Obsessive–compulsive disorder (OCD) is a ­neuropsychiatric disorder characterized by the presence of both obsessions and compulsions (American Psychiatric Association, 2000), and is expressed in approximately 2–4% of children (Esser, Schmidt, & Woerner, 1990; Flament et al., 1988; Maggini et al., 2003; Thomsen 1993). On the one hand, obsessions are composed of recurrent and persistent thoughts, impulses, and/or images that are experienced as intrusive and unwanted by the individual, with the most common including thoughts of contamination and images of violence (Leonard, Ale, Freeman, Garcia, & Ng, 2005; March & Leonard, 1996; Storch et al., 2009). Compulsions, on the other hand, are repetitive behaviors or mental acts that the individual feels compelled to perform (Carter & Pollock, 2000; Leonard et al., 2005; March & Leonard, 1996; Riddle et al., 1990), with the most common being excessive washing of the hands and a repetitive checking or touching of objects (Storch et al., 2009). In most cases, obsessions and compulsions are present together, and may relate in a meaningful way (e.g., obsessive thoughts about hygiene paired with compulsive hand-washing); however, neither a dual nor a meaningful presentation of obsessions and compulsions is required for a diagnosis of OCD (Carter & Pollock, 2000; Keeley, Storch, Dhungana, & Geffken, 2007). OCD is diagnosed when at least one obsession or compulsion is present and causes significant interference to the child’s life. In this context, significant interference is defined by the loss of 1 or more hours per day to an obsession or compulsion (American Psychiatric Association, 2000). In general, OCD is chronic and debilitating in its effects: without treatment only 10% of diagnosed children experience a remission; 10% experience a worsening of symptoms (and/or associated impairments) over time; and the other 80% experience a fairly stable, unremitting course (Hollander & Evers, 2004; Keeley et al., 2007).

/pdf/obsessive-compulsive-disorder-pyhdk198k7.pdf

Obsessive-Compulsive Disorder

The efficacy of cognitive– behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest–posttest effect sizes for disorderspecific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small.

/pdf/cognitive-behavioral-therapy-for-adult-anxiety-disorders-in-2nuz525u7q.pdf

Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies.

http://jasoncartermd.com/resources/pdf/Obsessive-Compulsive%20Disorder.pdf

Obsessive-compulsive disorder.

In this review, the extant literature concerning anxiety psychopathology in African American adults is summarized to develop a testable, explanatory framework with implications for future research. The model was designed to account for purported lower rates of anxiety disorders in African Americans compared to European Americans, along with other ethnoracial differences reported in the literature. Three specific beliefs or attitudes related to the sociocultural experience of African Americans are identified: awareness of racism, stigma of mental illness, and salience of physical illnesses. In our model, we propose that these psychological processes influence interpretations and behaviors relevant to the expression of nonpathological anxiety as well as features of diagnosable anxiety conditions. Moreover, differences in these processes may explain the differential assessed rates of anxiety disorders in African Americans. The model is discussed in the context of existing models of anxiety etiology. Specific follow-up research is also suggested, along with implications for clinical assessment, diagnosis, and treatment.

Anxiety psychopathology in African American adults: literature review and development of an empirically informed sociocultural model.

A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders.

Obsessive-compulsive disorder in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome with exposure and ritual prevention

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Obsessive-compulsive disorder in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome with exposure and ritual prevention