Perceived parental rearing style in obsessive-compulsive disorder: relation to symptom dimensions

The metacognitive experience of time passing in Chinese college students: scale development, structure verification, and influencing factors

The experience of time passing (ETP) is also the consciousness of the progress of life. ETP contributes to time regulation and life management, which basically conforms to the metacognitive theory. Also, the traditional Chinese cultural approach to time emphasizes ETP. It is an indispensable part of Chinese education and culture to strengthen one's appreciation of time by emphasizing the passage of time. In combination with the above two points, ETP equals metacognitive experience of time passing (METP) to a certain extent. However, we currently know little about the connotations of METP. To better understand traditional Chinese time culture, and referring to the concept of metacognition and model of time experience as proposed by Western scholars, the current study combined the results of open and semi-structured interviews, to explore the structure of METP in Chinese college students and developed a questionnaire with which to measure it. Using convenience sampling, 2,876 college students were recruited, the interview, and the reliability and validity tests were carried out. Five hundred and seventy-nine college students were tested a second time to investigate the correlation validity between METP and Ruminative Responses, time attitude, and meaning in life. The results led to the development of the METP Scale which contains 15 items and assesses two factors: ruminative and emotional experience of time passing. The two-factor model was well fitted, and invariable in measurements across gender, grade, and major. The internal consistency coefficients of the scale and its two factors ranged from 0.82 to 0.89, the half-point reliability between 0.76 and 0.88, and the retest reliability ranged from 0.77 to 0.78. METP Scale has good correlation validity, meanwhile, the results of regression analysis showed that symptom rumination, positive past, negative present, positive future, and searching for meaning in life significantly predict the intensity of METP.

Relationship between gene-environment interaction and obsessive-compulsive disorder: A systematic review

BACKGROUND

Gene-environment interaction (G × E) refers to the change of genetic effects under the participation of environmental factors resulting in differences in genetic expression. G × E has been studied in the occurrence and development of many neuropsychiatric disorders, including obsessive-compulsive disorder (OCD).

AIM

A systematic review was conducted to investigate the role of G × E plays in OCD. This review explored the relationship between G × E and the susceptibility to OCD occurrence, disease progression, and treatment response.

METHODS

This systematic literature search was performed using Web of Science, PubMed, Cochrane Library, and CNKI. Seven studies were selected, which included seven genes (BDNF, COMT, MAO, 5-HTT, SMAD4, PGRN, and SLC1A1) polymorphisms, polygenic risk score (PRS), and two environmental factors (childhood trauma and stressful life events).

RESULTS

Information from this systematic review indicated that G × E increased the susceptibility to OCD, played a crucial role in the clinical characteristics, and had an inconsistent impact on treatment response of OCD.

FUTURE DIRECTIONS

The multi-omics studies and the inclusion of G × E in future GWAS studies of OCD should be drawn more attention, which may contribute to a deeper understanding of the etiology of OCD as well as guide therapeutic interventions for the disease.

The relationship between moral judgment ability, parenting style, and perfectionism in obsessive-compulsive disorder patients: A mediating analysis

Introduction

Guilt is an important part of obsessive-compulsive disorder. The abnormal moral cognition of obsessive-compulsive disorder patients may be closely related to their high level of guilt. The purpose of this study was to explore the development level of moral judgment in patients with obsessive-compulsive disorder and the role of parenting style and perfectionism in moral judgment development.

Method

A cross-sectional study was conducted in the clinical psychology department of a Class III hospital in Beijing. The patients with obsessive-compulsive disorder were recruited, and the healthy control subjects were recruited at the same time. Questionnaires were used to collect data, including the Yale-Brown Compulsion Scale, the Moral Judgment Test, the Parenting Style Evaluation Scale, and the Frost Multidimensional Perfectionism Scale.

Result

A total of 231 patients with obsessive-compulsive disorder and 246 healthy controls were included. The results showed that, first, the obsessive-compulsive group scored significantly lower on moral judgment than the healthy control group. Second, the tendency of non-adaptive perfectionism was significantly higher in the obsessive-compulsive group than in the healthy control group. Third, parents' excessive control, denial, punishment, and other parenting styles and non-adaptive perfectionism are higher than those of healthy people. Fourthly, the mother of obsessive-compulsive disorder patients is overly interference and protective. Rejection, denial, punishment, harshness, and father's rejection and denial play a partial mediating role in moral judgment ability through the degree of non-adaptive perfectionism.

Conclusion

The development level of moral judgment ability of patients with obsessive-compulsive disorder was significantly lower than that of the normal group, and the level of non-adaptive perfectionism was significantly higher than that of the normal group. Parents of obsessive-compulsive patients use more high-pressure control education. Parenting style partially affects the moral judgment of obsessive-compulsive patients through the degree of non-adaptive perfectionism.

Interpersonal attachment, early family environment, and trauma in hoarding: A systematic review

The formation of intense emotional attachments to objects, difficulty parting with possessions, and the extreme accumulation of clutter are key features of Hoarding Disorder (HD). Although substantial literature implicates processes such as dysfunctional beliefs and maladaptive emotional cycles in HD, little is known about the vulnerability factors that lead to their development and hoarding symptomatology. The current review sought to systematically collate and integrate findings from studies investigating the relationship between hoarding symptoms and three proposed vulnerability factors: i) interpersonal attachment, ii) early family environment, and iii) traumatic or adverse life events. A comprehensive search of the databases PsycInfo, PubMed, and Scopus identified a total of 39 studies for inclusion. The results presented a complex pattern that supported the presence of relationships between insecure attachment, cold and controlling family experiences, and exposure to adverse life events with increased hoarding severity. However, the specificity of these factors to HD over other clinical groups remains unclear and findings are limited by the heterogenous and small number of studies. We conclude by discussing the clinical implications and limitations of these findings and propose new directions for future research.

Mechanisms of the Effects of Parental Emotional Warmth on Extraversion in Children and Adolescents

The purpose of this study is to probe into the influence mechanism of parental emotional warmth (PEW) on extraversion for children and adolescents, as well as the moderating and mediating role of brain functional activity. Thirty-two children and adolescents underwent functional magnetic resonance imaging (fMRI) scans and completed Egna Minnen av Barndoms Uppfostran (EMBU) and Eysenck Personality Questionnaire (EPQ). Small-worldness (SW) of brain networks, fractional amplitude of low-frequency fluctuations (fALFF), and region-of-interest to region-of-interest (ROI-ROI) functional connectivity were calculated to study intrinsic neuronal activity. We found that PEW had a positive direct effect on extraversion, and all participants in the current study showed an efficient small-world structure. The positive association between PEW and extraversion was mediated by SW. Furthermore, the fALFF and extraversion were significantly and negatively correlated in the right precuneus and dorsolateral superior frontal gyrus. The mediating effect of SW was moderated by the functional connectivity between the right precuneus and the right dorsolateral superior frontal gyrus. The indirect effect was significant with lower level of the functional connectivity between the right precuneus and the right dorsolateral superior frontal gyrus. These findings indicate that SW of brain networks may be a key factor that accounts for the positive association between PEW and extraversion in children and adolescents and the level of the functional connectivity between the right precuneus and the right dorsolateral superior frontal gyrus could moderate the relationship.

Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder

Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.

Clinical characteristics of moderate-severe obsessive-compulsive disorder in children and adolescents in China

Objective

This study reports clinical characteristic of moderate–severe obsessive–compulsive disorder (OCD) among school students in China.

Methods

We examined 153 patients for the distribution of OCD symptoms using the Yale-Brown Obsessive Compulsive Scale Symptoms Checklist, the severity of anxiety and depression symptoms using the Hamilton Anxiety Scale and the Hamilton Depression Scale-24, respectively, and impairment in learning, family and social functions using the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire.

Results

The number of total OCD, obsession and compulsion symptoms was 6.71 (standard deviation [SD] = 2.25), 3.77 (SD = 1.32) and 2.94 (SD = 1.59), respectively. The incidence of moderate and severe depressive symptoms for junior high school students was significantly higher than for primary and high school students. The number of children and adolescents with OCD increased with age, reaching a peak in the senior high school stage.

Conclusion

The most common symptoms in children and adolescent OCD patients are miscellaneous obsessions, aggressiveness, religiousness, checking, miscellaneous compulsions, cleaning-washing and repeating. These patients show a relatively high co-occurrence rate of anxiety symptoms and depressive symptoms, which impairs their learning, as well as their family and social functions.

A systematic review and realist synthesis on toilet paper hoarding: COVID or not COVID, that is the question

OBJECTIVE

To explore whether the coronavirus disease 2019 (COVID-19) pandemic is associated with toilet paper hoarding and to assess which risk factors are associated with the risk of toilet paper hoarding.

DESIGN

A systematic review and realist review were conducted.

DATA SOURCES

PubMed, Web of Science, Scopus and PsycINFO were searched (systematic review). PubMed, pre-prints and grey literature were also searched (realist review). The databases were searched from inception until October 2020.

STUDY SELECTION

There were no restrictions on the study design.

OUTCOMES AND MEASURES

For the systematic review, toilet paper hoarding was the main outcome, and pathological use of toilet paper was the secondary outcome. For the realist review, the context-mechanisms-outcome (CMO) scheme included the COVID-19 pandemic (context), four proposed mechanisms, and one outcome (toilet paper hoarding). The four potential mechanisms were (1) gastrointestinal mechanisms of COVID-19 (e.g. diarrhoea), (2) social cognitive biases, (3) stress-related factors (mental illnesses, personality traits) and (4) cultural aspects (e.g. differences between countries).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

All studies of human populations were considered (including general population studies and clinical studies of patients suffering from mental health problems).

RESULTS

The systematic review identified 14 studies (eight studies for the main outcome, six studies for the secondary outcome). Three surveys identified the role of the COVID-19 threat in toilet paper hoarding in the general population. One study pointed to an association between a personality trait (conscientiousness) and toilet paper buying and stockpiling as well as an additional significant indirect effect of emotionality through the perceived threat of COVID-19 on toilet paper buying and stockpiling. Six case reports of pathological use of toilet paper were also identified, although none of them were associated with the COVID-19 pandemic. The realist review suggested that of all the mechanisms, social cognitive biases and a bandwagon effect were potential contributors to toilet paper hoarding in the general population. The stressful situation (COVID-19 pandemic) and some personality traits (conscientiousness) were found to be associated with toilet paper hoarding. Cultural differences were also identified, with relatively substantial effects of toilet paper hoarding in several Asian regions (Australia, Japan, Taiwan and Singapore).

CONCLUSIONS

The COVID-19 pandemic has been associated with a worldwide increase in toilet paper hoarding. Social media and social cognitive biases are major contributors and might explain some differences in toilet paper hoarding between countries. Other mental health-related factors, such as the stressful situation of the COVID-19 pandemic, fear of contagion, or particular personality traits (conscientiousness), are likely to be involved.

REGISTRATION

PROSPERO CRD42020182308.

Parental rearing and personality traits as predictors for adolescents with obsessive-compulsive disorder (OCD)

We aim to determine the correlation between parental rearing, personality traits, and obsessive-compulsive disorder (OCD) in different quantiles. In particular, we created an intermediary effect model in which parental rearing affects OCD through personality traits. All predictors were measured at the time of the survey, comprising parental rearing (paternal rearing and maternal rearing), demographics (grade and gender), and personality traits (neuroticism, extroversion, and psychoticism). These results suggest that (a) paternal emotional warmth was negatively correlated with OCD at the 0.40-0.80 quantile, while maternal emotional warmth was positively correlated with the OCD at the 0.45-0.69 quantile. (b) The correlation between negative parental rearing and OCD ranged from the 0.67 to 0.95 quantile for paternal punishment, 0.14-0.82 quantile for paternal overprotection, 0.05-0.36 and >0.50 quantile for maternal over-intervention and overprotection, and 0.08-0.88 quantile for maternal rejection. (c) Extroversion, neuroticism, and psychoticism were not only associated with OCD in a particular quantile but also mediated between parental rearing (namely parental emotional warmth, paternal punishment, paternal overprotection, maternal rejection, maternal over-intervention, and overprotection) and OCD. These findings provide targets for early interventions of OCD to improve the form of family education and personality traits and warrant validation.

Perceived Parental Rearing in Paediatric Obsessive-Compulsive Disorder: Examining the Factor Structure of the EMBU Child and Parent Versions and Associations with OCD Symptoms

Parental rearing behaviours characterised by high levels of rejection and overprotection have been implicated in the development and maintenance of child psychopathology, including paediatric obsessive-compulsive disorder (OCD). The Egna Minnen Beträffande Uppfostran (EMBU) is a commonly used measure of perceived parental rearing. Using confirmatory factor analysis, the factor structure of the EMBU child and parent versions were examined in a sample of children and youth with OCD (n = 176), and their mothers (n = 162). Associations between rearing and clinical correlates of OCD were explored. For parents, a 4-factor model provided the best fit. For children, a higher order model was the best fit. Greater parent and child perceived negative rearing behaviours and lower perceived positive behaviours were associated with greater OCD severity, comorbid symptoms and impairment. The EMBU has a conceptually meaningful factor structure and provides a useful measure for assessing perceived rearing behaviours within paediatric OCD.

Inflated Responsibility Beliefs in Paediatric OCD: Exploring the Role of Parental Rearing and Child Age

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) propose that inflated responsibility beliefs are central to the maintenance of the disorder and are proposed to originate during early childhood via experiences of harsh and/or controlling parenting. The current study aimed to examine the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in children (aged 7-12 years) and adolescents (aged 13-17 years) with OCD (n = 136). Results indicated that for younger children, greater child perceptions of overprotection and anxious rearing were each associated with increased inflated responsibility beliefs. For older children, these positive associations remained, and furthermore, inflated responsibility beliefs mediated the association between perceived maternal anxious rearing and OCD impairment. Results highlight the role of the family in the development of inflated responsibility bias and OCD-related impairment.

Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study

Background

Punitive parenting and stressful life events are associated with obsessive-compulsive symptoms (OCS). However, the lack of longitudinal, genetically-informative studies means it remains unclear whether these factors represent environmentally-mediated risks for the development of OCS.

Methods

Twins and siblings from the Genesis1219 study completed self-report questionnaires two years apart (Time 1: N = 2616, mean age = 15.0; Time 2: N = 1579, mean age = 17.0 years) assessing OCS, maternal and paternal punitive parenting, and dependent stressful life events. Multiple regression models tested cross-sectional and longitudinal associations between the putative environmental risk factors and obsessive-compulsive symptoms using: (a) individual scores; and (b) monozygotic twin difference scores. The aetiologies of significant phenotypic associations between putative risk factors and OCS were further examined using multivariate genetic models.

Results

At a phenotypic level, maternal and paternal punitive parenting and stressful life events were all associated with OCS both cross-sectionally and longitudinally. However, only stressful life events predicted the subsequent development of OCS, after controlling for earlier symptoms. Genetic models indicated that the association between life events and change in OCS symptoms was due to both genetic (48%) and environmental (52%) influences. Overall, life events associated with change in OCS accounted for 1.2% of variation in OCS at Time 2.

Conclusions

Stressful life events, but not punitive parenting, predict OCS change during adolescence at a phenotypic level. This association exists above and beyond genetic confounding, consistent with the hypothesis that stressful life events play a causal role in the development of obsessive-compulsive symptoms.

A call for prevention and early intervention in obsessive-compulsive disorder

BACKGROUND

Evidence suggests that many people with obsessive-compulsive disorder (OCD) have subclinical symptoms years before the development of their disorder and that early treatment may reduce its severity.

AIM

To explore prevention and early intervention strategies for OCD.

METHODS

A narrative literature review was conducted.

RESULTS

The literature in relation to the prevention of OCD is sparse. Genetic and environmental factors appear to be relevant to the aetiology of OCD, for example, the observation that hoarding symptoms and contamination/cleaning symptoms are more likely to also be present in first-degree relatives. Psychoeducation and the reduction of family accommodation, that is the act of parents, siblings or partners accommodating to the high-risk individual's requests to comply with their compulsions, are promising areas for prevention and early intervention in high-risk groups. Tertiary prevention has also been limited by an inadequate number of trained clinicians to deliver evidence-based treatments.

CONCLUSIONS

Much more research is needed in relation to the prevention of OCD. There is limited scope for primary prevention with respect to biological aetiological factors, but there is potential for strategies addressing environmental factors (eg, family factors). The effectiveness of psychoeducation for parents with OCD as a primary prevention strategy for OCD in their children requires scientific evaluation. Improving access to effective treatments for OCD would also improve tertiary prevention.

Association of serotonin receptor 2a haplotypes with obsessive-compulsive disorder and its treatment response in Iranian patients: a genetic and pharmacogenetic study

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder causing intrusive thoughts or repetitive behaviors. Serotonin reuptake inhibitors are used for OCD treatment, but 40%-60% of patients do not respond to them adequately. In this study, the associations of serotonin receptor 2a polymorphisms rs6311 and rs6313 with OCD, its familial form and fluvoxamine treatment response in Iranian population were investigated.

PATIENTS AND METHODS

Association analyses were conducted in 293 OCD cases fulfilling the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR and 245 controls. Pharmacotherapy was defined as 12 weeks of treatment with fluvoxamine (150-300 mg). Treatment response was considered as >25% reduction in Yale-Brown Obsessive Compulsive Scale score. Genotyping was performed by means of PCR-RFLP.

RESULTS

The results showed no association of rs6311 or rs6313 with OCD, but their haplotypes had different distribution patterns in cases and controls. Moreover, rs6313 was associated with the familial form of OCD in females significantly (P=0.005) under the recessive genetic model. Moreover, rs6311-rs6313 haplotypes were associated with fluvoxamine treatment response in OCD patients with more AC and less AT in responders.

CONCLUSION

HTR2A haplotypes are associated with OCD and its treatment response with a fluvoxamine in Iranian patients. Furthermore, the observed association of rs6313 with the familial form of OCD in females suggests different genetic background of OCD familial and non-familial forms, which needs further investigation.

The cognitive-behavioural model of hoarding disorder: Evidence from clinical and non-clinical cohorts

The cognitive-behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive-behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self-report measures of hoarding severity, cognitions, meta-memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive-compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive-compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding-relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding-related cognitions and fears about decision-making being additional unique predictors. The study supports the augmented cognitive-behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding.

Relations among adults' remembrances of parental acceptance-rejection in childhood, self-reported psychological adjustment, and adult psychopathology

AIMS

The aim of the study was to examine relationships among recollections of maternal and paternal acceptance-rejection in childhood and the level of psychological adjustment among adults diagnosed with schizophrenia, social anxiety, and nonclinical control. The study focused primarily on adults with schizophrenia and social anxiety in comparison to nonclinical adults.

METHODS

Fifty-three adults diagnosed with schizophrenia, 51 adults with self-reported social anxiety, and 147 nonclinical controls between the ages of 18 and 62 participated in the study. Data were collected using adult versions of the Parental Acceptance-Rejection Questionnaire for mothers and for fathers, Personality Assessment Questionnaire, Brief Symptom Inventory, Liebowitz Social Anxiety Scale, and the Demographic Information Form.

RESULTS

Findings of analyses showed that participants in the schizophrenia and social anxiety groups remembered having experienced significantly more maternal rejection in childhood than did the nonclinical group. Patient with schizophrenia also reported more recollections of paternal rejection than the nonclinical group. Both clinical groups self-reported more psychological maladjustment than did the nonclinical group. Regression analysis indicated that even though the overall psychological adjustment of adults diagnosed with schizophrenia was predicted by both maternal and paternal acceptance-rejection, psychological adjustment of adults in the social anxiety group was predicted only by maternal (but not paternal) acceptance-rejection.

CONCLUSION

This study provides evidence about the long-lasting associations between adults' recollections of parental acceptance-rejection in childhood and their psychological adjustment in two mental disorders, in which genetic and environmental factors have a different weight.

Parental bonding and hoarding in obsessive-compulsive disorder

BACKGROUND

Hoarding behavior may indicate a clinically and possibly etiologically distinct subtype of obsessive-compulsive disorder (OCD). Empirical evidence supports a relationship between hoarding and emotional over-attachment to objects. However, little is known about the relationship between hoarding and parental attachment in OCD.

METHOD

The study sample included 894 adults diagnosed with DSM-IV OCD who had participated in family and genetic studies of OCD. Participants were assessed for Axis I disorders, personality disorders, and general personality dimensions. The Parental Bonding Instrument (PBI) was used to assess dimensions of perceived parental rearing (care, overprotection, and control). We compared parental PBI scores in the 334 hoarding and 560 non-hoarding participants, separately in men and women. We used logistic regression to evaluate the relationship between parenting scores and hoarding in women, adjusting for other clinical features associated with hoarding.

RESULTS

In men, there were no significant differences between hoarding and non-hoarding groups in maternal or paternal parenting scores. In women, the hoarding group had a lower mean score on maternal care (23.4 vs. 25.7, p<0.01); a higher mean score on maternal protection (9.4 vs. 7.7, p<0.001); and a higher mean score on maternal control (7.0 vs. 6.2, p<0.05), compared to the non-hoarding group. The magnitude of the relationships between maternal bonding dimensions and hoarding in women did not change after adjustment for other clinical features. Women who reported low maternal care/high maternal protection had significantly greater odds of hoarding compared to women with high maternal care/low maternal protection (OR=2.54, 95% CI=1.60-4.02, p<0.001).

CONCLUSIONS

Perceived poor maternal care, maternal overprotection, and maternal overcontrol are associated with hoarding in women with OCD. Parenting dimensions are not related to hoarding in men. These findings provide further support for a hoarding subtype of OCD and for sex-specific differences in etiologic pathways for hoarding in OCD.

Predictors of treatment response to group cognitive behavioural therapy for pediatric obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder, occurring in 1-2% of children and adolescents. Current evidence-based treatments produce promising rates of remission; however, many children and youth do not fully remit from symptoms. The current study explored predictors of treatment response to a group cognitive-behavioural treatment program for pediatric OCD (N=43). Higher levels of child depression and parental rejection at baseline were found to be associated with higher OCD symptoms at post-treatment. Family accommodation was found to be associated with OCD symptom severity at 12-months follow-up. Further, children who were classified as treatment responders at 12-months follow-up had fewer depressive symptoms at baseline than non-responders at 12-months. Results indicate that child depression and adverse family factors may contribute to poorer treatment response for children and youth with OCD. This finding suggests current treatments should be refined for these young people in order to better suit their individual needs.

Hoarding in Children and Adolescents: A Review

The diagnostic conceptualization of hoarding has recently changed, and yet the application of these changes to hoarding in youth remains to be clarified. In this review we examine the literature on hoarding in youth. We discuss issues related to the assessment of pediatric hoarding, and the nature of hoarding in youth. We consider evidence for hoarding disorder as a distinct diagnosis in youth, and review the relationship between pediatric hoarding and other psychiatric disorders. Finally, we describe preliminary models of treatment for pediatric hoarding. We conclude that there is support for hoarding disorder as a distinct diagnosis in youth. However, more precise and developmentally appropriate assessment tools are needed to provide stronger evidence for this claim and to further our knowledge of prevalence and associated clinical characteristics. Although there is no evidence-based treatment for pediatric hoarding, preliminary evidence from case studies suggests that cognitive and behavioral methods may have promise.

Family functioning in paediatric obsessive compulsive and related disorders

OBJECTIVE

Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among paediatric OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research.

METHODS

A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', 'paediatric OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting practices, family dynamics, family involvement with symptoms, and family emotional climate.

RESULTS

The literature reviewed demonstrated a strong relationship between paediatric OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in paediatric HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs.

CONCLUSIONS

This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed.

PRACTITIONER POINTS

The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in paediatric OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits in paediatric OCRDs may prove beneficial in developing or bolstering preventative and/or therapeutic interventions. Insufficient number of articles pertaining to family functioning in some paediatric OCRDs (i.e., hoarding, skin picking) inhibits formal conclusions. Magnitudes of family functioning effects were not calculated; therefore, future research should consider meta-analytic analyses.

Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study

Traumatic or stressful life events have long been hypothesized to play a role in causing or precipitating obsessive-compulsive symptoms but the impact of these environmental factors has rarely been investigated using genetically informative designs. We tested whether a wide range of retrospectively-reported stressful life events (SLEs) influence the lifetime presence and severity of obsessive-compulsive symptoms (OCS) in a large Swedish population-based cohort of 22,084 twins. Multiple regression models examined whether differences in SLEs within twin pairs were significantly associated with differences in OCS. In the entire sample (i.e., both monozygotic [MZ] and dizygotic twin pairs), two SLEs factors, “abuse and family disruption” and “sexual abuse”, were significantly associated with the severity of OCS even after controlling for depressive symptoms. Other SLEs factors were either not associated with OCS (“loss”, “non-sexual assault”) or were no longer associated with OCS after controlling for depression (“illness/injury”). Within MZ pair analyses, which effectively control for genetic and shared environmental effects, showed that only the “abuse and family disruption” factor remained independently related to within-pair differences in OCS severity, even after controlling for depressive symptoms. Despite being statistically significant, the magnitude of the associations was small; “abuse and family disruption” explained approximately 3% of the variance in OCS severity. We conclude that OCS are selectively associated with certain types of stressful life events. In particular, a history of interpersonal abuse, neglect and family disruption may make a modest but significant contribution to the severity of OCS. Further replication in longitudinal cohorts is essential before causality can be firmly established.

Relationship between early maladaptive schemas and symptom dimensions in patients with obsessive-compulsive disorder

The aims of this study were to evaluate early maladaptive schemas (EMSs) of patients with obsessive-compulsive disorder (OCD) and to clarify relationships between particular EMSs and the five factor-analyzed symptom dimensions and other clinical variables. Fifty-seven patients with OCD and 70 normal controls completed the Young Schema Questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Y-BOCS symptom checklist, and the Beck Depression Inventory. Patients with OCD had significantly higher scores for schema related to defectiveness/shame, social isolation/alienation, and failure than did normal controls. Among the five OCD symptom dimensions, the sexual/religious dimension was only significantly correlated with two schemas of vulnerability to harm or illness and enmeshment/undeveloped self. These two schemas were significant predictors of the sexual/religious dimension, accounting for 33% of the total variance in this dimension. Any EMSs in patients with OCD were not related to clinical variables such as severity of OCD and duration of illness. These findings may constitute evidence to improve our understandings of OCD from a perspective of schema theory.

The Role of Adult Attachment and Social Support in Hoarding Disorder

Background: Research concerning the role of attachment and social support in hoarding is currently under investigated. Aims: To investigate whether hoarders experience less social support and more problematic relationships, the degree to which attachment and social support predicts hoarding and whether attachment moderates the relationship between social support and hoarding. Method: Measures of hoarding, attachment and social support were taken in a cross-sectional methodological design. Hoarders were identified via scores reaching caseness on the Savings Inventory–Revised (SI-R). Results: Hoarders (N = 380) reported significantly higher levels of attachment anxiety and avoidance and significantly lower levels of social support than student (N = 670) and community (N = 379) controls. Attachment and social support predicted 13% of total SI-R scores for hoarders, and attachment anxiety (but not avoidance) moderated the inverse relationship between social support and hoarding. Conclusions: Attachment and social support appears problematic for hoarders. Clinical implications and methodological issues are noted.

Perceived Parental Rearing Behaviours, Responsibility Attitudes and Life Events as Predictors of Obsessive Compulsive Symptomatology: Test of a Cognitive Model

Background: It is important to investigate the role of cognitive, developmental and environmental factors in the development and maintenance of Obsessive Compulsive Symptomatology (OCS). Aims: The main objective of this study was to examine the vulnerability factors of OCS in a non-clinical sample. On the basis of Salkovskis’ cognitive model of OCD, the study aimed to investigate the role of perceived parental rearing behaviours, responsibility attitudes, and life events in predicting OCS. Furthermore, the mediator role of responsibility attitudes in the relationship between perceived parental rearing behaviours and OCS was examined. Finally, the specificity of these variables to OCS was evaluated by examining the relationship of the same variables with depression and trait anxiety. Method: A total of 300 university students (M = 19.55±1.79) were administered the Padua Inventory-Washington State University Revision, Responsibility Attitudes Scale, s-EMBU (My memories of upbringing), Life Events Inventory for University Students, Beck Depression Inventory, and State-Trait Anxiety Inventory-Trait Form. Results: Regression analysis revealed that perceived mother overprotection, responsibility attitudes and life events significantly predicted OCS. Furthermore, responsibility attitudes mediated the relationship between perceived mother overprotection and OCS. The predictive role of perceived mother overprotection and the mediator role responsibility attitudes were OCS specific. Conclusions: The findings of the present study supported that perceived mother over-protection as a developmental vulnerability factor significantly contributed to the explanation of a cognitive vulnerability factor (namely responsibility attitudes), and perceived maternal overprotection had its predictive role for OCS through responsibility attitudes.

The postpartum depressive state in relation to perceived rearing: a prospective cohort study

Background

The relationship between perceived rearing and the postpartum depressive state remains unclear. We aimed to examine whether perceived rearing is a risk factor for postpartum depression as measured by the Edinburgh Postnatal Depression Scale (EPDS), and whether the score of perceived rearing is affected by depressive mood (the state dependency of perceived rearing).

Methods

Pregnant women (n = 448, mean age 31.8±4.2 years) completed the EPDS as a measure of depressive state in early pregnancy (T1), late pregnancy (around 36 weeks), and at 1 month postpartum (T2), and the Parental Bonding Instrument (PBI) at T1 as a measure of perceived rearing. Changes in the EPDS and the PBI scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group.

Results

There were no significant differences in any PBI category for perceived rearing between the ND and PD groups at T1. EPDS scores did not change significantly from T1 to T2 in the ND group but increased significantly in the PD group. The PBI maternal care score increased significantly in the ND group (p<0.01), while decreasing in the PD group (p<0.05). Additionally, in both the ND and PD groups, significant negative correlation was observed regarding change in the EPDS and PBI maternal care scores from T1 to T2 (r = −0.28, p = 0.013).

Conclusions

The present study suggests that perceived rearing is not a strong risk factor for postpartum depression as measured by the EPDS. Furthermore, the results indicated the state dependency of the PBI maternal care score.

Brain activation during response interference in twins discordant or concordant for obsessive compulsive symptoms

One of the core behavioral features associated with obsessive compulsive symptomatology is the inability to inhibit thoughts and/or behaviors. Neuroimaging studies have indicated abnormalities in frontostriatal and dorsolateral prefrontal - anterior cingulate circuits during inhibitory control in patients with obsessive compulsive disorder compared with controls. In the present study, task performance and brain activation during Stroop color-word and Flanker interference were compared within monozygotic twin pairs discordant for obsessive compulsive symptoms and between groups of pairs scoring very low or very high on obsessive compulsive symptoms, in order to examine the differential impact of non-shared environmental versus genetic risk factors for obsessive compulsive symptomatology on inhibitory control related functional brain activation. Although performance was intact, brain activation during inhibition of distracting information differed between obsessive compulsive symptom high-scoring compared to low-scoring subjects. Regions affected in the discordant group (e.g., temporal and anterior cingulate gyrus) were partly different from those observed to be affected in the concordant groups (e.g., parietal gyrus and thalamus). A robust increase in dorsolateral prefrontal activity during response interference was observed in both the high-scoring twins of the discordant sample and the high-scoring twins of the concordant sample, marking this structure as a possible key region for disturbances in inhibitory control in obsessive compulsive disorder.

A review of obsessive-compulsive disorder in children and adolescents

This article is a review of recent literature on obsessive-compulsive disorder in the pediatric population. Areas covered include: a brief historical perspective, clinical presentation in relation to symptoms found in different age groups, epidemiology, psychiatric comorbidity, etiology (with regards to genetics, neuroimaging, and familial factors), clinical course and prognosis, and treatment, with special emphasis on individual and family-based cognitive-behavioral therapy and psychopharmacology.

Comparison of family functioning and social support between families with a member who has obsessive-compulsive disorder and control families in Shanghai

Background

Family functioning plays an important role in the etiology and course of obsessive-compulsive disorder (OCD) so understanding the types of problems families with OCD patients have will help in the creation of OCD-specific family interventions.

Objective

Compare family functioning and social support of OCD patients and their co-resident parents to that of community controls and their co-resident parents.

Methods

Thirty-two psychiatric outpatients at the Affiliated East Hospital of Tongji University (in Shanghai) who met DSM-IV criteria for OCD and one of their co-resident parents and 31 community controls matched for age and years of education with the patients and one of their co-resident parents independently completed Chinese versions of the self-administered McMaster Family Assessment Device (FAD), which assesses seven dimensions of family functioning, and the Multidimensional Scale of Perceived Social Support (MSPSS), which assesses perceived support from family members, from friends and from other associates.

Results

All of the FAD dimension scores for both patients and their parents were in the unhealthy range (based on cut-off scores used in the Western version of the scale). With the exception of the Affective Involvement dimension of the FAD, patients with OCD and their parents reported significantly more poor family functioning and more poor social support than community controls and their parents. The concordance of patients FAD scores of and their parents scores was significantly stronger than that of controls and their parents for the Problem Solving, Communication and Affective Involvement dimensions (all p<0.001) but significantly weaker for the Behavioral Control dimension (p=0.009). For all four groups of respondents the four measures of perceived social support were all positively correlated with each of the seven measures of family functioning, though several of the correlation coefficients did not reach statistical significance.

Conclusions

OCD, like several other psychiatric illnesses, is an illness that profoundly affects families in China. Interventions for OCD need to integrate family-based psychosocial approaches (e.g., family therapy) with individual-based biological and psychological interventions. Our finding that perceived social support—from family members and from others—are closely related to family functioning in all types of respondents highlights the central role of families in the personal identity and social networks of individuals in China.

Childhood Experiences and Adult Beliefs in Obsessive-Compulsive Disorder: Evaluating a Specific Etiological Model

Cognitive accounts of obsessive-compulsive disorder (OCD) propose that an individual’s early experiences contribute to the development of different belief domains, which in turn represent fertile ground for the development of the disorder (e.g., Salkovskis, Shafran, Rachman, & Freeston, 1999). This study examined the proximal relationship between specific, narrowly defined childhood experiences (CEs) and distinct adult OCD-related beliefs (Obsessive Beliefs Questionnaire-87 [OBQ-87]) through the self-reports of 83 participants with OCD and 213 unselected student participants. CEs variables were operationalized via theoretical groupings of items on an early experience questionnaire (QEE) relevant to distinct OBQ belief domains. These proximal relationships were assessed according to predictions from both a specific and a nonspecific vulnerability hypothesis. Correlational analyses were supportive of both but mostly of a nonspecific vulnerability model. Results are discussed regarding the understanding of the possible multideterministic pathways to OCD development.

The role of depression in perceived parenting style among patients with anxiety disorders

Despite a long tradition of research on the relationship between parenting style and anxiety disorders, few studies have taken the effect of comorbid depression into account. This study investigated perceived parenting in 504 outpatients with panic disorder/agoraphobia, social phobia or obsessive-compulsive disorder, and in 210 psychology students. The anxiety group reported both parents as less caring and their fathers as more controlling than did the student group. However, these between-group differences disappeared when taking self-reported depressive symptoms into consideration. Also no differences in parental style were found between the three diagnostic anxiety groups, when depressive symptoms were taken into account. Self-reported depressive symptoms were more consistently associated with negatively perceived parenting style than with self-reported anxiety symptoms in both the anxiety group and the student group. Results do not support theories of parental control as a specific risk factor for anxiety disorders, but they are in accordance with prior findings showing an association between depression and perceived lack of parental care.

Stressful life events at onset of obsessive-compulsive disorder are associated with a distinct clinical pattern

BACKGROUND

Environmental stressors are considered to play an important role in the triggering of mental disorders such as obsessive-compulsive disorder (OCD). Although there is extensive literature on traumatic life events, little is known about the role of nontraumatic but nonetheless stressful life events (SLEs) in OCD. The aim of this study was to establish whether OCD preceded by an SLE presents a different clinical pattern compared to non-SLE-preceded OCD.

METHODS

We interviewed 412 OCD patients to assess both SLEs at onset of OCD and other clinical variables, including OCD symptom dimensions. Logistic regression was then applied to explore the relationship between clinical variables and OCD preceded by an SLE.

RESULTS

The SLE-preceded OCD group showed a later onset of the disorder (OR = 1.04, P = .015), a history of complicated birth (OR = 5.54, P<.001), less family history of OCD (OR = 0.42, P = .014), and the presence of contamination/cleaning symptoms (OR = 1.99, P = .01).

CONCLUSIONS

Patients with OCD onset close to an SLE and those without an SLE close to OCD onset show a distinct clinical pattern.

Stressful life events and material deprivation in hoarding disorder

Traumatic life events and early material deprivation have been identified as potential environmental risk factors for the development of pathological hoarding behavior, but the evidence so far is preliminary and confounded by the presence of comorbid obsessive-compulsive disorder (OCD). This study retrospectively examined the occurrence of traumatic/stressful life events and material deprivation in four well-characterized groups: hoarding disorder without comorbid OCD (HD; n=24), hoarding disorder with comorbid OCD (HD+OCD; n=20), OCD without hoarding symptoms (OCD; n=17), and non-clinical controls (Control; n=20). Participants completed clinician and self-administered measures of hoarding, OCD, depression, psychological adjustment, and traumatic experience. Semi-structured interviews were undertaken to assess the temporal relation between traumatic/stressful life events and the onset and worsening of hoarding symptoms, and to determine the level of material deprivation. Although rates of post-traumatic stress disorder were comparable across all three clinical groups, hoarders (regardless of the presence of comorbid OCD) reported greater exposure to a range of traumatic and stressful life events compared to the two non-hoarding groups. Results remained unchanged after controlling for age, gender, education level, depression, and obsessive-compulsive symptoms. The total number of traumatic life events correlated significantly with the severity of hoarding but not of obsessive-compulsive symptoms. About half (52%) of hoarding individuals linked the onset of hoarding difficulties to stressful life circumstances, although this was significantly less common among those reporting early childhood onset of hoarding behavior. There was no link between levels of material deprivation and hoarding. Results support a link between trauma, life stress and hoarding, which may help to inform the conceptualization and treatment of hoarding disorder, but await confirmation in a representative epidemiological sample and using a longitudinal design.

Knock, and it will be opened to you? An evaluation of meridian-tapping in obsessive-compulsive disorder (OCD)

Meridian-tapping (MT) is a body-oriented therapeutic technique which among other psychological problems targets anxiety disorders. Despite bold claims by some of its advocates that it brings lasting success in the vast majority of patients with anxiety disorders, solid empirical evidence for its effectiveness is scarce and its theoretical foundations are refuted by many scientists. The present study tested the effectiveness of a published MT self-help approach for obsessive-compulsive disorder (OCD). Following a baseline assessment over the internet including standard outcome measures for OCD (Y-BOCS, OCI-R) and depression (BDI-SF), 70 participants with OCD were randomly allocated to MT or to progressive muscle relaxation (PMR). Four weeks after the dispatch of the self-help manuals (including video demonstrations of the technique), participants were requested to take part in a post assessment. Whereas subjects found MT more helpful than PMR in retrospect (39% versus 19%) and would continue to use it in the future (72% versus 48%) there was no evidence for a stronger decline of OCD symptoms under MT on any of the psychometric measures. Moreover, Y-BOCS scores did not significantly change across time for both interventions. The present study does not support bold claims about the effectiveness of MT as a stand-alone technique. Cognitive-behavioral therapy remains the treatment of choice for OCD. While self-help MT may enhance the well-being of a subgroup of participants, its potential for OCD appears to be small. Exaggerated success claims on the effectiveness of MT in conjunction with degrading appraisals of conventional psychotherapy as made by some of its leading figures may in our view foster fatalism in patients not experiencing major symptom relief by MT.

Clinical correlates of comorbid obsessive-compulsive disorder and depression in youth

A burgeoning body of literature addresses the comorbidity of depression and OCD in adults. The purpose of this study was to extend this area of research to children and adolescents by examining the clinical correlates associated with co-occurring depressive disorders in a clinical sample of youth with OCD. Participants included children and adolescents seeking treatment at a university-based research clinic. One group was comprised of 28 children (ages 10-17 years) who met diagnostic criteria for OCD but had no comorbid depressive disorders, whereas the second group consisted of 28 children matched for age and gender who met diagnostic criteria for OCD and co-occurring depressive disorder. The two groups were compared on measures of broad-band psychopathology, internalizing problems, social difficulties, and family characteristics. As anticipated, findings revealed comorbid depression and OCD was associated with more severe internalizing problems, more extensive obsessive-compulsive symptomatology, and more social problems. Youth with comorbid depression and OCD also had higher family conflict and lower family organization compared to those with OCD and no depression. These results may have implications for the treatment of youth with comorbid OCD and depression.

Brain activation during cognitive planning in twins discordant or concordant for obsessive-compulsive symptoms

Neuroimaging studies have indicated abnormalities in cortico-striatal-thalamo-cortical circuits in patients with obsessive–compulsive disorder compared with controls. However, there are inconsistencies between studies regarding the exact set of brain structures involved and the direction of anatomical and functional changes. These inconsistencies may reflect the differential impact of environmental and genetic risk factors for obsessive–compulsive disorder on different parts of the brain. To distinguish between functional brain changes underlying environmentally and genetically mediated obsessive–compulsive disorder, we compared task performance and brain activation during a Tower of London planning paradigm in monozygotic twins discordant (n = 38) or concordant (n = 100) for obsessive–compulsive symptoms. Twins who score high on obsessive–compulsive symptoms can be considered at high risk for obsessive–compulsive disorder. We found that subjects at high risk for obsessive–compulsive disorder did not differ from the low-risk subjects behaviourally, but we obtained evidence that the high-risk subjects differed from the low-risk subjects in the patterns of brain activation accompanying task execution. These regions can be separated into those that were affected by mainly environmental risk (dorsolateral prefrontal cortex and lingual cortex), genetic risk (frontopolar cortex, inferior frontal cortex, globus pallidus and caudate nucleus) and regions affected by both environmental and genetic risk factors (cingulate cortex, premotor cortex and parts of the parietal cortex). Our results suggest that neurobiological changes related to obsessive–compulsive symptoms induced by environmental factors involve primarily the dorsolateral prefrontal cortex, whereas neurobiological changes induced by genetic factors involve orbitofrontal–basal ganglia structures. Regions showing similar changes in high-risk twins from discordant and concordant pairs may be part of compensatory networks that keep planning performance intact, in spite of cortico-striatal-thalamo-cortical deficits.

Perceived parental rearing style in childhood: internal structure and concurrent validity on the Egna Minnen Beträffande Uppfostran--Child Version in clinical settings

BACKGROUND

We provide the first validation data of the Spanish version of the Egna Minnen Beträffande Uppfostran--Child Version (EMBU-C) in a clinical context. The EMBU-C is a 41-item self-report questionnaire that assesses perceived parental rearing style in children, comprising 4 subscales (rejection, emotional warmth, control attempts/overprotection, and favoring subjects).

METHODS

The test was administered to a clinical sample of 174 Spanish psychiatric outpatients aged 8 to 12. Confirmatory factor analyses were performed, analyzing the children's reports about their parents' rearing style.

RESULTS

The results were almost equivalent for father's and mother's ratings. Confirmatory factor analysis yielded an acceptable fit to data of the 3-factor model when removing the items of the favoring subjects scale (root mean squared error of approximation <0.07). Satisfactory internal consistency reliability was obtained for 2 of the 3 scales, rejection and emotional warmth (Cronbach alpha >.73), whereas control attempts scale showed lower values, as in previous studies. The influence of sex (of children and parents) on scale scores was inappreciable and children tended to perceive their parents as progressively less warm as they grew older. As predicted, the scores for rejection and emotional warmth were related to bad relationships with parents, absence of family support, harsh discipline, and lack of parental supervision.

CONCLUSIONS

The Spanish version of EMBU-C can be used with psychometric guarantees to identify rearing style in psychiatric outpatients because evidences of quality in this setting match those obtained in community samples.

Hoarding disorder: a new diagnosis for DSM-V?

This article provides a focused review of the literature on compulsive hoarding and presents a number of options and preliminary recommendations to be considered for DSM-V. In DSM-IV-TR, hoarding is listed as one of the diagnostic criteria for obsessive-compulsive personality disorder (OCPD). According to DSM-IV-TR, when hoarding is extreme, clinicians should consider a diagnosis of obsessive-compulsive disorder (OCD) and may diagnose both OCPD and OCD if the criteria for both are met. However, compulsive hoarding seems to frequently be independent from other neurological and psychiatric disorders, including OCD and OCPD. In this review, we first address whether hoarding should be considered a symptom of OCD and/or a criterion of OCPD. Second, we address whether compulsive hoarding should be classified as a separate disorder in DSM-V, weighing the advantages and disadvantages of doing so. Finally, we discuss where compulsive hoarding should be classified in DSM-V if included as a separate disorder. We conclude that there is sufficient evidence to recommend the creation of a new disorder, provisionally called hoarding disorder. Given the historical link between hoarding and OCD/OCPD, and the conservative approach adopted by DSM-V, it may make sense to provisionally list it as an obsessive-compulsive spectrum disorder. An alternative to our recommendation would be to include it in an Appendix of Criteria Sets Provided for Further Study. The creation of a new diagnosis in DSM-V would likely increase public awareness, improve identification of cases, and stimulate both research and the development of specific treatments for hoarding disorder.

Perceived parental rearing in subjects with obsessive-compulsive disorder and their siblings

OBJECTIVE

Perceived parenting in patients suffering from obsessive-compulsive disorder (OCD) is examined. We attempted to overcome some methodological limitations of prior studies by taking age of onset, parental OCD and comorbid depression into consideration. In addition, we included data from unaffected siblings to corroborate information on parental rearing.

METHOD

One hundred and twenty-two cases with OCD and 41 of their siblings as well as 59 healthy controls and 45 of their siblings completed the German short-version of the EMBU (FEE).

RESULTS

Obsessive-compulsive disorder cases reported less parental warmth and more parental rejection and control. Further analyses indicated that parenting is also associated with OCD in cases with late onset and cases without parents affected by OCD. OCD cases with comorbid depression described their parents particularly negatively. Data from siblings indicated good validity of perceived parenting in OCD.

CONCLUSION

This study provides further evidence for dysfunctional child rearing being relevant to the development of OCD and depression.

Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11

BACKGROUND

The extant major psychiatric classifications DSM-IV, and ICD-10, are atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis would be greatly enhanced by an understanding of risk factors and clinical manifestations. In an effort to group mental disorders on the basis of aetiology, five clusters have been proposed. This paper considers the validity of the fourth cluster, emotional disorders, within that proposal.

METHOD

We reviewed the literature in relation to 11 validating criteria proposed by a Study Group of the DSM-V Task Force, as applied to the cluster of emotional disorders.

RESULTS

An emotional cluster of disorders identified using the 11 validators is feasible. Negative affectivity is the defining feature of the emotional cluster. Although there are differences between disorders in the remaining validating criteria, there are similarities that support the feasibility of an emotional cluster. Strong intra-cluster co-morbidity may reflect the action of common risk factors and also shared higher-order symptom dimensions in these emotional disorders.

CONCLUSION

Emotional disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

Hurricane Katrina and youth anxiety: the role of perceived attachment beliefs and parenting behaviors

This study sought to examine the role of attachment beliefs and parenting behaviors on youth's anxious response to disaster by testing a theoretical model which posits youths' perceptions of attachment beliefs and parenting behaviors as moderators of the relation between pre and post disaster anxiety symptoms. Seventy-four youth (ages 6-17 years) and their parents exposed to Hurricane Katrina participated in pre and post disaster assessments. Results indicated that both youths' pre disaster perceived attachment beliefs (i.e., trust and communication) and perceptions of parenting behaviors (i.e., acceptance and firm control) moderated the relation between pre and post Katrina anxiety symptoms. Exploratory analyses demonstrated no age, gender, or ethnicity differences in post Katrina anxiety symptoms. Findings are discussed in terms of how parents may influence youths' pre and post disaster anxiety symptoms in the face of natural disasters and the implications for intervention.

Gender differences in obsessive-compulsive symptom dimensions

The aim of our study was to assess the role of gender in OCD symptom dimensions with a multivariate analysis while controlling for history of tic disorders and age at onset of OCD. One hundred and eighty-six consecutive outpatients with a DSM-IV diagnosis of OCD were interviewed. Yale-Brown Obsessive-Compulsive Scale (YBOC-S), YBOC-S Symptom Checklist, and Hamilton Depression and Anxiety Scales were administered to all patients. Lifetime history of tic disorders was assessed with the tic inventory section of the Yale Global Tic Severity Scale. Age at onset of OCD was assessed by direct interview. Statistical analysis was carried out through logistic regression to calculate adjusted female:male odds ratios (OR) for each dimension. A relationship was found between gender and two main OCD dimensions: contamination/cleaning (higher in females; female:male OR=2.02, P=0.03) and sexual/religious (lower in females; female:male OR=0.41, P=0.03). We did not find gender differences in the aggressive/checking, symmetry/ordering, or hoarding dimensions. We also found a greater history of tic disorders in those patients with symptoms from the symmetry/ordering, dimension (P<0.01). Both symmetry/ordering and sexual/religious dimensions were associated with an earlier age at onset of OCD (P<0.05). Gender is a variable that plays a role in the expression of OCD, particularly the contamination/cleaning and sexual/religious dimensions. Our results underscore the need to examine the relationship between OCD dimensions and clinical variables such as gender, tics, age at onset and severity of the disorder to improve the identification of OCD subtypes.

The association between parental bonding and obsessive compulsive disorder in offspring at high familial risk

BACKGROUND

The aim of the current study is to estimate the association between parenting factors derived from the Parental Bonding Instrument (PBI) and a lifetime DSM-IV diagnosis of OCD.

METHOD

Data were from approximately 1200 adults from 465 families assessed as part of a large family and genetic study of OCD. The association of three parenting factors, for fathers and mothers, with offspring OCD status were examined; analyses were stratified by parental OCD status and family loading for OCD (multiplex versus sporadic).

RESULTS

Three factors were derived by principal components factor analysis of the PBI (maternal and paternal care, overprotection and control). Maternal overprotection was associated with OCD in offspring with familial OCD (familial cases) but only if neither parent was affected with OCD, which suggests independent but additive environmental and genetic risk (OR = 5.9, 95% CI 1.2, 29.9, p = 0.031). Paternal care was a protective factor in those not at high genetic risk (sporadic cases) (OR = 0.2, 95% CI 0.0, 0.8, p = 0.027). Maternal overprotection was also associated with offspring OCD in sporadic families (OR = 2.9, 95% CI 1.3, 6.6, p = 0.012). The finding that parental overprotection and care were not associated with offspring OCD when at least one parent had OCD addressed directly the hypothesis of maternal or paternal OCD adversely impacting parenting.

CONCLUSIONS

This study provides evidence that aspects of parenting may contribute to the development of OCD among offspring. Prospective studies of children at risk for OCD are needed to explore the direction of causality.