Family functioning in paediatric obsessive compulsive and related disorders

Perceived Family Functioning of Adolescents with Affective Disorders: A Multicentric Cross-Sectional Study

Purpose

This study aims to investigate the status of family functioning and dissatisfaction of family function from the perception of adolescents with affective disorders and explore associated factors.

Methods

This was a multicentric cross-sectional study conducted from April 2022 to February 2023. Adolescents with affective disorders were surveyed in representative samples drawn from three hospitals in Sichuan province, China. Data were obtained from 235 participants regarding their demographic characteristics, family characteristics, disease-related characteristics, and family functioning.

Results

The study found family functioning and its' dissatisfaction both lower than national norms from the perspectives of adolescents. Younger age, single-parent family, and reconstituted family were predictors of not close of cohesion. Younger age, lower educational level of father, and reconstituted family were associated with less change of flexibility. Less times of hospitalizations, higher educational level of father, stem family were more satisfy with cohesion. Higher educational level of father, and stem family were also associated with greater satisfaction with flexibility.

Conclusion

The study demonstrated that the family function of adolescents of affective disorders was poor, more attention should be paid to it. Age, family structure, number of hospitalizations and the educational level of father were influencing factors of family functioning. Therefore, it is important for medical worker to assess demographic and family characteristics of adolescents with affective disorders. Younger children, children of reconstituted family and single-parent family, children with repeated hospitalizations and fathers of lower level of education should be given emphasized in implementation of interventions. Based on the evaluation results, personalized family therapy has been proved to be an affective measure and could be used in clinical work.

Resting State Psychophysiology in Youth with OCD and Their Caregivers: Preliminary Evidence for Trend Synchrony and Links to Family Functioning

The burden of OCD in children and adolescents extends to their caregivers. Prior work in other disorders and unaffected youth has found synchrony in psychophysiological arousal for youth-caregiver dyads. This preliminary study explored whether psychophysiological trend synchrony in youth-caregiver dyads (N = 48) occurred and was moderated by youth OCD diagnosis. We also explored whether psychophysiological indices (i.e., electrodermal activity, heart rate, respiratory sinus arrhythmia) were correlated with reported family functioning in the OCD subsample (n = 25). Youth with OCD had higher resting heart rate than unaffected peers; this was not replicated in caregivers. Trend synchrony was found across the full sample of dyads for electrodermal activity and heart rate, with no moderation by diagnostic group. In the OCD group, youth heart rate was correlated with family conflict and caregiver heart rate with expressiveness. Findings provide preliminary support for further examination of heart rate and family factors in OCD-affected youth and their caregivers.

The Research on Risk Factors for Adolescents' Mental Health

There is a growing tendency for mental health disorders to emerge during adolescence. These disorders impair emotional, cognitive, and behavioral functioning, such as unsatisfying peer relationships, disruptive behavior, and decreased academic performance. They also contribute to vulnerability in later adulthood which negatively influences life-long well-being. Thus, research into etiology is imperative to provide implications for prevention and intervention within family and school practices. It is suggested that the onset of psychological disorders, such as depression and anxiety, is closely related to stress levels and patterns of stress reaction. Therefore, considerable research has investigated the link between hereditary factors, economic status, dispositional vulnerability, social relationships, and stress levels. The current study examines existing evidence and identifies multifaceted risk factors for adolescents' mental problems across three layers, including individual traits and personality, family status and practices, as well as peer relationships, and school climate. It is also suggested that factors from these three perspectives interact and are closely interconnected, directly or indirectly contributing to adolescent psychopathology. The implications for future development of prevention and intervention programs, as well as therapy, are discussed.

The Impact of Family Functioning on Help-Seeking Behavior and Symptom Severity in Obsessive-Compulsive Disorder

ABSTRACT

Poor family functioning is associated with higher symptom severity in pediatric obsessive-compulsive disorder (OCD) and delayed help-seeking behavior in other forms of psychopathology. However, little is known about the impact of family functioning on help-seeking behavior and symptom severity in adults with OCD. The present study investigated the association between family functioning and both treatment delay and symptom severity in adults with obsessive-compulsive symptoms. Participants were 194 adults who self-identified as having OCD and completed an internet survey, including measures assessing family functioning, obsessive-compulsive symptom severity, help-seeking behavior, and depression symptom severity. Poorer family functioning was associated with higher obsessive-compulsive and depression symptom severity, after controlling for significant demographic variables. With respect to domains of family functioning, poorer general functioning, problem solving, communication skills, role functioning, affective involvement, and affective responsiveness were associated with higher obsessive-compulsive and depression symptom severity, after controlling for demographics. Poorer problem solving and communication were not significantly associated with treatment delay after controlling for demographics. Findings highlight the need for family intervention within the treatment framework for adult OCD and suggest targets ( e.g. , communication) to be addressed.

Childhood Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) frequently affects children and adolescents, with most cases beginning during this time. Symptoms of OCD in youth may present as exaggerated developmental concerns and excessive ritualistic behavior beyond what is part of normal development, yet low levels of insight may prevent recognition. Affected youth commonly have comorbid neurodevelopmental diagnoses, especially males. Early detection and intervention are critical to recovery and remission, as well as family involvement in treatment. Cognitive behavioral therapy and serotonin reuptake inhibitors are first-line treatments.

Family Functioning and Health-Related Quality of Life in Parents of Children with Mental Illness

Previous research suggests that family dysfunction may be related to lower health-related quality of life (HRQoL) in parent caregivers, but it is unknown if this association exists in the context of child mental illness. Therefore, the objectives of this study were to compare HRQoL between parent caregivers and Canadian population norms using the Short Form 36 Health Survey (SF-36); examine associations between family functioning and parental HRQoL; and investigate whether child and parental factors moderate associations between family functioning and parental HRQoL. Cross-sectional data were collected from children receiving mental healthcare at a pediatric hospital and their parents (n = 97). Sample mean SF-36 scores were compared to Canadian population norms using t-tests and effect sizes were calculated. Multiple regression was used to evaluate associations between family functioning and parental physical and mental HRQoL, adjusting for sociodemographic and clinical covariates. Proposed moderators, including child age, sex, and externalizing disorder, and parental psychological distress, were tested as product-term interactions. Parents had significantly lower physical and mental HRQoL versus Canadian norms in most domains of the SF-36, and in the physical and mental component summary scores. Family functioning was not associated with parental physical HRQoL. However, lower family functioning predicted lower parental mental HRQoL. Tested variables did not moderate associations between family functioning and parental HRQoL. These findings support the uptake of approaches that strive for collaboration among healthcare providers, children, and their families (i.e., family-centered care) in child psychiatry settings. Future research should explore possible mediators and moderators of these associations.

Early Identification and Intervention in Pediatric Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and course from adult OCD. Delayed and inadequate treatment is associated with a worse prognosis, making the need for early identification and intervention in pediatric OCD very urgent. In this paper, we reflected on the current constraints that make early interventions for pediatric OCD unpromoted and reviewed the approaches with potential application for early identification and early intervention in pediatric OCD, categorized by three-level prevention stages corresponding to a clinical staging model. Since the etiology of pediatric OCD is still unclear, primary prevention is most lacking, and early interventions for pediatric OCD are currently focused on the secondary prevention stage, which aims to prevent the conversion of obsessive-compulsive symptoms into full-blown OCD; tertiary prevention mostly focuses on the alleviation of mild to moderate OCD, while interventions for co-morbidities are still in their infancy. We closed by considering the important research questions on this topic.

Perceived Family Function and Associated Predictors in Nurses: A Cross-Sectional Study

Background

Nurses play a key role in the health care system. However, clinical nurses experience different kinds of stressors that might impact the nurses' quality of life or quality of care. Family is one of the main social support resources, and quality family function might improve the quality of care provided by nurses. However, evidence on family function in Chinese clinical nurses is quite limited.

Objectives

The current study was to evaluate the family function of the Chinese clinical nurses, and to explore associated predicting factors.

Methods

A multi-center cross-sectional anonymous online survey was carried out. Chinese Family Function Scale was used in the study. Spearman's rank correlation analysis, Mann-Whitney U test, or Kruskal-Wallis H test was performed in the univariate analysis. The pairwise comparison method was used to determine whether the difference was significant between pair groups. Categorical regression (optimal scaling regression) was the main method to analyze factors that had been confirmed to be statistically significant in the univariate analysis.

Results

Nineteen thousand four hundred and twenty-two nurses completed the online questionnaires. The median of the nurse's perceived family function score was three (Inter-quartile Range: IQR 2-5). The multivariate analysis showed that the highest education level (P <0.001), the hospital level (P <0 .001), rotation shift status (P <0.001), working department (P < 0.001), number of children (P < 0.001), monthly income per family member (P < 0.001) were significantly associated with family function. Moreover, the importance of the factors was the number of children (49.1%), monthly income per family member (20.7%), rotation shift status (12.4%), the highest education level (8.0%), the hospital level (7.6%), and working department (2.4%) in turn.

Conclusions

The family function was associated with multiple factors, which hints that managers, leaders, and government could make strategies to improve nurses' family function in order to lead nurses to make a balance between family and work. Policymakers, nursing managers, and employers should make strategies such as promoting children-care services, increasing nurses' income, educating and training enough nurses, and building a well-established system of career development to help clinical nurses improve their family function so that to improve the quality of care.

Parental Bonding in Trichotillomania and Skin Picking Disorder

BACKGROUND

One means of understanding the effect of environmental factors on psychiatric disorders is by examining perceived parenting behavior in the childhood of individuals with trichotillomania and skin picking disorder (i.e. body focused repetitive behaviors (BFRBs)). We hypothesized that adults with BFRBs would show higher scores on dimensions of "care" and "overprotection". Specifically, we predicted that adults with BFRBs would have parents in the "affectionate constraint" quadrant, based on a combination of high care and high protection scores.

METHODS

We assessed demographic and clinical differences in 184 adults between the ages of 18 and 65 with Trichotillomania (TTM) (n = 43) and Skin Picking Disorder (SPD) (n = 75), and both (n = 66). The Parental Bonding Instrument (PBI) measured "care" and "overprotection" items. Results from the PBI were compared across groups and with normal control data using independent sample t-tests.

RESULTS

Individuals in the BFRB group had significantly lower maternal and paternal care scores compared to controls. The TTM, SPD, and TTM + SPD (combined) groups all had lower maternal care scores than controls. The TTM + SPD (combined) group had significantly lower paternal care scores and higher maternal protection scores than the normative averages. The most common parenting patterns in subjects with BFRBs were maternal and paternal affectionless control (low care/high protection). From our sample, only 27 % reported optimal maternal parenting and 28 % reported optimal paternal parenting.

DISCUSSION

These preliminary data suggest that low maternal and paternal care may be associated with BFRBs. However, the nature of this relationship should be further explored, as these results do not necessarily mean that affectionless control parenting leads to a predisposition to BFRBs, and there may in fact be other environmental factors at play. Identifying how individuals perceive familial relationships may provide direction for clinicians in developing tools to address the burden caused by BFRBs.

Psychometric Evaluation of the Malay Version of the Family Adaptability and Cohesion Evaluation Scale III for Malaysian Adolescents

The Family Adaptability and Cohesion Scale III (FACES-III) has been widely used to measure an individual’s family functioning in terms of cohesion and adaptability. In Malaysia, the FACES-III has been translated into the Malay language for the community, but its psychometric properties in this context remain unknown. Thus, the purpose of this research is to examine the psychometric properties of the Malay version of the FACES-III in 852 adolescents attending secondary schools in Kuala Lumpur, Malaysia. Data were randomly split into two halves: the exploration sample and the validation sample. Exploratory factor analysis was conducted on the exploration sample and a two-factor model was discovered after removing nine items that showed low factor loading. Then, confirmatory factor analysis was conducted on the validation sample to compare the one-factor models, two-factor models, and three-factor models. Results showed that the 11-item two-factor model (FACES-III-M-SF) was superior to the other competing models. Both the exploratory and confirmatory factor analyses replicated the two-factor structure of the original version of FACES-III. The reliability of the overall scale was consistently good, but the subscale results were mixed. This suggests that researchers should use the overall score, but not the subscale scores, in analyses.

Prevalence, comorbidity, and predictors of obsessive-compulsive disorder in Iranian children and adolescents

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) is a disease that causes personal distress or social dysfunction, especially in childhood. The present study aimed to provide the prevalence, comorbidity, and predictors of OCD among children and adolescents.

METHODS

This was a cross-sectional national project conducted on 29,858 children and adolescents using the multi-stage cluster random sampling in Iran. There were both genders in each cluster and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research included a demographic questionnaire and K-SADS-PL. To analyze the data, logistic regression and cross-tab tests were used.

RESULTS

According to the results, the prevalence of OCD in children and adolescents was 3.1 in boys and 3.8 in girls. Also, gender, age, place of residence, and history of psychiatric hospitalization of parents could predict OCD. OCD had comorbidity with behavioral disorders (OR = 0.60, 95%CI: 0.39-0.92), elimination disorders (OR = 0.50, 95%CI: 0.30-0.83), mood disorders (OR = 2.92, 95%CI: 1.43-5.94), and smoking and alcohol disorders (OR = 4.33, 95%CI: 1.28-14.63).

CONCLUSION

In the development of the obsessive-compulsive disorder, other disorders and symptoms also environmental factors can play a role and are important. Based on our findings, given the prevalence rate of OCD was higher in the age groups of 10-14 and 15-18 years, are one of the most important stages of development for the prevention and treatment of mental disorders, especially OCD, clinical specialists can design appropriate clinical trials or modify existing interventions based on the results of such research.

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.

Predicting the Adult Clinical and Academic Outcomes in Boys With ADHD: A 7- to 10-Year Follow-Up Study in China

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and causes adverse effects on social functioning. The present study aimed to widely investigate the predictors, particularly childhood intelligence quotient (IQ) and family environment factors, on adult clinical and academic outcomes in boys with ADHD. Methods: A total of 101 boys with ADHD in a Chinese Han ADHD cohort were followed up 7-10 years later. Baseline ADHD symptoms were evaluated using the parent version of the ADHD Rating Scale-IV (ADHD-RS-IV) and the Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48). The intelligence of the child was tested by the China-Wechsler Intelligence Scale for Children (C-WISC), and family function was assessed by the Family Environment Scale-Chinese Edition (FES-CV). Adult ADHD persistence was defined using DSM-IV criteria for ADHD, and academic outcome fell into two categories: higher academic level group (studying in senior middle school or above) and lower academic level group (studying in vocational secondary schools or below). Results: Stepwise multiple logistic regression analysis revealed that the father's character, impulsive-hyperactive index as measured by the CPRS-48, and intellectual-cultural index as measured by the FES-CV independently predicted clinical outcomes in adults, with an AUC of 0.770 (p < 0.001, 95% CI = 0.678-0.863). The corresponding sensitivity and specificity were 0.743 and 0.727, respectively. The father's education level, family economic level, and verbal IQ (VIQ) on the C-WISC independently predicted adult academic outcomes, with an AUC of 0.870 (p < 0.001, 95% CI = 0.796-0.944). The corresponding sensitivity and specificity were 0.813 and 0.783, respectively. Conclusion: Initial ADHD symptom severity and IQ, father's character and education level, and family atmosphere and function affect adult clinical and academic outcomes. Addressing these areas early may help to improve the prognosis of ADHD into adulthood.

Association Between Obsessive-Compulsive Symptom Dimensions in Mothers and Psychopathology in Their Children

Background: The non-clinical presentation of obsessive-compulsive symptoms (OCS) in women may impact not only their daily lives and well-being but also increase the risk for emotional and behavioral problems in their children. This study aims to investigate the OCS dimension distribution in a large sample of mothers from a cohort of school age children and the association between these OCS dimensions with their own psychopathology, and with the presence of OCS and other psychopathology in their children. Method: Our final sample consisted of 2,511 mother-children dyads recruited from the elementary schools of two large cities. Throughout multiple regression analysis, we examined the correlations between demographic and clinical variables of mothers assessed by the Mini International Psychiatric Interview (MINI) and the Dimensional Yale-Brown Obsessive-Compulsive Scale-Short Version (DY-BOCS-SV) with children's psychopathology status reported by the Child Behavior Checklist (CBCL). Results: The overall prevalence of mothers who reported experiencing at least one OCS was 40% (N = 1,004). "Aggression/violence" was the most frequent symptom dimension (32.2%), followed by the "symmetry/ordering" (16.4%) and the "sexual/religious" dimensions (13.8%). There was a significant correlation between the presence of OCS and maternal psychopathology in general (p < 0.001, r = 0.397). Not only the presence but also the severity of the mother's OCS were strongly correlated to the total (p < 0.001), internalizing (p < 0.001), externalizing (p < 0.001), and OCS subscale scores (p < 0.001) on the CBCL. Conclusion: OCS dimensions are highly prevalent in women. Presence and severity of maternal OCS are related to children's psychopathology and behavioral problems.

Integrative Review of Related Factors and Defining Characteristics of Lack of Family Integrity

PURPOSE

To identify the related factors that compromise family integrity and the defining characteristics of poor family integrity.

METHODS

Integrative review in databases: Pubmed, Scopus, Cinahl, PsycInfo, and Web of Science. The inclusion and exclusion criteria led to the selection of 12 articles.

FINDINGS

Family conflicts, lack of communication, and detachment from family as risk factors that have a negative impact on family integrity. A decrease in the physical and psychological quality of life as defining characteristics of poor family integrity.

CONCLUSIONS

Lack of family integrity has a significant impact on the physical, mental, and social health of its members.

IMPLICATIONS FOR NURSING PRACTICE

Findings will allow nurses to implement interventions for the maintenance or improvement of family integrity.

Tic Disorders are Associated With Lower Child and Parent Quality of Life and Worse Family Functioning

OBJECTIVE

Chronic tic disorders occur in approximately 3% of children. Neuropsychiatric symptoms of attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, and depression are common. We evaluated the impact of tic disorders and comorbid symptoms on individual and parent quality of life and family functioning.

METHOD

In two cross-sectional studies children with tic disorders were enrolled at the University of Rochester or the University of South Florida; data were pooled for analyses. Control subjects were enrolled at the University of Rochester. We compared quality of life and function in youth and families with and without tic disorders. We evaluated the associations between comorbid symptoms and individual quality of life and family impact in youth with tic disorders using multiple regression analyses.

RESULTS

We enrolled 205 youths with tic disorders and 100 control subjects. Psychosocial (P < 0.0001) and physical (P < 0.0001) quality of life were lower in individuals with tic disorders compared with controls. Severity of attention-deficit/hyperactivity disorder (P < 0.0001) and depression (P = 0.046) symptoms were associated with lower psychosocial quality of life in youth with tic disorders. Families of youths with tic disorders had worse parent quality of life (P < 0.001) and family functioning (P < 0.001) than control families. Severity of attention-deficit/hyperactivity disorder (P < 0.0001), obsessive-compulsive disorder (P = 0.0004), and depression (P = 0.01) symptoms were associated with predicted worse family impact.

CONCLUSION

Youths with tic disorders had lower individual and parent quality of life and worse family functioning than controls. The impact of tic disorders on the family may have significant implications for approaches to providing comprehensive care to these families.

Family functioning in pediatric trichotillomania, obsessive compulsive disorder, and healthy comparison youth

Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was employed to examine relationships between TTM severity and family functioning. All youth completed standardized diagnostic assessment, including the Family Environment Scale (FES) and Children's Report of Parenting Behavior Inventory (CRPBI). Family functioning was more impaired among both TTM and OCD cases relative to controls, as evidenced by higher levels of child-reported FES conflict and lower cohesion, expressiveness, and organization. Less consistent findings emerged on parent report, with cohesion, but not conflict, distinguishing the HC and clinical groups. In keeping with prior research, parents of TTM-affected youth also reported lower expressiveness and cohesion than parents in the OCD group. There was limited evidence for links between hair-pulling severity and family impairment and no links to parenting behavior. Findings are discussed in terms of implications for family focused treatment.

Comorbid Hoarding and Obsessive Compulsive Disorder Manifested During Early Childhood

This case report outlines the use of cognitive behavioral therapy (CBT) used to treat an 11-year-old female, “Gabriela,” with comorbid hoarding and obsessive compulsive disorder (OCD). Gabriela participated in treatment involving CBT and exposure and response prevention (ERP) sessions for OCD and hoarding, following a cognitive rehabilitation software program designed for cognitive impairment. Upon completion of the treatment, Gabriela no longer exhibited behaviors consistent with a comorbid hoarding and OCD diagnosis and demonstrated marked improvements in her presenting problems (mental rituals; hoarding items for magical thinking purposes). This case report supports the focus of research, continuing to explore hoarding and comorbidity diagnoses across the life span.

Family accommodation of anxiety symptoms in youth undergoing intensive multimodal treatment for anxiety disorders and obsessive-compulsive disorder: Nature, clinical correlates, and treatment response

BACKGROUND

Family accommodation is associated with a range of clinical features including symptom severity, functional impairment, and treatment response. However, most previous studies in children and adolescents investigated family accommodation in samples of youth with obsessive-compulsive disorder (OCD) or anxiety disorders receiving non-intensive outpatient services.

AIMS

In this study, we aimed to investigate family accommodation of anxiety symptoms in a sample of youth with clinical anxiety levels undergoing an intensive multimodal intervention for anxiety disorders or OCD.

PROCEDURES

We first assessed the internal consistency of the Family Accommodation Scale - Anxiety (FASA). We next examined family accommodation presentation and correlates.

RESULTS

The FASA showed high internal consistency for all subscales and total score, and good item and subscale correlations with the total score. All parents reported at least mild accommodation, and the mean levels of family accommodation were particularly high. Child age, anxiety severity, and comorbid depressive symptoms predicted baseline accommodation. However, the association between anxiety severity and family accommodation no longer remained significant after adding the other factors to the model. In addition, family accommodation partially mediated the relationship between anxiety severity and functional impairment. Finally, post-treatment changes in family accommodation predicted changes in symptom severity and functional impairment.

CONCLUSIONS

These findings suggest the FASA is an appropriate tool to assess family accommodation in intensive treatment samples. Further, they underline the importance of addressing family accommodation in this population given the particularly high levels of accommodating behaviors and the evidence for adverse outcomes associated with this feature.

Obsessive-Compulsive Disorder in Paediatric and Adult Samples: Nature, Treatment and Cognitive Processes. A Review of the Theoretical and Empirical Literature

The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.

Mapping the Paths from Styles of Anger Experience and Expression to Obsessive-Compulsive Symptoms: The Moderating Roles of Family Cohesion and Adaptability

Previous research has shown strong connections of anger experience and expression with obsessive-compulsive (OC) symptoms. Additionally, studies have demonstrated links between family environment variables and obsessive-compulsive disorder (OCD). Our study aims to integrate the perspectives from these two literatures by exploring the moderating roles of family cohesion and family adaptability in the relationship between anger proneness and suppression and OCD symptoms. A total of 2008 college students were recruited from a comprehensive university in Shanghai, China between February and May 2016. The subjects completed self-report inventories, including the Symptom Check List-90, State-Trait Anger Expression Inventory 2 (Chinese version), and Family Adaptability and Cohesion Scale, second edition (Chinese Version). Controlling for age, one-child family status, ethnicity, family income, current depression, and anxiety, our analyses showed that the association between anger proneness and OC symptoms was moderated by family cohesion among men and that family adaptability moderated the connection between anger suppression and OC complaints among women. The findings imply that a more cohesive and empathic family environment may protect male students with high levels of anger proneness from developing OC behaviors or thoughts. The results suggest that for female subjects who are accustomed to suppressing angry feelings, flexible family coping strategies and communication atmospheres would reduce their vulnerability to OC symptoms. The findings are somewhat consistent with those of previous studies on psychotherapy outcomes that showed that OCD patients benefitted from psychotherapeutic interventions that cultivated the clients' family cohesion and adaptability.

Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder

BACKGROUND

Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood.

OBJECTIVES

To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview.

METHODS

Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups.

RESULTS

Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode.

CONCLUSION

A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.

A Multisite Study of Family Functioning Impairment in Pediatric Obsessive-Compulsive Disorder

OBJECTIVE

Familial aspects of pediatric obsessive-compulsive disorder (OCD), including accommodation and treatment, have received notable and warranted attention. However, individual perspectives of its repercussions on family functioning, including emotional and occupational parental burden, have not been closely examined. The present study details this topic using a large multicenter sample.

METHOD

Participants included 354 youth affected with OCD and their mothers and fathers ascertained through OCD programs in Boston, Massachusetts (n = 180) and Vancouver, British Columbia (n = 174). The validated OCD Family Functioning Scale and standard OCD measurements were completed. Descriptive, between-site, and cross-perspective comparative analyses were followed by regression model testing to predict family impairment.

RESULTS

Family functioning was negatively affected from youth, mother, and father perspectives. Impairment was reportedly more extensive at the time of worst OCD severity and was greater from maternal versus paternal viewpoints. Most frequently affected family tasks and implicated OCD symptoms included morning and bedtime routines and intrusive thoughts. Emotional repercussions in all members included stress and anxiety, followed by frustration or anger in youth and sadness in parents. Nearly half of mothers and one third of fathers reported daily occupational impairment. Compared with youth self-report, parents perceived fewer social and academic effects on their child. Family accommodation most consistently predicted family impairment, especially from parent perspectives. OCD and compulsion severity, contamination and religious obsessions, and comorbidities also predicted various perspectives of family subdomain impairment.

CONCLUSION

This study quantitatively details the pervasive burden that pediatric OCD places on families, as reported from complementary relative perspectives. Further attention to this topic is warranted in clinical and research realms.