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Parent-child interaction and OCD vulnerability

Guy Doron

Perceived parent-child interactions have been long linked with anxiety difficulties (e.g., Arrindell, Emmelkamp, Monsma, & Brilman, 1983) and vulnerability to psychopathology closely associated with OCD such as depression (e.g., Alloy et al., 2001; 2004), however, research into the specific role of parenting in OCD is scarce and results have been largely equivocal. Ehiobuche (1988) found that students with high scores on an obsessionality scale reported their parents to be more rejecting, more overprotective, and less emotionally warm compared with students with low obsessional scores. However, the presence of depressive symptoms and other anxiety symptoms was not accounted for in this study. Cavedo and Parker (1994) found a small but significant correlation between parental overprotection and obsessional symptoms in a student sample. These relationships were generally maintained when statistically controlling for levels of depression and anxiety. In another student sample, Trautmann (1994) reported correlations in the small to moderate range between OC symptoms and parental over-protectiveness and both anxious and avoidant attachment. In an outpatient adult cohort, Nordahl and Stiles (1997) reported that obsessive compulsive personality disorder was associated with higher levels of parental overprotection and lower levels of parental care. However, Parker et al. (1997) found that OCD and Generalized Anxiety Disorder (GAD) were not significantly associated with abnormal patterns of parenting, whereas Panic Disorder and Social Phobia were generally associated with higher levels of protection and control. Others (e.g., Merkel, Pollard, Wiener, & Staebler, 1993; Turgeon, O'Connor, Marchand, & Freeston, 2002; Vogel, Stiles, & Nordahl, 1997) have also found little evidence of specificity in perceived parenting variables in OCD patients compared with other anxiety disorders and depression.

Further to the methodological limitations of retrospectivity and the possible consequent contamination of results by recall biases (reviewed in Gerlsma, Emmelkamp, & Arrindell, 1990), most studies of the relationship between parenting and OCD have been fraught with additional measurement issues. Specifically, parenting measures may lack the relevant focus that is important to OCD. While Guidano and Liotti (1983) propose that individuals who experience confusing and ambivalent patterns of attachments with their parents maintain a risk of developing obsessional problems, such notions are not generally assessed by existing parenting measures.

According to Guidano & Liotti (1983), ambivalent attachments are characterized as insecure parent-child transactions, where children are uncertain of the degree to which they are loved, wanted or worthy. According to this theory, these attachment contexts lead to the concurrent experience of both validation and rejection, and result in difficulties integrating opposing self-perceptions as wanted/lovable or unwanted/unlovable. The insecure or ambivalent self worth further results in chronic self-monitoring and ruminations about one's relation to others. Perfectionism and compulsive behaviors emerge as means for securing approval and unifying one's self-perceptions as a worthy and lovable individual. Initial results with a student sample from an ongoing research program, using measures sensitive to the parenting styles identified by Guidano & Liotti (1983), have supported the role of ambivalent parenting styles and attachment in OC symptoms (Bhar et al., 1997). Support with clinical cohorts is only just emerging (Kyrios, Frost, Steketee & Moga, 2005).

More recently, Salkovskis et al., (1999) suggested several pathways for the development of the underlying beliefs associated with OCD. For instance, rigid parenting patterns with extreme codes of duty and conduct, as well as parenting styles that encourage implicitly and/or explicitly the importance of responsibility for reducing threat were argued to increase the likelihood for the development of OC-related cognitive beliefs. Again, valid and reliable measures assessing such parenting styles are yet to be developed. Hence, until such parenting measures have been validated, it is worthwhile to focus on the effects of negative parenting styles on the individuals using validated measures (e.g., adult attachment measures). The relationship between specific parenting and such perceptions can then be examined.

The present thesis proposes that self-perceptions are influenced by early attachment experiences, whereby impaired early child-caregiver interactions lead to the development of impaired representations of the self and the world that hamper the later assimilation of new experiences into self-knowledge. Such dysfunctional representations result in stereotyped and repetitious interactions with reality. Parenting variables that lead to an individual's over-reliance on certain aspects of self (i.e., a self-concept comprising relatively few domains that are "sensitive") coinciding with the belief that the world is controllable but threatening may be unique to OCD. However, there has been little empirical examination of such suppositions.

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