26.3  9.16  14.0  57.0  64.0  BSQ  6  37.5  11.10  16.0  64.0  64.0  CLQ  7  32.8  16.85  1.0  88.0  104.0  1 - Beck Depression Inventory 2 - Beck Anxiety Inventory 3 - Maudsley Obsessional Compulsive Inventory 4 - Vancouver Obsessional Compulsive Inventory 5 - Agoraphobic Cognitions Questionnaire 6 - Body Sensations Questionnaire 7 - Claustrophobia Questionnaire  27 Results - Phase 2  Inter-item reliability  The inter-item reliability of the SOAQ was extremely high, Cronbach's a=0.96.  Factor structure  The SOAQ data were subjected to a principal components analysis to confirm the factor structure used in Phase 1. Again, there was strong evidence for a one-factor solution, accounting for 58.5% of the variance. Eigenvalues are displayed i n Table 5. Factor loadings, item means and item standard deviations are displayed in Table 6.  28 Table 5 -Principal components analysis of the SOAQ, Study 1, Phase 2  Component 1 2 3 4 5  Total 11.691 0.992 0.891 0.819 0.654  6 7 8 9 10 11 12 13 14  0.614 0.593 0.495 0.449 0.400  15 16  0.356 0.323 0.312 0.284 0.239 0.222  17  0.203  18 19  0.183  20  Initial Eigenvalues % of variance Cumulative % 58.46 58.46 4.96 63.42 4.45 67.87 4.10 71.96 3.27 75.24 3.07 78.31 2.97 81.27 2.48 2.24 2.00 1.78 1.61 1.56 1.42 1.19  83.75 85.99 87.99 89.78 91.38 92.94 94.36 95.56 96.67  1.11 1.02  97.68  0.155  0.92 0.78  98.60 99.38  0.125  0.62  100.00  29 Table 6 - Factor loadings, item means and standard deviations for the SOAQ, Study 1, Phase 2  Item  Factor Loading 0.758  Item Mean 0.687  Standard deviation 0.901  0.639  0.615  0.849  0.724  0.844  0.999  0.712  1.447  1.132  5. I must keep my papers, receipts, documents, etc. organized according to a specific set of rules.  0.739  1.111  1.121  6. It is important that my belongings are placed i n a symmetrical and evenly distributed way.  0.783  0.838  1.097  7. If someone accidentally disturbs my belongings - however slightly, I become bothered or upset.  0.751  0.888  1.022  8. I feel compelled to arrange my possessions until it feels "just right".  0.844  0.860  1.004  9. When I think that my belongings are out of place, I am uncomfortable or  0.818  0.721  1.017  0.789  0.972  1.046  0.810  0.620  0.931  1. I feel upset if my furniture is not always i n exactly the same position. 2. Other people think I spend too much time ordering and arranging my belongings. 3. It is essential that I arrange my clothing i n a particular and specific way. 4. I am more at ease when my belongings are "just right".  anxious. 10. When I put things away, I feel compelled to do it carefully and precisely. 11. The furniture i n my home must be i n exactly the "right" spot.  30 12.1 feel c a l m a n d relaxed o n l y w h e n  0.756  0.972  1.109  0.692  0.905  0.993  0.873  0.777  1.009  0.794  0.821  1.045  0.764  1.212  1.176  0.770  1.123  1.160  0.754  1.168  1.109  0.793  0.888  1.091  0.689  1.084  1.101  objects a r o u n d me are organized a n d p l a c e d correctly. 13.1 feel c o m p e l l e d to arrange c a n s or boxes of food o n m y k i t c h e n shelves i n a specific way. 14. W h e n I see that m y belongings are out of place, I become a n x i o u s u n t i l I c a n arrange t h e m properly. 15.1 feel c o m p e l l e d to arrange objects so t h a t they are b a l a n c e d a n d evenly spaced. 16.1 feel c a l m / a t ease only w h e n m y s u r r o u n d i n g s are neat a n d tidy. 17. E v e n w h e n m y home is messy, I keep t h i n g s organized a c c o r d i n g to a specific set of r u l e s . 18. T h i n g s i n m y home have a proper a n d exact place. 19. I c a n n o t concentrate u n l e s s t h i n g s are i n the right place. 20.1 don't like to d i s t u r b objects once they are properly arranged.  Convergent a n d divergent validity  Convergent validity was e x a m i n e d t h r o u g h correlations between the S O A Q a n d the V O C I total score (r=0.64, p<0.001), a n d between the S O A Q a n d the V O C I "just right" subscale score (r=0.72, p<0.001). In order to assess divergent validity, these correlations were contr asted w i t h  31 correlations between the S O A Q a n d other scales (e.g., A C Q , B S Q , C L Q , B A I , B D I , etc.). C o r r e l a t i o n s between the S O A Q a n d other self report m e a s u r e s , the B D I (r=0.34, p<0.001), B A I (r=0.44, p<0.001), C L Q (r=0.41, p<0.001), B S Q (r=0.37, p<0.001) a n d A C Q (r=0.37, p<0.001) were significantly lower t h a n those between the S O A Q a n d O C D m e a s u r e s reported above (all Hotelling's t-tests for testing differences between d e p e n d a n t c o r r e l a t i o n s were significant, p_<0.001, a n d are d i s p l a y e d i n Table 7).  32 Table 7 - Hotelling's t-tests for differences between d e p e n d a n t correlations  V O C I Total  V O C I "just right"  1  BDI  2  5.90  7.70  BAI  3  4.31  6.01  CLQ  4  4.11  5.70  ACQ  5  5.65  7.03  BSQ  6  5.16  6.50  1 - V a n c o u v e r O b s e s s i o n a l C o m p u l s i v e Inventory 2 - B e c k D e p r e s s i o n Inventory 3 - B e c k A n x i e t y Inventory 4 - Claustrophobia Questionnaire 5 - Agoraphobic Cognitions Questionnaire 6 - Body Sensations Questionnaire  Table s h o w s Hotelling's t values for c o m p a r i s o n s of d e p e n d a n t correlations between the S O A Q a n d c o l u m n scales, w i t h correlations between the S O A Q a n d row scales. A l l p's<0.001.  33 Normative D a t a  T h i s r a n d o m sample of 190 u n d e r g r a d u a t e s t u d e n t s o b t a i n e d a m e a n of 18.6 w i t h a s t a n d a r d deviation of 16.0 o n the S O A Q . The range of scores o b t a i n e d by t h i s sample was from 0 to 70 w i t h a possible m a x i m u m range from 0 to 8 0 .  Discussion  T h i s s t u d y r e s u l t e d i n the development of the S y m m e t r y , O r d e r i n g a n d A r r a n g i n g Q u e s t i o n n a i r e (SOAQ). It is a 2 0 - i t e m self-report scale t h a t w a s designed to assess o r d e r i n g a n d a r r a n g i n g beliefs a n d b e h a v i o u r . Phase 1 of t h i s s t u d y r e d u c e d a pool of 34 items to the final 20 items a n d provided a p r e l i m i n a r y look at a one-factor structure, very good i n t e r - i t e m reliability, a n d good convergent a n d divergent validity. Phase 2 of t h i s s t u d y confirmed that the S O A Q h a s a strong a n d stable one-factor s o l u t i o n a c c o u n t i n g for a large p o r t i o n of the variance i n the scale. It also c o n f i r m e d that the S O A Q h a s very good inter-item reliability as well as very good convergent a n d divergent validity. Test-retest reliability w i l l be investigated i n S t u d y 2.  34 O f course, there are some l i m i t a t i o n s to this investigation of the p s y c h o m e t r i c properties of the S O A Q . A l l of the p a r t i c i p a n t s u s e d i n the development of the scale were u n d e r g r a d u a t e students, a n d w h i l e some of t h e m c e r t a i n l y c o u l d have been c o m p u l s i v e orderers a n d arrangers, t h i s w a s not a focus of the v a l i d a t i o n . We sought to base the development of t h i s scale o n a n u n d e r g r a d u a t e sample for several reasons. The m o s t i m p o r t a n t one is t h a t o r d e r i n g a n d a r r a n g i n g b e h a v i o u r is h y p o t h e s i z e d to o c c u r o n a c o n t i n u u m . Therefore, we expected to find a wide range of t h i s b e h a v i o u r i n a n u n d e r g r a d u a t e student sample. In fact, the range o b t a i n e d b y t h i s sample (0 to 70) reflects a wide d i s t r i b u t i o n of this b e h a v i o u r i n u n d e r g r a d u a t e students.  A c l i n i c a l v a l i d a t i o n w a s not i n c l u d e d i n the  p r o p o s a l for this project because of the n a t u r a l l y o c c u r r i n g preferences for order a n d s y m m e t r y i n the general p o p u l a t i o n (also see S t u d y 2), a n d because of time c o n s t r a i n t s . V a l i d a t i o n of the S O A Q u s i n g a c l i n i c a l sample of patients w i t h O C D is n o w u n d e r w a y at M a s s a c h u s e t t s G e n e r a l Hospital/Harvard Medical School, i n Boston. The one-factor s o l u t i o n of the S O A Q provides v a l u a b l e i n f o r m a t i o n a b o u t the n a t u r e a n d structure of t h i s behaviour. It is possible to a s s u m e that a preference for order a n d s y m m e t r y is either present i n some degree or absent, a n d is not likely the result of m u l t i p l e beliefs, fears, c o n c e r n s , etc. We chose i n i t i a l items for the scale a n t i c i p a t i n g the p o s s i b i l i t y t h a t there m a y be several d o m a i n s of ordering a n d a r r a n g i n g b e h a v i o u r (e.g., only at  35 home, o n l y i n the k i t c h e n , motivated b y anxiety, motivated b y pleasure, etc.) but, c o n s i s t e n t w i t h o u r hypotheses, there appears to be o n l y one. The u n i t a r y factor s t r u c t u r e of the S O A Q does however w a r r a n t further investigation. It m a y be that the n a t u r e of the p o p u l a t i o n u s e d i n t h i s v a l i d a t i o n of the scale is s u c h that more c o m p l i c a t e d v a r i a n t s or types of o r d e r i n g a n d a r r a n g i n g b e h a v i o u r were not adequately represented a n d t h i s leaves the possibility that a c l i n i c a l v a l i d a t i o n w o u l d r e s u l t i n a different factor s t r u c t u r e .  However, even if only a s m a l l n u m b e r of "different-type"  orderers (e.g., people w i t h only a need for symmetry, people w h o o n l y arrange t h i n g s at home, etc.) were i n the sample, it w o u l d be u n l i k e l y that the single factor s o l u t i o n w o u l d have a c c o u n t e d for as m u c h v a r i a n c e as it did. The S O A Q is strongly correlated w i t h other m e a s u r e s of O C D (e.g., the VOCI) a n d w i t h s y m p t o m s of O C D that are consistent w i t h o r d e r i n g a n d a r r a n g i n g b e h a v i o u r (e.g., the V O C I "just right" subscale). These correlations are significantly larger t h a n those between the S O A Q a n d other scales m e a s u r i n g c o n s t r u c t s less relevant to o r d e r i n g a n d a r r a n g i n g (i.e., c l a u s t r o p h o b i a (CLQ), s y m p t o m s of d e p r e s s i o n (BDI), s y m p t o m s of anxiety (BAI), a n d s y m p t o m s of p a n i c disorder a n d a g o r a p h o b i a ( A C Q , BSQ)). T h i s convergent a n d divergent validity lends s u p p o r t to the specificity of the scale.  36 However, it is of note that the S O A Q w a s significantly correlated w i t h a l l of the scales completed i n t h i s investigation. T h i s result c o u l d be interpreted as i n d i c a t i n g that ordering a n d a r r a n g i n g b e h a v i o u r is a n o n specific c o p i n g strategy for e m o t i o n a l distress; however another interpretation is likely more accurate.  It w o u l d not be s u r p r i s i n g to find  that people w h o engage i n a great deal of ordering a n d a r r a n g i n g b e h a v i o u r are p a r t i c u l a r l y depressed.  In fact, it h a s l o n g been e s t a b l i s h e d t h a t  d e p r e s s i o n is strongly associated w i t h v i r t u a l l y every anxiety disorder, w i t h the possible exception of specific p h o b i a (see B a r l o w , 1988 or C r a s k e , 1999). It w o u l d also not be s u r p r i s i n g to find that i n d i v i d u a l s w h o s p e n d a great deal of time o r d e r i n g a n d a r r a n g i n g their s u r r o u n d i n g s are likely quite a n x i o u s , p a r t i c u l a r l y since we are c o n c e p t u a l i z i n g o r d e r i n g a n d a r r a n g i n g b e h a v i o u r as a c o m p o n e n t of a n anxiety disorder (OCD). The l i n k s between the S O A Q a n d m e a s u r e s of c l a u s t r o p h o b i c - a n d panic-related anxiety however are a bit less straightforward u n t i l one c o n s i d e r s t h a t these m e a s u r e s have c o n s i s t e n t l y correlated w i t h e a c h other i n other investigations (see R a d o m s k y et a l . , i n press). The best likely e x p l a n a t i o n for t h i s is that i n d i v i d u a l s w h o are c h r o n i c a l l y depressed a n d / o r a n x i o u s (i.e., neurotic) exhibit m u l t i p l e a n d diverse s y m p t o m s a n d use m u l t i p l e c o p i n g strategies consistent w i t h d e p r e s s i o n a n d anxiety. T h i s w o u l d i n c l u d e not only p h y s i o l o g i c a l s y m p t o m s of anxiety (as m e a s u r e d by the BAI) b u t also s y m p t o m s of d e p r e s s i o n (as m e a s u r e d by the B D I ) , of O C D  37 (as m e a s u r e d by the M O C I , V O C I a n d S O A Q ) , of p a n i c disorder a n d a g o r a p h o b i a (as m e a s u r e d by the A C Q a n d B S Q ) a n d of c l a u s t r o p h o b i a (as m e a s u r e d b y the C L Q ) . A r e p l i c a t i o n of t h i s p s y c h o m e t r i c a n a l y s i s (particularly the convergent a n d divergent validity analyses) u s i n g a m e a s u r e of n e u r o t i c i s m as a covariate by might be u s e f u l to c o n s i d e r as a possible m e a n s of a d d r e s s i n g this issue. We anticipate that the S O A Q w i l l be useful i n a variety of r e s e a r c h a n d c l i n i c a l a p p l i c a t i o n s i n c l u d i n g m e a s u r i n g treatment progress, e x a m i n a t i o n s of ordering a n d a r r a n g i n g b e h a v i o u r i n n o r m a l a d u l t s , patients w i t h O C D , patients w i t h O C P D , a n d patients w i t h related p r o b l e m s (e.g., eating disorders). W h i l e more p s y c h o m e t r i c d a t a o n the scale is c u r r e n t l y b e i n g collected, there is already good evidence to s u p p o r t its u s e i n the field. It is provided here for p u b l i c use.  Study 2  A i m : The a i m of this experiment is to test the h y p o t h e s i s that people generally have a preference for orderly a n d arranged objects a n d e n v i r o n m e n t s over disorderly objects a n d environments.  Predictions:  1. P a r t i c i p a n t s w i l l indicate a preference for orderly e n v i r o n m e n t s (as depicted i n photographs). 2. P a r t i c i p a n t s w i l l indicate more u n e a s i n e s s a b o u t b e i n g i n d i s o r d e r l y e n v i r o n m e n t s (as depicted i n photographs) t h a n they w i l l a b o u t b e i n g orderly a n d arranged e n v i r o n m e n t s . 3. The degree/ a m o u n t of u n e a s i n e s s i n Prediction 2 w i l l be positively correlated w i t h S O A Q scores.  Method  Participants Seventy-four psychology u n d e r g r a d u a t e s t u d e n t s volunteered to participate i n t h i s study. P a r t i c i p a n t s h a d a m e a n age of 21.3 (SD=4.27) years. 8 1 . 1 % of the p a r t i c i p a n t s were female. O t h e r p a r t i c i p a n t c h a r a c t e r i s t i c s are d i s p l a y e d i n Table 8.  39 Table 8 - Participant characteristics, Study 2  Mean  Standard  Minimum . Maximum  Deviation Post-secondary education  2.47  BDI  1  BAP  1.70  0.0  9.0  11.40  '8.81  0.0  47.0  10.90  9.03  0.0  44.0  1 - Beck Depression Inventory 2 - Beck Anxiety Inventory  Procedure  Participants were asked to sort 60 photographs into one of six piles, indicating how comfortable/uneasy they would feel if they were in the environment depicted in each of the pictures. The piles were labeled "very uncomfortable", "uncomfortable", "slightly uncomfortable", "slightly comfortable", "comfortable", and "very comfortable". Participants were asked to visualize themselves in the scene depicted in each picture before placing it in one of the six piles.  40 P h o t o g r a p h s were r a n d o m l y ordered before b e i n g given to the p a r t i c i p a n t s for s o r t i n g a n d c o n s i s t e d of 15 p a i r s of target items a n d 15 p a i r s of d i s t r a c t o r items. Target items were 30 p h o t o g r a p h s of 15 scenes. E a c h scene w a s p h o t o g r a p h e d i n b o t h a n o r d e r l y / a r r a n g e d c o n d i t i o n a n d a d i s o r d e r l y c o n d i t i o n . D i s t r a c t o r items were 3 0 p h o t o g r a p h s of different objects or scenes, a n d c o n s i s t e d m o s t l y of p h o t o g r a p h s of scenery or r o o m s inside h o u s e s or a p a r t m e n t s . After s o r t i n g the target a n d distractor items, p a r t i c i p a n t s c o m p l e t e d the S O A Q , a n d were a s k e d to r e t u r n i n two week's time to complete it a g a i n (test-retest reliability - see S t u d y 1).  Results  O v e r a l l r a n k i n g s of organized target photographs (M=3.5, SD=0.73) w a s significantly higher t h a n those of d i s o r g a n i z e d target p h o t o g r a p h s (M=2.0, SD=0.79), p a i r e d - s a m p l e s t(73)=14.0, p<0.001. T h i s preference, m e a s u r e d by the difference between the organized target m e a n r a n k a n d the d i s o r g a n i z e d target m e a n r a n k , w a s h i g h l y correlated w i t h S O A Q scores, r=0.57, p < 0 . 0 0 1 , i n d i c a t i n g that p a r t i c i p a n t s w h o scored h i g h e r o n the S O A Q h a d a stronger difference between their r a n k i n g s of o r g a n i z e d a n d d i s o r g a n i z e d target photographs. A more conservative a n a l y s i s of t h i s  r e l a t i o n s h i p was c o n d u c t e d u s i n g a part correlation between S O A Q scores a n d r a n k differences, c o n t r o l l i n g for the influence of r a n k s m a d e of organized targets. T h i s part correlation d e m o n s t r a t e d a s i m i l a r significant r e l a t i o n s h i p , r=0.55, p<0.001.  A scatterplot of r a n k difference scores a n d  S O A Q scores is d i s p l a y e d i n Figure 1.  42 Figure 1 - Scatterplot of degree of preference of ordered target items over disordered target items and SOAQ scores, Study 2  -2  -1  0  1  2  3  4  Difference in rank between ordered and disordered targets  5  43 Test-retest reliability of the S O A Q  Of the 74 p a r t i c i p a n t s w h o completed the S O A Q at the time of s o r t i n g the photographs, 33 r e t u r n e d to complete the S O A Q a m e a n of 16.2 (SD=9.0) d a y s later. Test-retest reliability w a s very h i g h , Pearson's r=0.92, rj<0.001. There were no significant differences between the S O A Q scores of p a r t i c i p a n t s w h o r e t u r n e d to complete the scale a second time (M=20.52, SD=17.40) a n d those w h o d i d not (M=18.58, SD=21.25).  Discussion  R e s u l t s i n d i c a t e d that p a r t i c i p a n t s r a n k e d photographs of organized scenes h i g h e r t h a n photographs of disorganized scenes. T h a t i s , p a r t i c i p a n t s i n d i c a t e d that they w o u l d feel more comfortable / relaxed i n organized e n v i r o n m e n t s t h a n they w o u l d i n disorganized e n v i r o n m e n t s . Moreover, t h i s preference w a s present i n a l l b u t two of the 74 p a r t i c i p a n t s who completed S t u d y 2 (See F i g u r e 1). A d d i t i o n a l l y , the degree of t h i s preference w a s strongly correlated w i t h S O A Q scores, i n d i c a t i n g t h a t increases i n ordering a n d a r r a n g i n g beliefs a n d b e h a v i o u r were a s s o c i a t e d w i t h increases i n the degree to w h i c h p a r t i c i p a n t s preferred the p h o t o g r a p h s of ordered scenes over disordered scenes. T h i s r e l a t i o n s h i p w a s  44  d e m o n s t r a t e d t h r o u g h a s t a n d a r d c o r r e l a t i o n coefficient between S O A Q scores a n d m e a n r a n k difference scores, a n d also t h r o u g h a more conservative part correlation between S O A Q scores a n d difference scores, c o n t r o l l i n g for the variance a t t r i b u t e d to r a n k s of organized p h o t o g r a p h s . These r e s u l t s s u p p o r t the h y p o t h e s i s that there is a general preference for order over d i s o r d e r i n n o r m a l a d u l t s . T h i s preference i s adaptive (imagine a w o r l d w i t h o u t order) a n d it is not s u r p r i s i n g t h a t we find a n a s s o c i a t i o n between disorder a n d discomfort. O f course, it w o u l d be more ecologically v a l i d to have u s e d a c t u a l r o o m s i n ordered a n d d i s o r d e r e d states, a l t h o u g h m u c h less p r a c t i c a l . A d d i t i o n a l l y , it w o u l d have been i n t e r e s t i n g to have a t h i r d type of p h o t o g r a p h , one i n w h i c h the scene w a s only slightly disordered. Target photographs u s e d i n the s t u d y were p a i r s of p h o t o g r a p h s of the same scene i n d r a s t i c a l l y different states. F o r example, one of the organized target items w a s a p h o t o g r a p h of a p p r o x i m a t e l y 1 0 p a i r s of shoes, a l l neatly l i n e d u p i n a row. The d i s o r g a n i z e d target m a t c h i n g t h i s i t e m s h o w e d the same shoes b u t piled r a n d o m l y . S i n c e few of u s live a n d / o r f u n c t i o n i n s u r r o u n d i n g s w h i c h are completely d i s o r d e r e d (with the possible exception of some of the offices i n the K e n n y building), it m i g h t be u s e f u l i n future investigations of t h i s type to i n c l u d e a set of photographs w h i c h show scenes that are only p a r t i a l l y d i s o r d e r e d (e.g., 1 0 p a i r s of shoes, 9 of w h i c h are neatly l i n e d u p i n a row a n d one of w h i c h h a s been set a s k e w or u p s i d e down). T h i s w o u l d provide a n i n d i c a t i o n of h o w  45 sensitive people are to s m a l l a m o u n t s of disorder i n s t e a d of to a l m o s t complete disorder. T h i s s t u d y also d e m o n s t r a t e s a d d i t i o n a l convergent validity of the S O A Q . The fact that S O A Q scores were strongly a n d significantly correlated w i t h the degree of preference of ordered scenes over disordered scenes, whether m e a s u r e d by a s t a n d a r d correlation coefficient or t h r o u g h a more conservative p a r t correlation, indicates that the S O A Q score c a n predict the degree to w h i c h p a r t i c i p a n t s feel relaxed / comfortable w h e n i m a g i n i n g themselves i n scenes of v a r y i n g states of order. F i n a l l y , the S O A Q h a d a n extremely h i g h test-retest reliability coefficient. T h i s is very p r o m i s i n g for the potential use of the S O A Q i n longer t e r m a p p l i c a t i o n s b u t also m i g h t provide a n i n d i c a t i o n of the stability of these types of preferences.  C l i n i c i a n s often report t h a t the t r e a t m e n t of  c o m p u l s i v e orderers a n d arrangers is very difficult a n d slow going c o m p a r e d w i t h the t r e a t m e n t of patients w i t h other subtypes of O C D . W h i l e it h a s been e s t a b l i s h e d that the course of O C D fluctuates a n d cycles over time ( R a c h m a n 8B H o d g s o n , 1980), p e r h a p s the course of c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g concerns is m u c h more stable t h a n that of other subtypes. Alternatively, O C P D , a n A x i s 2 or personality disorder is t h o u g h t to be i n c r e d i b l y stable over time (APA, 1994), a n d p e r h a p s the h i g h test-retest reliability of the scale is s i m p l y a reflection of this. One w a y to resolve these  46  issues would be to examine the test-retest reliability of the scale in a larger sample and over longer periods of time.  Study 3  Aim: The aim of this experiment is to test the hypothesis that people who excessively order and arrange their surroundings are more likely to be disturbed (e.g., feel anxious) when forced to complete a difficult task in disorderly surroundings than are people who do not excessively order and arrange their surroundings. A supplementary aim of this experiment is to test for the presence of a memory bias for threat-relevant information (disorderliness) among people who feel compelled to keep their surroundings orderly and arranged.  Predictions: 1. Participants who score highly on the SOAQ will be more anxious after preparing a difficult task in a disorderly environment than will high SOAQ scoring participants who prepare the task in an orderly environment. 2. This difference in anxiety will not be significant among participants with low SOAQ scores.  47 S u p p l e m e n t a r y predictions: 3. H i g h S O A Q s c o r i n g p a r t i c i p a n t s w i l l r e m e m b e r more threat-relevant i n f o r m a t i o n (groups of objects that were disordered) t h a n threatirrelevant i n f o r m a t i o n (groups of objects that were well ordered a n d arranged). 4. P a r t i c i p a n t s w h o score low o n the S O A Q w i l l not demonstrate t h i s b i a s a n d w i l l recall s i m i l a r a m o u n t s of threat-relevant a n d threat-irrelevant information.  Method  P a r t i c i p a n t s were selected for this experiment b a s e d o n their S O A Q scores. Twenty-four p a r t i c i p a n t s w i t h S O A Q scores greater t h a n 0.5 s t a n d a r d deviations above the normative m e a n were a s s i g n e d to the H i g h S O A Q group, a n d twenty-four p a r t i c i p a n t s w i t h S O A Q scores lower t h a n 0.5 s t a n d a r d deviations below the n o r m a t i v e m e a n were a s s i g n e d to the L o w S O A Q group. A l l p a r t i c i p a n t s completed a s m a l l questionnaire package t h a t i n c l u d e d the V O C I , B D I , a n d the B A I . After c o m p l e t i o n of the q u e s t i o n n a i r e package, p a r t i c i p a n t s were a s k e d to provide a baseline m e a s u r e of anxiety on a subjective u n i t s of distress scale ( S U D S - reported from 0 - 100).  48 P a r t i c i p a n t s were t h e n told to prepare a s m a l l 5 - m i n u t e speech a b o u t a topic of their choice, w h i c h w i l l be presented to a p a n e l of three U n i v e r s i t y of B r i t i s h C o l u m b i a faculty m e m b e r s . P a r t i c i p a n t s were i n f o r m e d that their speech w a s to be graded o n b o t h its content a n d d e l i v e r y / s t y l e . T h e y were told that because this t a s k often p r o d u c e s some anxiety, they w o u l d be given a few m i n u t e s a n d a space i n w h i c h to prepare their speech. P a r t i c i p a n t s were t h e n be t a k e n to a desk i n a r o o m w h i c h h a s either been ordered a n d arranged, or w h i c h h a s been disordered, p r o d u c i n g two c o n d i t i o n s - organized w o r k s p a c e a n d disorganized w o r k s p a c e . Two experimenters verified that the desk w a s i n a n ordered or d i s o r d e r e d state. Regardless of w h i c h w o r k s p a c e c o n d i t i o n the p a r t i c i p a n t w a s a s s i g n e d to, there were four groups of objects o n the w i n d o w s i l l i n front of the desk. Two were organized (e.g., books arranged b y height, c r a y o n s sorted i n box b y colour) a n d two were disorganized (e.g., b o o k s piled r a n d o m l y , c r a y o n s i n r a n d o m pile o u t of box). After 3 m i n u t e s , the experimenter a s k e d p a r t i c i p a n t s to provide another (post-provocation) S U D S r a t i n g to indicate h o w a n x i o u s they were after p r e p a r i n g their speech. P a r t i c i p a n t s were not given i n s t r u c t i o n s about whether or not to alter their w o r k s p a c e , a l t h o u g h they were free to do so. The experimenter t h e n took the p a r t i c i p a n t away from the w o r k s p a c e a n d a s k e d e a c h p a r t i c i p a n t to write a list of a l l objects t h a t were o n the  49 windowsill in front of the desk in the room in w h i c h the speech was prepared. Participants were given 2 minutes to complete this task. Participants in the High S O A Q group were then given a very brief interview to assess their cognitions a n d beliefs about disorderly objects, environments, etc., a n d about why it is important to them to order a n d arrange their surroundings. The structured part of the interview consisted of four questions: 1. W h a t k i n d s of thoughts go through y o u r m i n d while y o u are ordering a n d arranging your surroundings or when y o u are u n a b l e to order or arrange y o u r surroundings? 2. W h y do y o u think y o u engage i n ordering a n d arranging behaviour? 3. W h a t do y o u think would h a p p e n if y o u were unable to order or arrange y o u r surroundings? 4.  Do y o u think that this behaviour is excessive? How m u c h of it do y o u t h i n k is acceptable?  Following each question, the interviewer was free to probe for more details or to ask for more information. Finally, all participants were told that there was no speech to be given a n d were debriefed from the study.  Participants  50 P a r t i c i p a n t s i n t h i s s t u d y h a d a m e a n age of 21.7 (SD=5.5) years. 7 9 . 2 % of p a r t i c i p a n t s were female. O t h e r p a r t i c i p a n t c h a r a c t e r i s t i c s are d i s p l a y e d i n Table 9.  51 Table 9 - P a r t i c i p a n t characteristics, S t u d y 3  Group  S O A Q Score  V O C I Total  VOCI  Score  "just right"  1  BDI  2  BAI  3  Subscale Low S O A Q  High SOAQ  4.75  0.26  0.33  6.22  6.25  (3.00)  (0.33)  (0.42)  (5.13)  (6.58)  44.42  1.09  1.30  16.71  15.13  (12.96)  (0.58)  (0.72)  (10.38)  (11.06)  1 - V a n c o u v e r O b s e s s i o n a l C o m p u l s i v e Inventory 2 - B e c k D e p r e s s i o n Inventory 3 - B e c k A n x i e t y Inventory  Results  B a s e l i n e S U D S ratings for the two groups a n d two c o n d i t i o n s are d i s p l a y e d i n Table 10, a n d a n A N O V A o n these d a t a c o n f i r m t h a t there were significant differences i n baseline S U D S ratings between the two c o n d i t i o n s , F(l,44)=6.26, p_<0.02. Post-provocation S U D S ratings are d i s p l a y e d i n Table 11 a n d i n F i g u r e 2.  Table 10 - B a s e l i n e S U D S ratings, S t u d y 3  Group  Organized workspace Condition Disorganized workspace  Low S O A Q  High SOAQ  4.25  8.33  (7.28)  (7.22)  12.66  16.92  (12.16)  (17.33)  53 Table 11 - Post-provocation S U D S ratings, S t u d y 3  Group  Organized workspace Condition Disorganized workspace  Low S O A Q  High SOAQ  22.92  45.00  (30.01)  (27.80)  21.83  70.00  (13.56)  (14.92)  54 Figure 2 - Post provocation S U D S ratings. S t u d y 3  • Low SOAQ group • High SOAQ group  Organized Room  Disorganized Room  55  B e c a u s e of baseline differences, a 2 (group) by 2 (room condition) between, between A N C O V A was c o n d u c t e d o n post-provocation S U D S m e a n s w i t h baseline S U D S ratings as covariates. Levine's equality of v a r i a n c e test i n d i c a t e d t h a t the a s s u m p t i o n of homogenaity of v a r i a n c e w a s tenable, F(3,44)=2.67, n.s. A d d i t i o n a l l y , there were no v i o l a t i o n s of a s s u m p t i o n s of co-linearity between the covariate a n d the d e p e n d a n t variable, or of p a r a l l e l regression lines w i t h i n each group. R e s u l t s i n d i c a t e d that while p a r t i c i p a n t s i n the H i g h S O A Q g r o u p were significantly more a n x i o u s at post-provocation t h a n were p a r t i c i p a n t s i n the L o w S O A Q group, F(l,43)=25.74, p<0.001, there w a s a significant i n t e r a c t i o n between c o n d i t i o n a n d S O A Q g r o u p , F ( l , 4 3 ) = 5 . 0 0 , p_<0.05. P l a n n e d u n i v a r i a t e one-way A N C O V A ' s confirmed that H i g h S O A Q p a r t i c i p a n t s were significantly more a n x i o u s after h a v i n g to prepare their speech i n a d i s o r g a n i z e d e n v i r o n m e n t t h a n i n a n organized e n v i r o n m e n t , F ( l , 2 1 ) = 5 . 8 9 , p_<0.02, while L o w S O A Q p a r t i c i p a n t s were not, F ( l , 2 1 ) = 2 . 7 1 , n.s.  Memory results  R e c a l l scores for organized items a n d disorganized items, from L o w S O A Q a n d H i g h S O A Q p a r t i c i p a n t s i n the organized w o r k s p a c e a n d  56 d i s o r g a n i z e d w o r k s p a c e c o n d i t i o n s are d i s p l a y e d i n F i g u r e 3. O f a possible total score of 4 for e a c h p a r t i c i p a n t , no single p a r t i c i p a n t achieved a score greater t h a n 1. A 2 (group) by 2 (room condition) by 2 (type of object), between, between, w i t h i n M A N O V A w a s c o n d u c t e d o n these data. were no significant effects f o u n d (all F's <1).  There  57 Figure 3 - Target item recall scores by group and condition, Study 3  2-i  1.81.61.4-  • Organized room Organized items  1.2-  • Organized room Disorganized items  1-  • Disorganized room • Organized items  0.80.6-  • Disorganized room • Disorganized items  0.40.2JZZL  0Low SOAQ  High SOAQ  58 Interview R e s u l t s  The 24 p a r t i c i p a n t s i n the H i g h S O A Q group i n d i c a t e d a n a r r o w range of e x p l a n a t i o n s a n d beliefs associated w i t h their o r d e r i n g a n d a r r a n g i n g b e h a v i o u r . Two p a r t i c i p a n t s i n d i c a t e d that they engaged i n o r d e r i n g a n d a r r a n g i n g b e h a v i o u r because it r e d u c e d feelings of i m p e n d i n g d o o m , a l t h o u g h neither w a s able to indicate a specific threat that they were t r y i n g to prevent. T h e other 22 p a r t i c i p a n t s i n t h i s group reported a variety of s i m i l a r e x p l a n a t i o n s for their o r d e r i n g behaviour. These i n c l u d e d "not feeling right" u n t i l t h i n g s were a r r a n g e d properly, w a i t i n g for a n i n t e r n a l "click" t h a t w o u l d enable t h e m to stop o r d e r i n g a n d a r r a n g i n g , a n d feelings that t h i s type of b e h a v i o u r w o u l d be the only way to reduce general or unspecified anxiety. A l l 24 p a r t i c i p a n t s i n this group reported t h a t they felt that t h i s b e h a v i o u r was s o m e w h a t i r r a t i o n a l , a l t h o u g h a l l of t h e m also reported that some degree of it w a s necessary for anyone to f u n c t i o n well i n their lives.  Discussion  R e s u l t s of t h i s s t u d y confirmed o u r hypothesis that (after a c c o u n t i n g for baseline v a r i a n c e s i n anxiety) people w i t h o u t strong o r d e r i n g c o n c e r n s  59 (Low S O A Q participants) do not report more anxiety about completing a difficult task i n a disordered environment t h a n they do about completing a difficult task i n a n ordered environment. However, people with strong ordering concerns (High S O A Q participants) are significantly more anxious about completing a difficult task (speech preparation) i n a disordered environment t h a n they are after completing the same task i n a n ordered environment. These participants also appear to be significantly more anxious generally t h a n are participants without strong concerns about ordering a n d arranging. Results from the memory portion of the study d i d not confirm o u r hypotheses a n d indicated that participants in both groups were unable to remember m u c h at all (including both ordered a n d disordered groups of objects) from the windowsill i n front of them, regardless of the condition of the room. Incidentally, when told to write a list of all of the groups of objects that were on the windowsill in front of the desk, 4 participants asked, "was there a windowsill there or is this a trick question?" Post-provocation anxiety results are completely consistent with those found i n other subtypes of O C D . It has been well established that compulsive washers become anxious w h e n exposed to contamination, a n d that compulsive checkers become anxious when exposed to doubt or uncertainty about the state of the compulsively checked object.  It is  therefore not s u r p r i s i n g that compulsive orderers a n d arrangers become  60  a n x i o u s w h e n a s k e d to complete a difficult t a s k i n a d i s o r d e r e d e n v i r o n m e n t . However, since the s t u d y of O C D h a s been a l m o s t exclusively l i m i t e d to c o m p u l s i v e w a s h i n g a n d c h e c k i n g (with a few recent c o n t r i b u t i o n s i n the areas of c o m p u l s i v e h o a r d i n g a n d r e p u g n a n t obsessions), it w a s i m p o r t a n t to e s t a b l i s h that the same basic phenomenology applies to c o m p u l s i v e orderers a n d arrangers as well. It is of some c o n c e r n that the baseline differences i n anxiety were not between groups b u t between c o n d i t i o n s that h a d yet to be a s s i g n e d . It h a d been p l a n n e d t h a t baseline anxiety levels w o u l d be u s e d as a covariate i n the a n a l y s e s , b u t w i t h the a s s u m p t i o n t h a t a n y differences w o u l d be between the L o w S O A Q group a n d the H i g h S O A Q group a n d not between p a r t i c i p a n t s w h o were about to prepare a speech at a tidy d e s k a n d those w h o were a b o u t to prepare a speech at a m e s s y desk. T h i s m a y s i m p l y be the r e s u l t of r a n d o m variance i n the p o p u l a t i o n a n d a relatively s m a l l sample size. However, it is also quite possible that o n the w a y to the d e s k where p a r t i c i p a n t s were a s k e d to give their i n i t i a l consent to participate i n the s t u d y a n d to fill out questionnaires, they were able to see the (organized or disorganized) w o r k s p a c e , w h i c h h a d been set u p i n advance. O n e w o u l d have a n t i c i p a t e d t h o u g h , that even if this were the case, it w o u l d have differentially effected the two groups b u t this does not seem to be the case. A r e p l i c a t i o n of t h i s s t u d y w o u l d a l m o s t certainly resolve t h i s i s s u e .  61 R e s u l t s from the brief interview a b o u t cognition a n d beliefs indicate that there m a y be s o m e t h i n g a b o u t c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g b e h a v i o u r that is quite different from other c o m p u l s i v e b e h a v i o u r . In m o s t manifestations of O C D , the p e r s o n engages i n c o m p u l s i v e activity to prevent some dreaded event from o c c u r r i n g ( R a c h m a n 8& H o d g s o n , 1980). C o m p u l s i v e w a s h e r s a n d cleaners are often a t t e m p t i n g to reduce the l i k e l i h o o d of disease or illness. C o m p u l s i v e c h e c k e r s are often a t t e m p t i n g to reduce the l i k e l i h o o d that their stove w i l l cause a fire, that they a c c i d e n t a l l y ran someone over a n d didn't stop, that they have left the water r u n n i n g a n d w i l l r u n u p a large b i l l , etc. E v e n w h a t we k n o w a b o u t other s u b t y p e s of O C D i s c o n s i s t e n t w i t h t h i s c o n c e p t u a l i z a t i o n (e.g., c o m p u l s i v e h o a r d e r s are often t r y i n g to ensure that they w i l l a l w a y s be prepared b y h a v i n g appropriate s u p p l i e s or d o c u m e n t a t i o n , patients w i t h b l a s p h e m o u s o b s e s s i o n s are often t r y i n g to avoid going to hell, etc.). However, t h i s p r e l i m i n a r y investigation of o r d e r i n g a n d a r r a n g i n g h a s s h o w n t h a t t h i s m a y not be the case i n this subtype. It appears as if c o m p u l s i v e orderers a n d arrangers engage i n this b e h a v i o u r as a n anxiety r e d u c i n g t e c h n i q u e b u t not as a threat r e d u c i n g technique. None of the p a r t i c i p a n t s i n the H i g h S O A Q g r o u p were able to articulate a specific threat t h a t w o u l d present itself s h o u l d they be u n a b l e to order a n d arrange their s u r r o u n d i n g s . It i s p o s s i b l e t h a t t h i s r e s u l t s from the u s e of u n d e r g r a d u a t e  students  i n t h i s study; however it is h i g h l y u n l i k e l y that c l i n i c a l manifestations of  62  c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g b e h a v i o u r w o u l d be d r a s t i c a l l y different from t h a t seen i n the H i g h S O A Q group u s e d i n t h i s investigation. It c o u l d be a c o n c e r n to cognitive theorists that there do not appear to be a n y threat related cognitions involved i n c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g , a l t h o u g h t h i s p r e l i m i n a r y investigation is b y no m e a n s definitive. O n e a d d i t i o n a l e x p l a n a t i o n is that i n s t e a d of direct threat-related cognition m a i n t a i n i n g c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g (e.g., "I m u s t keep m y belongings orderly a n d a r r a n g e d or I w i l l never be able to find a n y t h i n g i n m y home"), p e r h a p s there is some k i n d of broader b a s e d m e t a - c o g n i t i o n at w o r k (e.g., " O r d e r i n g a n d a r r a n g i n g m a k e s me feel more i n c o n t r o l of m y life" or " W h e n I order m y belongings, I c a n achieve a sense t h a t t h i n g s are 'just right' "). M e t a - c o g n i t i o n h a s already been i m p l i c a t e d i n generalized anxiety d i s o r d e r (Wells, 1995) as a w a y to justify the excessive w o r r y associated w i t h that disorder (e.g., " W h e n I worry, it m a k e s me feel like I a m h e l p i n g o u t i n some way"). M e t a - c o g n i t i o n is not t h i n k i n g a b o u t the direct r e s u l t of the t h o u g h t s or behaviour; it is a b o u t the i n d i r e c t f u n c t i o n of those t h o u g h t s or b e h a v i o u r . These types of thoughts a n d beliefs were not assessed i n the c u r r e n t s t u d y b u t c o u l d s h e d some light o n o u r u n d e r s t a n d i n g of c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g c o n c e r n s a n d o n the a p p a r e n t l a c k of direct, threat-relevant cognition i n a s s o c i a t i o n w i t h t h i s type of c o m p u l s i v e behaviour.  63 The m e m o r y results of the c u r r e n t s t u d y d i d not c o n f i r m o u r hypotheses.  W h i l e t h i s m a y s i m p l y be the result floor effects (e.g., the t a s k  w a s too difficult), it is more likely because of the design of t h i s p a r t i c u l a r experiment. A t least two studies have confirmed that if ecologically v a l i d s t i m u l i are u s e d that are perceived as p e r s o n a l l y threatening, a m e m o r y b i a s i n O C D is strong a n d detectable ( R a d o m s k y 8B R a c h m a n , 1999; R a d o m s k y , R a c h m a n 8B H a m m o n d , i n press). The c u r r e n t s t u d y w a s likely able to achieve the basic a i m s as far as the s t i m u l i were c o n c e r n e d b u t the provocation u s e d i n the experiment likely h a d a greater effect o n a t t e n t i o n t h a n it d i d o n m e m o r y . It h a s been proposed that i n social a n x i e t y d i s o r d e r (or social phobia), anxiety provocations result i n self-focused attention (Rapee & H e i m b e r g , 1997; Woody, 1996). A s k i n g p a r t i c i p a n t s to prepare a speech to be given to three faculty m e m b e r s is a c o m m o n p r o v o c a t i o n associated w i t h investigations of social anxiety. E v e n t h o u g h the c u r r e n t s t u d y h a d s t i m u l i a n d even a w o r k s p a c e that w o u l d be appropriate to test for p h e n o m e n a associated w i t h c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g , it is quite likely t h a t the provocation u s e d directed p a r t i c i p a n t s ' a t t e n t i o n i n w a r d a n d away from their external e n v i r o n m e n t , l e a d i n g to very poor m e m o r y a b o u t their s u r r o u n d i n g s at the later recall test. U s i n g a n alternate provocation, (e.g., a s k i n g p a r t i c i p a n t s to tidy u p the desk) m i g h t enable better e n c o d i n g a n d s u b s e q u e n t testing of b o t h recall a n d r e c o g n i t i o n m e m o r y associated w i t h t h i s subtype of O C D . It m i g h t also be fruitful to  64 consider a provocation i n w h i c h a r o o m is only slightly disordered (e.g., a very tidy d e s k w i t h a p l a n t tipped over i n one corner) as a m e a n s of e x a m i n i n g the sensitivity of p a r t i c i p a n t s to the degree of disorder i n their s u r r o u n d i n g s a n d its s u b s e q u e n t effects o n information p r o c e s s i n g a n d emotional arousal. O f course, it is also possible t h a t the r e c a l l t a s k w a s s i m p l y too difficult, i n w h i c h case, a recognition test of m e m o r y c o u l d have been u s e d . However, i n a s t u d y w i t h only four groups of objects to be r e m e m b e r e d , a recognition test is quite likely to p r o d u c e ceiling effects.  In o u r previous  w o r k w i t h m e m o r y i n O C D , recall tests were sufficient to detect effects t h a t were quite s t r o n g ( R a d o m s k y & R a c h m a n , 1999; R a d o m s k y , R a c h m a n & H a m m o n d , i n press).  Overall Discussion  T h e three s t u d i e s described above represent a very p r e l i m i n a r y investigation of c o m p u l s i v e ordering a n d a r r a n g i n g behaviour.  The first  s t u d y resulted i n the development of the S y m m e t r y , O r d e r i n g a n d A r r a n g i n g Q u e s t i o n n a i r e (SOAQ), a self-report m e a s u r e w i t h very good i n i t i a l p s y c h o m e t r i c properties, i n c l u d i n g very h i g h inter-item a n d test-retest reliability, a stable one-factor s o l u t i o n , a n d very good convergent a n d divergent validity. The second s t u d y provided a d d i t i o n a l i n f o r m a t i o n o n the  65 validity of the S O A Q , a n d also established that preferences for order are c o m m o n i n n o r m a l adults. The t h i r d s t u d y showed that w h i l e a n x i e t y r e s p o n d i n g i n c o m p u l s i v e ordering a n d a r r a n g i n g is consistent w i t h other subtypes of O C D , the beliefs a n d cognitions associated w i t h o r d e r i n g a n d a r r a n g i n g m a y be somewhat different. A s u p p l e m e n t a r y f i n d i n g of t h i s t h i r d s t u d y w a s that no m e m o r y effects were observed, likely r e s u l t i n g from selffocussed attention o c c u r r i n g i n response to a provocation c o m m o n i n s o c i a l anxiety d i s o r d e r experiments. T h i s last finding provides a d d i t i o n a l s u p p o r t for the u s e of b o t h ecologically v a l i d s t i m u l i A N D provocations i n the s t u d y of m e m o r y i n a s s o c i a t i o n w i t h anxiety disorders (see R a d o m s k y & R a c h m a n , 1999; or R a d o m s k y , R a c h m a n 8s H a m m o n d , i n press). O f course, these investigations have only p a r t i a l l y a n s w e r e d several i m p o r t a n t q u e s t i o n s about ordering a n d a r r a n g i n g b e h a v i o u r a n d have r a i s e d m a n y n e w ones. W h i l e there are some good reasons to expect a single factor associated w i t h m e a s u r e s of ordering a n d a r r a n g i n g b e h a v i o u r , it is possible that a future v a l i d a t i o n of the S O A Q u s i n g c l i n i c a l p o p u l a t i o n s m i g h t prove differently. In a d d i t i o n to reasons to expect a single factor listed above (e.g., c l i n i c a l i m p r e s s i o n s , possible l a c k of threat-related cognitions, u s e of u n d e r g r a d u a t e v a l i d a t i o n sample, etc.), there are n e u r o p s y c h o l o g i c a l models of O C D (see T a l l i s , 1997 for a review) t h a t m i g h t i m p l i c a t e o r d e r i n g a n d a r r a n g i n g b e h a v i o u r as a basic prepared response to  66 disorder. A s s u c h , it w o u l d be difficult to argue that o r d e r i n g a n d a r r a n g i n g b e h a v i o u r s h o u l d be m u l t i f a c t o r i a l . It is reasonable to a s s u m e t h a t there are adaptive preferences for order, as w e l l as for cleanliness, for stability, for confidence, etc. We m i g h t also a s s u m e that a s i m i l a r l y adaptive u n e a s i n e s s o c c u r s w i t h disorder, c o n t a m i n a t i o n , u n c e r t a i n t y a n d even for the basic m o v e m e n t s of reptiles a n d insects (possible carriers of disease). These tendencies w o u l d r e s u l t i n a n i n t e r n a l negative reinforcement of situations where, for example, order replaced disorder, a n d are likely at least p a r t i a l l y a c c o u n t e d for b y genetic a n d n e u r o p s y c h o l o g i c a l factors. The finding that a l l b u t two p a r t i c i p a n t s i n d i c a t e d feeling more relaxed i n ordered s u r r o u n d i n g s t h a n i n d i s o r d e r e d s u r r o u n d i n g s i n the p h o t o g r a p h sorting s t u d y lends s u p p o r t to a b a s i c c a l m n e s s a n d ease i n a s s o c i a t i o n w i t h a n orderly e n v i r o n m e n t . O f course, a genetic a n d / o r n e u r o p s y c h o l o g i c a l a n a l y s i s of prepared responses to d i s o r d e r is not w i t h i n the scope of t h i s investigation; however future studies of t h i s n a t u r e - or even the use of tachistoscopic studies of c o m p a r i s o n s between reactions to ordered a n d disordered scenes - m i g h t provide a n i n d i c a t i o n of h o w basic these processes are to h u m a n f u n c t i o n i n g . The c u r r e n t investigation d i d not examine possible gender differences i n preferences for order. C e r t a i n l y stereotypic d e s c r i p t i o n s of u n d e r g r a d u a t e males tend to indicate that they are m u c h less "tidy" t h a n u n d e r g r a d u a t e females. The development of the S O A Q enables c o n t r o l l e d  67 r e s e a r c h o n gender differences i n this behaviour. These differences were not a focus of the c u r r e n t studies because of o u r interest i n e x a m i n i n g the b a s i c s t r u c t u r e a n d f u n c t i o n of the b e h a v i o u r b u t w o u l d c e r t a i n l y be easy to examine i n future w o r k of this type. O n e i s s u e c o m m o n to c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g t h a t w a s not assessed i n the c u r r e n t set of investigations w a s m e n t a l o r d e r i n g or p r i o r i t i z i n g . It is not u n c o m m o n for patients w i t h these c o n c e r n s to report that they also engage i n a great d e a l of m e n t a l o r d e r i n g or p r i o r i t i z i n g before they c a n begin the p h y s i c a l o r d e r i n g a n d a r r a n g i n g of their s u r r o u n d i n g s . A n investigation of this more c o m p l e x m e n t a l aspect of t h i s b e h a v i o u r w o u l d follow w e l l from the investigations reported above. A l s o p a r t i c u l a r l y relevant to c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g b e h a v i o u r are the concepts of obsessive-compulsive p e r s o n a l i t y d i s o r d e r (OCPD) a n d of perfectionism. It is not u n c o m m o n to hear reports of patients w i t h O C P D w h o engage i n t h i s type of b e h a v i o u r , p a r t i c u l a r l y those w h o e x h i b i t a great deal of perfectionism. O r d e r i n g a n d a r r a n g i n g b e h a v i o u r h a s also been associated w i t h eating disorders ( M a t s u n a g a et a l . , 1999) (another area where perfectionism often plays a c r i t i c a l role). It follows that a perfectionistic style (associated w i t h b o t h O C P D a n d w i t h eating disorders) w o u l d be related to o r d e r i n g a n d a r r a n g i n g b e h a v i o u r . We often associate a sense of t h i n g s being 'just right' w i t h t h i n g s b e i n g 'perfect'. The role of c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g b e h a v i o u r w i l l likely be  68  different, d e p e n d i n g o n the p e r s o n a l significance it h o l d s for the i n d i v i d u a l . In a n eating disorder, for example, it m i g h t be i m p o r t a n t for the p e r s o n to order their food - or even to impose a n order o n their eating meals; i n body d y s m o r p h i c disorder, the order a n d s y m m e t r y w o u l d likely be a s s o c i a t e d w i t h the person's appearance; etc. It w o u l d not be s u r p r i s i n g to find that the form of o r d e r i n g a n d a r r a n g i n g b e h a v i o u r i n a s s o c i a t i o n w i t h these other disorders a n d personality styles is m u c h like that observed i n obsessive-compulsive disorder; however there are likely to be great differences i n the function  of  t h i s b e h a v i o u r i n these other groups. M o r e specifically, o r d e r i n g a n d a r r a n g i n g i n the context of O C D m i g h t serve the f u n c t i o n of a n e x t e r n a l search for i n t e r n a l feelings or cues of c e r t a i n l y a n d safely, whereas i n O C P D a n d perfectionism, it m i g h t serve the function of p r o v i d i n g e x t e r n a l a n d objective i n d i c a t i o n s of correctness.  O f course, there is overlap here as  there is between the two disorders, b u t a proper f u n c t i o n a l a n a l y s i s of o r d e r i n g a n d a r r a n g i n g b e h a v i o u r w i t h i n the disorder i n q u e s t i o n is likely to be m o s t fruitful i n e x p l a i n i n g its n a t u r e a n d function. These i s s u e s are e m p i r i c a l i n n a t u r e a n d w o u l d be best addressed by e x p e r i m e n t a l a n a l y s e s of o r d e r i n g a n d a r r a n g i n g b e h a v i o u r i n different n o r m a l a n d c l i n i c a l populations. A n o t h e r relevant issue here is the d i s t i n c t i o n between categorical a n d d i m e n s i o n a l c o n c e p t u a l i z a t i o n s of this behaviour. In these studies,  69  c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g have been d i s c u s s e d i n t e r m s of a d i m e n s i o n a l a p p r o a c h , a l t h o u g h it is possible to c o n s i d e r the b e h a v i o u r from a categorical perspective. We found it helpful to conceptualize the p r o b l e m a l o n g a c o n t i n u u m i n order to help u s reconcile b o t h n o r m a l a n d a b n o r m a l o r d e r i n g a n d a r r a n g i n g behaviour. O f course, it is posible to m a k e t h i s d i s t i n c t i o n a categorical one, b u t we feel that there is a great degree of v a r i a n c e i n the a m o u n t of order that different people prefer a n d that t h i s is best represented by a d i m e n s i o n a l m o d e l . O t h e r u s e f u l follow-ups, i n a d d i t i o n to the ones suggested above, i n c l u d e possible investigations of the r e l a t i o n s h i p s between some of the factors that have been established i n other subtypes of O C D (e.g., inflated responsibility, t h o u g h t - a c t i o n fusion, n e u t r a l i z a t i o n , etc.) a n d b e h a v i o u r s associated w i t h c o m p u l s i v e orderers a n d arrangers.  O n e w o u l d expect t h a t  i n a d d i t i o n to these factors, a need for c o n t r o l a n d / o r certainty m i g h t be p a r t i c u l a r l y relevant to o r d e r i n g a n d a r r a n g i n g a n d provocations w h i c h r e s u l t i n a l a c k of c o n t r o l or i n u n c e r t a i n t y m i g h t lead to amplified o r d e r i n g a n d a r r a n g i n g b e h a v i o u r i n these i n d i v i d u a l s . Before these projects c a n be u n d e r t a k e n t h o u g h , there is a need for a r e p l i c a t i o n of the above findings i n a c l i n i c a l p o p u l a t i o n . A d d i t i o n a l b e h a v i o u r a l experiments that elicit the u n e a s i n e s s d e m o n s t r a t e d here t h r o u g h p l a c i n g p a r t i c i p a n t s i n disordered s u r r o u n d i n g s are l i k e l y to be quite fruitful.  There w o u l d also be m u c h to be learned from a careful  70 e x a m i n a t i o n of the strategies a n d r u l e s b y w h i c h these people arrange their s u r r o u n d i n g s . W h a t are the v i s u a l a n d n o n - v i s u a l cues t h a t indicate that sufficient order h a s been achieved? A r e they s i m i l a r or different from those of n o r m a l p a r t i c i p a n t s ? Investigations of these i s s u e s w i l l likely provide a d d i t i o n a l i n f o r m a t i o n about the n a t u r e of the b e h a v i o u r b o t h i n n o r m a l a d u l t s a n d i n p o p u l a t i o n s of people w h o are greatly t r o u b l e d by their need for t h i n g s to be ordered, arranged, s y m m e t r i c a l a n d 'just right'. The w o r k reported here is very p r e l i m i n a r y b u t h a s already p r o v i d e d some b a s i s for u n d e r s t a n d c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g p r o b l e m s i n O C D , i n other disorders, a n d i n the n o r m a l a d u l t p o p u l a t i o n . U l t i m a t e l y , the largest gains i n o u r u n d e r s t a n d i n g of this b e h a v i o u r w i l l be from a testable m o d e l . It seems likely that s u c h a m o d e l of o r d e r i n g a n d a r r a n g i n g b e h a v i o u r w i t h i n the context of O C D w i l l i n c l u d e e x p l a n a t i o n s of the n o r m a l r e w a r d i n g value of ordered s u r r o u n d i n g s , a need for certainty, the c o n n e c t i o n between external order a n d i n t e r n a l sensations of t h i n g s being 'just right', a n d the apparent l a c k of associated threat-relevant cognitions. O n c e s u c h a m o d e l h a s been proposed, perhaps along cognitive b e h a v i o u r a l lines, careful h y p o t h e s i s testing w i l l hopefully result i n s u b s e q u e n t modifications of i n i t i a l c o n c e p t u a l i z a t i o n s of t h i s b e h a v i o u r a n d i n a better u n d e r s t a n d i n g of the n a t u r e a n d f u n c t i o n of c o m p u l s i v e o r d e r i n g a n d a r r a n g i n g i n n o r m a l a n d a b n o r m a l h u m a n behaviour.  71 O f c o u r s e , i s s u e s relevant to o r d e r i n g a n d a r r a n g i n g o c c u r i n m a n y other d i s c i p l i n e s . In different governments, c u l t u r e s a n d societies, the a m o u n t of 'order' i n the h i e r a r c h i c a l s t r u c t u r e of the society varies a great deal. O n e h a s o n l y to c o n s i d e r the c u l t u r e of the m i l i t a r y to appreciate the role of 'order' o n d a i l y life. A d d i t i o n a l l y , i n art (architecture, p a i n t i n g , dance, etc.) there is v a r y i n g e m p h a s i s o n order a n d s y m m e t r y . These more political, c u l t u r a l a n d p h i l o s o p h i c a l i s s u e s , while not e x a m i n e d directly i n this d i s s e r t a t i o n , a l l represent related a n d relevant areas of o r d e r i n g a n d a r r a n g i n g preferences i n o u r lives.  72 References  A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n . (1994). D i a g n o s t i c a n d s t a t i s t i c a l m a n u a l of m e n t a l d i s o r d e r s ( 4  th  Ed.). Washington, D C : American  P s y c h i a t r i c Press. B a e r , L . (1994). F a c t o r a n a l y s i s of s y m p t o m subtypes of obsessivec o m p u l s i v e disorder a n d their relation to personality a n d tic disorders. J o u r n a l of C l i n i c a l P s y c h i a t r y , 5 5 , 18-23. Barlow, D . H .  (1988). A n x i e t y a n d its disorders. NY: G u i l f o r d .  B e c k , A . T . , & Steer, R . A . (1990). B e c k A n x i e t y Inventory M a n u a l . Toronto: Psychological Corporation. B e c k , A . T . , Steer, R . A . , 8s G a r b i n , M . G . (1996). B e c k D e p r e s s i o n Inventory Manual (2  n d  ed.). S a n A n t o n i o : P s y c h o l o g i c a l C o r p o r a t i o n .  C h a m b l e s s , D . , C a p u t o , G . , B r i g h t , P., 8s Gallagher, R. (1984).  Assessment  of fear i n agoraphobics: The B o d y S e n s a t i o n s Q u e s t i o n n a i r e a n d the A g o r a p h o b i c C o g n i t i o n s Q u e s t i o n n a i r e . J o u r n a l of C o n s u l t i n g a n d C l i n i c a l Psychology, 5 2 , 1 0 9 0 - 1 0 9 7 . Craske, M . G .  (1999). A n x i e t y disorders. B o u l d e r : Westview Press.  de S i l v a , P . , 8& R a c h m a n , S. (1998). Obsessive c o m p u l s i v e disorder: T h e facts ( 2  n d  Ed.). Oxford: Oxford U n i v e r s i t y Press.  F a i r b u r n , C . 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A m e r i c a n J o u r n a l of P s y c h i a t r y , 154, 911-917.  M a t s u n a g a , H . , K i r i i k e , N . , I w a s a k i , Y . , M i y a t a , A . , Y a m a g a m i , S., 8& Kaye, W.H.  (1999). C l i n i c a l characteristics i n patients w i t h a n o r e x i a  n e r v o s a a n d obsessive-compulsive disorder. P s y c h o l o g i c a l M e d i c i n e , 29, 407-414. Meyer, V . (1966). The modification of expectations i n cases w i t h o b s e s s i o n a l r i t u a l s . B e h a v i o u r R e s e a r c h 66 Therapy, 4, 2 7 3 - 2 8 0 . M u r i s , P., M e r k e l b a c h , H . , 8B C l a v a n , M . (1997). A b n o r m a l a n d n o r m a l c o m p u l s i o n s . B e h a v i o u r R e s e a r c h 8B Therapy, 3 5 , 2 4 9 - 2 5 2 . Pigott, T.A. (1998). O b s e s s i v e - c o m p u l s i v e disorder: S y m p t o m overview a n d epidemiology. B u l l e t i n of the M e n n i n g e r C l i n i c , 6 2 , A 4 - A 3 2 . R a c h m a n , S. (1997). A cognitive theory of obsessions.  Behaviour Research  8B Therapy, 3 5 , 7 9 3 - 8 0 2 . R a c h m a n , S. (1998). A cognitive theory of obsessions: E l a b o r a t i o n s . B e h a v i o u r R e s e a r c h 8B Therapy, 36. R a c h m a n , S., 8B de S i l v a , P. (1978). A b n o r m a l a n d n o r m a l obsessions. B e h a v i o u r R e s e a r c h 8B Therapy, 16, 2 3 3 - 2 4 8 . R a c h m a n , S., 8B H o d g s o n , R . J . (1980). O b s e s s i o n s a n d c o m p u l s i o n s . N J : Prentice-Hall. R a c h m a n , S., 8B Taylor, S. (1993). A n a l y s e s of C l a u s t r o p h o b i a . J o u r n a l of A n x i e t y D i s o r d e r s , 7, 2 8 1 - 2 9 1 .  75 R a d o m s k y , A . S . , 8B R a c h m a n , S. (1999). M e m o r y bias i n obsessivec o m p u l s i v e disorder (OCD). B e h a v i o u r R e s e a r c h 8B T h e r a p y , 37(7), 605-618. R a d o m s k y , A . S . , R a c h m a n , S., 8B H a m m o n d , D . (in press). R e s p o n s i b i l i t y , confidence a n d m e m o r y i n c o m p u l s i v e c h e c k i n g . B e h a v i o u r R e s e a r c h 8& T h e r a p y . R a d o m s k y , A . S . , R a c h m a n , S., T h o r d a r s o n , D . S . , M c l s a a c , H . K . , 8B T e a c h m a n , B . A . (in press). The C l a u s t r o p h o b i a Q u e s t i o n n a i r e (CLQ). J o u r n a l of A n x i e t y D i s o r d e r s . Rapee, R . M . , 8B H e i m b e r g , R . G . (1997). A cognitive-behavioral m o d e l of anxiety i n s o c i a l p h o b i a . B e h a v i o u r R e s e a r c h 8B Therapy, 3 5 , 741 756. R a s m u s s e n , S., 8B E i s e n , J . (1992). The epidemiology a n d c l i n i c a l features of obsessive-compulsive disorder. P s y c h i a t r i c C l i n i c s of N o r t h A m e r i c a , 15, 7 4 3 - 7 5 8 . R o d i n , J . (1977). R e s e a r c h o n eating behavior a n d obesity: W h e r e does it fit i n personality a n d social psychology? Personality a n d S o c i a l Psychology B u l l e t i n , 3, 3 3 3 - 3 5 5 . S a l k o v s k i s , P . M . (1985). O b s e s s i o n a l - c o m p u l s i v e problems: A cognitiveb e h a v i o u r a l a n a l y s i s . B e h a v i o u r R e s e a r c h 8B Therapy, 2 7 , 6 7 7 - 6 8 2 . S a l k o v s k i s , P . M . , 8B H a r r i s o n , J . (1984). A b n o r m a l a n d n o r m a l obsessions: A r e p l i c a t i o n . B e h a v i o u r R e s e a r c h 8B Therapy, 2 2 , 5 4 9 - 5 5 2 .  S a s s o n , Y . , Z o h a r , J . , C h o p r a , M . , L u s t i g , M . , I a n c u , I., 8s H e n d l e r , T. (1997). E p i d e m i o l o g y of obsessive-compulsive disorder: A w o r l d view. J o u r n a l of C l i n i c a l P s y c h i a t r y , 58, 7-10. Summerfeldt, L . J . , R i c h t e r , M . A . , A n t o n y , M . M . , 8B S w i n s o n , R . P . (1999). S y m p t o m s t r u c t u r e i n obsessive-compulsive disorder: A confirmatory factor-analytic study. B e h a v i o u r R e s e a r c h 8B Therapy, 37, 2 9 7 - 3 1 1 . T a l l i s , F . (1997). The neuropsychology of obsessive-compulsive disorder: A review a n d c o n s i d e r a t i o n of c l i n i c a l i m p l i c a t i o n s . B r i t i s h J o u r n a l of C l i n i c a l Psychology, 36, 3-20. T h o r d a r s o n , D . S . , R a d o m s k y , A . S . , R a c h m a n , S., S a w c h u k , C , 8s S h a f r a n , R. (1993). The V a n c o u v e r Obsessive C o m p u l s i v e Inventory. Vancouver: R a c h m a n Fear Lab, U B C . T u r n e r , S . M . , B e i d e l , D . C , D a n c u , C . V . , 8B Stanley, M . A . (1989). A n e m p i r i c a l l y derived inventory to m e a s u r e s o c i a l fears a n d anxiety: The S o c i a l P h o b i a a n d A n x i e t y Inventory. P s y c h o l o g i c a l A s s e s s m e n t : A J o u r n a l of C o n s u l t i n g a n d C l i n i c a l Psychology, 1_, 3 5 - 4 0 . Valleni-Basile, L.A., Garrison, C.Z., J a c k s o n , K . L . , Waller, J . L . , McKeown, R . E . , A d d y , C . L . , 8s Cuffe, S.P. (1994). F r e q u e n c y of obsessivec o m p u l s i v e disorder i n a c o m m u n i t y sample of y o u n g adolescents. J o u r n a l of the A m e r i c a n A c a d e m y of C h i l d 8s A d o l e s c e n t P s y c h i a t r y , 33, 782-791.  77 Wells, A . (1995). M e t a - c o g n i t i o n a n d worry: A cognitive m o d e l of generalized anxiety disorder. B e h a v i o u r a l a n d Cognitive Psychotherapy. 23, 301-320. W i l h e l m , S. (2000). P e r s o n a l c o m m u n i c a t i o n . Wolpe, J . (1958). P s y c h o t h e r a p y by r e c i p r o c a l i n h i b i t i o n . Stanford: Stanford U n i v e r s i t y Press. Woody, S.R. (1996). Effects of attention o n anxiety levels o n s o c i a l performance of i n d i v i d u a l s w i t h s o c i a l p h o b i a . J o u r n a l of A b n o r m a l Psychology. 105. 6 1 - 6 9 .  78 A p p e n d i x I - Items from S t u d y 1, Phase 1  1.  I feel u p s e t if m y furniture is not always i n exactly the same p o s i t i o n .  2.  O t h e r people t h i n k I s p e n d too m u c h time ordering a n d a r r a n g i n g m y belongings.  3.  It is e s s e n t i a l that I arrange m y c l o t h i n g i n a p a r t i c u l a r a n d specific way.  4.  I a m more at ease w h e n m y belongings are "just right".  5.  I c a n n o t go to sleep u n l e s s m y belongings have been a r r a n g e d properly.  6.  I m u s t keep m y papers, receipts, d o c u m e n t s , etc. organized a c c o r d i n g to a specific set of rules.  7.  O r d e r i n g a n d a r r a n g i n g take u p so m u c h time t h a t I a m prevented from d o i n g i m p o r t a n t activities i n m y daily life.  8.  It is i m p o r t a n t t h a t m y belongings are p l a c e d i n a s y m m e t r i c a l a n d evenly d i s t r i b u t e d way.  9.  W h e n I a m a n x i o u s , I find myself a r r a n g i n g a n d o r d e r i n g m y s u r r o u n d i n g s m u c h more t h a n u s u a l .  10. The w a l l h a n g i n g s (pictures, posters, etc.) i n m y home m u s t be exactly even or straight. 11. If someone a c c i d e n t a l l y d i s t u r b s m y belongings - however slightly, I become bothered or upset. 12.1 feel c o m p e l l e d to arrange m y possessions u n t i l it feels "just right".  79 13. W h e n I t h i n k that m y belongings are out of place, I a m uncomfortable or anxious. 14.1 cannot leave m y desk or workspace u n t i l it has been arranged so that it is "just right". 15. W h e n I p u t things away, I feel compelled to do it carefully a n d precisely. 16. M y m a i n problem is that I spend too m u c h time arranging m y belongings 17. Putting objects i n order helps to c a l m me down. 18. T h e furniture i n m y home m u s t be i n exactly the "right" spot. 19.1 feel c a l m a n d relaxed only when objects a r o u n d me are organized a n d placed correctly. 20.1 feel compelled to arrange cans or boxes of food on m y k i t c h e n shelves in a specific way. 21. W h e n I see that m y belongings are out of place, I become anxious u n t i l I c a n arrange them properly. 22.1 feel compelled to arrange objects so that they are balanced a n d evenly spaced. 23. Ordering a n d arranging take u p so m u c h of m y time that I a m often late for appointments, events, etc. 24.1 a m m u c h more concerned about ordering a n d arranging t h a n is necessary.  80 25.1 i n s i s t that people not t o u c h m y belongings because they m i g h t move t h e m o u t of place. 26.1 feel c a l m / a t ease only w h e n m y s u r r o u n d i n g s are neat a n d tidy. 27. E v e n w h e n m y home is messy, I keep things organized a c c o r d i n g to a specific set of r u l e s . 2 8 . T h i n g s i n m y h o m e have a proper a n d exact place. 29. If I c a n n o t have a l l of m y belongings i n a properly a r r a n g e d m a n n e r , I feel t h a t s o m e t h i n g awful m i g h t h a p p e n . 30.1 c a n n o t concentrate u n l e s s things are i n the right place. 3 1 . It is sometimes difficult to tell w h e t h e r or not I have a r r a n g e d t h i n g s properly. 32.1 don't like to d i s t u r b objects once they are properly arranged. 3 3 . M e s s i n e s s i n m y h o m e a l w a y s m a k e s me uncomfortable or a n x i o u s . 34. C o o k i n g items i n m y k i t c h e n (e.g. pots, p a n s , m e a s u r i n g cups) m u s t be a r r a n g e d i n a p a r t i c u l a r way.  81  A p p e n d i x 2 - The S O A Q Please circle a number from 0 to 4 to indicate how much you agree with each statement:  I feel upset if my furniture or other possessions are not always in exactly the same position. 2. Other people think I spend too much time ordering and arranging my belongings. 3. It is essential that I arrange my clothing in a particular and specific way. 4. I am more at ease when my belongings are "just right". 5. I must keep my papers, receipts, documents, etc. organized according to a specific set of rules. 6. It is important that my belongings are placed in a symmetrical and evenly distributed way. 7. If someone accidentally disturbs my belongings however slightly, I become bothered or upset. 8. I feel compelled to arrange my possessions until it feels "just right". 9. When I think that my belongings are out of place, I am uncomfortable or anxious. 10. When I put things away, I feel compelled to do it carefully and precisely. 11. The furniture in my home must be in exactly the "right" spot. 12.1 feel calm and relaxed only when objects around me are organized and placed correctly. 13.1 feel compelled to arrange cans or boxes of food on my kitchen shelves in a specific way. 14. When I see that my belongings are out of place, I become anxious until I can arrange them properly. 15.1 feel compelled to arrange objects so that they are balanced and evenly spaced. 16.1 feel calm/at ease only when my surroundings are neat and tidy. 17. Even when my home is messy, I keep things organized according to a specific set of rules. 18. Things in my home have a proper and exact place. 1.  19.1 cannot concentrate unless things are in the right place. 20.1 don't like to disturb objects once they are properly arranged.  Not at all  Sligh tly  Moder ately  Very  Extre mely  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  

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