Core Motivations of Childhood Obsessive-Compulsive Disorder: The Role of Harm Avoidance and Incompleteness
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ORIGINAL ARTICLE
Core Motivations of Childhood Obsessive‑Compulsive Disorder: The Role of Harm Avoidance and Incompleteness Meghan Schreck1 · Christopher Georgiadis2 · Abbe Garcia3 · Kristen Benito3 · Brady Case3 · Jennifer Herren3 · Michael Walther3 · Jennifer Freeman3 Accepted: 2 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the associations between these two forms of OCD classification. Participant topographical symptoms were self-reported using the ObsessiveCompulsive Inventory-Child Version (OCI-CV). Clinicians assessed whether participant symptoms were motivated by harm avoidance and/or incompleteness. Structural equation modeling was employed to explore the associations between harm avoidance and incompleteness and symptom dimensions in youth with OCD. Results showed that harm avoidance was significantly associated with doubting/checking, obsessing, and neutralizing symptoms, whereas incompleteness was associated with doubting/checking, ordering, and neutralizing symptoms. Findings are consistent with child and adult literature and highlight the importance of assessing the underlying function of OC behaviors. Keywords OCD · Harm avoidance · Incompleteness
Introduction Pediatric obsessive-compulsive disorder (OCD) is a heterogeneous and disabling disorder that affects 1% to 4% of children and adolescents [1, 2]. When left untreated, OCD in youth may persist and be associated with long-term sequelae such as additional anxiety and mood concerns [3]. Cognitive-behavioral therapy (CBT) and medication are effective treatments for childhood OCD, yet up to 58% of youth with OCD do not attain symptom remission following a standard course of CBT [4]. To improve the treatment of OCD and the understanding of its etiology, researchers have sought to * Meghan Schreck [email protected] 1
Obsessive‑Compulsive Disorder Institute, McLean Hospital/ Harvard Medical School, 115 Mill St., Belmont, MA 02478, USA
2
Department of Psychology, Florida International University, Miami, FL, USA
3
Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
accurately and meaningfully classify heterotypic symptom clusters within OCD. Researchers seeking to categorize OCD phenotypes in adults [5, 6] and in children [7] have typically employed factor or cluster analytic techniques to identify OCD dimensions or subtypes based on the topographic qualities of obsessions and compulsions [8–10]. Within the OCD literature, topography has been defined as the structure or form of a behavior (e.g., “washing”), whereas function refers to the “purpose” or underlying motivation of a behavio
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