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Obsessive Compulsive Disorder (OCD) including Body Dysmorphic Disorder (BDD)

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts, images, urges, or impulses that are interpreted as threating (obsessions). These lead to active and counterproductive attempts to reduce the thoughts and/or discharge the perceived responsibility associated with them (compulsions). Cognitive and behavioral approaches including exposure, response prevention, and behavioral experiments are effective treatments for OCD. This page also includes resources for body dysmorphic disorder (BDD). Read more

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Obsessive Compulsive Disorder (OCD) including Body Dysmorphic Disorder (BDD)

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66 of 66 resources

Scaling - Testing Your Assumptions

Continuum strategies are a well-known cognitive intervention for re-evaluating absolute appraisals, including core beliefs and dysfunctional assumptio ... https://www.psychologytools.com/resource/scaling-testing-your-assumptions/

Cognitive Distortions – Unhelpful Thinking Styles (Extended)

Cognitive distortions (or ‘unhelpful thinking styles’) are ways that our thoughts become biased. Different cognitive biases are associated with di ... https://www.psychologytools.com/resource/cognitive-distortions-unhelpful-thinking-styles-extended/

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive distortions (or ‘unhelpful thinking styles’) are ways that our thoughts become biased. Different cognitive biases are associated with di ... https://www.psychologytools.com/resource/cognitive-distortions-unhelpful-thinking-styles-common/

Unrelenting Standards

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/unrelenting-standards/

Self-Sacrifice

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/self-sacrifice/

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal/

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty/

Vulnerability To Harm

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/vulnerability-to-harm/

Unhelpful Thinking Styles (Archived)

NOTE: Two improved versions of this resource are available here: Cognitive Distortions – Unhelpful Thinking Styles (Common) and Cognitive Disto ... https://www.psychologytools.com/resource/unhelpful-thinking-styles-archived/

Obsessive Compulsive Disorder (OCD) Formulation

The cognitive approach to obsessive compulsive disorder (OCD) suggesst that it is the client’s interpretation of normal intrusive thoughts, images, ... https://www.psychologytools.com/resource/obsessive-compulsive-disorder-ocd-formulation/

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty/

Theory A / Theory B

People naturally seek to understand their world and develop explanations based on their experiences. When these beliefs are inaccurate or only partial ... https://www.psychologytools.com/resource/theorya-theoryb/

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

Fear Ladder

The Fear Ladder is a tool for exploring and ranking the contexts or situations in which a client experiences fear. It is designed to help the client a ... https://www.psychologytools.com/resource/fear-ladder/

What Keeps Obsessive Compulsive Disorder (OCD) Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-obsessive-compulsive-disorder-ocd-going/

OCD Diary

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). Clients will find ... https://www.psychologytools.com/resource/ocd-diary/

Understanding Obsessive Compulsive Disorder (OCD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are ... https://www.psychologytools.com/resource/understanding-obsessive-compulsive-disorder-ocd/

Self-Blame

The Self-Blame information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively wi ... https://www.psychologytools.com/resource/self-blame/

Exposure And Response Prevention

Exposure And Response Prevention (ERP, EX/RP) is an effective treatment for obsessive compulsive disorder (OCD). This CBT worksheet guides therapists ... https://www.psychologytools.com/resource/exposure-and-response-prevention/

Intrusive Thoughts Images And Impulses

Intrusive Thoughts, Images, And Impulses that are experienced as distressing are a feature of obsessive compulsive disorder (OCD). They are also a com ... https://www.psychologytools.com/resource/intrusive-thoughts-images-and-impulses/

Habituation

The Habituation information sheets are designed to help clinicians to explain the concept of habituation and its role in exposure therapy. The handout ... https://www.psychologytools.com/resource/habituation/

Insufficient Self-Control

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/insufficient-self-control/

OCD Hierarchy

Part of traditional CBT treatment for OCD is exposure to situations which trigger obsessions (classically accompanied by the prevention of the associa ... https://www.psychologytools.com/resource/ocd-hierarchy/

Exposure Session Record

The Exposure Session Record is a tool for recording clients’ use of exposure. The worksheet guides clients to identify a specific fear they are will ... https://www.psychologytools.com/resource/exposure-session-record/

Social Isolation

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/social-isolation/

Treating Your OCD With Exposure And Response (Ritual) Prevention (Second Edition): Workbook

Exposure and Response (Ritual) Prevention for Obessssive-Compulsive Disorder comes in two volumes. This page is for the Client Workbook. Click on the ... https://www.psychologytools.com/resource/treating-your-ocd-with-exposure-and-response-ritual-prevention-workbook/

Defectiveness

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/defectiveness/

Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder (Second Edition): Therapist Guide

Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder comes in two volumes. This page is for the Therapist Guide. Click on the f ... https://www.psychologytools.com/resource/exposure-and-response-ritual-prevention-for-obsessive-compulsive-disorder-therapist-guide/

Subjugation

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/subjugation/

Thought-Action Fusion

The Thought-Action Fusion information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/thought-action-fusion/

Thought Suppression And Intrusive Thoughts

Suppression is a common approach to unwanted thoughts, worriers, doubts, or urges. Unfortunately, there are good reasons why this strategy fails. This ... https://www.psychologytools.com/resource/thought-suppression-and-intrusive-thoughts/

Catastrophizing

The Catastrophizing information handout forms part of the cognitive distortions series. It is designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/catastrophizing/

Emotional Inhibition

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/emotional-inhibition/

Approval-/Admiration-Seeking

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/approval-admiration-seeking/

Exposure Practice Form

Exposure is an effective treatment for many forms of anxiety. The Exposure Practice Form is a CBT worksheet which guides therapists and clients throug ... https://www.psychologytools.com/resource/exposure-practice-form/

Failure To Achieve

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/failure-to-achieve/

Emotional Reasoning

The Emotional Reasoning information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/emotional-reasoning/

"Should" Statements

“Should” statements (sometimes referred to as ‘musturbation’, ‘necessitous thinking’, ‘self-commands’, and ‘injunctions’) are char ... https://www.psychologytools.com/resource/should-statements/

Self-Monitoring Record (Universal)

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/self-monitoring-record-universal/

Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook

Cognitive Behavioral Treatment Of Childhood OCD: It’s Only A False Alarm comes in two volumes. This page is for the Workbook. Click on the following ... https://www.psychologytools.com/resource/cognitive-behavioral-treatment-of-childhood-ocd-its-only-a-false-alarm-workbook/

Your Stone Age Brain

Your Stone Age Brain is an information handout which describes the freeze-flight-fight response: a set of evolutionary adaptations that increase the c ... https://www.psychologytools.com/resource/your-stone-age-brain/

Therapy Blueprint For OCD

A therapy blueprint represents the past (the problems, what maintained them), the present (the therapy itself, new knowledge learned and skills develo ... https://www.psychologytools.com/resource/therapy-blueprint-for-ocd/

Recognizing Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is characterized by the presence of persistent and repeated obsessions and compulsions. The obsessions are intrusi ... https://www.psychologytools.com/resource/recognizing-obsessive-compulsive-disorder-ocd/

Pessimism

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/pessimism/

Checking Certainty And Doubt

Psychologists have discovered interesting relationships between Checking, Certainty, And Doubt. This information handout contains an exercise helpful ... https://www.psychologytools.com/resource/checking-certainty-and-doubt/

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record/

Punitiveness

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/punitiveness/

Dependence / Incompetence

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/dependence-incompetence/

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record/

Intrusion Record

What differentiates intrusive congitions in OCD is the meaning that clients with OCD attach to them. The Intrusion Record is a CBT worksheet for captu ... https://www.psychologytools.com/resource/intrusion-record/

Facing Your Fears And Phobias

The Facing Your Fears And Phobias guide is written for clients who struggle with fears or phobias. It provides comprehensive information about what fe ... https://www.psychologytools.com/resource/facing-your-fears-and-phobias/

What Is Exposure Therapy?

Exposure is an effective evidence-based treatment for fear. This information handout describes the key principles of Exposure Therapy. Clients who are ... https://www.psychologytools.com/resource/what-is-exposure-therapy/

Maximizing The Effectiveness Of Exposure Therapy

Despite its position as the leading treatment technique for anxiety disorders, not all clients respond to exposure therapy and some individuals relaps ... https://www.psychologytools.com/resource/maximizing-the-effectiveness-of-exposure-therapy/

Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide

Cognitive Behavioral Treatment Of Childhood OCD: It’s Only A False Alarm comes in two volumes. This page is for the Therapist Guide. Click on the fo ... https://www.psychologytools.com/resource/cognitive-behavioral-treatment-of-childhood-ocd-its-only-a-false-alarm-therapist-guide/

Disqualifying The Positive

This Disqualifying the Positive information handout forms part of the cognitive distortions series, designed to help clients and therapists work more ... https://www.psychologytools.com/resource/disqualifying-the-positive/

What Keeps Body Dysmorphic Disorder (BDD) Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-body-dysmorphic-disorder-bdd-going/

Am I Experiencing Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder (OCD) is a condition characterized by the presence of persistent obsessions, compulsions, or both. Am I Experiencing Obs ... https://www.psychologytools.com/resource/am-i-experiencing-obsessive-compulsive-disorder-ocd/

Avoidance Hierarchy (Archived)

NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are ava ... https://www.psychologytools.com/resource/avoidance-hierarchy/

Understanding Body Dysmorphic Disorder

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-body-dysmorphic-disorder/

Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD: Veale, 2004)

Individuals with body dysmorphic disorder (BDD) experience distress associated with their body image. The Cognitive Behavioral Model Of Body Dysmorphi ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-body-dysmorphic-disorder-bdd-veale-2004/

Urges – Self-Monitoring Record

The Urges – Self-Monitoring Record worksheet is designed to help clients capture information about their urges and cravings. It includes columns to ... https://www.psychologytools.com/resource/urges-self-monitoring-record/

What Is Body Dysmorphic Disorder (BDD)?

Many people have concerns about how they look, but significant and persistent worry about one's appearance may be a sign of body dysmorphic disorder ( ... https://www.psychologytools.com/resource/what-is-body-dysmorphic-disorder-bdd/

Jumping To Conclusions

The Jumping to Conclusions information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more ef ... https://www.psychologytools.com/resource/jumping-to-conclusions/

Personalizing

The Personalizing information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/personalizing/

Links to external resources

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

Assessment

  • Obsessive Beliefs Questionnaire (OBQ-44) | Obsessive Compulsive Cognition Working Group | 2001
    • Scale
    • Obsessive Compulsive Cognition Working Group. (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behaviour Research and Therapy, 39, 987–1006.

OCD

Guides and workbooks

  • What you need to know about OCD | International OCD Foundation (IOCDF)
  • Managing obsessive compulsive disorder | Simon Enright
  • Obsessive compulsive disorder: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD)
  • OCD: An OCD-UK Information Guides For People Affected By Obsessive Compulsive Disorder | OCD-UK
  • Self-Help: Managing Your OCD At Home | Anxiety Canada

Information Handouts

  • "Just Right" OCD Symptoms | IOCDF | 2009
  • What are postpartum and perinatal OCD? | IOCDF

Information (Professional)

Presentations

  • Cognitive behavioral therapy for OCD | Sabine Wilhelm
  • New directions in implementing exposure and response prevention: an inhibitory learning perspective | Jonathan Abramowitz | 2018
  • Cognitive Therapy for Contamination-Related OCD: ERP and Beyond | Adam Radomsky | 2011
  • Interoceptive exposure: an underused weapon in the arsenal against obsessions and compulsions | Jonathan Abramowitz | 2018
  • Family affair: involving a partner or spouse in exposure and response prevention for OCD | Jonathan Abramowitz | 2018
  • A couple-based approach to CBT for BDD | Lillian Reuman, Jonathan Abramowitz | 2016
  • Body dysmorphic disorder | David Veale | 2017

Treatment Guide

  • NICE Guidelines For OCD and BDD | NICE | 2005
  • Treatment of patients with OCD | American Psychiatric Association (APA) | 2007
  • Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014
  • A psychological perspective on hoarding – DCP good practice guidelines | Holmes, S., Whomsley, S., Kellet S. | 2015
  • Treatment Manual For OCD | Clinical Research Unit for Anxiety Disorders (CRUFAD) | 2010

Recommended Reading

BDD

  • Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image ,1, 113-125

OCD

  • Gillihan, S., Williams, M. T., Malcoun, E., Yadin, E., Foa, E. B. (2012) Common pitfalls in exposure and response prevention (EX/RP) for OCD. Journal of Obsessive-Compulsive and Related Disorders, 1, 251-257
  • Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793-802
  • Mataix-Cols, D., et al (2010). Hoarding disorder: A new diagnosis for DSM-V? Depression and Anxiety, 27, 556-572.
  • Salkovskis, P. (1999). Psychological treatment of obsessive–compulsive disorder. Behaviour Research and Therapy, 37, S37-S52
  • Salkovskis, P. M. (2007). Psychological treatment of obsessive–compulsive disorder.Psychiatry,6(6), 229-233
  • Veale, D. (2007). Cognitive behavioural therapy for obsessive compulsive disorder. Advances in Psychiatric Treatment. 13, 438-446
  • Veale, D., Freeston, M., Krebs, G., Heyman, I., & Salkovskis, P. (2009). Risk assessment and management in obsessive–compulsive disorder. Advances in psychiatric treatment, 15(5), 332-343.

BDD

  • Danesh, M., Beroukhim, K., Nguyen, C., Levin, E., & Koo, J. (2015). Body dysmorphic disorder screening tools for the dermatologist: A systematic review.Pract Dermatol,2, 44-49.
  • Krebs, G., de la Cruz, L. F., & Mataix-Cols, D. (2017). Recent advances in understanding and managing body dysmorphic disorder. Evidence-Based Mental Health, 20(3), 71-75.

OCD

  • Doron, G., & Derby, D. (2015). Assessment and treatment of relationship-related OCD symptoms (ROCD): a modular approach. Handbook of Obsessive-Compulsive Disorder across the Lifespan. Hoboken, NJ: Wiley (Forthcoming).

BDD

  • Veale, D. (2001). Cognitive-behavioural therapy for body dysmorphic disorder. Advances in Psychiatric Treatment, 7, 125-132
  • Assessment and treatment of relationship-related OCD symptoms | Guy Doron, Danny Derby | 2017

OCD

  • Clark, D. A., & Rhyno, S. (2005). Unwanted intrusive thoughts in nonclinical individuals. Intrusive thoughts in clinical disorders: Theory, research, and treatment, 1-29

What Is Obsessive Compulsive Disorder?

Signs and Symptoms of OCD

People with OCD experience obsessional thoughts, images, urges, and doubts. They often feel compelled to act or think in certain ways.

Obsessions are intrusive thoughts—thoughts that are unwanted and unacceptable, and which pop into our minds unbidden. Obsessions can be thoughts in the form of words, but also of images (pictures in our minds), urges or impulses, or feelings of doubt. Obsessive thoughts are experienced as unacceptable, disgusting, or senseless, and people with OCD find it hard not to pay attention to them. Examples of obsessions include:

  • thoughts such as ‘My hands have been contaminated with germs’ or ‘Perhaps I am a pedophile’
  • images of my family being murdered
  • doubts such as ‘Have I left the stove on?’
  • urges such as wanting to shout profanities

Compulsions follow from the way in which the individual interprets the intrusive thoughts. Compulsions are the reactions or mental actions that a person does in order to neutralize or ‘make safe’ following an obsession. People with OCD typically carry out compulsions in order to prevent a harm from happening for which they might be responsible, and/​or to reduce any strong emotion which they feel. Exactly what someone with OCD may feel compelled to do will depend upon the meaning their intrusions have for them. Examples of compulsions might include:

  • carefully washing food after having an intrusive thought about germs;
  • calling family members to check they are OK after having an intrusive image about their deaths;
  • going back to the house to check after doubting whether the stove was turned off;
  • avoiding a public place after having an urge to shout profanities.

Prevalence of OCD

The lifetime prevalence rate of OCD in the United States is estimated to be 2.3% in adults (Kessler et al., 2005), and 1% to 2.3% in children and adolescents (Zohar, 1999).

Psychological Models and Theory of OCD

The cognitive behavioral theory of OCD proposes that when someone experiences an intrusive thought it is the appraisal—what they make of having the thought—that is most important (Salkovskis, Forrester, & Richards, 1998). Intrusive thoughts, even very unpleasant ones, are common and entirely normal. What seems to happen in OCD is that the fact of having intrusive thoughts is interpreted as being especially significant and, as a result, is especially anxiety-provoking. People with OCD are more likely to feel especially responsible for any potential harms and may feel especially strong emotion should they have intrusive thoughts about harm occurring. Compulsions are understood to be an active attempt to reduce harm. According to the cognitive model of OCD targets for intervention include:

  • understanding and addressing the meaning of the intrusions;
  • targeting compulsions and safety-seeking behaviors;
  • modifying attentional biases.

Evidence-Based Psychological Approaches for Working with OCD

Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment for OCD. Historically, CBT for OCD has involved the behavioral approach of exposure with response prevention (ERP). More cognitive approaches within CBT attempt to understand the patient’s appraisal of their intrusions and to find ways of exploring the validity and consequences of these appraisals.

Resources for Working with OCD

Psychology Tools resources available for working therapeutically with OCD may include:

  • psychological models of obsessive-compulsive disorder (OCD)
  • information handouts for obsessive-compulsive disorder (OCD)
  • exercises for obsessive-compulsive disorder (OCD)
  • CBT worksheets for obsessive-compulsive disorder (OCD)
  • self-help programs for obsessive-compulsive disorder (OCD)

References

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
  • Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53–63.
  • Zohar, A. H. (1999). The epidemiology of obsessive-compulsive disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 8(3), 445–460.