Irritability in Children and Adolescents With OCD. Issue 4 (July 2021)

• Record Type: Journal Article
• Authors: Guzick, Andrew G.; Geller, Daniel A.; Small, Brent J.; Murphy, Tanya K.; Wilhelm, Sabine; Storch, Eric A.
• Is Part Of: Behavior therapy. Volume 52:Issue 4(2021)
• Page Start: 883
• Page End: 896
• Publication Date: 2021-07
• Subjects: OCD -- youth -- CBT -- disruptive behavior -- impairment; Behavior therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.beth.2020.11.001
• Languages: English
• ISSNs: 0005-7894

Abstract

Highlights: Irritability was directly associated with depression, defiance, and impairment. Irritability was significantly and positively associated with family accommodation. Irritability was not significantly associated with OCD severity or anxiety. Clinically significant improvement in irritability was found in 54% of youth. Improvement in irritability was not related to OCD symptom reduction. Abstract: Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.