Environmental and psychosocial factors are of major importance in any mental disorders. In the context of multiaxial diagnostic evaluation, such as is recommended by the guidelines for child and adolescent psychiatry (see under the heading “Diagnosis and differential diagnosis”), these should be considered in every examination. Environmental factors are also considered in the behavioral analysis, which includes aspects of life history and, in particular, interactional and subjective aspects. In the context of the therapeutic process they are continually newly evaluated and included in decision making. Within the chapter “The course of early-onset obsessive-compulsive disorder” we point out the importance of psychosocial factors, which we also investigated in our own study (particularly with a view of the prognostic relevance). There are currently no systematic studies that show that trauma or particular educational styles are increasingly the cause of obsessive-compulsive disorders in children and adolescents. Trauma seems to have a bigger role if a patient is older when s/he develops OCD.
Regarding psychoanalytic therapy, hardly any meaningful scientific studies exist, and therefore no conclusions can be drawn regarding the evidence level. We think it is important that the course is more favorable the earlier evidence based therapies are started.
Regarding cognitive-behavioral approaches and including the patient’s life history and family, the child’s “psyche” and “soul” is of course at the center, it’s just the nomenclature that is different. We see the whole child in its respective life relationships, not only its behavior, body, or soul. Furthermore, the treatment always includes the primary attachment figure.
Prof. Dr. med. Dipl.-Psych. Susanne Walitza
Zentrum für Kinder- und Jugendpsychiatrie, Universität Zürich
Conflict of interest statement
Professor Walitza has received honoraria for further medical educational events from Janssen-Cilag and AstraZeneca.
|1.||Walitza S, Melfsen S, Jans T, Zellmann H, Wewetzer C, Warnke A: Obsessive-compulsive disorder in children and adolescents. Dtsch Arztebl Int 2011; 108(11): 173–9. VOLLTEXT|