Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.

Body dysmorphic disorder affects 2.4% of the U.S. adult population, with the most common age of onset between 12 and 13 years. However, research in the area of adolescent BDD is minimal. This case study describes the intensive approach of treatment used for a 14-year-old female diagnosed with BDD. Treatment included an individualized course of cognitive behavioral therapy and exposure and response prevention. BDD symptoms decreased after 27 full-day sessions in an outpatient clinic. In addition, general levels of anxiety decreased and level of functioning increased. Tailoring standard treatments and utilizing developmentally appropriate techniques were significant factors for the adolescent’s success. Implications for future research and treatment are discussed.

As readers of this special issue will see, the treatments provided in the Obsessive-Compulsive Related Disorder (OCRD) cases described are highly varied. The unifying feature would be better described as an age group rather than a breakdown in inhibitory control as speculated to be the primary unifying mechanism in the OCRD. It is encouraging that effective treatments are emerging for adolescents with OCRDs. Providers will do well to recognize that the appearance of the OCRD does not imply that a treatment for one disorder (i.e., exposure with response prevention [ERP] for OCD) will necessarily also provide relief for another condition in this class (i.e., for Trichotillomania [TM] or Hoarding Disorder [HD]). Instead, given the heterogeneity of these disorders, it comes as little surprise that the interventions are also varied, and providers will require training in a wide range of interventions embedded in sound clinical conceptualization (i.e., Tolin, 2016). It is hoped that these cases will spark additional research on clinical presentations of adolescents with OCRDs.

Objective: Despite the substantial distress and impairment often associated with skin picking, there currently is only limited research examining various phenomenological aspects of this behavior. The present research contributes to the existing literature by investigating phenomenological variables related to skin picking, such as family involvement, anxiety, depression, and the emotional consequences of skin picking. Moreover, on the basis of symptom severity level, differences were explored between individuals with skin picking who were from a psychiatric population.

Method: Forty individuals with various clinician-ascertained DSM-IV diagnoses in addition to skin picking symptomatology participated in the present study, which was conducted from September 2002 through January 2003. Participants were administered a self-report questionnaire (which assessed demographic, symptom, and past diagnostic information) as well as the Beck Depression Inventory, the Beck Anxiety Inventory, and the Self-Injury Interview.

Results: Phenomenological data on various aspects of individuals with skin picking are presented. Individuals with mild skin picking and individuals with severe skin picking were compared and found to differ in the level of distress they experienced (t = -2.35, p = .05) and the amount of damage caused by their picking behavior (t = -3.06, p = .01).

Conclusions: Overall, skin picking represents a behavior with its own unique characteristics and accompanying levels of distress and impairment that warrants specific attention by clinicians.

This paper explores the relationship between primary anorexia nervosa (PAN) and obsessive-compulsive disorder (OCD) in both their concomitant and their sequential presentation. Their clinical descriptions demonstrate the presence of obsessionality and compulsiveness that seem to interface during their course and overlap in their symptomatologies has been noted for over sixty years. However, recent research in this regard is scant. Commonalities in pathophysiology indicate disturbances in neurotransmitters, notably serotonin. Biological challenges have failed to establish a definitive correlation with PAN and OCD, whether in combination or individually. We may postulate that, with limitations, they share some anatomical pathways. The areas affected are the amygdala, cingulum and orbito-frontal cortex. Few studies, however, have been devoted to the treatment of concomitant PAN and OCD.

The presence of overvalued ideas in obsessive–compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome [Kozak, M. J. & Foa, E. B. (1994). Obsessions, overvalued ideas and delusions in obsessive–compulsive disorder. Behaviour Research and Therapy, 32, 343–353]. To date, no measures have been developed which quantitatively assess levels of overvalued ideas in obsessive–compulsives. The present studies examined the psychometric properties of a scale developed to measure this form of psychopathology, the Overvalued Ideas Scale (OVIS). In study 1, 102 patients diagnosed with OCD were administered a battery of instruments including the OVIS at baseline and two weeks later, prior to initiating treatment. Results indicate that the OVIS has adequate internal consistency reliability (coefficient α=0.88 at baseline), test–retest reliability (r=0.86) and interrater reliability (r=0.88). Moderate to high levels of convergent validity was found with measures of obsessive–compulsive symptoms, a single item assessment of overvalued ideas and psychotic symptoms. Medium levels of discriminant validity with measures of anxiety and depression was obtained in this study. Individuals determined to have high OVI showed greater stability of this pathology than those with lower OVI, suggesting that overvalued ideas are stable for extreme scorers. In study 2 a total of 40 patients participated who were diagnosed with OCD. The same battery of instruments was administered as in study 1, as well as the Beck Depression Inventory and Beck Anxiety Inventories. Results were similar to that obtained in study 1, including a relative lack of discriminant validity with self-report measures of depression and anxiety. It is suggested that further research with the OVIS may show predictive value in treatment outcome studies of OCD.

Behavioral treatment of body dysmorphic disorder (BDD) is vastly neglected in the behavioral literature. The primary target symptom associated with BDD is a preoccupation with a perceived physical defect that is not noticeable to others but that the individual attempts to correct by the use of cosmetic/dermatological products, plastic surgery, or mirror checking. Five BDD patients who received exposure, response prevention, and cognitive therapy were described. These 5 patients all refused pharmacotherapy and underwent either intensive (n=3) or weekly (n=2) behavior therapy. Patients in intensive therapy received 90-minute sessions 5 days per week whereas patients in weekly treatment received one 90-minute session per week. Four out of 5 patients improved on the Overvalued Ideation Scale (OVI) and on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) modified for BDD. Based on these case histories, behavior and cognitive therapy may be a suitable treatment approach for BDD

OBJECTIVE: Although the role of pregnancy and childbirth in postpartum psychosis and depression has been studied, the association between pregnancy and obsessive-compulsive disorder has not been specifically addressed. The authors evaluated the role of pregnancy in the onset of obsessive-compulsive disorder.

METHOD: Female patients with obsessive- compulsive disorder (N = 106) completed a questionnaire assessing age at onset of symptoms, marital status, number of children, age at each pregnancy, and life events associated with the onset of obsessive- compulsive disorder.

RESULTS: Of the 106 women, 42 were childless and 59 had at least one child each; five others were also childless but had had abortions (N = 4) or a miscarriage (N = 1). Of the 42 women without children, 12 (28.6%) had first experienced obsessive-compulsive symptoms between the ages of 13 and 15 years, but there were two peaks of onset for the women with children: ages 22-24 and 29-32 years. Of the 59 patients with children, 23 (39.0%) had experienced symptom onset during pregnancy; this was the first pregnancy for 12, the second pregnancy for eight, and the third pregnancy for three. Four of the five women who had had abortions or a miscarriage had experienced the onset or an exacerbation of obsessive-compulsive symptoms during pregnancy.

CONCLUSIONS: The association between pregnancy and the onset of obsessive-compulsive symptoms in these female patients highlights the need for further research on psychological and biological factors associated with pregnancy and obsessive-compulsive disorder.

Obsessive-compulsive disorders are characterized by two main groups of symptoms, viz. (a) obsessions manifested by unpleasant and intrusive thoughts, images or melodies that dwell in the mind and cannot be repelled, and (b) compulsions, described by an urge to perform an act. Anxiety, depression, aggressive behavior, sexual pathology and family disturbances are secondary manifestations of obsessive-compulsive disorders. A high incidence of obsessive-compulsive symptoms observed in Gilles De La Tourette Syndrome, Lesch-Nyhan Syndrome, Parkinsonian Syndromes, Epilepsy, Primary Anorexia Nervosa, and certain forms of severe Self-Mutilation, suggested an organic pathology for obsessive-compulsive disorders. Based on the therapeutic efficacy of chlorimipramine, a potent serotonin re-uptake blocker, and L-tryptophan, a precursor of serotonin, a serotonergic theory for the physiopathology of obsessive-compulsive disorders was put forward. Biochemical data obtained from patients showed low blood levels of serotonin when compared to a control population (p < .05). Currently, clinical grouping of patients and biochemical studies of the indolamine pathway are being conducted.