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Maudsley Obsessional-Compulsive Inventory: Obsessions and

compulsions in a nonclinical sample

Article  in  Behaviour Research and Therapy · February 1990

DOI: 10.1016/0005-7967(90)90086-X · Source: PubMed

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Be/m. Rex. Thher. Vol. 28. No. 1. pp. 337-340. 1990 0005-7967 90 53.00 + 0.00
Pnnted in Great Britain. All nghts reserved Copyright C 1990 Pergamon Press plc

CASE HISTORIES AND SHORTER COMMUNICATIONS

Maudsley Obsessional-Compulsive Inventory: obsessions and compulsions in a

nonclinical sample

LEE G. STERNBERGER and G. LEONARDBURNS*

Department ofPsychology, Washington State University. Pullman. WA 991664820. U.S.A.

(Receiced 22 February 1990)

Summary-Obsessive<ompulsive disorder is increasingly being studied in nonclinical samples. The

self-report instruments used to select these samples, however, have not been validated with a diagnostic
interview. This study thus investigated the predictive validity of the Maudsley Obsessional-Compulsive
Inventory (MOCI) using the Anxiety Disorders Interview Schedule (ADIS), a semi-structured interview
created according to DSM-III guidelines. Four sections of the AD&-generalized anxiety disorder, simple
phobia. social phobia and obsessive<ompulsive disorder-were administered to I I individuals who scored
in the top 2% and I I individuals who scored in the normal range of the MOCI 6-7 months prior to the
interview. High nonclinical MOCI scorers reported more frequent and severe obsessions and compulsions
as well as greater disturbance by these symptoms. In addition, the high MOCI group experienced more
general worry and interference from worry, and more frequent and severe physiological symptoms when
they worry. However, the two groups did not differ in terms of simple and social phobia symptoms. High
MOCI scorers thus did not report a broad range of anxiety symptoms or fears, but specific obsessions
and compulsions. These results provide further support for the validity of the MOCI in nonclinical samples
over a 67 month interval.

The development of a variety of measurement procedures for obsessive-compulsive disorder (OCD) (Mavissakalian &
Barlow. 1981) has resulted in the study of OCD symptoms in both clinical and nonclinical samples (e.g. Salkovskis
& Harrison, 1984: Sher, Frost & Otto. 1983). While OCD appears to have a 2-3% lifetime prevalence rate (Rasmussen
& Tsuang, 1986). the research also suggests a significant percentage of the general population experiences obsessive
thoughts and performs compulsive behavior. For example, Rachman and de Silva (1978) found normal obsessions
to be similar to abnormal obsessions in meaningfulness to the individual, in form, and to some extent content
when comparing OCD patients to nonclinical individuals. Normal obsessions were, however, more easily dismissed,
shorter, less frequent. less intense, and produced less discomfort. In a replicaton of this study, Salkovskis and
Harrison (1984) found 88% of their nonclinical sample experienced intrusive cognitions. These researchers also found
higher levels of discomfort were significantly associated with more difficulty in dismissing the obsession in their nonclinical
sample.
Sher and colleagues (Sher et al., 1983; Sher, Mann & Frost, 1984) found college students who scored high on the Maudsley
Obsessive-Compulsive Inventory (MOCI) checking subscale reported a greater frequency of everyday checking behaviors
than students low on the checking subscale. These researchers also reported that nonclinical checkers experience more
problems (e.g. depression, general anxiety. fears relating to social and interpersonal situations and fears of harm or danger)
and manifest certain memory deficits, including poor memory for prior actions (Frost. Sher & Green. 1986; Sher et al.,
1983. 1984).
While there is evidence that nonclinical samples show aspects of OCD, no study to our knowledge has examined the
phenomenology of OCD in nonclinical samples through the use of a diagnostic interview. All of the studies have employed
self-report inventories such as the MOCI to select individuals high on the inventory for subsequent study. Though the results
from these studies are promising, it is nonetheless important to examine further the validity of these various self-report
inventories of OCD through the use of a diagnostic interview. Such a study would provide additional evidence on the
appropriateness of the MOCI in the selection of nonclinical samples to study OCD.
The Anxiety Disorders Interview Schedule (ADIS) (DiNardo, O’Brien, Barlow, Waddel & Blanchard. 1983) is the only
available interview schedule specific to DSM-III anxiety disorders. This 90min semi-structured interview schedule was
developed to provide a differential diagnosis among the anxiety disorders, to rule out other mental disorders, and to collect
additional information. DiNardo et al. (1983) examined the discriminative power and accuracy of the ADIS with 60 anxiety
disorder outpatients and found good agreement among raters for specific anxiety disorders. The ADIS accordingly allows
differential diagnosis of the anxiety disorders from other mental disorders and distinguishes between specific anxiety
disorders.
The purpose of this study was therefore to examine the predictive validity of the MOCI in the nonclinical population
through the use of the ADIS. Four sections of the ADIS were administered to individuals who scored high on MOCI (> 2
SD above the mean) and individuals who scored in the normal range. These four sections were the obsessive-compulsive
disorder, the generalized anxiety disorder, the simple phobia and the social phobia sections. The generalized anxiety disorder
section was administered to examine general anxiety and associated physiological symptoms while the simple and social

*To whom all correspondence should be addressed.

337
338 CASE HISTORIES AND SHORTER COMMUNICATIONS

phobia sections were given to ascertain the specificity of the MOCI. That is, high scorers on the MOCI were expected to
report moreOCD symptoms than the comparison group while the two groups were not expected to differ in terms of simple
and social phobias. Prior research with clinical and nonclinicat samples (Frost et nl., 1986) also suggested that the OCD
group would report more symptoms of GAD than the comparison group. The purpose of the study was thus to determine
the predictive validity of the MOCI through the use of the ADIS and therefore to provide information on the differences
between high and low MOCI scorers in terms of OCD symptoms, general anxiety and physiological symptoms as well as
the specificity of the response pattern. Moreover, the study sought to determine if such differences would be found over
a 67 month interval.

METHOD

Subjecrs
The Ss were recruited from introductory psychology classes at Washington State University as part of an earlier study
(Sternberger & Burns, 1990). For the earlier study the 579 Ss were administered the MOCI (Hodgson & Rachman, 1977).
Compulsive Activity Checklist (Freund, Steketee & Foa, 1987) and the Symptom Checklist-90-Revised (Derogatis, 1983).
Individuals with MOCI scores in the top 2% and individuals with MOCI scores at the 50th percentile were selected to
complete the ADIS interview 6-7 months after the original administration of the questionnaires. A total of I4 people scored
in the top 2% of the MOCI distribution. Of these 14 people, 13 were Caucasian and 12 of these 13 had given their permission
earlier to be contacted for the second study. When contacted 6-7 months later, I I of these 12 people agreed to take part
in the second study. The comparison group was matched to the OCD group by age and gender. There were thus 11
individuals in the OCD group and II in the comparison group with 64% of both groups being female. The mean age for
both groups was 18.36 (SD = 0.51).

Measures
Ansiery Disorders Inrewiew ~c~eda~e. For the present study we chose to administer four parts of the ADIS: (I)
Generalized Anxiety Disorder (GAD); (2) Simple Phobia; (3) Social Phobia; and (4) Obsessive-Compulsive Disorder. Each
section reviews the diagnostic criteria for the particular anxiety disorder. The GAD, simple and social phobia sections were
administered first to provide time for the participants to become comfortable before the completion of the OCD section.
Maudsley Obsessiona/-Compulsir’e inrenror.v. The MOCI (Hodgson & Rachman, 1977) is a 30-item true-false scale. A
total score as well as washing (1 I items), checking (9 items), slowness (7 items) and doubting (7 items) subscale scores may
be determined. The MOCI is considered to provide a self-report measure of the number of obsessive+zompulsive behaviors.

Procedwrs
The Ss were administered the four sections of the ADIS-GAD. simple phobia, social phobia and OCD with each
interview lasting 25113 min. The interviewer was unaware of the group membership of the student. The students were then
debriefed. paid S10.00 and thanked for their time.

RESULTS

Reliability of .ADIS
A second individual scored 36% of the ADIS interviews from the audiotape recordings (4 randomly selected from the
OCD group and 4 from the comparison group). There were a total of 61 questions on the ADIS interview relevant to the
current study (5 from the OCD section, 20 from the GAD section, 14 from the simple phobia section and 22 from the
social phobia section). A total of 58 of the questions were judged on a quantitative scale (j-point scale) with the other 3
being on a qualitative scale (i.e. ‘yes’ or ‘no’). The calculation of the percent agreement score between the two judges
required an exact match to count as an agreement. The average percent agreement for the 61 questions was 97% (range
75-1009/o), indicating adequate agreement between the interviewer and second individual.

The mean MOCI score for the OCD was 18.55 (SD = 1.51; range 18-22) and for the comparison group 5.00 (SD = 0.00).
The MOCI mean for the OCD group was 2.56 standard deviations above the total sample mean (M = 7.58, SD = 4.28,
N = 579). while the mean for the comparison group was at the 50th percentile. The MOCI mean of 18.55 for our OCD
group was similar to the MOCI mean of 18.86 (SD = 4.92) which Hodgson and Rachman (1977) reported for a group of
1130 obsessional patients.

Obsessions and compulsions

There were seven types of obsessions which the individual was specifically asked about during the obsessive-compulsive
section of the ADfS interview. These were: (I) unpleasant thoughts that will not go away; (2) concern about being clean
or feeling contaminated; (3) doubts about things you do; (4) worrying if you have done things right; (5) worrying about
germs or disease; (6) strict conscience; and (7) attention to detail. The OCD group reported significantly more obsessions
than the comparison group, I (20) = 5.60, P = 0.00002. The OCD group reported an average of 3.90 (SD = 1.45) obsessions
and the comparison group an average of 1.09 (SD = 0.83). In addition, 91% (n = to) of the OCD group reported that they
were bothered by the obsessions while only 9% (n = I) of the comparison group responded affirmatively to this question,
Fisher exact test P < 0.0001.
The ADIS interview asked specifically about five different types of compulsions. These were: (I) spending a great deal
of time checking things (e.g. stove. lights); (2) spending a great deal of time dressing: (3) spending a great deal of time
countine thinas; (4) washing hands over and over because they are never quite clean enough; and (5) being late or behind
becausevou h>ve‘to do things over and over. The OCD group reported sig&cantiy more compulsions than the comparison
group with the average for the OCD group being 1.00 (SD = 1.18) and for the comparison group 0.18 (SD = 0.41),
I (20) = 2. f7. P = 0.04. Also, 45% (n = 5) of the OCD group reported that they were bothered by the compulsions compared
 CASE HISTORIES ASD SHORTER COMMUNICATIONS 339

to 9% (n = 1) of the comparison group, Fisher exact test, P = 0.07 (l-tail). Finally, the OCD group reported that the
obsessions and/or compulsions interfered more with their lives than the comparison group, I (20) = 2.3 I, P = 0.03.

Generalized Anxiety Disorder

A j-point rating scale was used to quantify the Ss’ verbal responses to each GAD symptom (i.e. 0 = none; I = mild:
2 = moderate; 3 = severe; and 4 = very severe, grossly disabling). For 9 of the 18 symptoms there was a significant difference
with the OCD group reporting a greater frequency and severity of the particular symptom. The OCD group reported more
fatigability (P = 0.023), palpitations (P = 0.016). sweating (P = 0.02), flushes (P = 0.039), lump in throat (P = 0.049),
feeling keyed up (P = 0.018). easily startled (P = 0.009), difficulty concentrating (P = 0.026) and irritability (P = 0.006).
There was also a tendency for the OCD group to report more restlessness (P = 0.058). dry mouth (P = 0.075) and dizziness
(P = 0.096). In addition. the OCD group reported that they worried more and that their worries interfered with their lives
more than the comparison group, Fisher exact test P = 0.09 (l-tail) and I (20) = 3.44, P = 0.003, respectively.*

Simple phobia
Seven ADIS questions inquire about simple phobias. For each item the person was asked to indicate his or her degree
of fear and avoidance of the specific event (14 questions total). A S-point scale was used to quantify the Ss’ responses for
their degree of fear (0 = no fear; 4 = very severe fear) and avoidance (0 = no avoidance; 4 = always avoid). Only 2 of the
14 simple phobia items revealed a significant difference between the OCD group and the comparison group. The OCD group
reported a significantly greater fear (P = 0.003) as well as avoidance (P = 0.03) of the blood of others than the comparison
group.

Social phobia
Eleven ADIS questions deal with various social phobias. The individual was asked the degree to which he or she fears
as well as avoids the particular activity (22 questions total). A S-point scale was again used to quantify the Ss’ responses
to these questions. Significant differences were found on only 3 of these 22 questions. The OCD group reported greater
fear of eating in public (P = 0.03) as well as greater fear (P = 0.017) and avoidance (P = 0.03) of initiating a conversation
that the comparison group.

Group membership
Based on the information from the interview, the interviewer was able to judge correctly the group member of 82% (n = 9)
of the OCD group and 100% (n = I I) of the comparison group. Fisher exact test P < 0.0001. The two errors resulted from
two members of the OCD group being judged to be in the comparison group.

DISCUSSION

Six to 7 months after the completion of the MOCI, nonclinical high MOCI scorers reported significantly more obsessions
and concern about their obsessions than a comparison group in a diagnostic interview. The high scorers also reported more
compulsions and that they were bothered by these compulsions. In terms of GAD symptoms, the high MOCI scorers
reported significantly greater frequency and severity of 9 of 18 physiological symptoms and a trend toward significance on
three additional symptoms. The nonclinical OCD group also reported that they worried more and that their worry was
interfering compared to the individuals in the comparison group. While the OCD and comparison group differed in terms
of GAD symptoms. the differences between the groups in regard to social and simple phobias were not greater than that
expected by chance. Finally, the interviewer was able to categorize correctly 9 I % of the interviewees into their respective
groups (82% correct for the OCD group and 100% for the comparison group).
These results indicate that the MOCI is a valid instrument in identifying obsessions and compulsions in a nonclinical
sample and that these obsessions and compulsions are stable over time. Further nonclinical high MOCI scorers are more
bothered by these obsessions and compulsions than individual who score in the normal range, indicating that these two
groups differ in terms of number of symptoms and degree of distress. However, the high MOCI scorers are not merely
reporting a wide range of anxiety symptoms. That is, the high scorers do not report more simple and social phobias, but
instead report a greater number of specific obsessions and compulsions as well as more concern about these symptoms.
The MOCI is thus sensitive to differences between high and low scorers in terms of OCD symptoms and is not merely
identifying individuals who report a broad range of anxiety symptoms.
In addition, high nonclinical MOCI scorers report more overall worry, more interference from these concerns and more
physiological symptoms when they worry. Sher and colleagues (Frost er al., 1986) found that nonclinical MOCI checkers
report more general anxiety and depresson related to their checking behavior as well as specific fear symptoms related to
social criticism and competence, sudden noises, and active and potential physical assault. The present study did not find
a difference between high and average MOCI scorers on specific fears, but did find greater worry and interference from
worry among high nonclinical scorers. It may thus be that high nonclinical MOCI scorers experience a general level of worry
or distress. while specific fears may be related to a subgroup of high nonclinical scorers (e.g. checkers).
Obsessive-compulsive symptoms exist in nonclinical samples and are distressing and interfering to these individuals. The
validation of the MOCI using the ADIS provides further evidence that this self-report measure accurately identifies a
nonclinical sample manifesting significantly more frequent and severe OCD symptoms. These results also indicate that a
nonclinical analog sample is a promising avenue for studying the phenomenology of OCD. In this regard it should be noted
that the mean MOCI score for our OCD group was similar to that found in obsessive patients seeking treatment (Hodgson
& Rachman. 1977). Finally. research on OCD in nonclinical samples also allows for longitudinal work to study the possible
development of the disorder. Such research might allow the isolation of the factors associated with the transition from
normal obsessions and compulsions to obsessions and compulsions in the clinical range-that is, those that significantly
interfere with social and occupational functioning.

*The means and standard deviations for the GAD. social phobia and simple phobia symptoms are available from the
authors upon request.
 340 CASE HISTORES AND SHORTER COMMLWCATIONS

~cknow,ledgemenls-The authors would like to thank Kathy Harris for her assistance with the study. Preparation of this
study was supported in part by funds provided the second author by Washington State University.

REFERESCES

Derogatis. L. (1983). SCL-90-R administration, scoring and procedure manual--l1 for the (R&&d cersion and other
insrruments of rhe psychopathology rating scale series. Towson, Md: Clinical Psychometric Research.
DiNardo. P. A., O’Brien. G. T., Barlow, D. H., Waddel, M. T. & Blanchard. E. B. (1983). Reliability of DSM-III anxiety
disorders categories using a new structured interview. Archires of General Psychiafr?. 40. 1070-1074.
Freund. B.. Steketee, G. & Foa, E. (1987). Compulsive Activity Checklist (CAC): Psychometric analysis with obses-
siveecompulsive disorder. Behavioral Assessment, 9, 67-79.
Frost. R.. Sher, K. & Green, T. (1986). Psychopathology and personality characteristics of nonclinical compulsive checkers.
Behariottr Research and Therapy, 24. 133-143.
Hodgson, R. J. & Rachman. S. (1977). Obsessive-compulsive complaints. Behaciour Research and Therap?. IS, 389-395.
Mavissakalian. M. & Barlow, D. H. (1981). Assessment of obsessive-compulsive disorders. In Barlow. D. H. (Ed.).
Behatioral assessment of adult disorders (pp. 209-238). New York: Guilford Press.
Rachman, S. & de Silva. P. (1978). Abnormal and normal obsessions. Behariour Research and Therapy. 10. 233-248.
Rasmussen. S. A. & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM-III obsessive-compulsive
disorder. American Journal of Psychiatr.v. 43, 3 17-322.
Salkovskis, P. & Harrison. J. (1984). Abnormal and normal obsessions-a replication. Behariour Research and Therapy,
22, 549-552.
Sanavio, E. (1988). Obsessions and compulsions: The Padua Inventory. Behariour Research and Therap),, 26, 169-177.
Sher. K.. Frost. R. & Otto, R. (1983). Cognitive deficits in compulsive checkers: An exploratory study. Behariour Research
and Therapy. 21, 357-363.
Sher. K., Mann. B. & Frost, R. (1984). Cognitive dysfunction in compulsive checkers: Further explorations. Behaciour
Research and Therapy, 22. 493-502.
Sternberger, L. G. & Burns. G. L. (1990). Compulsive Activity Checklist and the Maudsley Obsessional-Compulsive
Inventory: Psychometric properties of two measures of obsessive compulsive disorder. Behavior Therap?.. II. 117-127.

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