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Validity and reliability of the Brazilian version of Yale-Brown obsessivecompulsive scale – shopping version (YBOCS-SV)

Priscilla Lourenco Leite, Tatiana Zambrano Filomensky, Donald W. Black,Adriana Cardoso Silva

PII: S0010-440X(14)00099-6DOI: doi: 10.1016/j.comppsych.2014.04.012Reference: YCOMP 51292

To appear in: Comprehensive Psychiatry

Received date: 30 January 2014Revised date: 22 April 2014Accepted date: 22 April 2014

Please cite this article as: Leite Priscilla Lourenco, Filomensky Tatiana Zambrano, BlackDonald W., Silva Adriana Cardoso, Validity and reliability of the Brazilian version ofYale-Brown obsessive compulsive scale – shopping version (YBOCS-SV), ComprehensivePsychiatry (2014), doi: 10.1016/j.comppsych.2014.04.012

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Validity and reliability of the Brazilian version of Yale-Brown obsessive

compulsive scale – shopping version (YBOCS-SV)

Priscilla Lourenço Leite

PhD student at Post-Graduate Program in Psychiatry and Mental Health at Institute of

Psychiatry / UFRJ. Researcher at Laboratory of Panic and Respiration, Psychiatric

Institute, UFRJ. INCT Translational Medicine. Master degree in clinical psychology

from Federal University of Rio de Janeiro - UFRJ.

Tatiana Zambrano Filomensky

MD, Psychologist. Departament of Psychiatry, University of São Paulo (USP). São

Paulo, Estado de São Paulo, Brazil.

Donald W. Black

MD, Professor of Psychiatry at University of Iowa. Director, Psychiatry Residency

Training Program Vice Chair for Education, Department of Psychiatry. Department of

Psychiatry. Iowa City, IA, United States of America.

Adriana Cardoso Silva

PhD. Professor of Universidade Federal Fluminense - UFF. Vice-coordinator of

Laboratory of Panic & Respiration. Institute of Psychiatry/ Federal University do Rio de

Janeiro (UFRJ). INCT Translational Medicine (CNPq).

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Indication of author responsible for correspondence and for contact information;

Priscilla Lourenço Leite

E-mail: priscilla.ufrj@gmail.com

Tel/ Fax: +55 021 2295-2549

Adress of the Laboratory of Panic and Respiration

Institute of Psychiatry

Federal University of Rio de Janeiro – INCT - Translational Medicine

Venceslau Brás Avenue, 71 - Botafogo

Rio de Janeiro - RJ, CEP: 22290-140

Brazil

Abstract

Introduction: The Yale-Brown Obsessive Compulsive Scale- Shopping Version

(YBOCS-SV) is considered the gold standard in the assessment of shopping severity. It

is designed to assess cognitions and behaviors relating to compulsive buying behavior.

The present study aims to assess the validity of the Brazilian version of this scale.

Methods: For the study, composed the sample 610 participants: 588 subjects of a

general population and 22 compulsive buyers. Factorial analysis was performed to

assess the relations and the correlation between the YBOCS-SV, the Compulsive

Buying Scale (CBS), and Richmond Compulsive Buying Scale (RCBS), was assessed

using Pearson coefficient, for study of convergent and divergent validity. Cronbach's

alpha coefficients were used to assess internal consistency.

Results: The results show good to excellent psychometric parameters for the YBOCS-

SV in its Brazilian version. With regard to correlations, the YBOCS-SV is inversely and

proportionally correlated with CBS and the RCBS, indicating that the YBOCS-SV is an

excellent instrument for screening compulsive buying. The YBOCS-SV presented high

Alpha coefficient of Cronbach's alpha (0.92), demonstrating good reliability.

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Conclusions: The Brazilian version of the YBOCS-SV is indicated to diagnose

compulsive buying disorder, and likely use for the purposes intended in the Brazilian

population.

Keywords

Compulsive Buying Disorder, Compulsive shopping, Compulsive Behavior, psychiatric

status rating scales, diagnosis, Impulse Control Disorder.

1. Introduction

Compulsive buying disorder (CBD) is characterized by buying urges or impulses

that are experienced as irresistible, intrusive, and uncontrollable. CBD is associated

with buying items considered unnecessary through an unplanned purchase in a longer

period of time than desired. [1] CBD is associated with significant impairment in social,

family and financial individual. [2] Recent studies indicate a prevalence of 5.8% in the

general population of the United States. [3] The prevalence reported in the German

population is 6.9%. [4] CBD is thought to occur more frequently in women [5].

Compulsive buying disorder is not included in DSM-IV-TR or the more recent

DSM-5 [6]. Nonetheless, the disorder has features that suggest that it falls within the

obsessive-compulsive spectrum. Grant and Potenza (2006) [7] argue that impulsive and

compulsive behaviors were not diametrically opposed, so could occur simultaneously as

the course of the same disorder. Others authors [8] suggest that compulsive buying may

be related to and behavioral addictions due to loss of control, resulting in repetitive and

harmful behaviors. Nevertheless, the difficulty in interrupting the compulsion to acquire

and that such behavior would occur in response to negative events or feelings, in an

attempt to reduce anxiety and discomfort [9].

Other authors [1,10] describe CBD as a compulsive behavior associated with

obsessive ideas. An uncontrollable urge to get items that are not necessary. The pattern

of obsessive thoughts, as well as the uncontrolled behavior for purchases may be

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associated with the same pattern of obsessions of the obsessive-compulsive disorder

(OCD).

Thus, the cognitive and behavioral aspects of compulsive buying suggest a

connection with OCD, from a theoretical point of view, resulting in implications in the

clinical care. Accordingly, Monahan, Black, and Gabel [11] developed the Yale - Brown

Obsessive Compulsive Scale- Shopping Version (YBOCS- SV). The main framework of

this version is to measure the rate of severity of symptoms of the disorder, once the

compulsive buying scale of O'Guinn and Faber [12] is useful only to making the

diagnosis.

In this report, we describe a cross-cultural validation of the scale YBOCS - SV,

evaluating its psychometric property in the Brazilian Portuguese version.

1.1.YBOCS-SV

The YBOCS - SV [11], 1996) was developed from the scale to measure the

severity of symptoms of obsessive-compulsive disorder. [13,14]. The YBOCS was

modified to assess interference with, and the ability to control one’s thoughts about

buying and spending behaviors. The YBOCS-SV was designed to measure the severity

of compulsive buying in a clinical population, but also to measure change in clinical

trials. The scale consists of 10 items and assessed by 4 points of gravity (1 = complete

control, 4 = no control). The score is given by the sum of the scores of each item of the

scale (total = 40 points). The higher the score, the greater the severity of disorder.

Cronbach's alpha was used to assess internal consistency, for participants buyers

and the general population, and the results were .65 and .70, respectively. There has

been described the scale factor analysis, since their sample was very small (Monahan et

al. 1996).

It was also performed convergent analysis of the scale. YBOCS-SV subscores

were correlated with other instruments screening for compulsive buying. The results

suggest low correlation between the YBOCS-SV and "National Institute of Mental

Health Obsessive - Compulsive Scale" (NIMHOCS) [15] (r = .12; P=.78), and a strong

inverse correlation between YBOCS-SV and " Compulsive Buying Scale" (CBS) [12], (r

=-.62;P=.10).

2. Methodology

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2.1.Participants

This study includes 610 adult participants over 18 years who fulfilled the Terms

of Informed Consent (IC). The group of patients was evaluated and assessed by a

psychiatrist for the presence of CBD. The inclusion criteria for participation in the

research involved presenting the disorder in question, with or without comorbidities,

such as depression and anxiety disorders or other impulse control disorder, which were

confirmed by clinical interview and outpatient care. Exclusion criteria included a

diagnosis of any personality disorder, bipolar disorder, severe depression with suicidal

ideation, schizophrenia, difficulty reading, age of 18 years and disagree with the IC.

The participants were divided into two groups: no clinical disorder (NC) and

compulsive buying disorder (CBD). The sample comprised 588 a general population

and 22 compulsive buyers, who were recruited at an ambulatory clinic for those with

impulse control disorders (compulsive buyers, kleptomaniacs, compulsive gamblers,

alcohol addicts, binge eaters, etc.).

2.2. Measures

Social, demographic, and clinical data were collected to characterize the sample.

The following scales were administered: Compulsive Buying Scale (CBS) [16]

Richmond Compulsive Buying Scale (RCBS), [17] - both in its version for Portuguese.

2.3.Procedure

Participants were asked to fill in the indexed online platform. The methods

adopted for the online survey were consistent with the conduct and specific needs for

application on the internet. All participants were informed about the objectives and

procedures of the study and after agreeing to the IC, were directed to fill out the

sociodemographic questionnaire followed by CBS, RCBS and YBOCS-SV scales.

The chi-square test and t-test were used to evaluate the differences between the

groups. The reliability of the YBOCS-SV was accomplished through the use of

Cronbach's alpha. For the calculation of the factors, we used the value equal to or

greater than 1.The index adequacy Kaiser-Meyer-Olkin (KMO) as well as Bartlett's test

of sphericity were used to evaluate the results. Exploratorial Factor analysis (EFA) with

oblique Direct Oblimin rotation was performed to define the convergent validity of the

scale.

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To assess the convergent validity, the Pearson coefficients obtained by

correlating the YBOCS-SV with other scales designed to measure the same construct,

the compulsive buying behavior were analyzed.

3. Results

3.1.Descriptive Statistics

The average age of participants was 32 years (SD = 11.3). There were no

differences between the non-clinical and the compulsive buyers group regarding gender

and schooling. Through the evaluation conducted by the chi-squared test, it can be

verified that there were no significantly statistical differences (p <0.005) and they could

occur by chance.

INSERT TABLE 1 HERE

3.2.Internal Consistency of the Scale

Internal consistency (reliability Scale) was assessed using Cronbach’s Alpha,

consistent with findings in the original study (.97) value has been found. Monahan,

Black, and Gabel (1996), in their sample of compulsive buyers and the general

population, found alphas of .70, .65, respectively, indicating that the homogeneity test

was moderately high at the start of the original study, but were not sustained in separate

comparisons. When we replicate reviews Cronbach’s alphas in the current study, the

following results were found: general population (.89) and compulsive buyers (.93),

compulsive buyers and non clinical population (.92), indicating that the release of this

study presents satisfactory internal consistency, even when compared to the original

scale of the study.

3.3.Exploratory Factor Analysis of YBOCS-SV

To exploratory factor analysis, was used as a criterion for extraction of factors

the "ScreePlot". The method for extraction of factors was the main components and

Oblimin rotation in oblique direction. Table 2 presents the descriptive data for the 10

items of the instrument.

INSERT TABLE 2 HERE

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Table 3 shows that all pairs of items show good correlation (coefficients of Pearson

correlations moderate high and high, all statistically significant with p<0.001) although

none of them demonstrate perfect correlation.

INSERT TABLE 3 HERE

The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) index

presented value .92, considered excellent and demonstrating the proper analysis to data

obtained with the 610 study participants. The individual values of KMO are shown in

Table 4, marked in bold.

The Bartlett's test of sphericity showed statistical significance (χ2 (45) =

3703.02, p <0.01) indicating that the original correlation matrix is not an identity

matrix, and, thereby, relationship between the variables analyzed.

INSERT TABLE 4 HERE

All the commonalities presented value 1 before extraction of factors by the

method of principal components extraction, which revealed the existence of a single

factor. The Eigen values and percentage of variance explained is presented in table 5.

INSERT TABLE 5 HERE

INSERT FIGURE 1 HERE

3.4. Pearson Correlation Between The Scales

For concurrent validity was presented the matrix of Pearson correlation

coefficient between the three scales used for measurement of construct, since CBS,

YBOCS-SV and RCBS seek to evaluate the compulsion to shop. Thus, it was observed

a high correlation of nature inversely proportional between the scale CBS and YBOCS-

SV (r=-.72; 0<0.01). The correlation is inversely proportional, due to the fact that in

assessing the CBS the higher the score obtained, the lower the score the amount of the

construct measured. By correlating the RCBS scales and YBOCS-SV score obtained

was r=.72; 0<0.01.

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4. Discussion

The study shows that the Brazilian version of the YBOCS-SV displays

satisfactory psychometric properties. Compared with the results found in the original

study [11], the Brazilian version obtained a superior performance on the Cronbach's

alpha test, enabling its suitability for use in the native population.

For exploratory factor analysis of the YBOCS-SV, on the original scale study

[11] the authors did not indicate the presence of factors of the instrument, keeping only

one factor. However, in another study of validating the YBOCS-SV were found two

factors explaining 59.2% of the variance. The Bartlett's test of sphericity was significant

(χ2 = 1.44, df = 45). [18]. Thus, items 4,5,6,9 and 10 loaded on the first factor and items

2,3 and 7 on the second factor. They found latent correlation r = - .51 between the two

factors. Through this evaluation, indicated that the factor 1 represented the resistance

against the compulsion to shopping and factor 2, the impairment of activities of daily

living over the compulsion to shop. Items 1 and 8 obtained saturation in both factors

and their interpretation cannot be performed.

Through the method of KMO, we confirmed that the analysis conducted was

appropriated to the participants of the study, considering its quantitative. Through factor

analysis, from the method of factor extraction and direct oblimin rotation, it was

possible to observe the structure of the scale. In the present study only one factor was

found. The first factor with eigen value 59.24 explaining the variance. It is estimated a

number of factors with eigen value equal to or greater than 1. Thus, the analysis

indicated the presence of only one factor.

In the present study, we found no differences that allow us to evaluate the

presence of two factors. Perhaps, for the Brazilian population both thoughts as

compulsive buying interfere in the functioning and impairment of daily life and thus

there is no difference between these putative factors. Another aspect about the presence

of a single factor, may be the influence of intrusive thoughts compulsion, so markedly,

making it impossible to differentiate into two different elements.

Finally, Pearson's correlation analysis allowed us to verify that there is a strong

convergence between scales. CBS and YBOCS-SV are inversely proportional

correlation and YBOCS-SV indicate a positive correlation. All of them correlate. The

results are consistent with the findings by Monahan et al [11]. For Brazilian YBOCS-

SV indications and applicability is also evaluating the severity of compulsive buying.

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Due to the difficulty in locating and diagnosing the compulsive buying disorder,

the number of participants in our study was very limited. It is expected that in future

studies, we find a higher proportion of individuals with the disorder. We conclude that

this version of the YBOCS-SV correspond well with the original version, including

keeping the psychometric characteristics, thereby allowing the use of this tool for the

study of the severity and impact on the population affected by compulsive buying.

The validation of the scale YBOCS-SV to Brazilian standards allows the

utilization of it widely in clinical practice, adopting the standardization of the

application of scales that are commonly used internationally. Another important factor

is due to the research in the field of compulsive buying, where we can compare our

findings through the scale, which is already applied in international surveys. For being a

gold standard scale, vastly used for evaluation and diagnosis of compulsive buying is of

paramount importance that there is the Brazilian version of the scale.

This paper considers the possibility of investigating the disorder when the

patient is already in care. Therefore, it allows new strategies that are carried out

management, from the clinical bias in an effort to treat the disorder in question.

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Figure 1. Diagram of declivity

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*Mean (Standard Deviation). NP = Non-Clinical; CBD= Compulsive Buying Disorder

Table 1. Characteristics of study sample

NC (N=588) CBD (N= 22) t-test or

χ2

df p-value

Age (Years) 31.9*

(SD±11.1)

Minimum=18;

maximum=66

32.6*

(SD±14,9)

Minimum=18;

Maximum=70

-.263 21.88 0.12

Gender (%) 16.02 1 .000

Male (230) 60.9% (4)18.2%

Female (358) 39.1% (18) 81.8%

Marital Status

(%)

47.89 5 .000

Single (361) 61.4% (12) 54.5%

Married (173) 29,4% (6) 27.4%

Separated (33) 5.6% -

Divorced (13) 2.2% (1) 4.5%

Widowed (6) 1.0% -

Outhers (2) 0.3% (3)13.6%

Education (%) - 3.61 3 .31

Elementary

School

(3)0.5% -

High School (28)4.8% (3)13.6%

College (395)67.2% (13) 59.1%

Higher education (162) 27.6% (6) 27.3%

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Table 2. Descriptive Statistics

Mean

Std.

Deviation

Analysis

N

YB1 1.13 .75 610

YB2 .45 .67 610

YB3 .77 .86 610

YB4 .70 1.01 610

YB5 .87 .87 610

YB6 .71 .74 610

YB7 .39 .67 610

YB8 .79 .86 610

YB9 .60 .92 610

YB10 .77 .87 610

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Table 3. Correlation Matrix

YB2 YB3 YB4 YB5 YB6 YB7 YB8 YB9 YB10

Correlation YB1 .51 .59 .46 .59 .47 .47 .52 .43 .57

YB2 .60 .43 .57 .58 .73 .50 .47 .51

YB3 .47 .64 .54 .56 .60 .48 .62

YB4 .61 .48 .43 .47 .64 .57

YB5 .57 .58 .61 .62 .74

YB6 .47 .47 .46 .54

YB7 .51 .52 .56

YB8 .56 .68

YB9 .64

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Table 4. Anti-image Matrices

YB1 YB2 YB3 YB4 YB5 YB6 YB7 YB8 YB9 YB10

Anti-image

Correlation

YB1 .95a -.09 -.20 -.09 -.13 -.13 -.03 -.08 .05 -.07

YB2 .88a -.21 -.04 -,08 -.08 -.05 -.02 .04 .09

YB3 .94a -.02 -.15 .00 -.03 -.19 .05 -.12

YB4 .92a -.19 -.01 .04 .02 -,36 -.07

YB5 .94a .00 -.07 -.05 -.11 -.32

YB6 .96a -07. -.06 -.07 -.16

YB7 .89a -.03 -.13 -.09

YB8 .94a -.15 -.26

YB9 .92a -.16

YB10 .92a

a. Measures of Sampling Adequacy(MSA)

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Table 5. Eigen values and Total Variance Explained

Component Initial Eigen values

Total % of Variance Cumulative %

0

1 5.92 59.24 59.24

2 .81 8.13 67.37

3 .63 6.37 73.74

4 .59 5.98 79.72

5 .51 5.12 84.85

6 .37 3.73 88.58

7 .35 3.53 92.12

8 .31 3.10 95.22

9 .25 2.52 97.74

10 .22 2.253 100.00