Leo Sher, M.D.

A research report, “Parents’ perceptions of internalizing and externalizing features in childhood OCD” has been published in Child Psychiatry & Human Development online ahead of print (1). The authors of the study sought to show that parents perceive both internalizing and externalizing behaviors in childhood obsessive-compulsive disorder (OCD) by examining the factor structure of the Child Obsessive-Compulsive Externalizing/Internalizing Scale (COCEIS), a parent-report questionnaire intended to measure internalizing and externalizing behaviors. The authors also examined clinical correlates of internalizing and externalizing factors in the COCEIS.

Study participants were 122 parent–child dyads (children ages 7–18) with a diagnosis of OCD and/or a score on the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) of at least 16. Child-parent dyads were enrolled during four clinical studies at a University-based OCD clinic between 2004 and 2016 and were administered a variety of questionnaires, including the Child Obsessive–Compulsive Externalizing/Internalizing Scale (COCEIS).

Externalizing behaviors in childhood OCD were associated with other, co-occurring externalizing behavior issues, while both factors were positively correlated with OCD severity and co-occurring internalizing symptoms.  Sixty-two percent of parents responded “often” or “always” to at least one externalizing item. Mean responses were significantly greater for internalizing items. This study provides evidence for different but related externalizing and internalizing behaviors specific to childhood OCD.

The authors suggest that externalizing behaviors in childhood OCD seem to be characterized by OCD-specific defiance (e.g., arguing about OCD-related issues, getting upset with others when rituals are interrupted) as well as more co-occurring behavior problems.  Internalizing obsessive–compulsive symptoms (e.g., being embarrassed about compulsions, experiencing distressing thoughts) seem to be independent but associated features of childhood OCD, as both appear to be tied to higher overall OCD severity.

Reference

1. Guzick AG, Cooke DL, McNamara JPH, Reid AM, Graziano PA, Lewin AB, Murphy TK, Goodman WK, Storch EA, Geffken GR. Parents’ perceptions of internalizing and externalizing features in childhood OCD. Child Psychiatry Hum Dev. 2019 Feb 18. doi: 10.1007/s10578-019-00873-w. [Epub ahead of print]