Ocrd Thesis Roughdraft

8/16/2019 Ocrd Thesis Roughdraft

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RUNNING HEAD: OCRD: UNDERSTANDING THE NEW CLASSIFICATION

OCRD: Understanding the New Classifi ati!n

Dana G!ld"erg

#r!fess!r Wal"a$%

&$inni'ia Uni(ersit)

*


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OCRD: UNDERSTANDING THE NEW CLASSIFICATION 3

TABLE OF CONTENTS

Chapter I: Introduction to OCRD’s , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Chapter II: OCD , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Chapter III: BDD , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Chapter IV: Groo in! Disorders , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Chapter V: "oardin! Disorder , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Re#erences , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Appendi$ A , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,


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OCRD: Understanding The New Classifi ati!n

Chapter One : De#inin! the OCRD’sA Brie# Introduction

At the %!%ent- the newest ateg!r) in the DS./ is OCRD0s !r O"sessi(e

C!%'$lsi(e and Related Dis!rders, This ateg!r) is a h!t t!'i a%!ng 's) h!l!g) resear hes

f!r a n$%"er !f reas!ns, This new ateg!r) in l$des 1 dis!rders 23DD-TT. -4OCD5 that were

're(i!$sl) 'la ed elsewhere- and tw! dis!rder were 're(i!$sl) n!t ateg!ri6ed at all 2S#D 4

HD5, While ea h !ne !f these dis!rders has $ni7$e hara teristi s- there is $rrentl) %$ h

!ntr!(ers) !f whether there are %!re si%ilarities !r %!re differen es, While s!%e resear h

2A"ra%!wit6- 89*15 lai%s that the effi a i!$s e(iden e is n!t e a tl) in s$''!rt !f the %!(e t!

the new OCRD lass- !ther resear hers- and the A%eri an #s) hiatri Ass! iati!n see% t! thin+

differentl), Thr!$gh!$t the ne t se(eral ha'ter I will dis $ss the lini al feat$res- a$ses- and

treat%ent f!r ea h !f these dis!rders, This resear h will 'erha's gi(e insight !n whether !r n!t

this new lassifi ati!n is an a''r!'riate 'la e%ent f!r these dis!rders- and de%!nstrate where

$rrent resear h is heading as well as what resear h still needs t! "e d!ne, H!we(er- first it is

i%'!rtant t! ta+e a l!se l!!+ at h!w ea h !f these dis!rders are defined in the DS.;/,%re&ious De#initions

Of the dis!rders re'resented in the DS.;I/- OCD- !r !"sessi(e !%'$lsi(e dis!rder- was

ateg!ri6ed as an an iet) dis!rder, .!re s'e ifi all) it was an e 'ressi!n !f an iet)- and an iet)

was $sed as an e 'lanati!n f!r the !%'$lsi!ns whi h were a signat$re !f the dis!rder, 3DD- !r

3!d) D)s%!r'hi Dis!rder was 're(i!$sl) ateg!ri6ed as a s!%at!f!r% dis!rder, The reas!ning

"ehind this "eing that the %ain feat$re !f %an) s!%at!f!r% dis!rders are that the) in(!l(eda"n!r%al th!$ghts a"!$t !ne0s "!d), Lastl)- TT. 2Tri h!till!%ania5 was ateg!ri6ed as

i%'$lse !ntr!l dis!rders- as TT.0s +e) feat$re is an ina"ilit) t! 're(ent the $rge t! '$ll )!$r

hair, This lea(es tw! 're(i!$sl) $n ateg!ri6ed dis!rders in the DS./- these n!w fall $nder the


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new lassifi ati!n !f OCRD0s, These dis!rders- H!arding and E !riati!n- thr!$gh %$ h

resear h and !nsiderati!n ha(e "een 'la ed in this ateg!r) d$e t! se(eral si%ilarities a r!ss

e'ide%i!l!g) and treat%ent- and this new 'la e%ent will h!'ef$ll) in rease awareness- resear h-

and rates !f s$ essf$l treat%ent 2DS.;I/;TR- 89995, In !rder t! esta"lish an $nderstanding !f

these dis!rders- it is i%'!rtant t! ta+e a "rief l!!+ at h!w these are defined in the new DS.;/,De#inin! OCD

O"sessi(e C!%'$lsi(e Dis!rder- !r OCD- is a l!ng lasting dis!rder that !ntin$all)

i%'a ts !ne0s a"ilit) t! f$n ti!n "!th s! iall) and as an indi(id$al, OCD- a !rding t! the

DS./ is hara teri6ed ") e 'erien ing !"sessi!ns and !%'$lsi!ns, O"sessi!ns "eing

a"n!r%al- intr$si(e- and 'ersistent th!$ghts $rges !r ideas whi h a$se signifi ant le(els !f

distress t! the indi(id$al, These !"sessi!ns- %$st als! "e a !%'anied !%'$lsi!ns- !r- a ti!ns

whi h ser(e the '$r'!se !f relie(ing the tensi!n- stress- !r an iet) that a !%'an) their

!"sessi!ns, F$rther%!re- in !rder t! 7$alif) f!r a diagn!sis !f OCD the diagn!sing 'r!fessi!nal

%$st als! n!t "e a"le t! "etter e 'lain the s)%'t!%s with an!ther dis!rder- !r with the $se !f

s$"stan es, Finall)- these !"sessi!ns and !%'$lsi!ns %$st "e ti%e !ns$%ing and a$se

signifi ant le(el !f i%'air%ent t! the indi(id$al0s life- whether that "e s! iall)- ! $'ati!nall)-

!r !therwise, As with !ther dis!rders ateg!ri6ed within the OCRD ateg!r)- the le(el !f insight

the indi(id$al has !n their disa"ilit) is ateg!ri6ed as g!!d insight- '!!r insight- !r n! insight,De#inin! BDD

The ne t dis!rder- as %enti!ned earlier was 're(i!$sl) ateg!ri6ed as a s!%at!f!r%

dis!rder as it in(!l(es a"n!r%al 'er e'ti!ns !f !ne0s "!d), 3DD !r 3!d) D)s%!r'hi dis!rder

is defined in the DS./ as ha(ing a 're! $'ati!n with !ne !r %!re defe ts !r flaws in the 'h)si al a''earan e !f an indi(id$al0s "!d), In %!st ases these flaws are slight !r

$nn!ti ea"le- and theref!re are greatl) e aggerated ") the indi(id$al e 'erien ing 3DD-

theref!re the) are !nsidered a"n!r%al th!$ghts !r "eliefs, In additi!n t! these "eliefs- t! "e


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diagn!sed with 3DD th!se e 'erien ing these s)%'t!%s %$st at s!%e '!int 'erf!r% re'etiti(e

"eha(i!rs !r a ts as a res'!nse t! this a''earan e !n ern, This an !%e in %an) f!r%s- fr!%

!(ering- hiding- !r e(en see+ing !$t s$rger) f!r the traits whi h the indi(id$al disli+es, As with

the !ther dis!rders- an indi(id$al d!es n!t 7$alif) if their s)%'t!%s are "etter e 'lained ")

an!ther dis!rder !r are !nset d$e t! s$"stan e $se, Indi(id$als with 3DD are s'e ified ") le(el

!f insight as well 2High- L!w- !r a"sent insight5,De#inin! Groo in! Disorders

Tri h!till!%ania 2TT.5 is a dis!rder hara teri6ed ") !%'$lsi(e '$lling !f the hair

fr!% (ari!$s 'la es !n the "!d), This re'etiti(e a ti!n is d!ne des'ite re'eated atte%'ts ") the

indi(id$al t! st!' "ef!re the) a$se f$rther da%age, This hair '$lling is d!ne f!r a n$%"er !f

reas!ns, In s!%e wa)s it is d!ne t! relie(e an iet) a"!$t gr!!%ing- while resear h has sh!wn

that it is als! d!ne "e a$se it 'r!(ides a sense !f release !r 'leas$re t! the indi(id$al d!ing it,

H!we(er- the effe ts !f this dis!rder %$st a$se lini all) signifi ant distress and

e 'lained ") this diagn!sis rather than dr$g $se !r !ther dis!rder,De#inin! "oardin!One !f the newest dis!rders in the "at h !f OCRD dis!rders is h!arding dis!rder, This

is a !%'letel) new diagn!sti riteria whi h "r!+e gr!$nd as 're(alen e !f this new dis!rders

was dis !(ered, Indi(id$als with H!arding Dis!rder ha(e diffi $lt) thr!wing awa) !">e ts as


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the) will assign $n !n(enti!nal %eaning t! an !">e t- s$ h as "elie(ing the) %a) need it at

an!ther ti%e- !r feeling a"n!r%al senti%ental (al$e, This f!r% !f !"sessi!n a$ses the

indi(id$al t! !%'$lsi(el) !lle t !">e ts in !rder t! a(!id distress and !ften "e a$se the)

e 'erien e 'leas$re in !lle ting, The !">e ts will then a $%$late !(er ti%e- "eginning t!

l$tter their li(ing s'a e, N!r%all) f!r th!se with H!arding Dis!rder- thr!wing awa) these

!">e t swill a$se signifi ant distress and an iet)- and indi(id$als will !ften "e $na"le t! 'art

with !">e ts whi h sh!$ld n!r%all) "e 'er ei(ed as >$n+, It is i%'!rtant t! %enti!n that a high

n$%"er !f ases als! h!ard ani%als- whi h in reases the health ha6ards that a !%'an) h!arding

dis!rder, F$rther%!re t! attain the diagn!sis !f h!arding dis!rder the !">e ts %$st "e l$ttering

their li(ing s'a e the '!int !f i%%!"ilit) and t! the detri%ent !f the indi(id$al0s s! ial life, Of

!$rse- this %$st "e the !nl) e 'lanati!n f!r this "eha(i!r- and !n e %!re it %$st n!t "e a$sed

") s$"stan e $se, H!arding dis!rder in l$des a $ni7$e s'e ifier- ?with e essi(e a 7$isiti!n@

%eaning that the indi(id$al will see+ !$t the !">e ts whi h l$tter the h!%e- rather than si%'l)

atta hing %eaning t! !">e ts that find their wa) int! their life,

C"' ( OCDSEC ) ( %re&a*ence+ Onset+ and C*inica* FeaturesThe first +e) feat$res t! $nderstand "!$t a dis!rder are its 're(alen e- age !f !nset-

!%!r"idit)- and the lini al feat$res whi h a !%'an) the dis!rder, Resear h ") R$s i! 289*95

de%!nstrates that OCD is a less !%%!n dis!rder with *8 %!nth 're(alen e esti%ated at ar!$nd

*,8 and a lifeti%e 're(alen e esti%ated ar!$nd 8,1 !f the US '!'$lati!n, It w!$ld a''ear

thr!$gh this sa%e resear h that %ales will "egin t! de%!nstrate signs !f OCD "ef!re the age !f

*9, H!we(erfe%ales !ften "egin t! de(el!' s)%'t!%s after the age !f *9, Of signifi ant

i%'!rtan e t! diagn!sing a dis!rder is !"ser(ing whi h dis!rders a''ear al!ngside the%,

R$s i!0s resear h sh!ws that the %!st !%%!n dis!rder diagn!sed al!ngside- !r !%!r"id with


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OCD- are an iet)- %!!d- and i%'$lse dis!rders, While s$"stan e a"$se dis!rders are !%%!n as

well- the) ha(e "een sh!wn t! ha(e a l!wer 're(alen e !f !%!r"id diagn!sis,In R$s i!0s st$d) resear hes f!$nd B ,1 !f indi(id$als were de%!nstrating se(ere

s! ial i%'a t- this is n!t s$r'rising when ta+ing int! !nsiderati!n h!w ti%e !ns$%ing OCD

an "e, On a(erage 'arti i'ants in R$s i!0s st$d) a(eraged , h!$rs dealing with their

!"sessi!ns, F$rther%!reas %an) as ,B h!$rs were s'ent dealing with !%'$lsi!ns that

res$lted fr!% these !"sessi!ns, These s)%'t!%s s$r'risingl) were de%!nstrated ") a 'arti i'ant

'!!l that was %!stl) ateg!ri6ed as ha(ing !nl) %!derate OCD, Des'ite the se(erit) !f

s)%'t!%s- !n a(erage !nl) ,8 !f the indi(id$als '!lled a t$all) atte%'ted t! see+ !$t

treat%ent f!r their OCD, On a(erage th!se s$ffering fr!% this dis!rder !ntin$e t! e 'erien e

these s)%'t!%s f!r as l!ng as , )ears, Clearl)- OCD has se(eral i%'li ati!ns !n the life !f an

indi(id$al, The first ste's t!wards de(el!'ing a treat%ent 'lan f!r these s)%'t!%s is t! l!!+ at

the (aria"les and lini al feat$res that a !%'an) this dis!rder,A !rding t! re ent resear h )!$ an ateg!ri6e !"sessi!ns int! tw! se'arate ateg!ries:

a$t!gen!$s- and rea ti(e 2Lee 4 Tel h- 899 5, A$t!gen!$s !"sessi!ns are !"sessi!ns whi h

ha(e n! identifia"le trigger and !ften 'resent the%sel(es as an intr$si(e th!$ght, A$t!gen!$s

th!$ghts are 'resented as $nrealisti - and e tre%el) intr$si(e, The) are !ften ti%es f!$nd t! "e

(er) $na e'ta"le ") th!se e 'erien ing the% and theref!re their f$n ti!nall) related

!%'$lsi!ns $s$all) in(!l(e dealing with dis%issing this distress, On the !ther hand- rea ti(e

!"sessi!ns are in res'!nse t! a sti%$li and are !ften ti%es >$stified in the indi(id$als %ind as

reas!na"le d$e t! their identifia"le nat$re,O"sessi!ns that are !nsidered a$t!gen!$s in(!l(e se and %!ralit)- religi!n- (i!len e !r

har% t! !thers, On the !ther hand- rea ti(e !"sessi!ns- whi h are 'er ei(ed as %!re realisti ")

th!se e 'erien ing the%- in l$de !"sessi!ns in(!l(ing s)%%etr) and !rder- !nta%inati!n- and

%ista+es !r a idents, These !"sessi!ns are rati!nali6ed and the !%'$lsi(e rea ti!ns are %!re


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easil) e 'lained ") the indi(id$al, A !rding t! resear h ") Rassin- C!$gle- 4 .$ris 2899 5-

ea h !ne !f these !"sessi!ns has a f$n ti!nall) related !%'$lsi!ns s'e ifi all) 'erf!r%ed t!

deal with the t)'e !f distress that ea h !"sessi!n is "ringing t! the indi(id$al, The !%'$lsi!ns

whi h are e 'erien ed ") th!se s$ffering fr!% OCD are= de !nta%inati!n 2i,e, washing )!$r

hands re'eatedl)- !r !nstant $se !f anti"a terial gel5, Che +ing 2i,e, %a+ing s$re )!$ t$rn the

st!(e !ff se(en ti%es e(er) ti%e )!$ lea(e- re'eatedl) he +ing )!$r l! + after )!$ ha(e alread)

left the h!$se5, Re'eating r!$tine a ti(ities 2i,e, ha(ing t! re'eatedl) 'i + $' and '$t d!wn an

!">e t )!$ ha(e rea hed f!r5, Ordering$st right@, F$rther%!re- th!se wh! end!rsed he +ing als! end!rsed ?s!%ething "ad

%a) ha''en@, F!r the %a>!rit) !f 'arti i'ants- th!se wh! end!rsed %!re f$n ti!ns !f

!%'$lsi!ns had %!re se(ere OCD, E(en %!re interesting- ea h f$n ti!n see%ed t! 'redi t

se(erit) !f OCD differentl), Th!se wh! 'erf!r%ed !%'$lsi!ns t! de rease distress had w!rse

OCD- and 'erf!r%ing !%'$lsi!ns t! 're(ent s!%ething "ad were !ften n!t as se(ere 2Star e(i

et al,- 89**5,


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Other i%'!rtant (aria"les t! ta+e int! !nsiderati!n when l!!+ing at the s)%'t!%!l!g)

and e 'ressi!ns !f OCD are diss! iati!n- insight- and the length !f illness, Ea h !ne !f these

(aria"les has "een sh!wn t! 'redi t negati(e treat%ent !$t !%es, H!we(er resear h has n!t

sh!wn a !rrelati!n "etween these %eas$res and the s$i idalit)- an iet)- !r de'ressi!n- whi h

a !%'an) l!ng ter% OCD 2Se%i6- Inan - 4 3e6gin- 89*15, When !nsidering treating s!%e!ne

with OCD- it is i%'!rtant t! !nsider h!w aware the) are !f their dis!rder, In O6+iris-

Essi6!gl$- G$le 4 A+sara)0s 289* 5 st$d) 1*, !f the sa%'le '!'$lati!n e 'erien ed l!w !r

n! insight, Ea h !ne !f these indi(id$als s !red signifi antl) higher !n OC s ales f!r s)%'t!%

e 'ressi!n, Ea h !ne !f these (aria"les- whether it "e s)%'t!% e 'ressi!n- !%!r"idit)- !r

!nset and length !f dis!rder- all are !nsidered when starting a !$rse !f treat%ent f!r OCD,

H!we(er- the 're $rs!rs and e 'ressi!ns !f OCD are >$st the "eginning !f a %$ h larger 'i t$re-

we %$st als! ta+e a l!!+ at the "i! he%i al %e hani s whi h are at 'la) in the %ind !f s!%e!ne

with OCD- as well as the !ther a$ses !f !nset,SEC ' ( Treat ent+ %s,chopatho*o!,A s$"stantial n$%"er !f resear hers ha(e dedi ated the%sel(es t! e 'laining the

'hen!%en!n !f OCD, What e a tl) is g!ing !n in the indi(id$al0s "rain that is a$sing this

s)%'t!%!l!g) What (aria"les are !ntri"$ting t! these !"sessi!ns and their re $rrent

"eha(i!rs And what is the "est a''r!a h t!wards $r"ing these s)%'t!%s in !rder t! reate a

%!re f$lfilling life f!r th!se affli ted with the dis!rder Re ent resear h has ta+en a l!!+ at the

(aria"les that are 'art !f triggering and fa ilitating the e'is!des !f OCD s)%'t!%s, F!r

e a%'le- A"ra%!(it h- D!r!n 4 Sarel 289*15 f!$nd that when indi(id$als were 'ri%ed withOCD irrele(ant sti%$li- t! 7$esti!n their %!ralit) !r self;'er e'ti!n- OCD s)%'t!%s were

triggered, While this %a) see% li+e !%%!n sense d$e t! the nat$re !f !"sessi!ns and

!%'$lsi!ns- this s$ggests that th!se wh! s$ffer fr!% OCD in !rre tl) e(al$ate their !wn


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!gniti!ns leading t! a rise in OCD e 'ressi!n, This is n!t the !nl) resear h st$d) whi h

s$''!rts the the!r) !f !gniti(e err!rs in OC,This idea is f$rther reinf!r ed ") Riesel- ath%ann- 4 Endrass 289* 5- wh! sh!w that

indi(id$als with OCD sh!w a rise in CRN 2C!rre t Related Negati(it)5 signals in the anteri!r

%id ing$late !rte , T! '$t this int! la)%an0s ter%s- the indi(id$als e 'erien ing e 'ressi!ns

!f OCD in !rre tl) e(al$ated !gniti!n- leading t! atte%'ted re%ediati!n !f these err!rs, These

re%ediati!n0s a%e in the f!r% !f !%'$lsi!ns- and the %!re rit$ali6ed "eha(i!rs 'erf!r%ed the

%!re 'erf!r%an e %!nit!ring err!rs are dete ted, This resear h g!es "e)!nd ha(ing an i%'a t

!n $nderstanding h!w the OCD "rain f$n ti!ns- it e(en has $se in de(el!'ing an effi a i!$s

treat%ent, F!r e a%'le- (er) re ent resear h t!!+ an e(en l!ser l!!+ at this err!r %!nit!ring-

and f!$nd that in d$al tas+ sit$ati!ns- indi(id$als with OCD were a"le t! red$ e the !(era ti(e

err!r %!nit!ring that has "een !"ser(ed- theref!re de reasing their OCD s)%'t!% e 'ressi!n

2 law!hn- J,- Endrass- T,- #re$ss- J,- Riesel- A,- 4 ath%ann- N- 89*B5, This s$ggests that ")

%!d$lating the sens!r) in'$t !r the w!r+l!ad !f an indi(id$al +n!wn t! s$ffer fr!% OCD-

resear hers are a"le t! de rease the a%!$nt !f OCD ind$ ing "rain a ti(it), H!'ef$ll) in ti%e-

this will "e a"le t! "e '$t t! $se in !rder t! reate alternati(e %eth!ds !f a''r!a hing 'r!"le%s

in !rder t! 're(ent e'is!des !f OCD "eha(i!r, F!r n!w h!we(er- this inf!r%ati!n is $sef$l in

$nderstanding that there are a"n!r%al th!$ght 'r! esses in(!l(ed in OCD- and these are 'h)si al

!"ser(a"le, This inf!r%ati!n is r$ iall) i%'!rtant f!r de iding the a''r!'riate t)'es !f

's) h!thera') that will w!r+ f!r treating OCD,

F$rther resear h l!!+ing at a$ses and treat%ent f!r this dis!rder ha(e sh!wn defi its ins'e ifi ne$r!trans%itters in the "rains !f an indi(id$al with OCD, This is %!st i%'!rtant in

deter%ining the s!rts !f %edi ati!n that are t! "e 'res ri"ed f!r treat%ent, #reli%inar) resear h

!n dr$g;naK(e d!gs has sh!wn defi its in HT8a 2Ser!t!nin5 and D8 2D!'a%ine5 "inding in their


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te%'!ral l!"e, These defi its were i%'r!(ed when intr!d$ ed t! Selective Serotonin Reuptake

Inhibitors (SSRI’s) 2/er%eire- A$denaert- De .eester- /ander%e$len- Wael"ers- De S'iegeleer-

#ere%ans- 89*85, F$rther resear h has sh!wn the signifi an e !f these findings in h$%ans- as

l!wer "inding '!tentials f!r ser!t!nin and d!'a%ine were "!th sh!wn in indi(id$als with OCD

and T!$rette0s when !%'ared t! health) !ntr!ls in a st$d) d!ne ") Den)s- de /ries- Cath-

Figee- /$lin+- /elt%an- (an 3er +el- and 3art 289*15, SERT !r ;HTT were als! sh!wn t! 'la) a

r!le in the "rain !f an OCD 'atient- h!we(er l!wer striatal DAT and SERT in the thala%$s and

h)'!thala%$s were f!$nd in 'atients with l!nger length !f illness- s$ggesting this t! "e a an

effe t !f the dis!rder rather than a a$se 2Hesse- S,- . ller- U,- Lin +e- T,- 3arthel- H,- /ill%ann-

T,- Anger%e)er- ., C,- Stengler;Wen6+e- ,- 899 5, D$e t! the high e%'iri al s$''!rt f!r ;

HT8a d)sf$n ti!n- SSRI0s ha(e "een- and !ntin$e t! "e- the 'ri%ar) line !f 'har%a !thera')

f!r OCD, H!we(er- d$e t! this re ent resear h in(!l(ing d!'a%ine- resear h !ntin$es t! see+

!$t alternati(e %edi ati!ns f!r th!se wh! d! n!t res'!nd t! first line thera') s$ h as

anti's) h!ti s,

C$rrentl) the %!st 'res ri"ed treat%ent f!r OCD is SSRIS, In /an A%eringen- Si%'s!n-

#atters!n- Dell0Oss!- Fine"erg- H!llander- and M!har0s st$d) 289* 5 !f 'arti i'ants were !n

SSRI0s- , !n antide'ressants- !n SNRI0s and ,B !n "en6!dia6e'ines, As %enti!ned

earlier- re ent resear h has s$ggested a r!le !f d!'a%ine in OCD "i! he%istr)- theref!re

A$g%enting treat%ents in l$ded 19 anti's) h!ti s- whi h 'ri%aril) a t !n the d!'a%ine

ne$r!trans%itter, In additi!n t! this a$g%enting %edi ati!n there was als! 8 !f 'arti i'ants

$sing "en6!dia6e'ines- 8* antide'ressants- *8 %!!d sta"ili6ers- and *9 $sing !ther

%edi ati!ns t! a$g%ent treat%ent, As with %an) dis!rders %enti!ned here- 'har%a !thera') is

>$st half !f the 'i t$re- !%"ined with 's) h!thera') there is a %$ h "etter !$t !%es, There


14/34


are se(eral different %eth!ds $sed t! treat this dis!rder with C3T- ea h aref$ll) !$tlined in

.a$reen0s resear h 2* 5,The first set !f %eth!ds $sed- are !ften $sed f!r ed$ ating a lient !n their dis!rder and t!

f!r%$late a 'lan f!r treat%ent, The first !f these %eth!ds is hallenging a''raisals, This is when

the lini ian will ha(e the 'atient !"ser(e h!w the) a''raise a sit$ati!n- in !rder t! assess

whether this is a n!r%al !r a"n!r%al a''raisal, Si%ilarl)- th!$ght sa%'ling is $sed f!r a"n!r%al

th!$ghts as !''!sed t! a''raisals, Using th!$ght sa%'ling- the lini ian will ha(e the 'atient

l!!+ at and dis $ss indi(id$al 'r!"le% th!$ghts whi h the) are ha(ing, Si%ilar t! anal)6ing

a''raisals- this an "e $sed t! lead the lient t! their !wn !n l$si!n !n the realis% !f their

a"n!r%al th!$ghts, In !rder t! treat these a"n!r%al th!$ghts and a''raisals- attenti!n and

"eha(i!ral e 'eri%ents are als! 'erf!r%ed, F!r th!se 'es+) th!$ghts whi h !"s $re the %ind !f

an indi(id$al with OCD- attenti!n e 'eri%ents will tea h the indi(id$al t! defer their attenti!n t!

th!$ghts whi h will n!t trigger there OCD, On the !ther hand- "eha(i!ral e 'eri%ents are $sed

t! $r" !%'$lsi!ns- as alternati(e "eha(i!rs are intr!d$ ed t! the lient and the) are instr$ ted

t! 'erf!r% these when the) feel the need t! 'erf!r% a !%'$lsi!n, In !rder t! hel' th!se with

OCD 'ra ti e these %eth!ds- tw! the!reti al a''r!a hes are !%%!nl) $sed, First- the

!$rtr!!% a''r!a h- where a lient is instr$ ted t! defend their a"n!r%al th!$ghts as if in !$rt,

An) 'ers!nal inf!r%ati!n li+e feelings !r !'ini!ns are inad%issi"le in !$rt- theref!re re7$iring

the lient t! 'r!(ide s!lid e(iden e- h!'ef$ll) t! re(eal t! the lient that their th!$ghts are indeed

a"n!r%al, Finall)- the d!wnward arr!w a''r!a h is $sed t! hel' lients $nderstand h!w !ne

th!$ght leads t! an!ther- and in the end ends $' a$sing !%'$lsi!ns, This %eth!d will "e $sed

t! hel' lients $nderstand the a"n!r%al th!$ght 'r! esses and h!'ef$ll) a''l) !ne !f the

af!re%enti!ned "eha(i!ral te hni7$es t! halt the !"sessi!ns "ef!re the) trigger an e'is!de, In


15/34


!rder t! %a+e the %!st !f the effi a ) !f ea h %eth!d- the) are aref$ll) 'lanned !$t int! a *8

wee+ treat%ent regi%en,The *8 %!nth treat%ent regi%en f!r the indi(id$al s$ffering fr!% OCD- starts with

ed$ ating the 'atient !n the g!al !f treat%ent and a''raising the OCD s)%'t!%!l!g) whi h the)

are e 'erien ing, Of $t%!st i%'!rtant is t! %a+e the lient aware !f the e 'e ted !$t !%es,

That is- that the) are n!t e 'e ted t! "e ? $red@ !f OCD- "$t instead treat%ent is intended t!

hel' de rease the a%!$nt !f e'is!des the) ha(e as well as t! tea h the% !'ing %e hanis%s

whi h will hel' their 7$alit) !f life, F$rther%!re- the g!al !f the lini ian is n!t t! %a+e the

lient $n !%f!rta"le- "$t instead t! w!r+ l!sel) with the% $sing alternati(e a''r!a hes and

S! rati dial!g$e t! reate a s!l$ti!n in !lla"!rati!n, Us$all)- ed$ ati!n !n a''raisals- as well

as h!%ew!r+ !n intr$si(e th!$ghts and a''raisal identifi ati!n are intr!d$ ed in the first

sessi!n Sessi!n tw! is $sed t! g! !(er h!%ew!r+- and dis $ss !gniti(e err!rs- as well as

identif)ing !re !n erns and fears, H!%ew!r+ !n anal)6ing these th!$ghts and fears $sing the

d!wnward arr!w 'r! ess is re !%%ended, In sessi!ns three thr!$gh se(en- the %!del f!r

thera') as well as the h!%ew!r+ is !ntin$all) %!dified t! +ee' treat%ent %!(ing al!ng,

3eha(i!ral e 'eri%ents- !lla"!rati(e h!%ew!r+ assign%ents- hallenging ass$%'ti!ns- and

de(el!'ing alternati(e "eliefs are all w!r+ed !n, Sessi!ns eight thr!$gh ten- add t! this

"eha(i!ral e 'eri%ents- and the last tw! sessi!ns are $sed t! tea h the lient t! "e their !wn

thera'ist and t! tea h the% rela'se 're(enti!n strategies,As far as treat%ent !$t !%e is !n erned- there are three t)'es !f treat%ent !$t !%e,

First- )!$ an s$ essf$ll) treat a dis!rder in !rder t! %itigate s)%'t!%s t! the "est !f )!$ra"ilit), Se !nd- there is treat%ent resistant- where an indi(id$al %a) sh!w s!%e signs !f

i%'r!(e%ent- "$t n!t lini all) signifi ant hange, Finall)- there is refra t!r)- where an

indi(id$al %a) sh!w s!%e i%'r!(e%ent then rela'se !r n!t sh!w an) i%'r!(e%ent at all, It is


16/34


i%'!rtant t! +ee' ta"s !n the stat$s !f an indi(id$al '!st treat%ent f!r OCD- as resear h has

sh!wn high rates !f s$i ide and s$i ide ideating in an OCD '!'$lati!n 2Redd) and anda(el-

899 5, As stated earlier- different !"sessi!ns ha(e different i%'li ati!ns f!r the se(erit) !f OCD-

h!we(er- the) als! i%'a t s$i idalit) and treat%ent !$t !%e, Th!se wh! e 'erien e religi!$s !r

reass$ran e see+ing t)'es !f OCD are %!re li+el) t! e 'erien e s$i idalit) than !thers 2Redd)

and anda(el- 899 5, In additi!n- indi(id$als wh! were diagn!sed with #TSD ha(e "een sh!wn

t! ha(e w!rse treat%ent !$t !%es 2Se%i6- Inan - 4 3e6gin- 89* 5, In the ase that these

indi(id$als are treat%ent resistant !r treat%ent refra t!r)- then we an l!!+ at s!%e !f the

resear h %enti!ned earlier f!r alternati(e treat%ent, F!r e a%'le- Gl$ta%ate %!d$lating dr$g

thera') has "een sh!wn t! hel' th!se wh! are resistant t! OCD treat%ent 2#ittenger Cr)stal 4

C!ri - 899B5, 3) ad%inistering these dr$gs- resear hers were a"le t! ad>$st a"n!r%al le(els !f

gl$ta%ate in the C!rti !;striat!;thala%!; !rti al ir $itr)- the sa%e ir $itr) that has "een sh!wn

t! ha(e a"n!r%al a ti(it) in Hesse et al0s resear h,C"- ( BDD

SEC ) ( %re&a*ence+ Onset+ and C*inica* Features

3!d) d)s%!r'hi dis!rder- an!ther !f the OCRD0s i%'a ts r!$ghl) *, t! 8, !f the

'!'$lati!n 2#hili's- 89* 5, Resear h int! 3DD has s$ggested that the a(erage age !f !nset is

ar!$nd the age !f * ;19 2/ander .eer et al,- 89**5 2.$nd) 4 Sed$s )- 89* 5, On a(erage- this

dis!rder i%'a ts %!re fe%ales than %ales 2/an der .eer et al,- 89**5 .an) indi(id$als

s$ffering fr!% 3DD als! s$ffer fr!% an iet)- .!!d dis!rders- .a>!r De'ressi(e Dis!rder-

S! ial #h!"ias- and !f !$rse OCD 2/an der .eer et al,- 89**5, Other st$dies ha(e s$ggested a

high 're(alen e !f 'ers!nalit) dis!rders a%!ng indi(id$als with 3DD 2Didie- L!er+e- H!wes 4

#hili's- 89*85, The rate !f indi(id$als s$ffering with !%!r"id dis!rders has "een esti%ated

thr!$gh resear h t! "e an)where fr!% ar!$nd 18 all the wa) $' t! 8 2C!sta et al,- 89*85,

F$rther%!re in C!sta0s st$d) ,8 had e ellent insight= * , had g!!d insight= 8 ,B had fair


17/34


insight= and 1 , had '!!r !r n! insight, This sh!ws the high 're(alen e !f indi(id$als with

l!w insight within this 'arti $lar dis!rder, This %a+es 'lent) !f sense ta+ing int! !nsiderati!n

the dis!rder is hara teri6ed ") irrati!nal ideas a"!$t !ne0s "!d), This is $nf!rt$nate- as this

sa%e resear h lin+s l!w insight t! w!rse s)%'t!%s- and e(en g!es as far as t! sa) that %an)

indi(id$als with high s)%'t!% e 'ressi!n g! !n t! e 'erien e an iet)- de'ressi!n- and

s$i idalit),SEC ' ( Treat ent+ %s,chopatho*o!,In !rder t! treat these s)%'t!%s- resear h %$st l!!+ at the +e) findings !n h!w and wh)

indi(id$als with 3DD are e 'erien e the s)%'t!%s whi h hara teri6e the dis!rder, F!r

e a%'le- indi(id$als wh! s$ffer fr!% 3DD ha(e "een sh!wn t! e 'erien e an ina"ilit) t! rel)

!n t!' d!wn !gniti(e 'r! esses 2.$nd)- ., E,- 4 Sad$s+)- A,- 89* 5, When an indi(id$al

'r! esses an i%age- the) 'r! ess this i%age in tw! wa)s- "!tt!% $' and t!' d!wn, These tw!

the!ries !f (is$al 'r! essing re'resent the wa)s whi h )!$ a''r!a h 'er e'ti!n, T!' d!wn

w!$ld %ean !"ser(ing a sit$ati!n !n a %!re gl!"al le(el- s$ h as ta+ing !nte t l$es- !r

re !gni6ing the f!r% !f an !">e t, On the !ther hand- 3!tt!% U' 'r! essing w!$ld "e l!!+ing

at +e) details t! '$t t!gether and $nderstanding !f what it is )!$ are 'er ei(ing, 3) rel)ing

hea(il) !n a "!tt!% $' 'r! essing %eth!d- indi(id$als with 3DD the!reti all) get h$ng $' !n

details %!re s! than the !ntr!l gr!$'s,In additi!n t! these findings- indi(id$als with 3DD wh! are %!re li+el) t! agree with

negati(e and riti al state%ents a"!$t the%sel(es- e 'ress higher a%!$nts !f distress and higher

e 'ressi!n !f s)%'t!% 2Didie- L!er+e- H!wes 4 #hili's- 89*85, S!%e (aria"les whi h 'la) a

r!le in the distress and d)sf$n ti!n !f an indi(id$al with 3DD in l$de= 'atients with 3DD

s !ring higher !n ne$r!ti is% s ales- and l!wer in s ales f! $sing !n e tr!(ersi!n 2Didie-

L!er+e- H!wes 4 #hili's- 89*85, As well as indi(id$als s$ffering fr!% 3DD s !ring greater !n

!(erall inter'ers!nal diffi $lties as their s !res !f 3DD se(erit) in rease, 2Didie- L!er+e- H!wes


18/34


4 #hili's 89*85, These findings are signifi ant in $nderstanding the distress a 'atient with 3DD

g!es thr!$gh- as well as the (aria"les that are at 'la) when ta+ing a l!!+ at their lini al stat$s,

Treat%ent f!r 3DD ta+es int! a !$nt what we +n!w a"!$t the iss$es th!se with 3DD fa e- and

$ses C3T t! hel' and de rease the i%'a t this dis!rder has !n an indi(id$al0s life,A !rding t! resear h ") /aele 289*95- C3T f!r 3DD starts !$t ") intr!d$ ing tw!

!nfli ting the!ries t! the lient, The!r) A w!$ld "e that the lient is !rre t- and there is

s!%ething wr!ng with their "!d), The!r) 3 w!$ld "e that this is in !rre t and )!$ ha(e a "!d)

i%age 'r!"le%, 3) g!ing !(er these the!ries and their i%'li ati!n- it is h!'ed that the lient

in reases their insight !n their !nditi!n, On e ed$ ated- the lient will then 'arti i'ate in

f!r%ati!n !f the treat%ent- in whi h the lient0s "eliefs and %alada'ti(e !'ing %e hanis%s are

anal)6ed, T)'i all)- the a"n!r%al "eliefs and !'ing %e hanis%s in l$de self;f! $sed

attenti!n- in whi h an indi(id$al s'ends an a"n!r%al a%!$nt !f ti%e f! $sing !n their !wn

a''earan e and r$%inati!n- where the 'ers!n !ntin$es t! thin+ a"!$t these 'er ei(ed flaws,

T)'i all)- the !%'$lsi!ns a$sed ") these in l$de safet) see+ing and a(!idan e- where an

indi(id$al will see+ !%'li%ents !r a safe en(ir!n%ent- !r si%'l) a(!id re(ealing the flaw t!

!thers either ") %as+ing- s$rger)- !r si%'l) n!t g!ing !$t,F!ll!wing sessi!ns in whi h the 'atients $nderstanding and 'er e'ti!ns !f the dis!rder

and their "!dies are e(al$ated- the !gniti(e thera') "egins, This in l$des i%ager) re;s ri'ting

and attenti!n training- t! na%e >$st a few, I%ager) re;s ri'ting f!r e a%'le- in l$des the lient

(iewing a sit$ati!n as a hild- then re(isiting it as an ad$lt, The lient will !%'are these '!ints

!f (iew t! see+ !$t alternati(e $nderstandings !f their a"n!r%al th!$ghts, Attenti!n traininghel's t! draw the lient0s attenti!n awa) fr!% the 'r!"le% areas, Lastl)- indi(id$als will "e

ta$ght self;%!nit!ring- deta hed %indf$lness- and t! as+ wh) instead !f h!w in !rder t! hel'

$r" !'ing "eha(i!rs and r$%inati!n, When !gniti(e thera') is !%'lete- "eha(i!ral thera')


19/34


s$ h as "eha(i!ral e 'eri%ents- graded e '!s$re- and res'!nse 're(enti!n "egins, Finall)- HRT

%eth!ds %a) als! "e $sed t! f$rther in rease the i%'a t treat%ent has !n the lient, Using these

%eth!d!l!gies- treat%ent has "een sh!wn t! "e signifi antl) effe ti(e at red$ ing OCD e'is!des,

Treat%ent !$t !%e resear h has s$ggested that n!t !nl) is C3T signifi antl) effe ti(e-

"$t !%"ined with SSRI treat%ent there is a high han e !f '!siti(e !$t !%es 2Grant et al,-

89* 5, There are se(eral 'redi t!rs !f treat%ent !$t !%e that sh!$ld "e +e't in %ind when the

final sessi!ns !f C3T are "eing !nd$ ted, First- there is a generall) high s$i idalit) rate !f

OCD 'atients 2C!sta et al,- 89*85, In additi!n- high !%!r"idit) as well as high inter'ers!nal

!nfli t are "!th s)%'t!%s and 'redi t!rs !f treat%ent !$t !%e f!r OCD High inter'ers!nal

!nfli t 2Didie- L!er+e- H!wes 4 #hili'ss- 89*85C". ( Groo in! Disorders

SEC ) ( %re&a*ence+ Onset+ and C*inica* FeaturesAn!ther !ne !f the %!re 're(alent !f the OCR dis!rders is e !riati!n!r de'ressi(e dis!rder2.DD5 and OCD 2O6ten et al,- 89* 5,

Resear h "eing d!ne !n h!w and wh) these dis!rders f!r% s$ggests that these gr!!%ing

dis!rders are f$eled ") a sense !f 'leas$re and relief !(er !%%itting these i%'$lsi(e a ts,

2L!(at!- 89*85, .!re re ent resear h ") T$ +er 289*95 has e(en s$ggested that indi(id$als wh!


20/34


'i + their s+in d! s! "e a$se the) feel the $rge d$e t! an $n !%f!rta"le "!dil) sensati!n whi h

the) %$st relie(es, This resear h als! s$ggested that in the ase !f S#D th!se e 'erien ing it

were %!re !ften Ca$ asian fe%ales with a %ean age !f 1 , H!we(er- th!se s$ffering fr!% this

dis!rder did n!t >$st 'i + their fa es- the (er) sa%e st$d) lai%ed that indi(id$als with this

dis!rder !ften 'i +ed $' t! !r sites !n their "!d), Often ti%es these 'arti i'ants had a high

awareness !f 'i +ing and $rges t! 'i +- h!we(er were si%'l) $na"le t! st!' the%sel(es fr!%

'arta+ing in the 'i +ing "eha(i!rs, In fa t- !f 'arti i'ants s'ent an h!$r !r %!re a da)

dealing with s+in 'i +ing "eha(i!r- s+in 'i +ing related th!$ghts- !r atte%'ts t! st!' 'i +ing,

.!re s'e ifi all)- these 'arti i'ants a(eraged ,1 s+in 'i +ing e'is!des 'er da)- ea h !ne

!ns$%ing !n a(erage 8*,8 %in$tes,1 , rising tensi!n !r ner(!$sness "ef!re 'i +ing- 8 ,* relief fr!% 'i +ing1B 'i + d$e t! it hiness a$sed ") : a ne- der%atitis- 's!riasis- dr) s+in- allergi

rea ti!ns- infe ti!n- !r s$n da%age 2 e$then- 89*95In T$ +ers st$d) the %!st !%%!n things that were 'i +ed ") these indi(id$als were 6its-

fl$id !r '$ss $nder the s+in and s a"s, Ea h with a 're(alen e !f ar!$nd ; * in this

'!'$lati!n, The least !%%!n things "eing 'i +ed were health) s+in- %!s7$it! "ites- s ars and

!'en s!res- all with a 're(alen e !f ar!$nd 19 , The t!!ls %!st !ften $tili6ed ") 'arti i'ants

were their finger nails, H!we(er- fingers- twee6ers and 'ins were l!se !ntenders as well all

with a 're(alen e !f ; , The least !ften $sed t!!ls were tiss$es and in s!%e ases teeth-

"!th with a 're(alen e "etween 8 ;8 , Ea h !ne !f these t!!ls was a !%'anied ") a %eth!d

!f e tra ti!n !r 'i +ing, The %!st !ften $sed %eth!ds were s7$ee6ing- s rat hing- and digging

with a 're(alen e !f 1; 9 , The %eth!ds with a %!derate a%!$nt !f $se were t!$ hing-

r$""ing and lan ing with a 're(alen e !f 9; , The %eth!ds $sed least was "iting !r

hewing- with a 're(alen e !f ar!$nd 8 ,


21/34


As !ne !$ld i%agine these s!rt !f a ti!ns an ha(e a signifi ant i%'a t !n an

indi(id$al0s life, !f this !h!rt re'!rted %!derate s a"s- s aring- !r s!res fr!% their

'i +ing "eha(i!rs, As a res$lt- the %a>!rit) !f 'arti i'ants re'!rted at ti%es a(!iding s! ial

e(ents- and %!re than half re'!rted at ti%es a(!iding g!ing !$t in '$"li at all, A 7$arter !f

'arti i'ants re'!rted a(!iding w!r+ dail)- a third !f wee+l)- and nearl) half %!nthl), On

a(erage these indi(id$als %issed 1 da)s !f w!r+ 'er )ear d$e t! their 'i +ing and the res$lting

der%at!l!gi al i%'erfe ti!ns, H!we(er- this dis!rder d!es n!t !nl) i%'a t th!se at w!r+-

nearl) 8 !f 'arti i'ants re'!rted %issing s h!!l d$e t! s+in 'i +ing, F$rther%!re- a third !f

the 'arti i'ants re'!rted ha(ing tr!$"le handling s h!!l related res'!nsi"ilities and ha(ing

tr!$"le f! $sing !n s h!!l %aterial d$e t! their $rges and 'i +ing "eha(i!rs, Des'ite the

see%ingl) se(er lifest)le i%'a t d$e t! S#D- as well as the high insight int! the dis!rder- !nl)

half !f the 'arti i'ants a t$all) s!$ght !$t treat%ent,In the ase !f hair '$lling- the %!st !%%!n sites t! '$ll hair are the s al'- e)elashes-

e)e"r!ws- "eard- and at ti%es the '$"i regi!n 2O6ten et al,- 89* 5,SEC ' ( Treat ent+ %s,chopatho*o!,

Resear h int! gr!!%ing dis!rders has reg$larl) de%!nstrated a lin+ t! tra$%a- es'e iall)

hildh!!d tra$%a as s$''!rted ") the l!w age !f !nset, O6ten et al, 289* 5 has !n l$ded as

%$ h as B !f indi(id$als with TT. re'!rted e 'erien ing tra$%a at s!%e '!int in their life,

In the ase !f S#D- O6ten et al, f!$nd that se $al tra$%a was f!$nd t! "e a !%%!n 're $rs!r,

F$rther%!re- 8*,1 !f res'!ndents t! the %eas$res in this st$d) re'!rted e 'erien ing

de'ers!nali6ati!n- a !nstr$ t f!$nd t! "e dire tl) related t! %!re se(ere gr!!%ing dis!rders,

Interestingl)- indi(id$als wh! e 'erien ed tra$%a and sh!wed lini al signs !f TT.- s !red

%$ h l!wer !n #TSD s ales than th!se wh! e 'erien ed tra$%a and did n!t sh!w TT.

s)%'t!%s, This s$ggests that TT. a ts as s!%ewhat !f a !'ing %e hanis% f!r th!se

e 'erien ing tra$%a, D$e t! these findings that TT. is l!sel) related t! #TSD and tra$%a-


22/34


es'e iall) as a !'ing %e hanis%- it is n!t s$r'rising that TT. als! !rrelates highl) with le(els

!f an iet) 2Ada%s- 89*85, In additi!n- it %a+es sense that TT. als! !rrelates highl) with

%eas$res !f i%'$lsi(it)- as indi(id$als with TT. and S#D ha(e "een +n!wn t! ha(e g!!d

insight- )et an ina"ilit) t! 're(ent the $rges t! 'i + and '$ll 2Ada%s- 89*85,Fa%ilial (aria"les als! 'la) a r!le in the de(el!'%ent !f TT. and S#D- in O6ten et al,0s-

st$d)- 1 !f the sa%'le had fa%ilial TT.- and 9 !f S#D had fa%ilial TT. ill$strating

h!w these !'ing %e hanis% %a) "e infl$en ed ") gr!wing $' ar!$nd !thers with si%ilar

tenden ies, In additi!n- this resear h s$ggested that the %a>!rit) !f indi(id$als with a gr!!%ing

dis!rder e 'erien ed signifi ant le(els !f e%!ti!nal negle t while gr!wing $', As these

indi(id$als gr!w !lder- the se(erit) !f their dis!rder !ften leads t! signifi ant i%'air%ent, Often

ti%es- indi(id$als with TT. and S#D are single and li(ing al!ne 2O6ten et al, 89* 5,As far as treat%ent is !n erned- the %!st !%%!n treat%ents $sed are %edi ati!n

"eha(i!ral treat%ent- 's) h!thera')- s$''!rt gr!$'s- and h)'n!sis, St$dies ha(e sh!wn that

HRT and ACT- "!th !f whi h are third wa(e f!r%s !f C3T- see% t! "e the %!st effi a i!$s

%eth!ds !f treating gr!!%ing dis!rders 2Ca'i!tti- 89* - Flessner- 899 5, .!re i%'!rtantl)-

AE3T- !r the !%"inati!n !f these tw! %eth!ds !f treat%ent has 'r!(en t! ha(e a l!t !f 'r!%ise

in treating these dis!rders, In "!th !f these st$dies- nearl) !f 'arti i'ants sh!wed a '!siti(e

res'!nse t! AE3T- signifi antl) red$ ing the a%!$nt !f hair '$lled- and the n$%"er !f s+in

'i +ing e'is!des, Flessner0s st$d) 2899 5 aref$ll) !$tlines h!w AE3T treat%ent is !nd$ ted,

The treat%ent regi%en !nsists !f *9 sessi!ns- ea h !ne ta+ing s%all ste's t!wards a '!siti(e

treat%ent !$t !%e,D$ring the first sessi!n- the lini ian will intr!d$ e the lient t! ed$ ati!nal %aterials !n

"!th tri h!till!%ania and s+in 'i +ing dis!rder, F!ll!wing this- in sessi!n tw! the inter(iewer

will intr!d$ e ha"it re(ersal training 2HRT5 te hni7$es, HRT te hni7$es in l$de re !gni6ing

!%'eting res'!nse thera')- $e !ntr!lled rela ati!n- and '!st$ral hanges- t! na%e >$st a few,


23/34


The first ste' in HRT is t! hel' the lient re !gni6e their ha"its and h!w the) are 'erf!r%ed,

Using this insight- !%'eting res'!nses t! the ha"it %a) "e ta$ght, IN additi!n- $e !ntr!lled

rela ati!n tea hes these lients t! rela their %$s les !n de%and in !rder t! 're(ent ha"it$al

a ti!ns, Finall)- '!st$ral hanges an "e ta$ght where indi(id$als are instr$ ted t! hange their

'!st$re t! a(!id ha"its, This is effe ti(e as '!st$re an a t as a trigger as well as an inhi"it!r !f

ha"it$al a ti!ns,F!r the third sessi!n- a e'tan e and !%%it%ent thera') "egins, First- indi(id$als are

led ") the lini ian t! identif) their (al$es- and re !gni6e h!w the dis!rder has i%'a ted these

(al$es, On e this is !%'lete- sessi!n f!$r is $sed t! e a%ine h!w the indi(id$al has tried t!

!ntr!l their dis!rder, This inf!r%ati!n is then ta+en int! sessi!n fi(e- where the lini ian will

dis $ss !r lead the 'atient t! re !gni6e alternati(e %eth!ds that %a) "e $sed t! 're(ent

s)%'t!%s, When sessi!n si "egins- the lini ian will tr) and g$ide the 'atient t! re !gni6e and

hange the lang$age whi h the) in regards t! their dis!rder- and atte%'t t! hange the !nte t !f

h!w the) thin+ a"!$t their dis!rder ") d!ing s!, Sessi!n se(en is $sed t! dire t indi(id$als

t!wards e 'erien ing their dis!rder differentl), T! d! this- the lini ian will dire t their

e 'erien e awa) fr!% a ting !n $rges and t!wards e 'erien ing their $rges as th!$ghts and

feelings, 3) !%"ining these tw! thera'ies in sessi!n eight- the 'atient learns h!w t! integrate

the t!!ls whi h the) ha(e learned thr!$gh!$t thera'), Sessi!n nine and ten are $sed t! tea h

rela'se 're(enti!n, After ad%inistering this thera')- s!%e res'!nded "etter t!wards HRT and

s!%e "etter t! ACT "$t nearl) all 'arti i'ants "enefited the %!st when these %eth!ds were

!%"ined- sh!wing less 'i +ing and less '$lling in nearl) all ases,F$rther resear h ") Ar"a"i 2899 5 has s$ggested effi a ) !f SSRI0s f!r gr!!%ing

dis!rders as well, In this st$d)- the SSRI gr!$' sh!wed signifi ant i%'r!(e%ent !n the ale

3r!wn O"sessi(e C!%'$lsi(e S ale- whi h has sh!wn signifi ant relia"ilit) in %eas$ring


24/34


gr!!%ing dis!rder related "eha(i!r, Effe ts "egan t! ta+e 'la e "etween tw! and f!$r wee+s !f

treat%ent with SSRI0s F$rther%!re- 'arti i'ants s !red "etter !n the Der%at!l!g) Life &$alit)

Inde - as well as !n /is$al Anal!g S ale s !res, This resear h f!$nd that there was a 'ri%ar)

effe t "etween SSRI0s and S#D s)%'t!%s, The st$d) e(ent went as far as sh!wing that SSRI0s

%a) hel' indi(id$als deal with !%!r"id dis!rders- hel'ing t! a hie(e "etter treat%ent

!$t !%es, Treat%ent !$t !%es are (er) i%'!rtant in these dis!rders when the , treat%ent

resistan e rate is ta+en int! !nsiderati!n 2t$ +er- 89*95SEC - ( I portant Research and Current Direction / 0hat a1es this an OCRD2H!arding- "eing the %!st re entl) added dis!rder !$t !f this l$ster- has a l!ng hist!r)-

"$t a (er) sh!rt lini al hist!r), In the 'ast the !nl) wa) that a h!arding diagn!sis was

re !gni6ed- !r e(en treated was thr!$gh a !%%$nit) "ased a''r!a h, On a(erage- s! ial w!r+

'r!fessi!nals re'!rted en !$ntering 8;1 ases 'er )ear 2. G$ire 89*15, .ental health w!r+ers

als! re'!rted s'ending an a(erage !f P1- 11 t! !nd$ t a >$n+ re%!(al,C"3 ( "oardin! Disorder

SEC ) ( %re&a*ence+ Onset+ and C*inica* FeaturesD$e t! la + !f resear h it is hard t! 'in'!int the 're ise ne$r!"i!l!gi al %e hanis%s that

a$se h!arding dis!rder- %$ h !f the de(el!'ing treat%ent f!r h!arding ste%s fr!% i%'!rtant

the!ries, Re ent dis $ssi!n !n h!arding the!r) ") S%ail 289* 5 ha(e dis $ssed h!w the

the!reti al se'arati!n !f "i!l!g) and $lt$ral 're $rs!rs ha(e %ade it diffi $lt t! 'in'!int the

a$se !f in reasing 're(alen e, This ?hands !ff %!del@ as dis $ssed ") S%ail- %isses !$t !n

the the!reti al e(!l$ti!n !f )!$r end! rine s)ste%- and is $na"le t! !nsider the the!r) that

$lt$re is !ne !f the i%'!rtant infl$en ing fa t!rs !n this e(!l$ti!n, 3) (iewing the dis!rder

fr!% a !%"ined e(!l$ti!nar) 'ers'e ti(e- $nderstanding this in rease 're(alen e an "e

signifi antl) easier, This e(!l$ti!n is de%!nstrated ") what S%ail alls an ?e !n!%) !f trash@,

As !$r !ns$%erist $lt$re has in reased its !"sessi!n with %aterial !">e ts- the 're(alen e !f

%aterial h!arding dis!rder has in reased, This !ns$%eris% !%"ined with the a"n!r%al


25/34


senti%entalit) !f a h!arder- the!reti all)- hel' t! fa ilitate these h!arding "eha(i!rs, An!ther

diffi $lt) t! !nsider in this resear h is that it is in redi"l) diffi $lt t! e(en 'r!(e whether an)

"i!l!gi al s)ste%s i%'a ting h!arding are a$sal !r a$sed ") the dis!rder, H!we(er- w!r+ing

with what we an dis !(er thr!$gh resear h gi(es h!'e that there are effe ti(e treat%ents f!r this

dis!rder a(aila"le t! th!se s$ffering with it,It is 'redi ted that a"!$t *, ;1, !f the '!'$lati!n e 'erien es h!arding dis!rder

2N!rdletten- 89*1- Sa%$als et al- 899 5, A re ent st$d) ") A)ers 289*95- 'r!(ided 7$ite a "it !f

inf!r%ati!n !n h!w and wh) h!arding dis!rder de(el!'s, T)'i all) indi(id$als "egin t! de(el!'

s)%'t!%s !f h!arding dis!rder t!wards their ad!les en e- and s)%'t!%s are f$ll) de(el!'ed

"ef!re the age !f 19, Theref!re- h!arding dis!rder is 'ri%aril) diagn!sed in ad$lts 2Ashle)

89*1- . g$ire 89*15, A $ni7$e fa t!r t! h!arding dis!rder- is that as age in reases- the se(erit)

!f the dis!rder in reases as well, F!r ea h de ade the dis!rder g!es $ntreated- it is esti%ated that

the s)%'t!%s an in rease an)where fr!% tw! t! f!$r f!ld 2A)ers- 89*9- Sa%$als et al- 899 5,

T)'i all)- %!derate se(erit) is rea hed ") the ti%e the 'ers!n s$ffering fr!% h!arding rea hes

9 )ears !ld, O(erall h!arding s)%'t!%s are t)'i all) !nset an)where "etween B; )ears !ld

2. g$ire- 89*15- and %!st s$ffering fr!% h!arding start t! "egin t! see+ treat%ent ") the age !f

9 2Sa%$als- 899 5,As with %an) !ther OCRD0s the i%'a t that this dis!rder an ha(e !n the indi(id$al0s

life an "e e tre%el) detri%ental, The %a>!rit) !f indi(id$als wh! s$ffer fr!% h!arding are

fre7$entl) $ne%'l!)ed 2N!rdletten- 89*1 . g$ire- 89*1 Sa%$als et al- 899 5, In additi!n-

%an) !f the% s$ffer fr!% e !n!%i diffi $lt)- in fa t e !n!%i stat$s an "e $sed t! 'redi t these(erit) !f h!arding 2N!rdletten- 89*15, .an) wh! are retired and n! l!nger w!r+ ha(e "een

sh!wn t! "e diagn!sed with h!arding as well 2. g$ire- 89*15,T)'i all)- th!se s$ffering fr!%

h!arding are $n%arried 2N!rdletten- 89*15, F$rther%!re- these indi(id$als are !ften f!$nd in


26/34


single fa%il) h!%es in s$"$r"an neigh"!rh!!ds 2. g$ire- 89*15, Alth!$gh there is %$ h

dis re'an )- resent resear h s$ggest that there is an e7$al 're(alen e "etween %ales and fe%ales

with h!arding dis!rder 2T!lin- 89* 5,

A !rding the DS.;/ !f indi(id$als with h!arding dis!rder s$ffer fr!% !%!r"id

dis!rders as well, The dis!rders with the highest !%!r"idit) rates are an iet) and de'ressi!n

2T!lin 89* 5, H!we(er resear h ") Sa%$el0s and his !lleag$es 289*85 s$ggest that OCD is %!st

!%!r"id with de'ressi!n and d)sth)%ia- with signifi antl) l!wer !%!r"idit) with OCD-

#TSD- and an iet), T! %a+e %atters w!rse- this resear h als! states there is a high 're(alen e !f

al !h!l de'enden e in the h!arding '!'$lati!n, Oddl)- there is a relati(el) l!w !%!r"idit) rate

with OCD 2Sa%$als et al- 89*85- whi h will "e dis $ssed in relati!n t! h!ardings integrati!n int!

the OCRD ateg!r) later,One !%%!n e 'ressi!n !f h!arding dis!rder- is h!arding ani%als, A !rding

. G$ire0s resear h 289*15- nearl) half !f the 'arti i'ants in his st$d) h!arded ani%als as well as

!">e ts 2 * 5 while slightl) less than half h!arded >$st !">e ts 2 5, In !ntrast- !nl) a s%all

'er entage h!arded >$st ani%als 28 5 These h!arding s)%'t!%s an lead t! a n$%"er !f

negati(e !nse7$en es "esides >$st i%'a ting s!%e!ne inter !r intra'ers!nal life, This resear h

als! indi ated that h!arders !ften fa e legal a ti!ns- fines- e(i ti!n- referrals t! !ther

'r!fessi!nals- !r e(en %aterials "eing re%!(ed fr!% their h!%e, While these %eas$res %a)

see% e tre%e- se(ere h!arding is a !%'anied ") e tre%e fire and health ris+s- as well as

'!ssi"le health ris+s t! !%%$nit), F!r e a%'le- resear h has sh!wn that %edi al ail%ents s$ h

as h)'ertensi!n- slee' a'nea- sei6$res- and str!+e sh!w %$ h higher 're(alen e in h!arder thanin the general '!'$lati!n 2A)ers- 89*95, This s$s e'ti"ilit) t! illness %a) "e d$e t! "!th the

!nditi!ns !f li(ing that a h!arder are e '!sed t! as well as "eing d$e t! 'ree isting !nditi!ns

whi h reinf!r e the h!arding "eha(i!r,SEC ' ( Treat ent+ %s,chopatho*o!,


27/34


In deter%ining the a$ses and treat%ent !f this dis!rder- resear h ") T!lin 289* 5 has

sh!wn that indi(id$als with h!arding dis!rder ha(e %ar+edl) l!wer !gniti(e f$n ti!ning,

F$rther%!re indi(id$als wh! h!ard tend t! ha(e w!rse %e%!r) and e e $ti(e f$n ti!ning- the

s+illset whi h hel's fa ilitate !rgani6ati!n and de isi!n %a+ing, H!arders- $nli+e the 're(i!$sl)

%enti!ned gr!!%ing dis!rders ha(e little t! n! insight, H!arders theref!re ha(e little %!ti(ati!n

t! hange- %a+ing treat%ent (er) diffi $lt, 2. g$ire 89*15, In diagn!sing h!arding dis!rder-

the han es !f re ei(ing a h!arding diagn!sis in rease with higher s !res !n 'ers!nalit) dis!rder

traits, F!r e a%'le- s !ring higher !n 'aran!id- s hi6!t)'al- !r a(!idant traits 2Sa%$als et al

899 5, In %an) h!arding ases- the 'arents !f the h!arders were re'!rted t! ha(e 's) h!l!gi al

iss$es as well 2Sa%$als et al- 899 5, In A)ers st$d) 289*95 !n h!arding- 11 !f h!arders fa%il)

%e%"ers were h!arders as well- and B* !f the 'arti i'ants had a fa%il) %e%"er with a

's) h!l!gi al dis!rder, N!t !nl) did fa%il) %e%"er s$ffer fr!% 's) h!l!gi al d)sf$n ti!n- the

treat%ent !f the indi(id$al with h!arding dis!rder ") the fa%il) %e%"ers %a) als! ha(e had an

i%'a t !n the !nset !f the dis!rder, In Sa%$als st$d) 2899 5 %an) indi(id$als re'!rted that

the) had re ei(ed 'h)si al dis i'line fr!% their 'arents, In additi!n t! this- the h!arders als!

re'!rted ha(ing had "een %ateriall) de'ri(ed while the) were gr!wing $' in their h!$seh!ld,

Lastl)- indi(id$als in this st$d) als! re'!rted ha(ing a la + !f h!%e se $rit), That is- %an)

indi(id$als re'!rted e 'erien ing "rea+;ins and si%ilar tra$%ati e(ents that %a) ha(e

infl$en ed the dis!rders de(el!'%ent,F!r h!arders t! enter treat%ent- the dis!rder %$st !ften re !gni6ed ") !thers- d$e t! the

l!w insight and the a"sen e !f will t! see+ !$t treat%ent, Oftenti%es- the ases are re'!rted ")

the h!arders neigh"!rs- strangers that n!ti e what is g!ing !n- !r e(en ") l! al !ffi ials that are

!n erned a"!$t the 'ers!n0s well"eing 2. G$ire- 89*15, With!$t this- e(iden e fr!%

N!rdletten0s st$d) 289*15 s$''!rts that !nl) a third !f h!arders will a t$all) see+ !$t the


28/34


treat%ent !n their !wn, This is des'ite the fa t that B8 !f these indi(id$als fre7$entl) t!!+

ad(antage !f a health are s)ste%, Other st$dies ha(e s$ggested that as %an) as !f ases

%a) ha(e g!ne $ntreated 2. G$ire- 89*15, This !ntin$es t! sh!w the rel$ tan e with whi h

h!arders see+ !$t thera'ies t! a%eli!rate their s)%'t!%s,Resent literat$re !n treat%ent f!r h!arding dis!rder has "e !%e !f (ital i%'!rtan e in the

field !f OCRD0s as "ef!re %an$ali6ed thera') there was a rela'se rate as high as 8 when

h!arders relied s!lel) !n the !%%$nit) f!r treat%ent 2. G$ire- 89*15, C3T )et again reigns

+ing as the %!st effi a i!$s thera') f!r h!arding dis!rder, Ste+etee0s 289*95 resear h st$d)

!$tline the %ain ste's !f C3T f!r h!arding dis!rder, The first ste' in ad%inistering C3T is

si%'l) an assess%ent whi h anal)6es the t)'e and se(erit) !f the dis!rder, The se !nd ste'

w!$ld "e ase f!r%$lati!n- where details !n the ase are sl!wl) '$t t!gether, Thirst- the

lini ian will de(el!' a C3T %!del $sing a n$%"er !f %eth!ds $sed within this t)'e !f thera'),

The lini ian will the !nd$ t treat%ent 'lanning with the lient- and "$ild a 'lan t! 're(ent

rela'se,T!lins resear h 289* 5 de%!nstrates this s!rt !f C3T is- and des ri"es these indi(id$al

%eth!ds that are $sed thr!$gh!$t this thera'), One %eth!d $sed ") T!lin0s resear h gr!$' was

%!ti(ati!nal inter(iews, These are inter(iews with the lients designed t! get the% t! reali6e the

e tent !f their h!arding and "egin t! %!ti(ate the% t!wards hange, Graded e '!s$re is als! a

!%%!n %eth!d $sed in h!arding dis!rder, Graded e '!s$re w!$ld "e when the indi(id$al is

grad$all) e '!sed t! the re%!(al !f !">e ts fr!% their life- w!r+ing fr!% s!%ething eas) li+e a

news'a'er- $' t! harder !">e ts with %!re senti%ental (al$e, F!ll!wing this- there is s!rting anddis arding training, This s!rt !f training is $sed t! hel' train the h!arder h!w t! s!rt and dis ard

their !">e ts !n e the) ha(e gained the s+ills t! let g! !f the atta h%ents whi h are 'lag$ing

the%, C!gniti(e restr$ t$ring is an!ther %eth!d $sed- in whi h the !gniti!ns whi h are


29/34


a !%'an) the h!arding "eha(i!r are anal)6ed- and the lini ian w!r+s l!sel) with the 'atient

t! atte%'t t! hange these th!$ghts in !rder t! $r" h!arding "eha(i!rs, Lastl) there is

!rgani6ati!nal training- in whi h the lini ian will w!r+ !n the e e $ti(e f$n ti!ning a"ilities !f

the lient in !rder t! tea h the% lifel!ng s+ills that an hel' the% a(!id h!arding and 're(ent

rela'se, Ste+etee0s st$d) 289*95 sh!wed a 9 i%'r!(e%ent rate in s)%'t!%s and a *

lini al i%'r!(e%ent rate, Si%ilarl)- T!lins st$d) 289* 5 sh!wed a 1 ,8 lini all)

signifi ant hange in s)%'t!%s, #redi t!rs !f !$t !%e in l$ded: that %en res'!nded w!rse t!

C3T than w!%en, The )!$nger the indi(id$al re ei(ing the C3T- the "etter !$t !%es the

treat%ent had, Als! )!$nger indi(id$als e 'erien ed %!re !%'$lsi(e "$)ing !r e essi(e

a 7$isiti!n whi h infl$en ed a w!rse treat%ent !$t !%e, Finall)- th!se ta+ing 's) hiatri %eds

as a$g%enting thera')- !ften did "etter in this st$d) than th!se wh! did n!t,As %enti!ned earlier- "ef!re effi a i!$s treat%ents f!r H!arding Dis!rder were

disse%inated- and "ef!re H!arding Dis!rder %ade its wa) int! the DS.- a !%%$nit) "ased

tas+ f!r e a''r!a h was $sed, T)'i all)- tas+ f!r es w!$ld ha(e %eetings that lasted *;8 h!$rs

t! dis $ss se(eral different ases, These %eetings w!$ld !nsist !f B;* !rgani6ati!ns- fr!% the

fire de'art%ent- t! the h!$sing and %ental health de'art%ent, These !rgani6ati!ns 7$i +l)

reali6ed that si%'l) leaning !$t the h!arders 'la es is n!t en!$gh and n!t !st effe ti(e,

Instead- the tas+ f!r e s'ends an)where fr!% se(en da)s t! fi(e %!nths w!r+ing with the

indi(id$al, The tas+ f!r e will hel' !nne t the indi(id$al with h!arding s)%'t!%s t! the

res!$r es the) need and d! their "est t! hel' where the) an, Des'ite these eff!rts h!we(er- !nl)

!f indi(id$als '!lled as ha(ing $sed this %eth!d !f treat%ent i%'r!(ed, It is i%'!rtant t!

+ee' in %ind that this is n!t a lini al i%'r!(e%ent- as t)'i all) these tas+f!r es did n!t in l$de

lini ians and %an$ali6ed thera'), 2CITATION 5


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With the 'r!'er treat%ent- in this ase C3T- treat%ent !$t !%es are n!t as "ad as the)

$sed t! "e, In !rder t! %a+e the "est !f treat%ent it is i%'!rtant t! ta+e int! !nsiderati!n the

fa t!rs that i%'a t treat%ent !$t !%es, First !f all- treat%ent !$t !%es are w!rse f!r

indi(id$als with higher !%!r"idit) in a h!arding '!'$lati!n, Resear h s$ggest that high

!%!r"idit) gr!$'s s$ffer fr!% i%'aired dail) f$n ti!ning- i%'aired s$stained attenti!n- and

i%'aired e e $ti(e f$n ti!ning- '!!r e%!ti!n reg$lati!n- and '!!r self; !ntr!l, Ea h !ne !f

these (aria"les i%'a ting h!w treat%ent t$rns !$t, F$rther%!re- indi(id$als wh! test high !n

ADHD %eas$res als! tend t! ha(e w!rse treat%ent !$t !%es, This is d$e t! "!th the la + !f

e e $ti(e f$n ti!ning with ADHD as well as the diffi $lt) these indi(id$als ha(e !%'leting

assigned h!%ew!r+ tas+s- a +e) 'art !f C3T treat%ent,SEC - ( I portant Research and Current Direction / 0hat a1es this an OCRD2

C"3 ( CONCL4SION3) a $%$lating this "!d) !f resear h- a the!reti al trend has "eg$n t! %a+e itself

e(ident, Des'ite s!%e %in!r differen es ea h !ne !f these dis!rders 'la es itself !n what !$ld

"e alled a 'art !f the OCDR s'e tr$%, This s'e tr$%- w!$ld !nsist !f an i%'$lse !ntr!l

side and a 's) h!ti and !%'$lsi(e feat$re side, There are a n$%"er !f as'e ts t! these

dis!rders that agree with this the!r)- and e(en s!%e as'e ts that d! n!t,The %!st i%'!rtant and !nsistent e(iden e t! s$''!rt this the!r) is treat%ent and

treat%ent res'!nse, The str!ng af!re%enti!ned e(iden e f!r C3T a r!ss these dis!rders n!t

!nl) s$ggests their in l$si!n as OCRD0s was the right %!(e- "$t the t)'es !f C3T $sed f!r ea h

dis!rder hel' t! "a +$' this s'e tr$% the!r), One n!ti ea"le trend in the resear h literat$re is

the relian e !n %!re !gniti(e thera') as'e ts f!r OCD and 3DD, .!re treat%ent sessi!nssee%ed t! "e dedi ated t!wards f! $sing !n the th!$ght 'r! esses and !rre ting a''raisals-

'!inting t!wards s$''!rt f!r the 's) h!ti and !"sessi(e feat$re 'art !f the OCRD s'e tr$%,


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In !rder t! f$rther (alidate these the!ries a n$%"er !f things %$st ha''en, First %!re

're(alen e- !nset- and !%!r"idit) resear h %$st "e d!ne f!r %an) !f these newer dis!rders,

.$ h !f the resear h d!ne in this 'a'er had sh!wn ranges f!r statisti s- as lini ians ha(e f!$nd

it hard t! 'in'!int s'e ifi n$%"ers, F$rther resear h %$st als! "e !nd$ ted !n "rain f$n ti!nal

ND ne$r!trans%itter irreg$larit), While %$ h !f the resear h 'resent in this 'a'er has "een

fleshed !$t- gr!!%ing dis!rder and h!arding "!th had sh!wn a la + !f resear h and e(iden e t!

draw an) %eaningf$l !n l$si!ns, Finall)- resear h in treat%ent f!r %an) !f these dis!rders

%$st "e !nd$ ted t! !%'are %ainstrea% and alternati(e treat%ents and their effi a ),%RO%OSAL

C3T and SSRI in lini al H!arding Dis!rder #!'$lati!nIntr!d$ ti!nH!arding- as a new dis!rder- still is la +ing in %an) areas !f resear h, As the 're(alen e

!f h!arding dis!rder has e(!l(ed fr!% 'redi ti!ns as l!w as ,B $' t! %!dern esti%ates as high

as B - resear h !n the %atter has "e !%e in reasingl) i%'!rtant 2A)ers- 89*9- Sa%$als- 899 5,

#ri!r t! %an$ali6ed thera') a !%%$nit) a''r!a h has "een $sed 23rati!tis- 89*85, H!we(er-

with the %ini%$% res!$r es the !%%$nit) an 'r!(ide- rela'se rates an "e as high as

2. g$ire- 89*15, .!re %!dern C3T f!r h!arding dis!rder has sh!wn t! "e %$ h %!re

'r!%ising with a rate !f lini all) signifi ant hange as high as 1 ,8 2T!lin- 89* 5,

F$rther%!re- SSRI0s ha(e "een sh!wn t! als! ha(e a signifi ant i%'a t !n treat%ent !$t !%es in

h!arding dis!rder 2T!lin- 89* 5, H!we(er- resear h has )et t! !%'are these a''r!a hes- and

%!re i%'!rtantl)- has )et t! l!!+ at the i%'a t !f a$g%enting C3T with SSRI treat%ent, This

st$d)- ") !%'aring these different a''r!a hes- will !%'are the effi a ) !f different %!dernh!arding treat%ents, It is h)'!thesi6ed that 2H*a5 SSRI0s will red$ e h!arding "eha(i!r "etter

than the !%%$nit) treat%ent a''r!a h- 2H*"5 C3T will red$ e h!arding "eha(i!r "etter than


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The "aseline !r !ntr!l gr!$' will re ei(e the %ini%al treat%ent re ei(ed ") h!arders- "eing

intr!d$ ed t! !%%$nit) res!$r es, This gr!$' will !%'ete against three different gr!$'s,

These in l$de an SSRI gr!$' a C3T gr!$' as well as an a$g%enting gr!$' whi h will re ei(e

"!th SSRI and C3T treat%ent,.eth!d

After s reening 'arti i'ants and "riefing the% !n the st$d)- 'arti i'ants will "e assigned

(ia %at hing design !r rand!% sele ti!n t! their treat%ent gr!$', Th!se in the "aseline gr!$'

will re ei(e n!r%al s$''!rts s$ h as s! ial w!r+ers and !ther netw!r+ed re !$rses, Th!se

'la ed in t! treat%ent !nditi!ns will re ei(e *8 wee+s !f SSRI0s- *8 wee+s !f C3T- !r "!th, In

the ase !f treat%ent resistan e the SSRI will "e swit hed !$t f!r the ne t %!st effi a i!$s, A

'retest assess%ent- as well as a '!sttest assess%ent will "e !nd$ ted, In the 'retest- indi(id$als

will "e gi(en the 3OC as well as the SIHD- lini ians will als! (isit their h!%e and rate the%

!n a l!w;high s ale !n h!arding se(erit), A within s$">e ts "lind '!sttest will "e !nd$ ted ")

lini ians- and s !res will "e re !rded,Des ri'ti(e Statisti s

A 8 8 "etween s$">e ts ANO/A will "e r$n in !rder t! deter%ine the effi a ) !f ea h

treat%ent, It is e 'e ted that "!th C3T and SSRI treat%ent will sh!w signifi antl) %!re

effi a ) then the !%%$nit) treat%ent "aseline, F$rther%!re it is e 'e ted that the effe t !f

!%"ining C3T and SSRI treat%ent in the a$g%ented gr!$' will f$rther "!!st the lini all)

signifi ant hanges t! h!arding "eha(i!r,

Ocrd Thesis Roughdraft

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