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The purpose of this study was to use the Maudsley Obsessional-Compulsive Inventory (MOCI) to assess obsessive-compulsiveness in a population of 196 tinnitus patients and to correlate MOCI scores with measures of anxiety, depression, and tinnitus severity. Obsessive-compulsive disorder (OCD) is a syndrome characterized by obsessions or compulsions (or both) that last at least 1 hour per day and interfere with one's normal social or occupational functioning [1]. Even if they do not fulfill the DSM criteria for diagnosis of OCD, many patients with severe tinnitus exhibit obsessive thoughts or compulsive behaviors related to their auditory symptoms. Previous studies investigated associations between tinnitus and psychological factors, such as depression [7] and anxiety [8].
Our study used the Maudsley Obsessional-Compulsive Inventory (MOCI)[11] to assess obsessive-compulsiveness of patients who were evaluated in the Tinnitus Clinic at Oregon Health and Science University (OHSU). Detailed questionnaires were completed by 200 consecutive patients before their initial appointment at the OHSU Tinnitus Clinic. Data relating to patient demographics, matched and self-rated tinnitus loudness, TSI, MOCI, SAI, and aBDI scores were analyzed using the Pearson correlation, analyses of variance, and two-tailed t-tests.
Table 2 contains Pearson correlation coefficients and two-tailed p values that resulted from statistical analyses of these measures.
Because OCD is a type of anxiety disorder, it is not surprising that MOCI scores were positively correlated with SAI scores. Though the correlation between MOCI and TSI scores in this study was moderate (r = 0.28), patients who scored 9 or more on the MOCI scored significantly higher on the TSI than did patients who scored 0-8 on MOCI. Tinnitus severity is often correlated with the degree of patients' depression [7] and anxiety [8]. Self-administered questionnaires, such as the aBDI, SAI, and MOCI, can be used to assess the presence and severity of depression, anxiety, and obsessive-compulsiveness in tinnitus patients.
If patients experience tinnitus, anxiety, depression, and obsessive-compulsiveness, these conditions can form a vicious circle and exacerbate one another. Improvement in obsessive-compulsiveness has been achieved by patients through the use of selective serotonin reuptake inhibitor (SSRI) medications [23], cognitivebehavioral therapy [24], or both these treatment strategies employed simultaneously.
Effective management of tinnitus requires identification of psychological disorders or symptoms when they are present, so that patients can receive appropriate treatment as soon as possible. In this video, hear Headache Center of Chicago patient Kara talk about her treatment results. Chronic Head and Neck Tension is often caused by neuromuscular imbalances in the head, neck, jaw and shoulders.
Most people don’t know that Tinnitus symptoms are often linked directly to dental-related force imbalances. Obsessions are expressed internally and subjectively by patients as thoughts, impulses, or images.
These patients are often preoccupied with or anxious about personal health issues to the point of hypochondriasis [4] or somatization [5].
However, few studies of tinnitus patients assessed obsessive-compulsiveness in this population. The MOCI was selected as the assessment instrument for the following reasons: (1) It is a patient-administered questionnaire, (2) its validity has been verified in numerous studies [12,13], and (3) it is easy to administer and to score because it consists of 30 statements that patients rate as either true or false.
Tinnitus severity was highly correlated with SAI and aBDI scores; aBDI scores were positively correlated with MOCI and SAI scores.

Nine was chosen as the MOCI score criterion for increased obsessivecompulsiveness because this value is one standard deviation greater than the mean MOCI score for the entire group of patients (see Table 1). However, MOCI scores of tinnitus patients in this study were positively correlated with their SAI, aBDI, and TSI scores.
The relationship between obsessivecompulsiveness and general anxiety was particularly evident in the group of 40 patients who scored 9 or higher on the MOCI. According to aBDI criteria, 96 patients (49%) exhibited some degree of depression; 52 patients (27%) exhibited moderate or severe depression. Our study showed that tinnitus severity was positively correlated with obsessive-compulsiveness. Patients can also be referred to psychiatrists or psychologists for evaluation if any of these conditions are suspected or recognized. Tinnitus is not always the starting point of this cycle; it can begin at any point and progress in any direction.
Depression and general anxiety disorders can also be treated with SSRI medications and psychotherapy. At The Headache Center of Chicago we can help you minimize or even eliminate these types of pain for good. HCC employs cutting-edge technologies to accurately diagnose your condition and provide you with long term relief from headache and migraine pain. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th edition [2], obsessions are intrusive and cause marked anxiety and distress.
Stephens and Hallam [9] administered the Crown- Crisp Experimental Index (CCEI) to 472 tinnitus patients participating in a multicenter study.
Aims of this study were twofold: to use the MOCI to assess obsessivecompulsiveness in a population of tinnitus patients and to correlate MOCI assessments of obsessive-compulsiveness with measures of anxiety, depression, and tinnitus severity.
The questionnaires requested information about patients' medical, hearing, and tinnitus histories. The prevalence of depression among patients in this study was similar to that reported in previous studies of our tinnitus clinic population [7,18].
Possibly louder tinnitus contributed to higher TSI, aBDI, and SAI scores for patients who scored 9 or more on the MOCI.
According to Hiller and Goebel [22], "Chronic tinnitus often fails to respond to somatic treatment, and the continuous annoyance due to the noises may then lead to a widespread and severe psychological distress and interfere with social and occupational functioning. Regardless of the method used, identifying psychological disorders when they are present is imperative so that patients can receive appropriate treatment as soon as possible.
In most cases, patients experienced some degree of anxiety, depression, or obsessive-compulsiveness before their tinnitus began.
Cognitive-behavioral therapy has been used successfully to decrease the severity of tinnitus [25]. Maudsley obsessional-compulsive inventory: Obsessions and compulsions in a nonclinical sample. Comorbidity of obsessive-compulsive disorder and depression: Prevalence, symptom severity, and treatment effect. Cognitivebehavioral group therapy in obsessive-compulsive disorder: A randomized clinical trial.

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Categories of obsessions include contamination, aggression, religion, safety or harm, exactness or symmetry, and somatic or body fears. Some patients also exhibit compulsions, such as repeatedly checking the status of their tinnitus or environmental sound levels. As compared to Crown-Crisp normative data, tinnitus patients scored significantly higher on anxiety, obsessionality, and depression subscales of the CCEI.
Included were 12 questions that comprise the Tinnitus Severity Index (TSI) [8], an efficient indicator of the negative impacts of tinnitus on patients. No significant difference between the groups as regards age, tinnitus duration, or self-rated tinnitus loudness was found. Furthermore, tinnitus patients who scored 9 or more on the MOCI scored significantly higher on the aBDI than did patients who scored 0-8 on the MOCI. However, previous studies reported that the matched loudness of tinnitus was not correlated with measures of the symptom's severity [21], aBDI, or SAI scores [8].
However, tinnitus can increase the severity of existing psychological disorders or tendencies. Effective management of tinnitus requires identification of psychological disorders or symptoms when they are present so that patients can receive appropriate treatment as soon as possible. Compulsions are repetitive behaviors or purposeful mental acts that are performed to prevent distress or a dreaded event.
These obsessive-compulsive tendencies are counterproductive to the tinnitus habituation process. McKee and Stephens [10] used the CCEI to compare tinnitus patients with a similar number of control subjects who did not hear tinnitus. The MOCI [11], the State Anxiety Inventory (SAI)[14], and an abbreviated version of the Beck Depression Inventory (aBDI)[15] were also completed by patients.
However, the group of 40 patients who scored 9 or more on the MOCI exhibited significantly higher values for matched tinnitus loudness, MOCI, TSI, aBDI, and SAI scores as compared to the other group of 156 patients. When tinnitus patients also experience depression, anxiety, or obsessive-compulsiveness, medication or psychotherapy or both should be used to treat these concurrent conditions. Compulsions can include checking, cleaning or washing, counting, repeating, ordering or arranging, and hoarding or collecting [3]. Tinnitus patients scored significantly higher than did control subjects on CCEI anxiety and obsessionality subscales.
Patients rated the loudness of their usual tinnitus on a 1-10 scale and also matched the pitch and loudness of their tinnitus to sounds played through headphones. Sustained improvements in psychological symptoms can contribute to long-term reductions in tinnitus severity [18].

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