Explore our library of resources

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.