Table Of ContentThe Clinician’s Guide to
Cognitive-Behavioral Therapy for
Childhood Obsessive-Compulsive
Disorder
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The Clinician’s Guide to
Cognitive-Behavioral
Therapy for Childhood
Obsessive-Compulsive
Disorder
Edited by
Eric A. Storch
Joseph F. McGuire
Dean McKay
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To those struggling with OCD either in themselves
oralovedone;itismygreathopethatthisbookcan
make a difference in your lives. And, for my loved
ones who inspire and support me each day (JFS,
MLS, NRS, and EMS).
—Eric A. Storch
For Ariel and Lilly, my unwavering sources of
support,andforallofthechildrenandfamilieswho
have served as the sources of inspiration for
this book.
—Joseph F. McGuire
For my mentors, in graduate school and in the
academy.
—Dean McKay
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Contents
Contributors xvii
1. Introduction 1
EricA.Storch,JosephF.McGuire,andDeanMcKay
References 4
2. Diagnosing Childhood OCD 7
EllaL.Oar,CarlyJohnco,andCynthiaM.Turner
DevelopmentalConsiderations 9
CommonOCDSymptomPresentations 10
Contamination(ContaminationObsessionsandCleaning
Compulsions) 10
Symmetry(SymmetryObsessionsandRepeating,Ordering
andCountingCompulsions) 11
ForbiddenorTabooThoughts(Aggressive,Sexual,orReligious
ObsessionsandRelatedCompulsions) 11
Hoarding 12
OtherMiscellaneousSymptoms 12
DifferentialDiagnosisandComorbidity 12
GeneralizedAnxietyDisorder 16
Illness/Health-RelatedAnxietyandEmetophobia 17
BodyDysmorphicDisorder 18
EatingDisorders 18
TicDisorders 19
AutismSpectrumDisorder 21
OtherIssuesinDiagnosis 22
RiskAssessment 22
PediatricAcute-OnsetNeuropsychiatricSyndrome 23
Conclusions 23
References 24
vii
viii Contents
3. Psychoeducation for Children, Parents, and
Family Members About Obsessive-Compulsive
Disorder and Cognitive Behavior Therapy 29
GudmundurSkarphedinssonandBernhardWeidle
OCDInformation 30
BasicPrinciples 30
DevelopmentalConcerns 31
NormalizeOCD 32
AnxietyResponse 33
FalseAlarm 33
ExternalizingOCD 34
CausesofOCD 34
BiologicalModel 36
CognitiveBehavioralModel 38
GeneticModel 39
IntegratedModel:NeurobiologicalBehaviorModel 40
CBTRationaleandDefinitions 40
TreatmentRationale 40
ExposureandResponsePrevention 41
Disgust 43
MetacognitivePerspective 43
CBTandMedications 44
Challenging/ComplexIssues 46
FamilyFunction/FamilyAccommodation 46
PoorMotivation 46
PoorInsight 47
LimitedCognitiveCapacity 47
Comorbidity 48
Conclusions 49
References 50
4. Assessment of Children With OCD 55
MichelleRozenmanandR.LindseyBergman
InitialConsiderationsandComponentsofAssessment 55
DeterminingOCDDiagnosis,CooccurringPsychopathology,and
DifferentialDiagnosis 57
InitialOCDSymptomPrompts 57
OCDDiagnosis 58
HoardingDisorder 59
DifferentialDiagnosisandCooccurringPsychopathology 60
DiagnosticandSymptomSeverityAssessmentTools 60
OCDSeverity 61
OrganizationoftheClinicalInterview—DiagnosticandOCDSeverity
Assessments 63
ChallengesandComplexIssuesinAssessment 63
Contents ix
YouthAgeandCognitiveDevelopment 63
ReconcilingYouthandParentReports 64
ParentalOCDorOtherMentalHealthProblems 64
FamilialandCulturalConsiderations 64
YouthandParentOCDSymptomQuestionnaires 65
OCDSymptomsandSeverity 65
AssociatedCharacteristicsofOCD:YouthandParentReports 67
Impairment 68
InsightandCognition 68
FamilyFunctioningandAccommodation 69
ConcludingRemarks 70
References 70
FurtherReading 73
5. Developing Exposure Hierarchies 75
DeanMcKay
DevelopingExposureHierarchies 75
GettingOriented:AssessingSymptomsDomainsforHierarchy
Development 76
APhenomenologicalPerspectiveonHierarchies 76
TheNutsandBolts 77
DevelopingtheHierarchy 78
HierarchyDevelopmentforComplexSymptoms 80
AllorNothingReportsofFear 81
NotJustRightExperiences/Incompleteness 82
LongDelayinConsequences 82
DistressIsNotAlwaysFear 84
SymptomsThatProvokeDiscomfortinClinicians 85
Conclusions 86
References 87
6. Developing and Implementing Exposure Treatment
in Youth Obsessive-Compulsive Symptoms 89
DeanMcKay
AftertheHierarchy:GettingStartedonERP 90
IllustrativeExample1:OverorUnderestimationofDistress 90
IllustrativeExample2:EmbeddedHierarchyItems 91
IllustrativeExample3:UnfoundedBravery 91
DoesExposureNeedtobeScary? 92
ExpectancyViolations 92
ReinforcedExtinction 93
AffectLabeling 94
ExposureinMultipleContexts 95
BetweenSessionReinforcement 96
AnatomyofaSession 99
