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Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.

Hoarding disorder (HD) is a multifaceted problem that presents challenges both for understanding its dimensions and for developing effective treatments. We are grateful to have known Dr. Stanley J. Rachman and his incredibly thoughtful approach to clinical psychology and research on anxiety, obsessive-compulsive dis-orders (OCD) and their treatment. His work has helped set the stage for our own efforts to study this challenging condition. The discussion below reviews a range of mysteries we and others have encountered in working with people who exhibit HD symptoms. Of particular interest to us are questions about biological vulnera-bilities like heritability and the high rate of concurrent health problems and whether hoarded objects might serve as safety signals that protect people from traumatic life events. We are curious about the attachment process in HD and whether attachment to objects is related to early parental experiences that affect self-concept. We raise questions about the several information processing problems often seen in people with HD - attention focusing, memory, and associative responses to objects and information. Raising many questions are observations about strong emotional attachments to objects and multiple reasons given for saving them, as well as what sometimes appears to be remarkable aesthetic appreciation and creative interest in objects. Emotions in HD seem to range more widely than in some psychological disorders as both positive and negative reactions appear to reinforce excessive acquisition and difficulty discarding. Clutter blindness may be an effort to avoid confrontation with overwhelming clutter in the home. Finally, we comment on difficulty achieving more positive outcomes following a carefully designed cognitive and behavioral treatment for HD and encourage the next generation of researchers to follow in Jack Rachman's footsteps as they try to unravel these mysteries.

Disorder (HD) is a complex mental health problem defined by an overabundance of clutter, difficulty with organization and discarding, and problems regulating acquisition. This chapter describes the features of HD, evidence-based intervention approaches and outcomes, and the elements of a manualized treatment approach with emphasis on flexible delivery to meet clients’ needs. Opportunities to flexibly implement cognitive and behavioral treatments (CBT) for HD include modification of assessment methods, the order of therapy components, treatment timing and focus, responsiveness to client comorbidity and context, consideration of treatment planning, and approaches to increasing motivation and building skills. Also covered are supports for cognitive and behavioral changes in acquisition/organizing/discarding, assessing the appropriateness of a home cleanout, and determining “flexibility within fidelity” (Kendall & Frank, 2018) for group HD treatments and online interventions.

Disorder (HD) is a complex mental health problem defined by an overabundance of clutter, difficulty with organization and discarding, and problems regulating acquisition. This chapter describes the features of HD, evidence-based intervention approaches and outcomes, and the elements of a manualized treatment approach with emphasis on flexible delivery to meet clients’ needs. Opportunities to flexibly implement cognitive and behavioral treatments (CBT) for HD include modification of assessment methods, the order of therapy components, treatment timing and focus, responsiveness to client comorbidity and context, consideration of treatment planning, and approaches to increasing motivation and building skills. Also covered are supports for cognitive and behavioral changes in acquisition/organizing/discarding, assessing the appropriateness of a home cleanout, and determining “flexibility within fidelity” (Kendall & Frank, 2018) for group HD treatments and online interventions.

(Appeared originally in Depression and Anxiety 2015; 32:158-166).

Abstract Background The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study, we aim to operationally define treatment response and remission in BDD. Method We pooled data from three randomized controlled trials of cognitive-behavior therapy (CBT) for BDD (combined n = 153) conducted at four academic sites in Sweden, the USA, and England. Using signal detection methods, we examined the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD–YBOCS) score that most reliably identified patients who responded to CBT and those who achieved remission from BDD symptoms at the end of treatment. Results A BDD–YBOCS reduction ⩾30% was most predictive of treatment response as defined by the Clinical Global Impression (CGI) – Improvement scale (sensitivity 0.89, specificity 0.91, 91% correctly classified). At post-treatment, a BDD–YBOCS score ⩽16 was the best predictor of full or partial symptom remission (sensitivity 0.85, specificity 0.99, 97% correctly classified), defined by the CGI – Severity scale. Conclusion Based on these results, we propose conceptual and operational definitions of response and full or partial remission in BDD. A consensus regarding these constructs will improve the interpretation and comparison of future clinical trials, as well as improve communication among researchers, clinicians, and patients. Further research is needed, especially regarding definitions of full remission, recovery, and relapse.

The post-9/11 conflicts have taken a substantial toll on military families. Although positive effects of reintegration-focused programs are well-documented for service members, less is known about military spouses who are parents of young children. This article examines the outcomes of a formal reflective parenting program developed for military families who have very young children, and whether aspects of informal social support moderate spouse outcomes of anxiety, depression, and parenting stress. Data are drawn from a randomized, clinical trial (RCT) of 103 military families with children ages birth to 5 years of age. Structural equation models examined the main effects of the program and the relationship of 3 social support dimensions (perceived support, social connectedness and dyadic satisfaction) to program outcomes of interest. Analyses revealed a statistically significant reduction in anxiety in the treatment group, with a small effect size. No significant program effects emerged on parenting stress or depression. None of the social support dimensions was significantly associated with outcomes of interest. The interaction of dyadic support and treatment showed a significant moderate effect on parenting stress. Spouses with lower baseline satisfaction who were assigned to the treatment condition reported similar levels of parenting stress at baseline and posttest, whereas their counterparts in the waitlist condition reported significantly higher parenting stress at posttest compared with baseline. Findings suggest a targeted approach to preventive intervention for military spouses who are mothers of young children. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The adverse effects of deployment-related stress (DRS) on military service members, spouses, and children are well documented. Findings from a recent Consensus Report on Military Families by the National Academies of Science, Engineering, and Medicine (2019) underscore the priority of gaining a more comprehensive understanding of the diversity of today's military families and their needs and well-being. While social support is generally regarded as helpful during times of stress, it has not been studied extensively in National Guard/Reserve spouses who are parents of young children. This qualitative study of 30 women examines the unique ways in which DRS affects women who are National Guard/Reserve spouses and mothers of young children, as well as the processes through which they encountered support to manage these stressors. Salient themes spanned experiences involving deployment cycle phases of separation and reintegration and included both anticipated and unanticipated changes in family-related division of labor, dynamics, and communication patterns. These were complicated by geographic, social, and cultural isolation and misguided efforts to support spouses initiated by civilians. Women managed these stressors primarily through seeking, acquiring, and repurposing existing sources of informal social support for themselves and formal supports for their children, with varying degrees of success.

What kinds of problems does hoarding cause? Although hoarding leads to adverse effects that are apparent to others, the person with hoarding behavior is sometimes unable to recognize the problems caused by having a house too full of stuff. Even if they have insight into...

What don’t we understand about hoarding disorder? As evident from our previous chapters, there are many aspects of hoarding problems and hoarding disorder (HD) that are not well understood at this time. This chapter discusses several of the main areas of uncertainty about this complex...

In addition to the treatment methods described in Chapter 7, a few other methods may be helpful for family members and for those who suffer from hoarding symptoms. In considering alternative ways to resolve hoarding problems, it is important to distinguish clutter from...

The effects of medications and psychotherapy treatments have been studied in clinical settings for people with serious hoarding problems. This chapter describes the treatments that have been investigated and summarizes the findings from those studies with regard to the potential benefits for resolving hoarding symptoms....

Spouses of National Guard/Reserve (NG/R) military service members cope with deployment-related stressors (DRS) that may contribute to increased psychological distress. Research indicates that higher levels of social support are associated with reduced depression and anxiety in military spouses, but longitudinal relationships have not yet been examined bidirectionally. This study examines temporal relationships between 3 dimensions of social support (social connectedness, dyadic satisfaction, and perceived support), and psychological distress in a sample of NG/R spouses during the first year after a service member returns from deployment. Data from 103 military spouses were drawn from a larger intervention development study. Autoregressive cross-lagged panel analyses examined the stress-buffering and support erosion hypotheses over a 3-month period. DRS were measured by the cumulative number of deployments and duration of most recent deployment. Distress was assessed using latent variables of depression and anxiety. Statistically significant relationships emerged between initial levels of psychological distress and social connectedness at 3 months. Social support dimensions of dyadic satisfaction and perceived support did not predict subsequent levels of psychological distress. No significant relationships emerged between any dimension of social support at baseline and either form of psychological distress at 3 months. The support erosion hypothesis may more accurately describe the relationship between social support and psychological distress in this sample than the stress-buffering mechanism. During the first year of reintegration, social connectedness may be of particular relevance for NG/R spouses, as they may not have access to supports typically available to their active duty counterparts. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Background: The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders. Methods: Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given. Results: Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as ‘primary constructs’ and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity). Conclusion: This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.

In previous chapters we’ve described the criteria for hoarding disorder (HD) and detailed the features of acquiring, saving, and clutter. We also discussed the common features associated with hoarding symptoms and HD, including demographic characteristics, as well as the beliefs, emotions, and behaviors, including brain...

Abstract Hoarding disorder is the excessive saving of objects and difficulty parting with them to a point that interferes with one's ability to properly use rooms and furnishings in the home. Hoarding can become dangerous, sometimes resulting in structural problems and fires, or in hazardous sanitary conditions. Studies indicate that around one in every 25 people suffers from hoarding. This means that almost all of us know someone who hoards. Hoarding: What Everyone Needs to Know demystifies this complex problem, what it looks like and why it may develop, and how it can be treated. With their combined expertise in psychological treatments for hoarding and community interventions, Drs. Steketee and Bratiotis explain how to understand hoarding as a mental illness, describing the disorder in layman's terms and explaining the various facets and manifestations of the behavior. Chapters focus on one or more common questions regarding diagnosis, features, how to assess severity, and treatment. The book will dispel myths and help readers identify hoarding that touches their own lives. As such it will be of great value not only to those who suspect a loved one may be hoarding, but also to first responders, such as firefighters, public health officials, and housing and social service personnel, who will find here an essential resource for use in the field.

How is hoarding defined? In a seminal article published in 1996, Drs. Randy Frost and Tamara Hartl described a syndrome they called “compulsive hoarding.” They identified three main elements of this condition: Excessive acquiring and failure to discard a large number of possessions, often...