The impact of climate change on obsessive compulsive checking concerns.

OBJECTIVE: To investigate whether climate change has impacted on the nature of the obsessions or compulsions experienced by patients with obsessive compulsive disorder (OCD). METHODS: The sample comprised 50 patients with OCD checking subtype who had presented at the Anxiety Disorders Clinic at The University of Sydney seeking treatment during the period March 2008 to November 2009. Details of the type of obsessions and compulsions directly related to climate change phenomena were identified. RESULTS: Fourteen of the 50 participants (28%) were identified as having OCD concerns directly related to climate change. The most frequent concerns involved electricity, water and gas wastage. Less frequent concerns included pets dying of thirst and one participant was concerned about house damage due to floors cracking, pipes leaking; roof problems and white ant activity. Compulsions included checking and rechecking pet water bowls, light switches, taps, stoves, skirting boards, pipes, roofs and wooden structures. While these behaviours are not particularly unusual for people with this condition, it was the rationale they provided for carrying them out that was surprising. Instead of checking and rechecking so as to prevent fire or flood, the rituals were specifically performed so as to reduce their global footprint, or respond to climate change-induced negative events. CONCLUSIONS: Our findings demonstrate that the types of obsessions and compulsions experienced by 28% of our sample were directly aligned with the current issue of climate change and the perceived dangers associated with this phenomenon. To our knowledge this represents the first documentation of the significant impact of climate change on the nature of the concerns experienced by people with OCD checking subtype. We suggest that mental health professionals need to be aware of, and assess for the presence of such concerns.

The efficacy of exposure and response prevention for geriatric obsessive compulsive disorder: a clinical case illustration.

Obsessive compulsive disorder (OCD) is one of the most frequently occurring psychiatric conditions in older adults. While exposure and response prevention (ERP) is considered the most effective psychological treatment for children and adults with OCD, research investigating its effectiveness for older adults is scarce. This clinical case study investigates the effectiveness of ERP in an 80-year-old man with a 65-year history of OCD. The client received 14 individual, 50-minute ERP treatment sessions. Clinician-based Y-BOCS scores reduced by 65% from 20 (moderate) at pretreatment to 7 (subclinical) at 7-month posttreatment followup. OCI-R total scores reduced by 45% from 38 at baseline to 21 at 7-month follow-up. Despite his long history of the disorder, ERP was effective and well tolerated. The application of ERP for older adults with OCD, including age-specific modifications that may be required for this treatment approach, is discussed.

Danger ideation reduction therapy for obsessive-compulsive checking: preliminary findings.

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive-compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive-compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.