ABSTRACT
Obsessive-compulsive disorder (OCD) is an anxiety disorder that can affect children, adolescents, and adults of any age. This chapter explores the major psychological theories that have been put forward to explain the nature of OCD and its etiology. In discussing these models, the foundation of which primarily includes clinical observations and laboratory research with adults, we highlight considerations for the explanation of OCD as observed in pediatric samples. We begin with a look at the clinical presentation of OCD, as exemplified by three children with typical presentations of the disorder. These cases are used to illustrate aspects of the theoretical models discussed further below:
Bob, a 12-year-old boy, suffered from obsessional thoughts of making mistakes when completing schoolwork. For example, while working on math problems, he would often get the idea that perhaps he had added, subtracted, or multiplied incorrectly, or that he had copied a number
incorrectly from the output of his calculator. Such thoughts evoked subsequent ideas and images of bad grades, punishment from his parents, social embarrassment, and being “a failure” in life. These concerns evoked high levels of doubt and distress. Driven by the desire to reduce the distress evoked by these persistent doubts about mistakes, Bob reluctantly re-checked all of his schoolwork multiple times. Even if initial checks revealed no apparent errors, he would review mathematical computations, spelling, and so forth, up to 10 times. When Bob presented for treatment, he was unable to complete assignments in class in the allotted time, and was spending in excess of 5 hours re-checking his homework each night.
