This diploma thesis deals with selected problems that result from a person's obsessive compulsive disorder and that can influence and impact their social functioning. It also looks at selected possibilities for social work that can help to address these problems and to restore social functioning. The first chapter of this diploma thesis is focused on obsessive compulsive disorder. This chapter contains basic information about this mental disorder and the problems caused by this disease. The second chapter deals with the treatment of this disease. The third chapter focuses on the social functioning of a person suffering from obsessive compulsive disorder. This chapter contains selected examples of problems caused by this disease and their impact on the social functioning of a person suffering from obsessive compulsive disorder. These are examples from the scientific literature supplemented with examples from the particular case of Peter N.. The fourth chapter deals with selected possibilities of social work that can help to solve these problems and to restore social functioning.

The overarching aim of this dissertation is to use health services research methods to address three problems in behavioral health services. This dissertation seeks to address the knowledge gaps in behavioral health services through the generation of evidence intended to support evidence-based practices (EBP). Previous work has examined epidemiology of behavioral health disorders in the ED, but they have not attempted to examine disorders by the cause of injury. Chapter 2 examines the epidemiology of psychiatric disorders among adults who seek care in the emergency department (ED) by cause of injury. Data from a national hospital discharge survey was analyzed using logistic and multinomial regression. Estimates are given as average marginal effects (AME) to simplify the interpretation and application. Intentionally-caused injury and undetermined cause of injury are significantly associated with psychiatric disorders. Patients with undetermined cause of injury were more likely to be diagnosed with anxiety disorders, depressed mood, and psychoses relative to patients with unintentional injuries Since there are several treatment options for obsessive-compulsive disorder (OCD), including cognitive behavioral therapy (CBT), serotonin reuptake inhibitors (SRIs), and combinations of these, a comparison of treatment effects denominated in dollars is helpful when comparing risks and benefits. Chapter 3 builds on previous randomized control trials of treatments for OCD in children and adolescents by ranks the cost-benefits of first-line treatments. The analysis aggregates treatment effects from published trials in meta-analytic framework and a Monte Carlo simulation of 100,000 hypothetic children and adolescents to derive ranked cost-benefit. Treatments strategies starting with CBT, but not CBT and SRIs concurrently, were the most cost-beneficial. The relationship between cost-sharing and utilization of behavioral health services has been studied in the aggregate, but there has been little work examining the relationship by disorder and treatment modality. The aim of Chapter 4 is to examine the association between cost-sharing and utilization of psychotherapy and adherence to pharmacotherapy among insured adults with OCD. This chapter utilizes the Truven MarketScan Commercial Claims and Encounters dataset to perform zero-inflated negative binomial regression and logistic regression analyses. Increased cost-sharing was significantly, negatively associated with psychotherapy intensity and dose, but not associated with SRI adherence. This dissertation examined three different research questions to address gaps in the behavioral health services research. The findings of these chapters have implications for patients, clinicians, insurers, and policymakers. The results can be used to improve aspects of cost, quality, access, and efficiency of behavioral health services.

Obsessive-compulsive disorder (OCD) is associated with diminished quality of life and cognitive control dysfunction. Conflict adaptation is a reflection of cognitive control, and consists of the ability to detect conflict in previous trials and adjust performance on current trials. Conflict adaptation is thought to rely on interplay between the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (dlPFC) for detecting conflict and signaling for increases in control, respectively. We hypothesized that individuals with OCD would show reduced conflict adaptation effects in response times, error rates, ACC activation, and dlPFC activation when compared with healthy control subjects. We also expected diminished conflict adaptation to be associated with poorer quality of life in those with OCD. Nineteen individuals with OCD and twenty psychiatrically-healthy controls completed a Stroop task while response times, error rates, and fMRI data were recorded. 2-Group (OCD, control) x 2-Previous Trial Congruency (congruent, incongruent), x 2-Current Trial Congruency (congruent, incongruent) ANOVAs were conducted for both behavioral and fMRI data. Indices of conflict adaptation were correlated with quality of life scores. There was a significant response time conflict adaptation effect collapsed across groups; however, there were no between-groups interactions or main effects. No error rate conflict adaptation was observed at any level of the analysis. On fMRI analyses, the dlPFC showed increased activation on incongruent relative to congruent trials collapsed across groups; however, no ACC activation differences were observed between current incongruent and congruent trials. Conflict adaptation-related activation was noted in the ACC collapsed across groups. The between-groups ANOVA revealed a significant cluster in the ACC with control participants showing greater ACC, medial prefrontal cortex, and left orbitofrontal cortex conflict adaptation activation-related activation relative to individuals with OCD. No between-groups differences were seen in the dlPFC. Conflict adaptation was not significantly related to quality of life. Individuals with OCD may use different neural processes to achieve similar behavioral results to those of healthy controls. Alternative explanations of conflict adaptation effects such as temporal learning theory are also discussed. Our hypothesized model for the ACC and dlPFC functioning as the evaluative and regulative components of cognitive control was only partly supported. ACC and dlPFC activation appeared to highlight different roles, but these roles may be independent rather than existing in a feedback loop. Although quality of life is significantly diminished in individuals with OCD, this loss of quality of life does not appear to be mediated by conflict adaptation differences.

It is of crucial importance to identify and disseminate effective treatments for paediatric obsessive-compulsive disorder (OCD). OCD is time-consuming and distressing, and can substantially disable functioning at school, at home, and with peers (Piacentini, 2003). Children who do not receive treatment are at risk of psychological difficulties in adulthood, including continued OCD, clinical anxiety and depression, personality disorders, and social maladjustment (Wewetzer et al., 2001). Two-thirds of adult cases of OCD develop in childhood, and adults with OCD have lower employment, poorer academic achievement, and lower marital rates compared to non-OCD adults (Hollander et al., 1996; Koran, 2000; Lensi et al., 1996; Steketee, 1993). The distressing nature of OCD in childhood, accompanying psychosocial impairment and risk of future psychopathology, underscore the need to identify effective treatments. The primary aim of this thesis was to expand knowledge of evidence-based treatments for paediatric OCD. A mixed-methodology approach was employed to examine key issues in this area. The first study used meta-analytic methodology to determine the evidence supporting available treatments for paediatric OCD. An extensive literature search revealed over 100 published reports of treatments, encompassing a broad array of theoretical approaches and treatment strategies. Examples of treatments used for paediatric OCD included psychodynamic therapy, pharmacotherapy, cognitive-behavioural therapy (CBT), hypnosis, family therapy, immunotherapy, and homeopathy. / Study 1 comprised the first known meta-analysis of randomised, controlled treatment trials (RCTs) for paediatric OCD. Included studies were limited to RCTs as they are the most scientifically valid means for determining treatment efficacy and provide a more accurate estimate of treatment effect by removing error variance associated with confounding variables. The literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons (N = 1016) and 5 CBT to control comparisons (N = 161). Random effects modelling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = 0.48, 95% CI = 0.36 to 0.61, p < .00001) and CBT (ES = 1.45, 95% CI = 0.68 to 2.22, p =.002). The results support the efficacy of CBT and pharmacotherapy, and confirm these approaches as the only two evidence-based treatments for paediatric OCD. Implications and suggestions for future research are discussed. The effectiveness of CBT provided impetus to further examine this treatment. Group CBT is an understudied treatment modality among children with OCD. It was hypothesised that group CBT would possess efficacy because of the effectiveness of individual CBT for children with OCD, the demonstrated effectiveness of group CBT among adults with OCD, the practical and therapeutic advantages afforded by a group treatment approach, and the embeddedness of the approach in robust psychological theory. The aim of the second study was to evaluate the efficacy of group CBT. The study comprised the largest known conducted randomised, placebo-controlled trial of group CBT for paediatric OCD. / Twenty-two children and adolescents with a primary diagnosis of OCD were randomly assigned to a 12-week program of group CBT or a credible psychological placebo. Children were assessed at baseline, end of treatment, and at 1 month follow-up. Outcome measures included the Children’s Yale-Brown Obsessive-Compulsive Scale, global measures of OCD severity, Children’s Depression Inventory, and parent- and child-rated measures of psychosocial functioning. An intention-to-treat analysis revealed that children in the group CBT condition had statistically significantly lower levels of symptomatology at posttreatment and follow-up compared to children in the placebo condition. Analysis of clinical significance showed that 91% of children that received CBT were ‘recovered’ or ‘improved’ at follow-up, whereas 73% of children in the placebo condition were ‘unchanged’. Effect size analysis using Cohen’s d derived an effect of 1.14 and 1.20 at posttreatment and follow-up, respectively. These effects are comparable to results from studies of individual CBT. This study supported group CBT as an effective treatment modality for paediatric OCD and demonstrated that the effect extends beyond placebo and nonspecific treatment factors. In addition to treatment efficacy, the inherent worth of a treatment lies in its adoption by the relevant clinical population. Children with OCD are known to be secretive and embarrassed about symptoms, and there is often a long delay between onset of symptoms and treatment-seeking (Simonds & Elliot, 2001). An important observation during the course of conducting the RCT was that a high rate (39%) of eligible families declined participation. / This led to the question, "What barriers prevent participation in group CBT for paediatric OCD?" Qualitative methodology was employed to address this research question. Eligible families that had declined participation in the RCT were contacted and invited to participate in semi-structured interviews that explored reasons for non-participation and positive and negative perceptions of group CBT. The average time between non-participation and interview was 1.33 years (SD = 3 months). Data were collected from nine families and thematic analysis methodology was utilised to identify emergent themes. Failure to participate was predicted by practical and attitudinal barriers. Practical barriers included a lack of time, distance, severity of OCD symptoms, financial, and child physical health. Attitudinal barriers included child embarrassment about OCD symptoms, child belief that therapy would be ineffective, fear of the social aspect of the group, lack of previous success with psychology, lack of trust in strangers, parental concern about the structure of the group, denial of a problem, and ‘not being ready for it’. Attitudinal barriers more frequently predicted treatment non-participation. Positive and negative perceptions of this treatment modality were informative. Parents showed no differences in preference for individual or group CBT. An important finding was that 56% of the children had not received treatment since parental expression of interest in the group CBT program. Application of the findings to methods that promote service utilisation is discussed.

Abstract not available

The pivotal role of inflated responsibility beliefs in the maintenance and treatment of obsessive-compulsive disorder (OCD) has been clearly demonstrated (Rachman, 1993; Salkovskis, 1998; Shafran, 1997; van Oppen & Arntz, 1994). Yet little is known about the origins of these beliefs, their contribution to a sense of inflated responsibility or the symptoms of OCD, or the contribution of personality to inflated responsibility and to OCD, The aims of this thesis were to investigate a model of the inter-relationships among the personality dimensions of neuroticism and psychoticism, inflated responsibility and OCD, and the origins of inflated responsibility to inflated responsibility and to OCD. In order to achieve these aims, a scale was developed to assess the origins of inflated responsibility based upon the five pathways proposed by Salkovskis, Shafran, Rachman, and Freeston (1999) and the additional domains of guilt, vigilance and thought-action fusion (Shafran, Thordarson, & Rachman, 1996; Shafran, Watkins & Charman, 1996; Tallis, 1994). Eighty-four participants with OCD (age M = 43.36) and 74 control participants (age M =37.14) volunteered to participate in the two studies of this thesis. The aim of Study 1 was to develop and validate a measure of the Origins of Inflated Responsibility (OIR). The results of the first study yielded a 25-ttem scale, the Origins of Inflated Responsibility Questionnaire (OIRQ) with five independent factors: responsibility, strictness, protection from responsibility, critical incidents, and peer blame which demonstrated both internal reliability and temporal stability over a 2-week period. In Study 2, participants also completed the Responsibility Attitudes Scale (Salkovskis, Wroe, Gledhill, Morrison, Forrester, Richards, ct al. (2000) (a measure of inflated responsibility), the Padua Inventory (Sanavio, 1988) (to measure of the symptoms of OCD)y and the Eysenck Personality Inventory-Revised (Eysenck & Eysenck, 1991). Multivariatc Analysis of Variance revealed that the OCD group scored higher on all variables than the control group except for strictness where the groups were not different, and psychoticism where the OCD group scored lower. A series of Multiple Regression analyses revealed that both group and the OIR contributed to inflated responsibility (R2 = .56). When all variables, OIR, inflated responsibility and neuroticism were entered as predictors of OCD, 60% of the variance in OCD was explained however, 49% of the variance was shared by the independent variables suggesting the presence of some underlying construct. Structural Equation Modelling, where all the constructs in the model were examined simultaneously, revealed that neuroticism contributed to the OIR, inflated responsibility and OCD. The OIR were also significant predictors of inflated responsibility and indirectly through inflated responsibility predictive of OCD. The OIR also directly predicted OCD and when the total effects are considered, their contribution was greater than the total effect for inflated responsibility alone. The results of these studies provide good support for the origins of inflated responsibility proposed by Salkovskis et al. (1999), as measured by the OIRQ developed for use in the current thesis. The results also support the contribution of inflated responsibility and neuroticism, as well as the OIR, to OCD, The large amount of variance shared by the OIR, inflated responsibility and neuroticism suggest that there might be some underlying construct, perhaps of a biopsychosocial nature, that requires further investigation for its role in the onset and maintenance of OCD. The clinical relevance of these findings is discussed in terms of early prevention strategies and interventions.

The current coginitive models of the Obsessive-Compulsive Disorder (OCD) symptoms focuses on the different cognitive factors. Like other nonspecific and noncognitive variables, these factors may also function as vulnerability factors. However, they have been mostly studied separately and majority of the findings in the literature come from the Western samples. Accordingly, the studies examining these factors together and the impact of the culture in these studies are sparse in number. The present study suggested a comprehensive cognitive model for OCD symptoms, including several distal and proximal vulnerability factors. It was aimed to adapt three instruments to examine the interrelationships among the vulnerability factors and OCD symptoms in different cultures. Relevant ten instruments were administered to the university students from Turkey and Canada. The analyses showed that Turkish versions of three instruments had satisfactory psychometric properties for Turkish students. These analyses also revealed some cross-cultural similarities and differences in these factors and OCD symptoms. Neuroticism, age, introversion, OCD beliefs on responsibility/threat estimation, perfectionism/certainty and thought-action fusion in likelihood dimension were found to be associated with the OCD symptoms in both Turkish and Canadian samples. The relational paths between non-specific, appraisal and control factors, and OCD symptoms were also significant in both samples. However, religiousness was only significant factor in OCD symptoms and contributed to several belief and control factors toward these symptoms, only for Turkish subjects. The analyses of the religiousness differences indicated that psychological fusion in general and in morality was more related to the religiosity for Canadian Christians. Besides, Turkish students seemed to utilize worry more for OCD symptoms / whereas, Canadian participants used self-punishment. These common and unique patterns of the relationships were discussed within relevant findings about characteristics of the religion and culture.

The purpose of the present study was to examine the underlying mechanism of memory distrust as a function of repeated checking in a nonclinical student sample. Recent literature proposes that repeated checking increases familiarity with the material checked. Then, familiarity makes the recollections less vivid and detailed. Afterwards, this condition promotes distrust in memory. Before the experimental phase of the study, Padua Inventory- Washington State University Revision (PI-WSUR) and demographic information form were applied to the 381 students (232 female, 149 male) university students. Then, 84 students were selected according to their PI-WSUR scores. The students scored half standard deviation below the mean of the group were assigned to the low OCD group (N= 42) and the students scored half standard deviation above the mean were assigned to the high OCD group (N= 42). In the experimental phase of the study, an interactive computer animation was developed to test repeated checking behavior. Before the experiment, participants were randomly assigned to two groups: primed with feedback group and primed with no feedback group. In the experiment, participants were all asked to carry out checking rituals on a virtual gas ring. Each participant performed turning on, turning off and checking processes for 15 trials. However, half of the participants in the primed with feedback group were given feedback indicating that the checking activity was successful and complete and half of the participants in the primed with no feedback group were not given any feedback. The data are analyzed by 2 (Group: Low OCD group - High OCD Group) X 2 (Feedback condition: Primed with Feedback Group - Primed with no Feedback Group) Between Subjects ANOVA. Results showed that participants in the primed with feedback group had significantly higher scores on both memory confidence for the last checking trial of the gas rings and overall outcome confidence for all fifteen checking trials than participants in the primed with no feedback group. There was no significant group main effect and interaction effect (group x feedback condition) for the level of memory confidence and overall outcome confidence. There were also no significant group and feedback condition main effects and interaction effect for the level of vividness and detail of the recollections of the last checking behavior. Results are discussed in the light of the related literature.

Title from title page of PDF (University of Missouri--St. Louis, viewed February 23, 2010). Includes bibliographical references (p. 53-60).

Family accommodation of symptoms conflicts with the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can be an obstacle to positive outcomes. This study examined a structural equation model of parent and child variables related to family accommodation using a sample of 65 parent-child dyads recruited from a university-based clinic. Additionally, parents' motivations for engaging in accommodation were explored. Results generally supported the hypothesized model. Family accommodation mediated the relationship between OCD symptom severity and parent-rated functional impairment, child internalizing problems mediated the relationship between parent anxiety and family accommodation, and parent empathy and consideration of future consequences interacted to predict accommodation. Child externalizing problems significantly influenced family accommodation but neither of these two variables was affected by parent depression. Excessive reassurance seeking and cleaning/washing compulsions were relatively likely to be accommodated. Implications for clinical practice and directions for future research are discussed.