Dysregulation in pediatric obsessive compulsive disorder

Joseph F. McGuire, Brent J. Small, Adam B. Lewin, Tanya K. Murphy, Alessandro S. De Nadai, Vicky Phares, Gary Geffken, Eric A. Storch

Research output: Contribution to journalArticlepeer-review

Abstract

Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalPsychiatry research
Volume209
Issue number3
DOIs
StatePublished - Oct 30 2013
Externally publishedYes

Keywords

  • Attrition
  • Children
  • Dysregulation
  • Impairment
  • Obsessive compulsive disorder
  • Symptom severity
  • Treatment outcome

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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