The classification of Obsessive-Compulsive and Related Disorders in the ICD-11.

BACKGROUND: To present the rationale for the new Obsessive-Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping. METHODS: Review of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity. RESULTS: The rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing. LIMITATIONS: Alternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability. CONCLUSION: It is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.

Shear properties of some dental and other polymers.

The shear modulus and elastic limit in shear were determined for a number of polymers of clinical interest, using a static torsion method. In particular, ultra-high modulus polyethylene was studied as a function of draw ratio, and compared with corresponding Young's modulus data. Materials of high shear moduli of potential clinical value are described.

The bedtime pass: an approach to bedtime crying and leaving the room.

OBJECTIVE: To evaluate a novel intervention for bedtime problems. DESIGN: We used an ABAB withdrawal-type experimental design. SETTING: The intervention was prescribed in an outpatient primary health care context and evaluated in the home setting. PARTICIPANTS: Two normally developing boys aged 3 and 10 years were the primary participants. Twenty parents and 23 practicing pediatricians rated the acceptability of the intervention. INTERVENTION: A bedtime pass, exchangeable for 1 excused departure from the bedroom after bedtime. MAIN OUTCOME MEASURES: For both primary participants, instances of crying and/or coming out from the bedroom after bedtime; for the 20 parents and 23 pediatricians, comparative ratings of acceptability for the pass and 2 other commonly used approaches to bedtime problems (ignoring crying and letting children sleep with their parents). RESULTS: Crying and coming out from the bedroom reduced to zero rates in both children. Pediatricians rated using the pass as significantly more acceptable than letting children sleep with parents and equivalent to ignoring. Parents rated the pass as more acceptable than either alternative. CONCLUSION: The bedtime pass provides pediatricians with a readily usable, potentially effective, and highly acceptable novel intervention for bedtime problems, one of the most common complaints in outpatient pediatrics.

Case study: Exposure and response prevention for an adolescent with Tourette's syndrome and OCD.

Using recently refined diagnostic criteria, the authors hypothesized that the frequent touching of others by a 16-year-old male adolescent with Tourette's syndrome was a compulsion and not a tic. Consistent with the study's hypothesis, the authors applied exposure and response prevention, a procedure empirically supported for treatment of compulsions but not for tics, to the touching. Results showed a significant decrease in touching attempts, overt anxiety, and subjective anxiety across time.

Habit reversal: a review of applications and variations.

Research is reviewed on habit reversal treatment of tics and other nervous habits, and on the components of such treatment. Awareness training and the use of a competing response are found to be its essential components. Studies which evaluate the habit reversal procedure and its variations in the treatment of stuttering are also reviewed.

Dismantling simplified regulated breathing: a case of a bilingual stutterer.

In this case study of a 28-year-old bilingual male, the Simplified Regulated Breathing treatment for stuttering was further dismantled. Implementing noncontingent diaphragmatic breathing in one treatment session, stuttering was reduced in both English (his second language) and Russian (his native language), while his words per minute increased. In addition, the implementation of treatment resulted in a decrease in secondary struggle behaviors associated with stuttering. The results were seen as socially valid and the treatment was seen as acceptable to the participant. Implications of this case study are presented.

A simplified habit reversal treatment for pica-related chewing.

In this study the frequency of chewing behavior in a 6-year-old male diagnosed with pica was reduced using a simplified habit reversal procedure. Data were collected on the frequency of chewing behavior, treatment acceptability, parent satisfaction, and social validity of the behavior change. This study represents the first known application of the habit reversal procedure to treat pica-related chewing in a normally intelligent child.

Comparing the effectiveness of similar and dissimilar competing responses in evaluating the habit reversal treatment for oral-digital habits in children.

In the present study 26 children with chronic oral-digital habits were randomly assigned to 1 of 3 conditions. Group 1 received habit reversal using a similar competing response. Group 2 received habit reversal using a dissimilar competing response, and Group 3 served as a wait-list control group. Three videotaped observations were taken at pretreatment and again at posttreatment. In addition, social acceptability data were collected on the treatment groups at posttreatment. Results showed that the similar and dissimilar groups were engaging in significantly less oral-digital behavior at posttreatment when compared to the control group. However, the two treatment groups did not differ from each other in terms of treatment gains or acceptability. These results suggest that habit reversal is an effective treatment for oral digital habits in children. In addition, it appears that the competing response does not function as a physically incompatible behavior. Implications of the findings are discussed.

Habits, tics, and stuttering. Prevalence and relation to anxiety and somatic awareness.

This study examines the prevalence of nervous habits, tics and stuttering in 256 college students, as well as the relationship between these behaviors and self-reported general anxiety and awareness of bodily sensations. Improving on previous studies, this study strengthens the operational definition of a nervous habit by using a more stringent operational definition, giving what is arguably a more valid set of prevalence statistics. Participants were asked to complete self-report measures of general anxiety and somatic awareness. Relationships were found between number of nervous habits and tics that participants endorsed and their self-reported awareness of bodily sensations, as well as between number of habits endorsed and self-reported general anxiety. This article concludes with suggestions for future research in the area of nervous habits and motor tics.

Are persons with nervous habit nervous? A preliminary examination of habit function in a nonreferred population.

In this study, 44 individual were exposed to three conditions (anxiety, bored, and neutral) while being covertly videotaped. The videotapes were then scored for the occurrence of five classes of habits including hair, face, and object manipulation; object mouthing; and repetitive movement of the limbs. Results showed that hair and face manipulation increased during the anxiety condition, whereas object manipulation increased in the bored condition. The implications of this research are discussed.

Habit reversal as a treatment for chronic skin picking in typically developing adult male siblings.

In this study, habit reversal was evaluated as a treatment for skin picking in typically developing adult male siblings using a nonconcurrent multiple baseline across participants design. Results showed socially valid decreases in reported picking as a result of treatment.

Evaluating the duration of the competing response in habit reversal: a parametric analysis.

The effectiveness of habit reversal was compared across three different competing response (CR) durations. Results showed that 1-min and 3-min CR durations were associated with short-term and long-term increases in nail length for people who bit their nails. A 5-s CR duration produced immediate increases in nail length that were not maintained. Social validity data were consistent with these findings.

Sequential application of major habit-reversal components to treat motor tics in children.

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habit-reversal components included (a) awareness training; (b) awareness training and self-monitoring; (c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.

Applying behavior analysis to clinical problems: review and analysis of habit reversal.

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.

Using positive peer reporting to improve the social interactions and acceptance of socially isolated adolescents in residential care: a systematic replication.

We studied how rewarding youth in residential care for publicly reporting positive social behavior influenced the social interactions and acceptance of their most socially isolated peers. Results showed that the intervention resulted in substantial improvements in social interactions by the previously isolated peers. Peer acceptance ratings also improved for 2 of the target youths.

Analyzing the influence of tic-related talk on vocal and motor tics in children with Tourette's syndrome.

This study examined the effect of tic-related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.