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Parents’ Perceptions of Internalizing and Externalizing Features in Childhood OCD

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Abstract

Although obsessive–compulsive disorder (OCD) has often been characterized as an internalizing disorder, some children with OCD exhibit externalizing behaviors that are specific to their OCD. This study sought to demonstrate that parents perceive both internalizing and externalizing behaviors in childhood OCD by examining the factor structure of the Child Obsessive–Compulsive Externalizing/Internalizing Scale (COCEIS), a parent-report questionnaire intended to measure these constructs. This study also investigated clinical correlates of internalizing and externalizing factors in the COCEIS. A factor analysis of questionnaire responses from 122 parents of youth with OCD revealed both externalizing and internalizing factors in the COCEIS. Externalizing behaviors in childhood OCD were associated with other, co-occurring externalizing behavior problems, while both factors were positively correlated with OCD severity and co-occurring internalizing symptoms. They were positively associated with each other at a trend level, and neither showed a significant relationship with insight. Sixty-two percent of parents endorsed “often” or “always” to at least one externalizing item, though modal responses to items suggested that each individual feature captured by the COCEIS may be relatively uncommon. Mean responses were significantly greater for internalizing items. This study provides evidence for distinct but related externalizing and internalizing behaviors specific to childhood OCD. Treatment for children with OCD presenting with more externalizing behaviors may require a greater emphasis on behavioral parent training and motivational enhancement.

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Notes

  1. The same factor structure was retained when using an orthogonal (i.e., uncorrelated) rather than oblique rotation.

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Author information

Authors and Affiliations

  1. College of Medicine, University of Florida (UF), 8491 NW 39th Ave, Gainesville, FL, 32606, USA

    Andrew G. Guzick, Danielle L. Cooke & Joseph P. H. McNamara

  2. UF College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL, 32611, USA

    Andrew G. Guzick, Danielle L. Cooke & Joseph P. H. McNamara

  3. UF College of Liberal Arts and Sciences, 945 Center Drive, Gainesville, FL, 32611, USA

    Joseph P. H. McNamara

  4. McLean Hospital, Harvard Medical School, 115 Mill Street, Boston, MA, 02478, USA

    Adam M. Reid

  5. Florida International University, AHC4, Room 459, 121200 SW 8th Street, Miami, FL, 33199, USA

    Paulo A. Graziano

  6. Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, FL, 33701, USA

    Adam B. Lewin & Tanya K. Murphy

  7. Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA

    Wayne K. Goodman & Eric A. Storch

  8. Department of Pediatrics, Texas Children’s Hospital, Houston, TX, 77030, USA

    Eric A. Storch

  9. The Geffken Group, 2833 NW 41 St #140, Gainesville, FL, 32606, USA

    Gary R. Geffken

Authors
  1. Andrew G. Guzick
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  2. Danielle L. Cooke
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  3. Joseph P. H. McNamara
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  4. Adam M. Reid
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  5. Paulo A. Graziano
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  6. Adam B. Lewin
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  7. Tanya K. Murphy
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  8. Wayne K. Goodman
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  9. Eric A. Storch
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  10. Gary R. Geffken
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Correspondence to Andrew G. Guzick.

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Appendix

Appendix

figure a

Scoring guidelines:

Internalizing subscale (COCEIS-I) = sum of items 1, 2, 3, and 10: _____.

Externalizing subscale (COCEIS-E) = sum of items 4, 5, 6, 7, 8, 9, and 11: _____.

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Guzick, A.G., Cooke, D.L., McNamara, J.P.H. et al. Parents’ Perceptions of Internalizing and Externalizing Features in Childhood OCD. Child Psychiatry Hum Dev 50, 692–701 (2019). https://doi.org/10.1007/s10578-019-00873-w

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