Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) has proven to be an effective treatment modality for children with obsessive-compulsive disorder (OCD). Less research exists demonstrating efficacy for this treatment modality among children with comorbid diagnoses of OCD and autism spectrum disorder (ASD), and virtually, nothing has been reported examining intensive interventions for the most severe cases. As such, this article discusses the treatment of an adolescent male with severe OCD comorbid with ASD, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), and chronic tic disorder using a cognitive behavioral approach and ERP. We conclude with recommendations for continued clinical research to understand approaches to help nonresponders to standard therapeutic approaches with this challenging population.

Emetophobia, or a specific phobia of vomiting, is an underresearched disorder characterized by extensive avoidance and safety-seeking behaviors. Extant literature has primarily focused on online support groups and qualitative investigations, thereby limiting the generalizability of results. As such, this study sought to examine the clinical correlates, phenomenology, and impairment related to emetophobia in 436 undergraduate students. About 5% of the sample exhibited significant emetophobia symptoms (n = 21), with all participants in this subsample reporting an age of onset prior to adulthood. In addition, participants’ most distressing aspects of emetophobia were reported to be the somatic sensations of vomiting and the social impact of the disorder. For the entire sample (N = 436), emetophobia symptoms were associated with heightened anxiety, somatization, and depressive symptoms. In addition, functional impairment was observed across home/family, school/work, and social domains of life, even after controlling for the effects of anxiety and depressive symptoms. Detailed results and implications of the findings are discussed, and suggestions for future studies are presented.

Orthorexia nervosa, characterized by pathological preoccupation with healthy eating and food purity, is conceptualized as being linked to cultural concepts of health pervasive in contemporary Western societies. However, little is known about the phenomenology and clinical correlates of orthorexia nervosa in non-Western cultures. The current study examined symptoms of orthorexia nervosa, obsessive-compulsive disorder, depression, anxiety, and fear of negative evaluation among 418 Chinese university students. A minority of participants endorsed frequent or impairing orthorexia nervosa symptoms, and females reported slightly higher severity of orthorexia nervosa symptoms than males. Orthorexia nervosa symptom severity was moderately associated with obsessive-compulsive and anxiety symptoms, and weakly associated with depressive symptoms and fear of negative evaluation. Although this study generates initial data about orthorexia nervosa among Chinese students, further research is greatly needed to establish the prevalence and clinical characteristics of orthorexia nervosa in Western and Non-Western cultures.

Orthorexia nervosa is characterized by an obsession with eating “pure” or “healthy” foods. Despite emergent interest, few studies have been published about orthorexia to date. This study examined the phenomenology, correlates, and associated impairment of orthorexia in 404 undergraduate students. A battery of self-report questionnaires assessed orthorexia symptoms, related functional impairment, disordered eating, perfectionism, obsessive-compulsive symptoms, appearance anxiety, fear of negative evaluation, anxiety, and depressive symptoms. In total, 35.4% of participants endorsed elevated orthorexia symptoms, with primary concerns related to guilt associated with dietary transgressions and experiencing control when eating in a desired manner. Orthorexia symptoms demonstrated small to medium correlations with associated impairment variables, perfectionism, disordered eating, appearance anxiety, and obsessive-compulsive symptoms. Mean differences were observed across all variables (except depressive symptoms) between individuals elevated and not elevated on orthorexia symptoms. Collectively, this study suggests a relatively high frequency of orthorexia symptoms using current methods (which have significant limitations) and demonstrate fairly modest associations with psychological symptomology.

This study examined the relations between overt and relational aggression, social anxiety, loneliness, depressive symptoms, and alcohol and drug use in a sample of 287 undergraduate college students. Consistent with prior work, men reported engaging in more overt aggression than women. Contrary to our predictions, men also reported engaging in more relational aggression than women. Results also indicated that overt and relational aggression were positively associated with social anxiety, loneliness, depressive symptoms, alcohol use, and drug use for the overall sample. Hierarchical regression analyses showed positive relations between overt aggression and alcohol use for men and no relations between relational aggression and any psychosocial adjustment index. For women, overt aggression uniquely predicted social anxiety, loneliness, and depressive symptoms, whereas relational aggression uniquely predicted social anxiety, loneliness, depression, and alcohol and drug problems. Implications of these findings are discussed in terms of the role of peer aggression in students’ psychosocial adjustment.

Background and Objectives: Socially anxious individuals often engage in various safety and avoidant behaviors to temporarily decrease distress. Similarly, friends or family members may engage in accommodating behaviors, commonly manifesting through the facilitation of avoidance, completion of tasks, or schedule modifications. Studies examining symptom accommodation in adult social anxiety are lacking, so this study seeks to better understand symptom accommodation and its consequent impairment in socially anxious adults. Design and Methods: There were 380 undergraduate students who completed a battery of self-report questionnaires through an online system. Constructs assessed include social anxiety, symptom accommodation, and impairment as well as related variables such as general anxiety, fear of negative evaluation, alcohol use, and anxiety sensitivity. Results: Symptom accommodation was positively correlated with social anxiety symptoms, functional impairment, general anxiety, anxiety sensitivity, fear of negative evaluation, and alcohol use. Individuals with considerable social anxiety reported significantly higher levels of symptom accommodation than individuals who reported lower levels of social anxiety. Anxiety sensitivity predicted symptom accommodation beyond the contribution of social anxiety. Symptom accommodation mediated the relationship between social anxiety and impairment. Conclusions: These data help elucidate the presentation and impact of symptom accommodation related to social anxiety. Implications for assessment, treatment, and future directions are presented.

A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients with autogenous thoughts who appraised their intrusions as more important than others. OCD is heterogeneous regarding thought content and strength of appraisals but can be quite homogeneous in terms of CBT treatment response. Also, and in line with cognitive theory, recovery from OCD is associated with changes in appraisals.

Anxiety disorders among children are common, disabling, and run a chronic course without treatment. Cognitive behavioral therapy (CBT) has shown robust efficacy for childhood anxiety. However, dissemination of CBT into community mental health centers (CMHCs) is limited. Computer-assisted CBT (CCBT) programs have been developed to improve dissemination by providing a structured treatment format that allows therapists to reliably deliver evidence-based treatments with fidelity. In this pilot study involving therapists with limited CBT experience, the effectiveness, feasibility, and acceptability of a CCBT program, Camp Cope-A-Lot (Khanna & Kendall, 2008b), were examined in three CMHCs. Seventeen youth ages 7–13 years and diagnosed with a primary anxiety disorder were enrolled. Assessments were conducted by a rater not involved in treatment at baseline and posttreatment. Significant reductions in anxiety severity and impairment were demonstrated at the posttreatment assessment. High levels of family satisfaction were reported. These results provide preliminary support for the effectiveness of a computer-assisted treatment into CMHCs and warrant replication in a controlled setting.

Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13–18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed.

Background: Many youth with tic disorders experience distress about having tics and how others may perceive them. Such symptoms are often more impairing and distressing than the tics themselves and negatively impact self-concept, psychosocial functioning, and quality of life. Objective: Although there exist pharmacological and behavioral treatments that target the frequency and severity of tics, no intervention has been developed specifically to help youth with tics cope with their condition and limit associated functional impairment and distress. With this in mind, we report an intervention case series of eight youth (ages 8–16 years) supporting the initial efficacy of a cognitive-behavioral therapy program entitled “Living with Tics” that promotes coping and resiliency among youth with tics. Method: Eight youth with a principal diagnosis of a tic disorder (i.e., Tourette syndrome [N = 6]; Chronic Tic Disorder [N = 2]) and associated psychosocial impairment participated. Assessments were conducted at screening, pretreatment, and posttreatment by trained raters. Treatment consisted of 10 weekly individual psychotherapy session focused on improving coping with having tics. Results: Six of eight youth were considered treatment responders. On average, participants exhibited meaningful reductions in tic-related impairment, anxiety, and overall tic severity as well as improvements in self-concept and quality of life. Conclusions: These data provide preliminary evidence for conducting a larger controlled trial to examine the utility of the Living with Tics psychosocial intervention for promoting adaptive functioning among youth with tics.

The aim of this article is to raise awareness of the underdiagnosis of body dysmorphic disorder (BDD) in clinical practice and provide suggestions to overcome key barriers to BDD detection. Disclosure of BDD symptoms is uncommon during routine assessments but can be increased by asking specifically about such symptoms. When BDD symptoms are present, it is important to differentiate them from anxiety, depression, obsessive-compulsive disorder, and eating disorders, which may present with some similarities and are commonly comorbid with BDD. Assessment of BDD should be sensitive to issues of poor insight, elevated suicide risk, subthreshold BDD presentations, and the possibility of BDD by proxy. Furthermore, assessment should consider the potential impact of age, gender, ethnicity, and minor physical defects on the presentation of BDD. Improving the assessment of BDD in routine clinical practice will enhance disclosure, improve case conceptualization, and provide the opportunity to deliver appropriate treatment for this underdiagnosed and often serious disorder.

Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.

Emotional disorders, including anxiety, depressive, and obsessive-compulsive spectrum disorders are prevalent and impairing for youth. Dissemination efforts have been implemented to address these disorders in youth, but these are limited by cost and barriers to accessing mental health services. Stepped care is a method of treatment delivery meant to be cost-effective and less time intensive than administering a full treatment manual. Much, if not all of the research, assessing the efficacy of stepped care delivery has utilized disorder-specific treatment manuals. However, transdiagnostic stepped care approaches may prove more efficacious given that youth commonly present to treatment with more than one disorder and that such problems are not always comprehensively assessed at intake. This manuscript provides details regarding the implementation of a transdiagnostic stepped-care delivery (UPA-SC) using three case examples. Youth evidenced significant improvement in anxiety, depression, and quality of life. Future work to investigate the efficacy of UPA-SC in a larger, more heterogeneous sample of youth may be warranted.

A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children (N = 105; M_age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.

We describe the perceptions of mental health clinicians practicing in the United States about the effects of the COVID-19 pandemic on the presentation and treatment course of active clients with anxiety. Clinician participants reported on client symptomology at the beginning of treatment, just before (prior to March 2020), and at a mid-pandemic timepoint (December 2020/January 2021). An initial sample of 70 clinicians responded to a survey assessing their clients’ overall anxiety severity, anxiety sensitivity, pathological uncertainty, family accommodation, and avoidance levels. Of these, 54 clinician responses were included in study analyses, providing detailed clinical information on 81 clients. Findings suggest that the COVID-19 pandemic was associated with increases in anxiety severity in the majority of clients; overall, clinicians reported that 53% of clients had symptoms worsen due to COVID-19 and that only 16% experienced improvement of symptoms during treatment. Those who had lower levels of avoidance pre-pandemic and those who increased their frequency of treatment were more likely to experience increases in anxiety severity by the mid-pandemic timepoint. Further research is needed to understand the extended effects of the COVID-19 pandemic on anxiety symptomology and treatment.