The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive-compulsive disorder.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients. METHOD: The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n=87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. RESULTS: The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (ß=.27, p=.02) and hoarding dimensions (ß=.23, p=.04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. CONCLUSIONS: EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.

Racial differences in the associations of neighborhood disadvantage, exposure to violence, and criminal recidivism among female juvenile offenders.

The current study examined the impact of exposure to violence and neighborhood disadvantage on criminal recidivism among Black (n = 69) and White (n = 53) female juvenile offenders. Participants were girls between the ages of 13 and 19 (M = 16.8; SD = 1.2) who were sentenced to secure custody. Using a multi-method research design, the study assessed neighborhood disadvantage through census level data, exposure to violence through self-report, and criminal recidivism through official records. Results indicated that Black girls were significantly more likely than White girls to live in disadvantaged neighborhoods, but both reported similar levels of parental physical abuse and witnessing neighborhood violence. In structural equation models, neighborhood disadvantage and witnessing neighborhood violence were indicative of future recidivism for the group as a whole. However, multiple group analyses indicated the existence of race specific pathways to recidivism. Witnessing neighborhood violence was associated with recidivism for Black girls while parental physical abuse was associated with recidivism for White girls. Results suggest that characteristics within the neighborhood play a considerable role in recidivism among female juvenile offenders generally and Black female juvenile offenders, specifically. Race specific risk models warrant further investigation, and may help lawmakers and clinicians in addressing racial disparities in the justice system.

Childhood sexual abuse moderates genetic influences on age at first consensual sexual intercourse in women.

We examine interactive effects of childhood sexual abuse (CSA) on heritable variation in age at first consensual sexual intercourse in a young cohort of 3,350 female and 2,724 male Australian twins. Consistent with hypotheses, genetic influences explained little if any variation in age at first consensual sexual intercourse for female twins reporting CSA (CSA(+)), with shared environment explaining 73%. For female twins reporting no history of CSA (CSA(-)), 39% of variation in age at first consensual sexual intercourse was explained by genetic effects, with shared environment accounting for 30%. For male twins, significant interactive effects of CSA on genetic and environmental variation in age at first consensual sexual intercourse were not observed. Overall genetic influences explained 51% of variation in age at first consensual sexual intercourse for male twins, with shared environment accounting for 8%. For both female and male twins, results from models that included conduct disorder as a covariate were near identical to results from models without conduct disorder.

The role of the children of twins design in elucidating causal relations between parent characteristics and child outcomes.

BACKGROUND: Determination of causal connections between parental measures and child outcomes using typical samples is limited by the inability to account for all confounds, both environmental and genetic. This paper discusses the strength of the Children of Twins (COT) design to highlight the role of specific environments. METHODS: A new analytical model is presented which helps differentiate and quantify the environmental and genetic processes underlying associations between family-level risk factors and child adjustment. In order to illustrate the COT design, the relation between smoking during pregnancy and child birth weight (BW) is examined in a sample of female twins and their children from Norway and the United States. RESULTS: The results illustrate that smoking during pregnancy is influenced by genetic factors. However, the Children of Twins model supports the claim that smoking during pregnancy has a direct environmental influence on BW and that genetic and shared environmental confounds cannot account for the association. CONCLUSIONS: An assessment of the strengths and limitations of the Children of Twins design and a comparison with other research strategies suggest that the design plays a unique role in the study of developmental psychology and psychopathology. Finally, the authors describe how methodological advances and future applications of the design will provide additional insight into the causal processes underlying children's adjustment to environmental stimuli.