BODY DYSMORPHIC DISORDER IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE AND CLINICAL CORRELATES

Background The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.

History of Maltreatment and Psychiatric Impairment in Children in Outpatient Psychiatric Treatment

There is increasing evidence that childhood victimization and attachment disruptions impact a child’s development. In this study, children and adolescents from an outpatient psychiatric clinic were assessed, measuring history of trauma, history of out-of-home placement, initial diagnoses, and CBCL internalizing and externalizing problem scores. Multiple regression analyses showed that both violent abuse trauma (physical/sexual abuse) and victim trauma (physical abuse/sexual abuse/witnessing domestic violence/witnessing community violence) are prevalent among patients with externalizing severity problems; concluding that diagnosis alone may not account for a history of victimization, but externalizing problem severity does. Overall, the study is consistent with past literature that it is important to acknowledge a child’s history of maltreatment and out-of-home placement when understanding their psychiatric development and diagnosis.

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.

Corrélats neuronaux du circuit des récompenses chez les jeunes à risque parental de troubles de l'humeur

Cette thèse a pour objectif l’investigation du circuit des récompenses, sur les plans comportementaux et neuronaux, chez des adolescents à risque parental élevé de dépression majeure et de trouble bipolaire, en comparaison à des jeunes à risque parental peu élevé. Plus précisément, le but est d’identifier des marqueurs comportementaux et neuronaux du risque de développer une dépression majeure ou un trouble bipolaire, afin d’être en mesure de détecter et de prévenir ces troubles le plus tôt possible pour éviter, ou du moins retarder, leur émergence. Pour ce faire, nous avons réalisé deux études, présentées ici dans deux articles empiriques. Dans le premier article, le fonctionnement comportemental et neuronal du circuit des récompenses a été investigué au moyen d’une tâche d’anticipation et d’obtention de gains et de pertes monétaires, chez des adolescents à risque parental de dépression majeure (i.e., jeunes asymptomatiques dont un des parents souffre de dépression majeure), des adolescents à risque parental de trouble bipolaire (i.e., jeunes asymptomatiques dont un des parents souffre de trouble bipolaire) et des adolescents contrôles (i.e., jeunes asymptomatiques dont les deux parents sont en bonne santé mentale). Au niveau comportemental, les résultats ont révélé une meilleure performance chez les jeunes à risque de dépression majeure lorsqu’ils devaient éviter d’obtenir des pertes monétaires de magnitude variée (0,20$, 1$ ou 5$), ainsi qu’une meilleure performance chez les jeunes à risque de trouble bipolaire sur les essais impliquant d’éviter des pertes monétaires de magnitude nulle (0$). Au niveau neuronal, les jeunes à risque de dépression majeure démontraient une diminution de l’activation du cortex préfrontal dorsolatéral lors de l’anticipation de potentielles pertes monétaires de magnitude variée, tandis que les jeunes à risque de trouble bipolaire démontraient une diminution de l’activation du cortex préfrontal dorsolatéral lors de l’anticipation de potentielles pertes monétaires de magnitude nulle. De plus, les jeunes à risque de dépression majeure tendaient à démontrer une augmentation de l’activité du cortex orbitofrontal durant l’évitement réussi de pertes monétaires, tandis que les jeunes à risque de trouble bipolaire tendaient à démontrer une augmentation de l’activité du cortex orbitofrontal lors de l’obtention de pertes monétaires. Dans le deuxième article, l’intégrité structurelle des régions fronto-limbiques a été investiguée, au moyen de mesures du volume, de l’épaisseur corticale et de la superficie corticale. Les résultats ont mis en évidence, chez les jeunes à risque de trouble bipolaire, un volume plus élevé du cortex préfrontal dorsolatéral, par rapport aux jeunes à risque de dépression majeure et contrôles. De plus, les jeunes à risque de trouble bipolaire présentaient un volume plus élevé du cortex cingulaire postérieur, en comparaison aux jeunes à risque de dépression majeure. Enfin, une diminution de l’épaisseur corticale du cortex orbitofrontal et du gyrus frontal moyen a été observée chez les adolescents à risque de trouble bipolaire, en comparaison au groupe contrôle. L’ensemble de ces résultats démontre ainsi l’existence de particularités comportementales et d’altérations neuronales sur les plans fonctionnel et structurel, chez des jeunes à risque élevé de troubles de l’humeur, et ce, avant même l’émergence des premiers symptômes thymiques. Plus particulièrement, ces caractéristiques pourraient constituer des marqueurs du risque de développer un trouble de l’humeur. Par conséquent, ces marqueurs pourraient aider à mieux identifier les jeunes qui sont le plus à risque de développer un trouble de l’humeur, et ainsi permettre la mise en place précoce de stratégies préventives adaptées, afin d’éviter des trajectoires développementales psychopathologiques.

Corrélats neuronaux du circuit des récompenses chez les jeunes à risque parental de troubles de l'humeur

Cette thèse a pour objectif l’investigation du circuit des récompenses, sur les plans comportementaux et neuronaux, chez des adolescents à risque parental élevé de dépression majeure et de trouble bipolaire, en comparaison à des jeunes à risque parental peu élevé. Plus précisément, le but est d’identifier des marqueurs comportementaux et neuronaux du risque de développer une dépression majeure ou un trouble bipolaire, afin d’être en mesure de détecter et de prévenir ces troubles le plus tôt possible pour éviter, ou du moins retarder, leur émergence. Pour ce faire, nous avons réalisé deux études, présentées ici dans deux articles empiriques. Dans le premier article, le fonctionnement comportemental et neuronal du circuit des récompenses a été investigué au moyen d’une tâche d’anticipation et d’obtention de gains et de pertes monétaires, chez des adolescents à risque parental de dépression majeure (i.e., jeunes asymptomatiques dont un des parents souffre de dépression majeure), des adolescents à risque parental de trouble bipolaire (i.e., jeunes asymptomatiques dont un des parents souffre de trouble bipolaire) et des adolescents contrôles (i.e., jeunes asymptomatiques dont les deux parents sont en bonne santé mentale). Au niveau comportemental, les résultats ont révélé une meilleure performance chez les jeunes à risque de dépression majeure lorsqu’ils devaient éviter d’obtenir des pertes monétaires de magnitude variée (0,20$, 1$ ou 5$), ainsi qu’une meilleure performance chez les jeunes à risque de trouble bipolaire sur les essais impliquant d’éviter des pertes monétaires de magnitude nulle (0$). Au niveau neuronal, les jeunes à risque de dépression majeure démontraient une diminution de l’activation du cortex préfrontal dorsolatéral lors de l’anticipation de potentielles pertes monétaires de magnitude variée, tandis que les jeunes à risque de trouble bipolaire démontraient une diminution de l’activation du cortex préfrontal dorsolatéral lors de l’anticipation de potentielles pertes monétaires de magnitude nulle. De plus, les jeunes à risque de dépression majeure tendaient à démontrer une augmentation de l’activité du cortex orbitofrontal durant l’évitement réussi de pertes monétaires, tandis que les jeunes à risque de trouble bipolaire tendaient à démontrer une augmentation de l’activité du cortex orbitofrontal lors de l’obtention de pertes monétaires. Dans le deuxième article, l’intégrité structurelle des régions fronto-limbiques a été investiguée, au moyen de mesures du volume, de l’épaisseur corticale et de la superficie corticale. Les résultats ont mis en évidence, chez les jeunes à risque de trouble bipolaire, un volume plus élevé du cortex préfrontal dorsolatéral, par rapport aux jeunes à risque de dépression majeure et contrôles. De plus, les jeunes à risque de trouble bipolaire présentaient un volume plus élevé du cortex cingulaire postérieur, en comparaison aux jeunes à risque de dépression majeure. Enfin, une diminution de l’épaisseur corticale du cortex orbitofrontal et du gyrus frontal moyen a été observée chez les adolescents à risque de trouble bipolaire, en comparaison au groupe contrôle. L’ensemble de ces résultats démontre ainsi l’existence de particularités comportementales et d’altérations neuronales sur les plans fonctionnel et structurel, chez des jeunes à risque élevé de troubles de l’humeur, et ce, avant même l’émergence des premiers symptômes thymiques. Plus particulièrement, ces caractéristiques pourraient constituer des marqueurs du risque de développer un trouble de l’humeur. Par conséquent, ces marqueurs pourraient aider à mieux identifier les jeunes qui sont le plus à risque de développer un trouble de l’humeur, et ainsi permettre la mise en place précoce de stratégies préventives adaptées, afin d’éviter des trajectoires développementales psychopathologiques.

The development of preferences for specific body shapes

Research with adults has shown a preference for average-weight female figures with waist-to-hip ratios (WHR) of 0.7, and average weight male figures with waist-to-hip ratios of 0.9. This study investigated the development of preferences for WHR sizes as well as preferences for specific body weights. Five-hundred eleven children ranging in age from 6 to 17 were presented with drawings of 12 male and 12 female silhouettes varying in weight and WHR and asked to select one they thought looked the nicest or most attractive. The youngest children showed preferences for the underweight figures, changing to consistent preferences for the average weight figures in the teenage years. The developmental curves for waist-to-hip ratio preferences were linear, changing gradually over time to become more adult-like. Potential developmental models for the development of preferences for specific body shapes are considered in relation to these data.

Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression

Supervision of psychotherapists and counselors, especially in the early years of practice, is widely accepted as being important for professional development and to ensure optimal client outcomes. Although the process of clinical supervision has been extensively studied, less is known about the impact of supervision on psychotherapy practice and client symptom outcome. This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. The authors randomly assigned 127 clients with a diagnosis of major depression to 127 supervised or unsupervised therapists to receive eight sessions of problems-solving treatment. Supervised therapists were randomly assigned to either alliance skill- or alliance process-focused supervision and received eight supervision sessions. Before beginning treatment, therapists received one supervision session for brief training in the working alliance supervision approach and in specific characteristics of each case. Standard measures of therapeutic alliance and symptom change were used as dependent variables. The results showed a significant effect for both supervision conditions on working alliance from the first session of therapy, symptom reduction, and treatment retention and evaluation but no effect differences between supervision conditions. It was not possible to separate the effects of supervision from the single pretreatment session and is possible that allegiance effects might have inflated results. The scientific and clinical relevance of these findings is discussed.

Patterns of diagnostic comorbidity in children and adolescents with anxiety

Comorbidity is defined as the co-occurrence of two or more psychological disorders and has been identified as one of the most pressing issues facing child psychologists today. Unfortunately, research on comorbidity in anxious children is rare. The purpose of this research was to examine how specific comorbid patterns in children and adolescents referred with anxiety disorders affected clinical presentation. In addition, the effects of gender, age and total number of diagnoses were also examined.^ Three hundred fifty-five children and adolescents (145 girls and 210 boys, hereafter referred to as "children") aged 6 to 17 who presented to the Child Anxiety and Phobia Program during the years 1987 through 1996 were assessed through a structured clinical interview administered to both the children and their families. Based on information from both children and parents, children were assigned up to five DSM diagnoses. Global ratings of severity were also obtained. While children were interviewed, parents completed a number of questionnaires pertaining to their child's overall functioning, anxiety, thoughts and behaviors. Similarly, while parents were interviewed, children completed a number of self-report questionnaires concerning their own thoughts, feelings and behaviors.^ In general, children with only anxiety disorders were rated as severe as children who met criteria for both anxiety and externalizing disorders. Children with both anxiety and externalizing disorders were mostly young (i.e. age 6 through 11) and mostly male. These children tended to rate themselves (and be rated by their parents) equally as anxious as children with only anxiety disorders. Global ratings of severity tended to be associated with the type of comorbid pattern versus the number of diagnoses assigned to a child. The theoretical, development and clinical implications of these findings will be discussed. ^

Perceptions of family environment, body image and self-esteem of eating disordered and non-eating disordered women

This study explored the perceptions of family environment, body image and self esteem of women who suffer from anorexia nervosa, bulimia nervosa, and depression. Using a nonequivalent control group design, one hundred and fifty women with anorexia nervosa (n = 50), bulimia nervosa (n = 50), and depression (n = 50) were given the Family Environment Scale (FES) and the Eating Disorders Inventory-2 (EDI-2). The objectives of this study were to: (1) study how women with anorexia nervosa and bulimia nervosa perceive their family environment as measured by the FES; (2) compare and contrast perceptions of family environment of women with anorexia nervosa and bulimia nervosa with the control group; (3) compare and contrast perceived levels of self esteem and body image as measured by the EDI-2 of women with anorexia nervosa and bulimia nervosa with the control group; and (4) examine the perceived family environments of eating disordered and non-eating disordered women with regard to body image and self esteem. Results suggested, women who suffered from anorexia nervosa or bulimia nervosa scored significantly lower (p $<$.021) on the Expressiveness, Intellectual-Cultural Orientation, and Active-Recreational subscales of the FES. The results also indicated that women who suffered from bulimia nervosa scored significantly higher (p $<$.015) than women who suffered from anorexia nervosa on the Conflict and Independence subscales of the FES. The results of studying these three populations reflected that women who suffered from anorexia nervosa scored significantly different (p $<$.000) than women who suffered from bulimia nervosa on many of the subscales of the EDI-2. The findings of the study confirmed that women who suffered from anorexia nervosa or bulimia nervosa scored significantly different (p $<$.000) on the subscales of the EDI-2 compared to women who suffered from depression. It was also confirmed that a relationship does exist between perceptions of body image and self esteem and perceptions of family environment amongst women with anorexia nervosa and bulimia nervosa as compared to depressed women. The findings of the study indicated that women who suffered from anorexia nervosa tended to: be less expressive and independent; handle conflict less openly; have a greater drive for thinness; have greater body dissatisfaction; be more perfectionistic; and struggle more intensely with fears around maturity and social insecurity than did women who suffered from bulimia nervosa or depression. In addition, the findings of the study also suggested that women who suffered from bulimia nervosa tended to: be raised in homes where openly expressed anger is permitted amongst family members; have a lesser drive for thinness; have less body dissatisfaction; be less perfectionistic; and not struggle as intensely with fears around maturity and social insecurity as do women who suffered from anorexia nervosa, but more than women who suffer from depression. Treatment implications that may assist community college professors and counselors in meeting the special needs of this special group of women were also discussed. (Abstract shortened by UMI.) ^

Assessment of anxiety sensitivity in depressed, older patients and its relation to hypochondriacal concerns

Anxiety disorders in older adults are often overlooked as part of other mental disorders or as part of medical illnesses. Theoretically, anxiety sensitivity is a common component in anxiety disorders, a personality construct and a fundamental fear. Anxiety sensitivity was assessed in a sample of older adults: 53 depressed, M age = 78.8 years; and 53 healthy controls, M age = 70.9 years. This study examined whether anxiety sensitivity: (1) explained unique variance beyond that explained by trait anxiety, (2) was observed in the depressed group in levels similar to individuals who suffer from non-panic, anxiety disorders, and (3) correlated with current number of medical illnesses, previous number of medical illnesses, and hypochondriasis. The results indicated that anxiety sensitivity: predicted hypochondriasis better than trait anxiety, was present in the depressed group similarly to individuals suffering from non-panic, anxiety disorders, and was strongly associated with hypochondriacal concerns. ^

Fostering the development of identity and intimacy during late adolescence

This dissertation tested the effectiveness of a psychosocial intervention, the Personal Development in the Context of Relationships (PDCR) program. The aim of the PDCR seeks to foster the development (or enhancement) of a sense of identity and intimacy among adolescents who participate in the program. The PDCR is a psychosocial group intervention which utilizes interpersonal relationship issues as a context to foster personal development in identity formation and facilitate the development of an individual's capacity for intimacy. The PDCR uses intervention strategies which include skills and knowledge development, experiential group exercises, and exploration for insight. Participants consisted of 110 late adolescents. A mixed-subjects design (pre-post-follow up) was used to assess the effectiveness, efficacy and utility of the PDCR on the experimental condition relative to a content/social contact control group and a time control condition. Identity exploration and identity commitment were measured by the Ego Identity Process Questionnaire (EIPQ). Total intimacy and identity role satisfaction were measured by the Erikson Psychosocial Stage Inventory (EPSI). Relationship quality and closeness were measured by the Relationship Quality Scale (RQS) and the Relationship Closeness Inventory (RCI) in an effort to assess whether any potential impact on interpersonal relationships occurs. Mixed MANOVAs were used to analyze the data with results yielding significant values for increased total identity exploration from pre to post test and decreases in total identity commitment from pre to post to follow-up test in the experimental group relative to the control conditions on the EIPQ. Further results indicated increases in total intimacy from pre to post to follow-up test in the experimental group relative to the control conditions on the EPSI. No clear trends emerged from pre to post to follow-up test for the Relationship measures. Results are discussed in terms of both practical and theoretical implications. ^

Salient factors in child molestation: Moral development, social competence, and type of offender

The current study was designed to build on and extend the existing knowledge base of factors that cause, maintain, and influence child molestation. Theorized links among the type of offender and the offender's levels of moral development and social competence in the perpetration of child molestation were investigated. The conceptual framework for the study is based on the cognitive developmental stages of moral development as proposed by Kohlberg, the unified theory, or Four-Preconditions Model, of child molestation as proposed by Finkelhor, and the Information-Processing Model of Social Skills as proposed by McFall. The study sample consisted of 127 adult male child molesters participating in outpatient group therapy. All subjects completed a Self-Report Questionnaire which included questions designed to obtain relevant demographic data, questions similar to those used by the researchers for the Massachusetts Treatment Center: Child Molester Typology 3's social competency dimension, the Defining Issues Test (DIT) short form, the Social Avoidance and Distress Scale (SADS), the Rathus Assertiveness Schedule (RAS), and the Questionnaire Measure of Empathic Tendency (Empathy Scale). Data were analyzed utilizing confirmatory factor analysis, t-tests, and chi-square statistics. Partial support was found for the hypothesis that moral development is a separate but correlated construct from social competence. As predicted, although the actual mean score differences were small, a statistically significant difference was found in the current study between the mean DITP scores of the subject sample and that of the general male population, suggesting that child molesters, as a group, function at a lower level of moral development than does the general male population, and the situational offenders in the study sample demonstrated a statistically significantly higher level of moral development than the preferential offenders. The data did not support the hypothesis that situational offenders will demonstrate lower levels of social competence than preferential offenders. Relatively little significance is placed on this finding, however, because the measure for the social competency variable was likely subject to considerable measurement error in that the items used as indicators were not clearly defined. The last hypothesis, which involved the potential differences in social anxiety, assertion skills, and empathy between the situational and preferential offender types, was not supported by the data. ^

Anxiety sensitivity in children and the development of panic and anxiety in adolescents: A prospective study

Research with adult samples has identified a cognitive risk factor for the development of panic and other anxiety disorders in the concept of anxiety sensitivity. The research to date on anxiety sensitivity in children, using the Childhood Anxiety Sensitivity Index (CASI), suggests that the CASI may help to garner knowledge regarding the development of anxiety sensitivity and also help to understand the development of panic attacks, panic disorder and other anxiety disorders in youth. To examine the development of anxiety sensitivity and its relation to panic in youth, data were collected on 44 children in 1998 who were administered the CASI in 1991. Results indicated that children whose CASI scores increased from Time 1 to Time 2 were significantly more likely to report experiencing panic attacks than children whose CASI scores decreased from Time 1 to Time 2. Specifically, 64% (9/14) of children whose CASI scores increased from Time 1 to Time 2 reported having one or more panic attacks versus 36% (5/14) reported having none. Moreover, 72% (21/29) of children whose CASI scores decreased from Time 1 to Time 2 reported no panic attacks. These results suggest that childhood may be the time when anxiety sensitivity as a risk factor for panic and panic disorder is developing. Results are discussed in terms of their relevance for understanding the development of panic and the need for further research to determine the generalizability of these findings in larger samples of children followed over different time spans. ^

Parental behaviors in child anxiety: An observational study

The increasing awareness of the prevalence, impairment, and long-term consequences of childhood anxiety disorders have led investigators to explore psychosocial factors in the etiology of these disorders. Recent investigations have begun to focus on family-level processes in the etiology and/or maintenance of childhood anxiety disorders, specifically patterns of parent-child interaction. The present study compared parent-child interactions across three problem-solving tasks of clinically anxious children and their mothers versus non-referred children and their mothers in terms of (1) direct observation measures, (2) children's, mothers', and independent observer's subjective ratings, (3) and children's evaluations using videotape-aided thought reconstruction. ^ Results suggested that the mothers of clinically anxious children engaged in fewer positive and more negative parenting strategies as compared to the mothers of non-referred children across three tasks. Although not significant, trends were evident among the subjective ratings reported by the clinically anxious children, mothers, and observer for the global perception indices. When videotape-aided thought reconstruction was used as a cue to elicit children's perceptions of the parent-child interactions, clinically anxious children reported less mother-referent positive statements and more mother-referent negative statements than non-referred children. ^