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Concepts and Controversies in Obsessive-Compulsive Disorder SERIES IN ANXIETY AND RELATED DISORDERS Series Editor: Martin M. Antony, Anxiety Treatment and Research Centre, St Joseph’s Hospital, Hamilton, Ontario, Canada CONCEPTS AND CONTROVERSIES IN OBSESSIVE-COMPULSIVE DISORDER Edited by Jonathan S. Abramowitz and Arthur C. Houts SOCIAL ANXIETY AND SOCIAL PHOBIA IN YOUTH: Characteristics, Assessment, and Psychological Treatment Christopher A. Kearney A continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Concepts and Controversies in Obsessive-Compulsive Disorder Edited by Jonathan S. Abramowitz Mayo Clinic Rochester, MN Arthur C. Houts The West Clinic Memphis, TN Jonathan S. Abramowitz Arthur C. Houts The Mayo Clinic The West Clinic Department of Psychiarty and Psychology 100 Humphreys Blvd. North 200 First St. SW Memphis, TN 38120 Rochester, MN 55905 Library of Congress Control Number: 2005927379 ISBN-10: 0-387-23280-X e-ISBN 0-387-23370-9 Printed on acid-free paper. ISBN-13: 978-0387-23280-X C 2005 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now know or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if the are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed in the United States of America. (MVA/TB) 987654321 springeronline.com To Stacy, Emily, and Miriam, and in loving memory of Morris “Grandpop” Abramowitz—J.S.A. To Mary and Margaret—A.C.H. ABOUT THE EDITORS Jonathan S. Abramowitz, PhD, ABPP received his PhD from the University of Memphis in 1998 and is currently Associate Professor and Director of the OCD/Anxiety Disorders Program in the Department of Psychiatry and Psychology at Mayo Clinic in Rochester, Minnesota. He is a member of the Obsessive Compul- sive Foundation Scientific Advisory Board and the Anxiety Disorders Association of America Clinical Advisory Board. He also served on the Anxiety Disorders Work Group for the DSM-IV-TR. Dr Abramowitz conducts research on the psychopathol- ogy and treatment of OCD and other anxiety disorders and has published widely on these topics. He has received numerous grants to support his research and was awarded the Outstanding Contributions to Research Award in 2003 from the Mayo Clinic Department of Psychiatry and Psychology and the David Shakow Early Career Award for Outstanding Contributions to Clinical Psychology in 2004 from Division 12 of the American Psychological Association. Dr Abramowitz also maintains an ac- tive consultation and clinical practice involving the supervision and mentorship of trainees in clinical psychology and psychiatry. Arthur C. Houts, PhD received his PhD from Stony Brook University in 1981 and taught at the University of Memphis from 1981 to 2003. He was Professor and Director of Clinical Training. He retired in 2003 to work full time at The West Clinic, a large community oncology center in Memphis, Tennessee. He is currently developing a model for delivering empirically supported behavior therapy for cancer patients in the community setting. He is also developing technology to provide better quality of life assessment in cancer care and building a research network of community oncology practices for clinical trials. He has published broadly in adult and child clinical psy- chology as well as the interdisciplinary field of science studies. His interest in animal models of OCD goes back to his graduate training where he studied learning models of psychopathology with the early founders of behavior therapy, many of whom had primary interests in animal learning. vii CONTRIBUTORS Jonathan S. Abramowitz, PhD, OCD/Anxiety Disorders Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA Cheryl N. Carmin, PhD, Stress and Anxiety Disorders Center, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA Meredith E. Coles, PhD, Department of Psychology, Binghamton University, Binghamton, New York, USA Maria Concei¸c˜ao do Rosario-Campos, MD, MSc, Yale University School of Medicine, New Haven, Connecticut, USA and University of S˜ao Paulo Medical School, S˜ao Paulo, Brazil Brett J. Deacon, PhD, Department of Psychology, University of Wyoming, Laramie, Wyoming, USA Nicholas H Dodman, BVMS, DACVB, Tufts University School of Veterinary Medicine, Boston, Massachusetts, USA Ronald Faber, PhD, University of Minnesota, Minneapolis, Minnesota, USA Jeanne Fama, MA, Department of Psychology, Harvard University, Charlestown, Massachusetts, USA Andrea Fougere, BA, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA Martin E. Franklin, PhD, Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Jennifer P. Friedberg, MA, Ferkauf Graduate Psychology/Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA Scott Hannan, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA Sian Hemmings, MSc, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa Eric Hollander, MD, Compulsive, Impulsive, and Anxiety Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA Arthur C. Houts, PhD, The West Clinic, Memphis, Tennessee, USA ix x CONTRIBUTORS Rupa Iyengar, Compulsive, Impulsive, and Anxiety Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA Sony Khemlani-Patel, PhD, Biobehavioral Institute, Great Neck, New York, USA Craig Kinnear, MSc, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa Michael J. Kozak, PhD, National Institute of Mental Health, Bethesda, Maryland, USA James F. Leckman, MD, Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA Michael R. Liebowitz, MD, New York State Psychiatric Institute and Columbia University, New York, New York, USA Christine Lochner, MA, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa David Mataix-Cols, PhD, Institute of Psychiatry, London, UK James E. Mitchell, MD, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA Fugen Neziroglu, PhD, Biobehavioral Institute, Great Neck, New York, USA Kieron O’Connor, PhD, Fernand Seguin Research Center, Louis-H Lafontaine Hospital, University of Montreal, Montreal, Canada David R. Rosenberg, MD, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA Aileen Russell, BA, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA Stefanie A. Schwartz, PhD, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA Roz Shafran, PhD, Department of Psychiatry, Oxford University, Oxford, UK Louis Shuster, PhD, Tufts University School of Veterinary Medicine, Boston, Massachusetts, USA H. Blair Simpson, MD, PhD, New York State Psychiatric Institute and Columbia University, New York, New York, USA Ann Speckens, MD, Institute of Psychiatry, University of London, London, UK Dan J. Stein, MD, PhD, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa Lorraine A. Swan-Kremeier, PsyD, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA Steven Taylor, PhD, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA and University of Connecticut School of Medicine, Farmington, Connecticut, USA CONTRIBUTORS xi Stacey Wasserman, MD, Compulsive, Impulsive, and Anxiety Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA Pamela S. Wiegartz, PhD, Stress and Anxiety Disorders Center, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA Sabine Wilhelm, PhD, OCD Clinic, Massachusetts General Hospital-East and Harvard Medical School, Charlestown, Massachusetts, USA Kevin D. Wu, PhD, Stress and Anxiety Disorders Center, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA Chin-Chin Yeh, BA, Compulsive, Impulsive, and Anxiety Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA PREFACE Few syndromes in psychopathology generate as much popular curiosity and clinical exploration as does obsessive-compulsive disorder (OCD). Since the 1970s, research on OCD has increased exponentially. Specific advances include an improved grasp of the heterogeneity of the disorder,

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