Search

Objective: Although Avoidant/Restrictive Food Intake Disorder (ARFID) has existed since the publication of DSM‐5 in 2013, research on the descriptive psychopathology of treatment‐seeking patients with formal ARFID diagnoses is sparse, and limited to tertiary eating disorder‐focused treatment settings where most patients present with weight loss/malnutrition. In these settings, the selective/neophobic symptom presentation is rare compared to other primary eating restrictions. We aimed provide initial descriptive psychopathology of ARFID primary selective/neophobic symptom presentation in an outpatient setting, and to explore the prevalence of the core ARFID symptoms and clinical differences among patients meeting criteria based on weight/nutritional symptoms versus psychosocial impairment only. Method: We reviewed the charts of 22 consecutive outpatients diagnosed with ARFID caused by selective/neophobic eating, and describe symptoms, impairment, illness trajectory, and demographic features. Patients who met ARFID criteria because of weight loss/nutritional problems were compared to those who met for psychosocial impairment only on demographic and clinical characteristics. Results: Patients were predominantly male (81.8%) and school‐aged (4–11 years). 81.8% had no weight/nutritional symptoms documented by a medical provider. All met criteria for significant psychosocial impairment. There were few differences between patients who did versus did not meet weight loss/nutritional criteria for ARFID; they differed only in age and in the presence of appetite disturbances consistent with another proposed presentation of ARFID. Discussion: These results provide novel data on the clinical characteristics of individuals who present with a primary presentation of selective/neophobic ARFID, including support for psychosocial impairment as sufficient for fulfilling ARFID criterion A. [ABSTRACT FROM AUTHOR]

Objective: We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context.Method: One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed measures at admission and discharge. Almost all (92.4%) participants had at least two diagnoses and nearly half (44.2%) had three or more. Treatment consisted of intensive ERP (i.e., approximately 26.5 hr per week), additional cognitive behavioral therapy interventions, and medication management within a residential setting. In contrast to the samples reported on in the vast majority of other pediatric OCD trials, participants in the current study were living apart from their families and were immersed within the treatment setting, with staff members available at all times.Results: Paired samplet-tests revealed significant decreases in OCD and depression severity.Conclusions: Results suggest that residential treatment for adolescents with OCD using a multimodal approach emphasizing ERP can be effective for complex cases with significant comorbidity. Results were comparable with several randomized controlled trials. [ABSTRACT FROM PUBLISHER]

Background: One presentation of Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by picky eating, i.e., selective eating based on the sensory properties of food. The present study has two aims. The first is to describe distress and impairment in individuals with ARFID secondary to picky eating. The second is to determine whether eating behaviors hypothesized to be specific to picky eating can differentiate picky eaters with and without ARFID from typical eaters (e.g., individuals not reporting picky or disordered eating) and individuals who strongly endorse attitudes associated with anorexia and bulimia (eating disordered attitudes). Methods: Participants were recruited from Amazon's Mechanical Turk (N= 325) and an online support group for adult picky eaters (N = 81). Participants were grouped based on endorsement of picky eating, ARFID symptoms, and elevated eating disordered attitudes on the Eating Attitudes Test (EAT-26). The resulting four eating behavior groups were compared on measures of distress and impairment (e.g., anxiety/depression and, obsessive compulsive disorder symptoms, eating-related quality of life) and on measures of eating behaviors associated with picky eating (e.g., food neophobia, inflexibility about preparation and presentation of preferred foods, sensitivity to sensory stimuli, and eating from a very narrow range of foods). The groups were compared using one way ANOVA with post-hoc Tamhane's T2 tests. Results: On measures of distress and impairment, participants with ARFID reported higher scores than both typical eaters and picky eaters without ARFID, and comparable scores to those with disordered eating attitudes. Three of four measures of picky eating behavior, eating inflexibility, food neophobia, and eating from a range of 20 or fewer foods, distinguished picky eaters with and without ARFID form typical eaters and those with disordered eating attitudes. Picky eaters with ARFID reported greater food neophobia and eating inflexibility, and were more likely to eat from a narrow range of foods, compared to picky eaters without ARFID. Conclusions: Adult picky eaters can be differentiated from those with symptoms of anorexia and bulimia by their stronger endorsement of food neophobia and inflexible eating behaviors, and by eating from a very narrow range of foods. Picky eaters with ARFID symptoms can be differentiated from picky eaters without these symptoms on the basis of these three eating behaviors, and by their higher endorsement of internalizing distress, OCD symptoms, and eating-related quality of life impairment. This study provides evidence that ARFID symptoms exist independently of symptoms of other eating disorders and are characterized by several distinct eating behaviors. In a clinical analogue sample of disordered eaters, ARFID symptoms were associated with distress and impairment at levels comparable to symptoms of anorexia and bulimia. [ABSTRACT FROM AUTHOR]

The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist controls, pill placebo, psychosocial comparison conditions, active medication, combined treatments, and brief CBT. This review is part of a series commissioned by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) in an effort to publish in one place what is known about the efficacy of treatments for OCD. A total of fourteen studies were identified; collectively their findings support the efficacy of CBT for youth with OCD. CBT protocols that emphasized either strictly behavioral or cognitive conceptualizations have each been found efficacious relative to waitlist controls. Efforts to enhance CBT׳s efficacy and reach have been undertaken. These trials provide guidance regarding next steps to be taken to maximize efficacy and treatment availability. Findings from studies in community clinics suggest that significant treatment benefits can be realized and are not reported only from within academic contexts. These findings bode well for broader dissemination efforts. Recommendations for future research directions are provided. [ABSTRACT FROM AUTHOR]

Efforts to understand the nature of "Not Just Right Experiences" (NJREs) have expanded the scientific understanding of obsessive-compulsive (OC) behavior. Approximately 80% of unselected adults report experiencing NJREs and these experiences have been found to highly correlate with OC behavior. The purpose of this study was to assess NJREs in an unselected sample of adolescents (ages 14-17; N = 152), to compare their experience with adults (N = 237), and to assess the relation between NJREs and OC symptoms. Findings from questionnaires completed on the Internet were consistent with previous findings in adults, 81% of adolescents endorsed recently having an NJRE. Some reactions differed according to age: adults reported NJREs as more frequent and adolescents endorsed feeling more compelled to respond. Surprisingly, OC symptoms were not significantly related to NJREs in the adolescents. Implications, limitations, and future directions for the study of NJREs in youth are discussed. [ABSTRACT FROM AUTHOR]

Highlights: [•] Detail the knowledge and skills needed to treat pediatric obsessive-compulsive disorder. [•] Review CBT theory, assessment strategies, and treatment outcome literature. [•] Review goals to be accomplished in the delivery of CBT for pediatric OCD. [•] Suggest next steps in dissemination of CBT for pediatric OCD. [ABSTRACT FROM AUTHOR]

The article discusses a study of the effects of cognitive behavior therapy (CBT) augmentation of serotonin reuptake inhibitors (SRI) for the treatment of pediatric obsessive-compulsive disorder (OCD). The study involved 124 pediatric outpatients at academic medical centers in the U.S. from September 2004 to March 2009. The SRI medications were dispensed by a child/adolescent psychiatrist during the study period. A post hoc analysis was conducted in response to the high premature termination rate of medication management. Also highlighted is the effectiveness of SRI augmentation with CBT.

Objective: To examine the efficacy and durability of a behavioral therapy (BT) protocol for pediatric TTM compared with a minimal attention control (MAC) condition. It was hypothesized that the BT condition would be superior to MAC at the end of acute treatment, and would also demonstrate durability of gains through the maintenance treatment phase. Method: A randomized controlled trial in which 24 youths were assigned to either a pilot-tested BT protocol, consisting of eight weekly sessions, or to MAC, consisting of three sessions and five telephone calls over 8 weeks. Independent evaluators assessed outcome at pretreatment (week 0) and post-treatment (week 8) for BT and MAC, and again at week 16 for BT patients only. The primary outcome measure was the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). Results: For the BT condition, the week 8 mean NIMH-TSS score was significantly lower than that of the MAC condition. The BT condition's mean week 8 score was also significantly lower than their own mean week 0 score, whereas no such reductions were observed for the MAC condition. Upon completion of acute treatment at week 8, the BT group's gains were maintained through an 8-week maintenance treatment phase. Conclusions: BT produced a superior outcome compared with a condition that controlled for participation in a pediatric TTM research study, nonspecific therapist contact effects, repeated assessments, and the passage of time. Maintenance of gains after acute BT provides preliminary support for the durability of treatment gains. Clinical Trial Registration Information -- Cognitive Behavioral Treatment of Pediatric Trichotillomania; http://www.clinicaltrials.gov; R21 MH 61457 J. Am. Acad. Child Adolesc. Psychiatry, 2011;50(8): 763-771. Key Words: trichotillomania, behavior therapy, TTM [ABSTRACT FROM AUTHOR]

Background: A randomized controlled trial examining the efficacy of behavior therapy for pediatric trichotillomania was recently completed with 24 participants ranging in age from 7 - 17. The broad age range raised a question about whether young children, older children, and adolescents would respond similarly to intervention. In particular, it is unclear whether the younger children have the cognitive capacity to understand concepts like "urges" and whether they are able to introspect enough to be able to benefit from awareness training, which is a key aspect of behavior therapy for trichotillomania. Methods: Participants were randomly assigned to receive either behavior therapy (N = 12) or minimal attention control (N = 12), which was included to control for repeated assessments and the passage of time. Primary outcome measures were the independent evaluator-rated NIMH-Trichotillomania Severity Scale, a semi-structured interview often used in trichotillomania treatment trials, and a post-treatment clinical global impression improvement rating (CGI-I). Results: The correlation between age and change in symptom severity for all patients treated in the trial was small and not statistically significant. A 2 (group: behavioral therapy, minimal attention control) × 2 (time: week 0, 8) × 2 (children < 9 yrs., children > 10) ANOVA with independent evaluator-rated symptom severity scores as the continuous dependent variable also detected no main effects for age or for any interactions involving age. In light of the small sample size, the mean symptom severity scores at weeks 0 and 8 for younger and older patients randomized to behavioral therapy were also plotted. Visual inspection of these data indicated that although the groups appeared to have started at similar levels of severity for children ≤ 9 vs. children ≥ 10; the week 8 data show that the three younger children did at least as well as if not slightly better than the nine older children and adolescents. Conclusions: Behavior therapy for pediatric trichotillomania appears to be efficacious even in young children. The developmental and clinical implications of these findings will be discussed. Trial Registration: Clinicaltrials.gov NCT00043563. [ABSTRACT FROM AUTHOR]

Little is known about how pediatric trichotillomania (TTM), a clinically significant and functionally impairing disorder, is impacted by, and impacts, family functioning. We explored dimensions of family functioning and parental attitudes in a sample of children and adolescents who participated in an Internet-based survey and satisfied conservative diagnostic criteria for TTM (ages 10-17, n = 133). Analyses reveal trends toward higher levels of dysfunction in families of TTM youth relative to normative samples, although no differences achieved statistical significance. However, scores on the Family Assessment Measure and the Attitudes Toward My Child scales were similar to those in clinical samples of youth with cystic fibrosis, an eating disorder, or an anxiety disorder. While these results indicate that family functioning and parental attitudes in TTM were not generally or extremely problematic, family issues may nevertheless warrant particular clinical evaluation and attention in more severe TTM cases. [ABSTRACT FROM AUTHOR]

Objetivo: La negatividad relacionada con los errores es una desviación negativa en el potencial provocado máximo, que aparece unos 50 mseg después de cometer errores. La negatividad relacionada con los errores se genera en la corteza cingular anterior, y tanto la hiperactividad de la corteza cingular anterior como el aumento de la actividad cerebral relacionada con los errores se ha descrito en adultos con trastorno obsesivo-compulsivo (TOC). Sin embargo, por lo que sabemos, hasta la fecha no se ha realizado ningún estudio que examinara la actividad cerebral relacionada con los errores en pacientes pediátricos con TOC, y ningún estudio ha examinado la actividad cerebral relacionada con los errores antes de la instauración del tratamiento y después de éste. Método: Se midió la negatividad relacionada con los errores en 18 pacientes pediátricos con TOC que buscaron tratamiento y en 18 individuos sanos de comparación de edades apareadas. De estos pacientes, 10 regresaron para una segunda sesión de evaluación después de haber recibido terapia cognitivo-conductual; 13 niños del grupo de comparación participaron una segunda vez después de un período similar. Resultados: En el grupo antes del tratamiento, la negatividad relacionada con los errores fue sistemáticamente mayor en los pacientes pediátricos con TOC frente a los individuos de comparación. Esta diferencia también fue evidente después del tratamiento. No se constató relación alguna entre la negatividad relacionada con los errores y la gravedad de los síntomas o los cambios en la gravedad de los síntomas. Conclusiones: En concordancia con los resultados de otros estudios con pacientes adultos, el aumento de la actividad cerebral relacionada con los errores es evidente en los pacientes pediátricos con TOC. Además, este aumento no parece variar en función de la reducción de los síntomas obtenida con la terapia. Estos resultados sugieren que el aumento de la negatividad relacionada con los errores puede ser un rasgo indicador de psicopatología y podría constituir un endofenotipo útil. [ABSTRACT FROM AUTHOR]

Objective: The error-related negativity is a negative deflection in the event-related potential maximal approximately 50 msec after the commission of errors. The error-related negativity is generated in the anterior cingulate cortex, and both anterior cingulate cortex hyperactivity and increased error-related brain activity have been reported in adults with obsessive-compulsive disorder (OCD). However, no study to date, to the authors' knowledge, has examined error-related brain activity in pediatric patients with OCD, and no study has examined error-related brain activity in OCD both before and after treatment. Method: The error-related negativity was measured in 18 treatment-seeking pediatric patients with OCD and 18 age- matched comparison subjects. Of these patients, 10 returned for a second testing session after cognitive behavior therapy; 13 comparison children participated a second time after a comparable interval. Results: In the pretreatment group, the error-related negativity was reliably larger in pediatric patients with OCD in relation to comparison subjects. This difference was also evident after treatment. There was no relationship between error-related negativity and symptom severity or changes in symptom severity. Conclusions: Consistent with studies in adult patients, increased error-related brain activity is evident in pediatric patients with OCD. Furthermore, increased error-related brain activity does not appear to change as a function of symptom reduction after therapy. These results suggest that an increased error-related negativity may be a trait-like marker for psychopathology and might be a useful endophenotype. [ABSTRACT FROM AUTHOR]

“Evidence-Based Psychosocial Treatments for Tic Disorders” ( Cook & Blacher, 2007 ) provided a current and comprehensive summary of the evidence base for psychosocial approaches to these conditions, and concluded that habit reversal training meets established criteria as an empirically supported treatment. This commentary delves further into the theoretical implications of the treatment outcome findings for chronic tic disorders (CTDs), and highlights the importance of conducting studies that better elucidate the mechanism underlying symptom reduction. We maintain that significant advances in our understanding of these mechanisms will improve our understanding of the causal and maintaining factors in CTDs, which in turn will inform treatment refinements. We also believe that this line of research will improve the acceptability of these psychosocial approaches among all of those who encounter CTDs in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). Methods: Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-behavior therapy (CBT), medical management with sertraline (SER), and the combination of CBT and SER (COMB), to pill placebo (PBO) in children and adolescents with OCD, we asked whether the presence of a comorbid tic disorder influenced symptom reduction on the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) after 12 weeks of treatment. Results: Fifteen percent (17 of 112) of patients exhibited a comorbid tic disorder. In patients without tics, results replicated previously published intent-to-treat outcomes: COMB > CBT > SER > PBO. In patients with a comorbid tic disorder, SER did not differ from PBO, while COMB remained superior to CBT and CBT remained superior to PBO. Conclusions: In contrast to CBT outcomes, which are not differentially impacted, tic disorders appear to adversely impact the outcome of medication management of pediatric OCD. Children and adolescents with obsessive-compulsive disorder and a comorbid tic disorder should begin treatment with cognitive-behavior therapy alone or the combination of cognitive-behavior therapy plus a serotonin reuptake inhibitor. [Copyright &y& Elsevier]

The current study examined the frequency and associated distress of both hairpulling and skin picking behaviors in 1,324 college students using the Massachusetts General Hospital Hairpulling Scale (MGHHS) and Skin Picking Scale (SPS). In this sample, many participants reported significant distress secondary to both hairpulling and skin picking. Participants who endorsed relatively frequent hairpulling or skin picking ( N = 72) were scheduled for a follow-up testing session to further assess the relationship between these behaviors and measures of affective distress. Compared to a control sample, the follow-up sample endorsed significantly more symptoms of anxiety and stress reactivity, and had higher scores on a measure of obsessive-compulsive symptoms. [ABSTRACT FROM AUTHOR]

The efficacy of cognitive-behavioral therapy (CBT) involving exposure and ritual prevention (EX/RP) for obsessive compulsive disorder (OCD) has been well documented, as has the efficacy of pharmacotherapy using serotonin reuptake inhibitors (SRIs). Response to these monotherapies is neither universal nor complete, however, and in the past 20 years significant progress has been made in examining the efficacy of combined EX/RP plus SRI treatment. Results of randomized controlled trials that have employed adequate methodology suggest that combined treatment may afford some advantages over the monotherapies, although the effect is generally not robust and there are some negative findings. Combined treatment may be especially useful in certain clinical circumstances, however, and case examples are provided describing the use of combined treatment for one patient who presented with comorbid depression and for another who refused EX/RP because he perceived it as too threatening. [ABSTRACT FROM AUTHOR]

Interpretation bias, defined as the tendency to interpret ambiguous stimuli as threatening, is thought to play a central role in the maintenance of social phobia. However, the effect of cognitive-behavioral therapy (CBT) on this bias has not been determined. The present study examined interpretation bias in individuals with generalized social phobia (GSP) who had been treated with CBT, untreated GSPs, and nonanxious controls (NACs). Results indicated that untreated GSPs had higher negative bias scores than treated GSPs and NACs on a forced-choice measure of interpretation bias, although the latter two groups did not differ. Following study hypotheses, the interpretation bias found in untreated GSPs was specific to social items, and was evident when raters coded participants’ initial written responses to the scenarios, when compared with control subjects. Treated patients had open-ended responses that did not differ from controls or untreated GSPs. Findings are discussed in the context of other GSP interpretation bias studies, and future research directions are recommended. [ABSTRACT FROM AUTHOR]

In their comprehensive review of the literature on combined treatments for mood and anxiety disorders in adults, Otto, Smits, and Reese (this issue) suggested that the data do not support the use of combined approaches as the default treatment for these conditions. They advocated a nuanced view of the existing findings and emphasized that much is yet to be discovered about whether and how best to combine psychosocial and pharmacological interventions. An empirical update from several recently completed randomized controlled trials (RCTs) examining combined treatment is provided here, and points of convergence and divergence between these findings and the broader literature are considered. Additionally, this commentary supplements their discussion by (a) supporting their strong emphasis on interdisciplinary research and creativity in conceptualizing and designing combined treatments, (b) emphasizing the importance of studying predictors of treatment response in adequately powered trials to better clarify which subgroups require the additional expenditure of resources associated with combined treatment, and (c) encouraging the development and empirical evaluation of combined treatments for children and adolescents. [ABSTRACT FROM AUTHOR]

To assess how different criteria for relapse affect inferences about relapse in obsessive-compulsive disorder (OCD), a post hoc analysis of relapse was conducted using data from a multisite randomized controlled trial comparing clomipramine (CMI), exposure and ritual prevention (EX/RP), and its combination (EX/RP+CMI) in adults with OCD. Different relapse definitions were constructed based on criteria used in prior studies. For each definition, the number of relapsers was computed, and the proportion of relapsers and time to relapse were compared. When applied to this data set, relapse criteria used in prior OCD studies yielded different observed relapse rates (range: 27-63% for CMI; 0-50% for EX/RP; and 7-67% for EX/RP+CMI). Most criteria found that EX/RP responders (with or without CMI) had a significantly lower relapse rate and longer time to relapse after treatment discontinuation than did responders to CMI alone. However, some relapse criteria (e.g., those requiring minimal worsening) found no significant treatment differences in relapse rates or time to relapse, and some generated biases against one treatment or another. Most definitions concurred: in adults with primary OCD, EX/RP treatment (with or without CMI) can produce more durable short-term gains after treatment discontinuation than CMI alone. However, different relapse criteria can lead to very different observed relapse rates and even contradictory inferences about relapse. Standard criteria for relapse are needed in OCD to facilitate comparisons between studies (enabling better treatment guidelines) and to advance research on mechanisms of relapse and relapse prevention. [ABSTRACT FROM AUTHOR]

Previous researchers have classified obsessive-compulsive disorder (OCD) patients by the themes of their obsessions and compulsions (e.g., washing, checking); however, mental compulsions have not been adequately assessed in these studies. The authors conducted 2 studies using a large sample of OCD patients (N = 132). In the 1st study, they categorized patients on the basis of symptom presentation, giving adequate consideration to mental compulsions. Five patient clusters were identified: harming, contamination, hoarding, unacceptable thoughts, and symmetry. Mental compulsions were most prevalent among patients with intrusive, upsetting religious, violent, or sexual thoughts. In the 2nd study, they compared response to cognitive-behavioral therapy across symptom categories, finding poorer outcomes among patients with hoarding symptoms compared with those with other symptom themes. [ABSTRACT FROM AUTHOR]

We examine treatment exclusion and refusal rates as well as reasons for non-participation in a sub-sample of phone interviews conducted to determine eligibility for a randomized study of treatments for generalized social phobia (GSP). This study compared group comprehensive cognitive behavioral therapy (CCBT) to fluoxetine (FLU), placebo (PLA), or their combination. Results suggest that the major exclusion for the study was due to comorbid depression, followed by having a different diagnosis as primary. Patient refusal to enter the study was also common, with the most frequently reported reason being not wanting to take medication. Notably, few people who refused stated an objection to entering CCBT or PLA. These results suggest that there is a need to develop and evaluate a treatment for social anxiety with comorbid depression and to systematically study reasons for reluctance to take medication among individuals with GSP. [Copyright &y& Elsevier]

Cognitive-behavioral therapy (CBT) and pharmacotherapy demonstrate efficacy across the anxiety disorders, but recognition of their limitations has sparked interest in combining modalities to maximize benefit. This article reviews the empirical literature to examine whether combining treatments influences efficacy of either monotherapy.We conducted a comprehensive literature search of published randomized trials that compared combined treatment with pharmacologic or CBT monotherapies. Ten studies that met our inclusion criteria were reviewed in detail, and within-subjects effect sizes were calculated to compare treatment conditions within and across studies.At posttreatment and follow-up, effect size and percentage responder data failed to clearly demonstrate an advantage or disadvantage of combined treatment over CBT alone for obsessive-compulsive disorder, social phobia, and generalized anxiety disorder. Some advantage of combined treatment over pharmacotherapy alone emerged from the few studies that allowed for such a direct comparison. In contrast, combined treatment for panic disorder seems to provide an advantage over CBT alone at posttreatment, but is associated with greater relapse after treatment discontinuation.The advantage of combined treatment may vary across the anxiety disorders. The potential differences in usefulness of combined treatment are discussed, directions for future research are suggested, and implications for clinical practice are considered. [Copyright &y& Elsevier]

Exposure and ritual prevention (EX/RP) is an effective treatment for obsessive compulsive-disorder (OCD), although it is neither universally nor completely helpful. Compliance with EX/ RP treatment procedures has been linked theoretically to posttreatment outcome, yet empirical exploration of this relationship has been insufficient. In this study, therapists were asked to rate the treatment compliance of 28 consecutive patients who received EX/RP on a fee-for-service basis. Results indicated that understanding the treatment rationale and compliance with in-session and homework exposure instructions, but not with ritual prevention and self-monitoring of rituals, was significantly related to posttreatment OCD symptom severity. Clinical implications of these findings and future directions in treatment compliance research with OCD patients are discussed. [ABSTRACT FROM AUTHOR]

Presents a study which investigated the uncertain efficacy of cognitive-behavioral therapy in the treatment of obsessive compulsive disorders (OCD) in the U.S. Factors to consider in the treatment of the disease; Association tasked to develop, test and improve cognitive-behavioral treatments for anxiety disorders, including OCD; Participants of the study.

Probability and emotional impact estimates of intense positive and negative social events were examined in individuals with generalized social phobia (GSPs), obsessive compulsive disorder (OCDs), and nonanxious controls (NACs). Participants completed a questionnaire containing 20 event descriptions. For each event, they indicated the probability that the event would happen to them and rated aspects of their reactions to the event: magnitude, duration, self-esteem change, and strength of bodily reaction. Compared to NACs, GSPs estimated positive events as less likely and negative events as more likely to happen to them. GSPs rated the impact of both negative and positive social events higher than did NACs. Moreover, GSPs anticipated experiencing more frequent and intense negative reactions to positive social events than did NACs. On most measures, GSPs also differed from OCDs. Although evaluation biases of social events may be more characteristic of anxious individuals than of nonanxious individuals, they appear to be particularly related to social phobia. [ABSTRACT FROM AUTHOR]

Examines the efficacy of exposure and ritual prevention (EX/RP), a behavioral therapy in reducing symptoms of obsessive-compulsive disorders in Pennsylvania. Variations of the therapy; Benefits of EX/RP; Evidence of substantial and clinical symptom reductions at posttreatments; Superiority of intensive EX/RP treatment.

Presents a study which examined the effects of comorbid depression on response to treatment for obsessive-compulsive using cognitive-behavioral therapy with or without medication. Obsessive-compulsive symptoms; Effects of depression at posttreatment; Treatment responder rates; Results and discussion.

Examines the effectiveness of cognitive behavior treatment program for trichotillomania (TTM). Extension of length of treatment for the reduction of greater initial symptom; Impulse-control disorder; Association of TTM with significant psychological and medical complications.

Studies cognitive biases in generalized social phobia (GSP). Rating of negative social events by people with GSP; Effects of cognitive behavioral treatment; Factors mediating improvement in social phobia.

Discusses the results of a study which sought to identify the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder. Methodology used in conducting study; Number of patients involved; Details on the findings; Conclusions made.

Introduction: Trichotillomania is a heterogeneous disorder with a wide range of presentations. Past studies have described the phenomenology of trichotillomania, but individual differences based on the body site from which hair is pulled have not been thoroughly explored. Contextual variables relevant to pulling (e.g., settings, tool use) may vary as a function of pulling site. We constructed a detailed profile of individual and clinical characteristics based on pulling site and describe contextual factors associated with different pulling sites. Methods: Data were drawn from two randomized control trials of psychotherapy for trichotillomania. Participants included treatment-seeking adults with trichotillomania (N = 153; 89% women; Mage=33.41) who took part in either a face-to-face (n = 92) or an online (n = 61) trial. Study 1 explored differences in age, gender, trichotillomania symptom severity, and levels of automatic and focused pulling as a function of pulling site. Study 2 included a subset of Study 1 participants (n = 65) and examined pulling site differences for relevant contextual variables. Results: Study 1 revealed differences in age, gender, and level of automatic vs. focused pulling based on pulling site. Study 2 showed that pulling from different bodily sites was more likely to occur in specific settings and with certain tools. Discussion: These results reflect considerable variability in the phenomenology of trichotillomania across pulling sites and contribute to the overall understanding of trichotillomania. A clearer picture of contextual cues and clinical characteristics for different hair pulling sites has treatment implications. Clinical applications and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Background: Trichotillomania (TTM) is a psychiatric disorder that leads to significant hair loss, distress, and impairment. Few validated measures exist to assess TTM, and psychometric research examining these tools is sparse. This study evaluated the psychometric properties of commonly used TTM severity measures and extended prior research by including hair loss severity ratings in our analyses. Methods: Participants included 91 adults (92.3% Female; M age = 35.0) with TTM who completed baseline assessments as part of a randomized clinical trial of psychotherapy for TTM. TTM measures included the Massachusetts General Hospital Hairpulling Scale (MGH-HS) and National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). Independent evaluators rated photos of participants' most severely affected pulling sites using a one-item hair loss severity scale. Results: Results showed mixed psychometric properties for TTM measures. The MGH-HS showed acceptable internal consistency (alpha = 0.83; omega = 0.89), while the NIMH-TSS had lower internal consistency (alpha = 0.52; omega = 0.73). Both the MGH-HS and NIMH-TSS demonstrated low test-retest reliability. Total scores on the MGH-HS and NIMH-TSS were not associated with hair loss severity. Conclusions: Given these findings, it is imperative to develop new, psychometrically-sound TTM measures. These results also emphasize the importance of a multi-method approach to TTM assessment. In addition to self-report and clinician-administered measures, hair loss severity ratings may offer valuable information as part of a comprehensive assessment of TTM. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Cognitive Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized Controlled Trial," by M. E. Franklin, J. Sapyta and J. B. Freeman.

Trichotillomania is characterized by recurrent pulling out of one's hair, leading to significant hair loss and accompanied by clinically significant distress and/or functional impairment. The current study used data from a randomized controlled trial comparing the effectiveness of acceptance-enhanced behavior therapy (AEBT) to psychoeducation plus supportive therapy (PST; active control) for trichotillomania in an adult sample. The objectives were to examine the moderating and mediating influence of trichotillomania-specific psychological flexibility in treatment for trichotillomania. Participants with lower baseline flexibility performed better in AEBT than PST in terms of greater symptom reduction and quality of life. Lower baseline flexibility also predicted higher likelihood of disorder recovery in AEBT relative to PST. In addition, relative to PST, symptom reduction in AEBT was mediated by psychological flexibility, controlling for anxiety and depression. These findings suggest that psychological flexibility is a relevant process of change in the treatment of trichotillomania. Clinical implications and directions for future research are discussed. • Examined moderating and mediating role of psychological flexibility in AEBT for TTM. • Lower baseline flexibility predicted better outcomes in AEBT relative to control. • Psychological flexibility mediated symptom reduction in AEBT relative to control. [ABSTRACT FROM AUTHOR]

In this article the author discusses the results of the Pediatric OCD Treatment Study II (POTS II) wherein he mentions that the addition of a full course of cognitive behavior therapy (CBT) in treating obsessive compulsive disorder (OCD) is deemed beneficial to patients who are experiencing partial response to medication.

Objective: Trichotillomania (TTM) is associated with significant embarrassment and is viewed negatively by others. A potentially important outcome variable that is often overlooked in treatment for TTM is appearance and social perception. Method: The present study tested whether participants in a randomized controlled trial (RCT) of psychotherapy for TTM are viewed more positively by others. All participants in the trial were photographed at baseline and posttreatment. Three treatment responders and three treatment nonresponders were selected randomly for the present study. Several healthy controls were also photographed in a similar manner. Undergraduate college students (N = 245) assessed whether they would reject the person socially, whether the individual has a psychological or medical problem, and attractiveness. Results: Individuals with TTM were viewed more negatively than healthy controls at baseline, but treatment responders showed positive improvements on all perceptions relative to nonresponders. While treatment responders were still perceived more poorly than controls on social rejection and perceptions of problems at posttreatment, responders where rated no differently than controls on attractiveness at posttreatment. Conclusions: The results suggest that persons with TTM who respond to treatment are rated by others as significantly improved in appearance, but they might be still stigmatized or socially rejected. [ABSTRACT FROM AUTHOR]

Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13-18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed. [ABSTRACT FROM AUTHOR]

Objective: A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes.Method: A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively.Results: The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a ≥35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7-84.1; specificity = 81.7, 95% CI = 81.5-81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8-82.2; specificity = 84.6, 95% CI = 84.4-84.8).Conclusion: Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD. [ABSTRACT FROM AUTHOR]

Trichotillomania (TTM) is associated with impairments in response inhibition and cognitive flexibility, but it is unclear how such impairments relate to treatment outcome. The present study examined pre-treatment response inhibition and cognitive flexibility as predictors of treatment outcome, change in these domains from pre-to post-treatment, and associations with TTM severity. Participants were drawn from a randomized controlled trial comparing acceptance-enhanced behavior therapy (AEBT) to psychoeducation and supportive therapy (PST) for TTM. Adults completed assessments at pre-treatment (n = 88) and following 12 weeks of treatment (n = 68). Response inhibition and cognitive flexibility were assessed using the Stop Signal Task and Object Alternation Task, respectively. Participants completed the MGH-Hairpulling Scale. Independent evaluators administered the NIMH-Trichotillomania Severity Scale and Clinical Global Impressions-Improvement Scale. Higher pre-treatment TTM severity was associated with poorer pre-treatment cognitive flexibility, but not response inhibition. Better pre-treatment response inhibition performance predicted positive treatment response and lower post-treatment TTM symptom severity, irrespective of treatment assignment. Cognitive flexibility did not predict treatment response. After controlling for age, neither neurocognitive variable changed during treatment. Response inhibition and cognitive flexibility appear uniquely related to hair pulling severity and treatment response in adults with TTM. Implications for treatment delivery and development are discussed. • Examined neurocognition in adults with trichotillomania in a treatment trial. • At baseline, higher TTM severity correlated with poorer cognitive flexibility. • Better baseline response inhibition predicted lower post-treatment TTM severity. • Response inhibition and cognitive flexibility did not improve pre-to post-treatment. [ABSTRACT FROM AUTHOR]

Trichotillomania ( TTM) was long classified as an impulse-control disorder; however, the many characteristics it shares with obsessive-compulsive disorder ( OCD) led to its recategorization in the DSM- V. The present study aimed to assess and inform the taxonomic placement of TTM through an examination of its neural correlates. While research has consistently associated OCD with enhanced response monitoring, the present study investigated whether a similar neural process is associated with TTM. Undergraduates reporting TTM symptoms and controls performed a modified version of the flanker task, and their event-related potentials were examined for between-group differences in error-related negativity ( ERN). Results confirm that individuals who have symptoms of hair pulling have significantly smaller ERNs than the control group. Smaller ERNs reflect decreased levels of response monitoring and support the idea that TTM is distinct from OCD. [ABSTRACT FROM AUTHOR]

• Six-month outcomes from an RCT of acceptance-enhanced behavior therapy (AEBT) for TTM. • AEBT was compared to psychoeducation and supportive therapy (PST). • AEBT treatment gains were maintained from post-treatment to six-month follow-up. • At follow-up, symptom severity did not differ between AEBT and PST. • Higher TTM severity at baseline predicted higher TTM severity at follow-up for PST Acceptance-enhanced behavior therapy for trichotillomania (AEBT-TTM) is effective in reducing trichotillomania (TTM) symptoms, but the durability of treatment effects remains in question. This study analyzed 6-month follow-up data from a large randomized clinical trial comparing AEBT-TTM to an active psychoeducation and supportive therapy control (PST). Adults with TTM (N =85; 92% women) received 10 sessions of AEBT-TTM or PST across 12 weeks. Independent evaluators assessed participants at baseline, post-treatment, and 6 months follow-up. For both AEBT-TTM and PST, self-reported and evaluator-rated TTM symptom severity decreased from baseline to follow-up. TTM symptoms did not worsen from post-treatment to follow-up. At follow-up, AEBT-TTM and PST did not differ in rates of treatment response, TTM diagnosis, or symptom severity. High baseline TTM symptom severity was a stronger predictor of high follow-up severity for PST than for AEBT-TTM, suggesting AEBT-TTM may be a better option for more severe TTM. Results support the efficacy of AEBT-TTM and show that treatment gains were maintained over time. Although AEBT-TTM yielded lower symptoms at post-treatment, 6-month follow-up outcomes suggest AEBT-TTM and PST may lead to similar symptom levels in the longer term. Future research should examine mechanisms that contribute to long-term gain maintenance. [ABSTRACT FROM AUTHOR]

Abstract: In this Internet study, we explore differences among minority and Caucasian participants in the phenomenology of, interference and impairment related to, and perceived efficacy of treatments for trichotillomania (TTM) symptoms. A demographic difference was found for number of children only. Results indicate that the minority sample was less likely to report pulling from their eyebrows and eyelashes than the Caucasian sample. Minorities were less likely to report increased tension before a pulling episode. Minorities reported high levels of TTM interference with home management but Caucasians reported higher TTM interference with their academic life. Caucasians with TTM reported higher daily stress than their minority counterparts. Although minorities were less likely to utilize treatment, no significant differences were found for treatment improvement. This Internet study sheds important light on differences in TTM symptoms among minorities and Caucasians. The lack of economic and education differences between groups is a strength of this research. [Copyright &y& Elsevier]

In DSM-IV-TR, trichotillomania (TTM) is classified as an impulse control disorder (not classified elsewhere), skin picking lacks its own diagnostic category (but might be diagnosed as an impulse control disorder not otherwise specified), and stereotypic movement disorder is classified as a disorder usually first diagnosed in infancy, childhood, or adolescence. ICD-10 classifies TTM as a habit and impulse disorder, and includes stereotyped movement disorders in a section on other behavioral and emotional disorders with onset usually occurring in childhood and adolescence. This article provides a focused review of nosological issues relevant to DSM-V, given recent empirical findings. This review presents a number of options and preliminary recommendations to be considered for DSM-V: (1) Although TTM fits optimally into a category of body-focused repetitive behavioral disorders, in a nosology comprised of relatively few major categories it fits best within a category of motoric obsessive–compulsive spectrum disorders, (2) available evidence does not support continuing to include (current) diagnostic criteria B and C for TTM in DSM-V, (3) the text for TTM should be updated to describe subtypes and forms of hair pulling, (4) there are persuasive reasons for referring to TTM as “hair pulling disorder (trichotillomania),” (5) diagnostic criteria for skin picking disorder should be included in DSM-V or in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and (6) the diagnostic criteria for stereotypic movement disorder should be clarified and simplified, bringing them in line with those for hair pulling and skin picking disorder. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The current study utilized a cross-sectional design to examine pulling severity, phenomenology, functional impact, and “focused” and “automatic” pulling styles in women with TTM across a wide age spectrum. “Automatic” pulling refers to pulling occurring primarily out of one’s awareness, while “focused” pulling refers to pulling with a compulsive quality that may include pulling in response to a negative emotional state (e.g., anxiety, stress, anger, etc.), an intense thought or urge, or in an attempt to establish symmetry. In the present study, data were collected from 1,471 female participants (age 10–69) meeting modified diagnostic criteria for TTM via two separate online surveys (one for children/adolescents, one for adults). Pulling severity remained stable across the different developmental cohorts. However, fluctuations in functional impact (e.g., social and interpersonal impairment) were noted. “Automatic” pulling showed relatively little fluctuation from adolescence to adulthood, while “focused” pulling demonstrated considerable fluctuation coinciding with psychological distress and typical ages of important biological changes (e.g., pubertal onset) in children/adolescents and adults (e.g., perimenopause). Conclusions, treatment implications, limitations, and future areas of research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: To date, no studies have examined possible phenomenological differences between the automatic and focused styles of pulling in youths with TTM. The aims of the current study were to examine differences in TTM severity, phenomenology, comorbid psychiatric symptoms, and functional impact across youths with varying degrees of these pulling styles. Youths between the ages of 10 and 17 years (and their parent) were recruited via an Internet-based survey. A total of 186 youths with chronic hair pulling was classified as “high-focused” or “low-focused” and either “high-automatic” or “low-automatic” based upon scores obtained on the Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C) using a median-split procedure. Results demonstrated significant differences between pulling styles. More specifically, “high-focused” pullers reported more severe TTM and greater symptoms of anxiety and depression than “low-focused” pullers, and “high-automatic” pullers reported greater symptoms of depression than “low-automatic” pullers. Subsequent analyses suggest that, in comparison to youths with low levels of both automatic and focused pulling, those experiencing high levels of focused pulling but low levels of automatic pulling reported phenomenological differences and were more likely to engage in additional repetitive behaviors (i.e., skin picking, lip/cheek biting). Clinical and research implications, study limitations, and future areas of research are discussed. [Copyright &y& Elsevier]

This article describes the development of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A), which was designed to assess “automatic” and “focused” pulling subtypes of trichotillomania (TTM). Participants reporting symptoms of TTM ( n = 1,697) completed an internet survey; participants were later randomly assigned to either Exploratory ( n = 848) or Confirmatory ( n = 849) Analyses. Exploratory Analyses examined the development and psychometric properties of the MIST-A. Results of an exploratory factor analysis revealed a two-factor solution. Factor 1 (“focused” pulling scale) and 2 (“automatic” pulling scale) consisted of ten and five items respectively, with both scales demonstrating adequate internal consistency and good construct and discriminant validity. Subsequent confirmatory factor analysis demonstrated support for the scale’s underlying factor structure. The MIST-A provides researchers with a reliable and valid assessment of “automatic” and “focused” pulling, although replication using a clinically ascertained sample is necessary. [ABSTRACT FROM AUTHOR]

This article describes the development and initial psychometric properties of the Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C), a self-report scale designed to assess styles of hair pulling in children and adolescents diagnosed with trichotillomania (TTM). Using Internet sampling procedures, the authors recruited 164 parent-child dyads, the children of whom met modified diagnostic criteria for TTM. The MIST-C was administered in the context of a larger survey examining functional impairment experienced by children with TIM. Results of an exploratory factor analysis on MIST-C items revealed a two-factor solution. Factors I (‘focused’ pulling scale) and 2 (‘automatic’ pulling scale) consisted of 21 and 4 items, respectively, with both scales demonstrating acceptable internal consistency and good construct and discriminant validity. The development of the MIST-C provides researchers with a reliable and valid assessment of ‘automatic’ and ‘focused’ pulling, and provides a means by which to examine the developmental trajectory and treatment implications of these pulling styles. [ABSTRACT FROM AUTHOR]

In the treatment of anxious youth, children''s symptom presentations cannot always be readily distinguished as indicative of obsessive–compulsive disorder (OCD) or generalized anxiety disorder (GAD). Following a definition and brief description of the phenomenology, epidemiology, and treatment of OCD and GAD in youth, consideration is given to factors that contribute to the proximity of the two disorders. In an effort to better understand the distinctive and overlapping features of these neighboring disorders, we review (a) obsessions and worry, with reference to process, form, content, and metacognitive beliefs, and (b) the literature on pathological worry and covert compulsions. Studies from the adult literature are considered throughout, and the absence of related work with samples of youth, within a developmental framework, is highlighted. Suggestions for future research are offered. [Copyright &y& Elsevier]

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. Previous research has shown that adults with social anxiety disorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the case in adolescents with social anxiety disorder. Elucidation of the cognitive processes of social anxiety disorder in the adolescent population may aid in a better understanding of the etiology and maintenance of the disorder, and may suggest directions for treatment and prevention efforts. This study investigated probability and cost estimations of negative social and nonsocial events among adolescents with social anxiety disorder relative to nonanxious controls. Results indicated that socially anxious adolescents overestimated the cost and probability of negative social events compared to nonanxious adolescents, even after controlling for depressive symptoms. Implications and limitations of these findings are discussed. [ABSTRACT FROM AUTHOR]