Il ruolo della famiglia nella genesi e nel trattamento del Disturbo Ossessivo-Compulsivo nell’infanzia: la prospettiva cognitivo-comportamentale

The role of family in the development and treatment of obsessive compulsive disorders: The cognitive behavioral perspective. It is widely recognized that specific parental attitudes and parental style defined by high expressed emotion (Renshaw et al., 2003), overprotection, overcontrol (Alonso et al., 2004), low affection (Alonso et al., 2004) and low support (Valleni-Basile et al., 1996) can influence obsessive compulsive disorders in children (Waters, Barrett, 2000). It has also been underlined that the family involvement in the patient’s rituals tends to perpetuate and reinforce the child’s obsessive compulsive symptoms (Cooper, 1996; Geller, MBBS, FRACP, 2006). As a consequence, cognitive behavioural family treatment is largely suggested for these patients (Pollock, Carter, 1999). In this treatment both parents and children attend separate group sessions and some concurrent family therapy (Mendlowitz et al., 1999). Overall, the treatment literature reveals that a substantial percentage of patients remains symptomatic post-treatment (POTS, 2004). In order to improve treatment for children with obsessive compulsive disorders, several studies identified personal and family predictors of response to treatment (Ginsburg, Kingery, Drake, Grados, 2008; Keeley, Storch, Merlo, Geffken, 2008). Results displayed that family attitudes defined by high expressed emotion (Leonard et al.,1993), hostile criticism, emotional overinvolvement (Chambless, Steketee, 1999) and high family accommodation were associated with greater dropout and/or poor cognitive behavioural treatment outcome for children with obsessive compulsive disorders (Merlo, Lehmkuhl, Geffken, Storch, 2009;Van Noppen, Steketee, 2003). Clinical implications of these studies are discussed