Graduation Year

2023

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Curriculum and Instruction

Major Professor

Kathy Bradley-Klug, Ph.D.

Committee Member

Joshua Nadeau, Ph.D.

Committee Member

Shannon Suldo, Ph.D.

Committee Member

John Ferron, Ph.D.

Keywords

Trichotillomania, Tics, OCD, Comorbidity, Health Related Quality of Life

Abstract

Anxiety disorders are one of the most common mental health concerns that affect youth. It is estimated about 9.4% of youth have an anxiety disorder such as panic disorder, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder or specific phobias (CDC, 2022). The present study includes obsessive compulsive disorder and post-traumatic stress disorder as a part of the definition of anxiety disorders. Anxiety disorders can be comorbid with many mental health conditions. The focus of this study was on the comorbidity between anxiety disorders and body-focused repetitive behaviors (BFRBs) and related disorders. BFRBs are behaviors that involve repeated picking, pulling, and biting on areas of the body, marked by difficulty stopping the behavior (APA, 2022). This includes, but is not limited to, disorders such as trichotillomania (hair-pulling disorder) and excoriation disorder (skin-picking disorder). Some youth with anxiety disorders engage in BFRBs to self-regulate negative affective states while others engage in these behaviors throughout many daily activities. There is limited research on BFRBs in youth, and in particular in youth with comorbid anxiety disorders. Therefore, the current study sought to contribute to the literature by examining treatment outcomes for anxious youth with (anxiety + BFRB) and youth without (anxiety) comorbid BFRBs. Data from 5,980 patients who received treatment from a large behavioral health clinic with locations from across the country were included in the study. Patients ranged from 5-17 years of age. Chi-square, t-tests, and mixed model ANOVAs were conducted to compare differences in pre- and post-treatment scores on health related quality of life, depressive symptoms, obsessive compulsive symptoms, health-related quality of life, treatment connectedness and autonomy, trait anxiety, and emotionality. When comparing the anxiety (N=3931) and anxiety and BFRB (comorbid) group (N=2049) statistical differences were seen for all clinical measures from pre- to post-test. This demonstrated that for all patients included in the study, there were treatment related gains. However, there were limited statistically significant differences between the two groups with the exception of CYBOCS Severity. Patients in the comorbid group started with statistically significantly higher scores compared to the anxiety-only group. Additionally, patients with BFRBs were more likely to have symmetry related obsessions compared to patients with only an anxiety disorders. Overall, the study provided further insights into the clinical treatment outcomes related to anxiety disorders comorbid with BFRBs among youth within intensive treatment settings.

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