Understanding and Treating Family Factors in Child and Adolescent Obsessive Compulsive Disorder

Abstract

Obsessive compulsive disorder (OCD) is a debilitating mental health condition affecting approximately 1-4% of children and adolescents. Despite the effectiveness of gold-standard treatment, cognitive behaviour therapy (CBT) that involves exposure and response prevention, a significant number of young people show limited treatment response. Emerging evidence suggests that family factors may play a role in maintaining OCD symptoms and affecting treatment outcomes. In support of this, recent family-enhanced CBT interventions have shown promising results. However, the specific family factors that contribute to improved treatment outcomes, and their relative importance for OCD symptom change, remain poorly understood. Further investigation of family factors in child and adolescent OCD is warranted to inform theory and improve treatment. As such, this thesis aims to investigate the relevance and role of a range of family factors in child and adolescent OCD, its treatment, and OCD symptom change. The current thesis presents four studies to address these aims, a systematic-review and meta-analysis, and three empirical studies, specifically a treatment trial and two observational studies. Overall, the current thesis presents novel findings that highlight the importance of family factors in child and adolescent OCD and its treatment, including for OCD symptom change. Findings suggest that family factors characterising paediatric OCD families may be contextual, and demonstrate the importance of addressing these family factors in OCD treatment to improve treatment outcomes. Findings support the integration of a range of family factors into models of OCD maintenance and the direct targeting of these family factors during treatment to optimise outcomes for children and adolescents with OCD.