Obsessive Beliefs in Youth with OCD and Their Mothers
Pietrefesa, Ashley S., Schofield, Casey A., Whiteside, Stephen P., Sochting, Ingrid, Coles, Meredith E., Journal of Cognitive Psychotherapy
The current study builds from mounting support for a role of OCD-related beliefs in pediatric OCD and evidence suggesting a role of both genetic and environmental factors in conferring risk for obsessive-compulsive behaviors. Specifically, data are presented examining the correspondence in OCD-related beliefs in 28 youth with OCD and their mothers. Findings showed a significant, moderate, positive correlation between youth and their mothers' beliefs regarding inflated perceptions of personal responsibility and the likelihood of threat. However, perfectionism and certainty beliefs were not significantly correlated across generations, and beliefs regarding the importance and control of thoughts were negatively correlated in youth with OCD and their mothers. These initial findings are consistent with previous studies from unselected adolescents and adults with OCD and their relatives in suggesting that familial loading may be particularly strong for responsibility and threat beliefs.
Keywords: obsessive compulsive disorder; OCD; pediatric OCD; cognitions; beliefs; children; adolescents; youth
There is mounting evidence for the role of maladaptive beliefs in the development and maintenance of obsessive-compulsive disorder (OCD). Maladaptive obsessive beliefs are considered to be irrational assumptions and dysfunctional attitudes about oneself, one's world, and one's thoughts that are consistent across situations ( Obsessive Compulsive Cognitions Working Group [OCCWG], 1997 ). Cognitive theories of OCD propose that particular types of beliefs (e.g., an inflated sense of responsibility for harm and a need for perfectionism) lead to maladaptive appraisals of normal intrusive thoughts (OCCWG, 1997, 2001, 2003; Rachman, 1997, 1998, 2002; Salkovskis, 1985; Salkovskis & Kirk, 1997 ). For example, to the extent that an individual believes that he/she is responsible for preventing harm to others, he/she is more likely to interpret normal intrusive thoughts (e.g., "I have disease-causing germs on my hands") in a catastrophic manner, transforming them into distressing obsessions (e.g., "I am going to contaminate others") that subsequently elicit compulsive coping behaviors (e.g., compulsive handwashing).
Data from a variety of studies support cognitive models of OCD in adults. A large body of cross-sectional research has revealed significant, positive associations between various belief domains and OCD symptoms (see Frost & Steketee, 2002, for a review). In addition, increases in OC behaviors have been observed following experimental manipulations of OCD-related beliefs (e.g., heightened perceptions of personal responsibility for harm resulting in more hesitations and checking behaviors during task performance; Bouchard, Rhéaume, & Ladouceur, 1999; see also Jones & Menzies, 1998; Ladouceur, Rhéaume, & Aublet, 1997; Mancini, D'Olimpio, & Cieri, 2004; Rassin, Merckelbach, Muris, & Spaan, 1999; Salkovskis & Campbell, 1994 ). Furthermore, research has shown that cognitive-behavioral treatment for OCD (i.e., exposure and ritual prevention) leads to decreases in dysfunctional cognitions, and that such decreases are associated with positive changes in OCD symptom status ( Belloch, Cabedo, & Carrió, 2008; Emmelkamp, van Oppen, & van Balkom, 2002; Grenier, O'Connor, & Bélanger, 2008; Storchheim & O'Mahony, 2006 ). In line with these data, several longitudinal studies have found that OCD-related beliefs predict prospective changes in OCD symptoms over time ( Abramowitz, Khandker, Nelson, Deacon, & Rygwall, 2006; Coles & Horng, 2006; Coles, Pietrefesa, Schofield, & Cook, 2008 ). In sum, there is a large body of literature indicating that dysfunctional beliefs may contribute to the pathogenesis and persistence of OCD symptoms in adults.
Recently, there has been increasing support for the applicability of cognitive models of OCD to youth. Several research groups have documented significant positive correlations between domains of OCD-related beliefs and OCD symptoms in unselected samples of children and adolescents ( Magnúsdóttir & Smári, 2004; Mather & Cartwright-Hatton, 2004; Matthews, Reynolds & Derisley, 2006 ). …