13) Most of studies in this area investigation the association between SLEs and OCD have held limitations of: (1) small sample sizes; and (2) difficulty of establishing retrospectively the temporal relationship between onset and SLEs; and (3) a limited scope with regard to the effect of SLEs on OCD. (2005; p.13) Cromer relates that "mounting evidence suggests that early life-stress, in particular may preferentially incline individuals to develop adult psychiatric disorders." (2005; p.13) McCauley et al. (1997) states evidence from a large epidemiological investigation that childhood abuse "was related to a large range of physical and psychosocial difficulties." (Cromer, 2005; p. 14) the work of Nemeroff et al. (2004)states findings that there is an association between experiences in childhood and "increased adult psychopathology" which can be explained by the "profound effect early-life experiences have on the developing brain...research indicates that changes in the brain can lead to life-long psychiatric sequelae." (Nemeroff, 2004; as cited in Cromer, 2005; p.14) Nemeroff et al. along with other researchers state implications from both preclinical and clinical investigations that "neurobiological systems, relating the corticotropic releasing factor (CRF) system in the etiology of mood and anxiety disorders." (Cromer, 2005; p. 14) Related is: "In conjunction with the hypothalamic-pituitary-adrenal (HPA) axis, this system represents the major mammalian neuroendocrine stress response system Hypothalamic CRF is released by an organism in response to stress that leads to the stimulation of the HPA axis, which in turn results in the secretion of the adrenocorticotropic hormone (ACTH). ACTH stimulates the secretion of other neuropeptides, which ultimately releases cortisol (Dallman et al., 1994). Through a number of well-executed analogue Nemeroff and colleagues have proposed a neurochemical hypothesis that would explain how early life-stress antecedes psychological disorders, such as anxiety disorders. It is hypothesized that particularly early life-stress leads to neuronal changes that result in the induction of persistently-elevated neuronal releases of CRF. The net effect is an increased responsiveness to stress Several investigations have shown that this increased responsiveness then renders individuals more susceptible to psychopathology in adulthood (Heim & Nemeroff, 2002; as cited in Cromer, 2005; p. 14).Cromer relates the 'biopsychosocial model of psychopathology which is illustrated in the following figure. Biopsychosocial Model of Psychopathology

Source: Cromer (2005)

The findings of Cromer (2005) include those relating that the experience of SLEs "would be more strongly associated with specific OC symptom dimensions (hoarding and obsessions/checking) as SLEs were "significantly correlated with the obsessions/checking and symmetry/ordering symptoms dimensions, as well as the SI-R hoarding dimensions." (p. 27) Cromer relates that the total number of "comorbid disorders was not significantly associated with SLEs" which indicates that the SLEs are closer related to mood and anxiety disorder comorbidty as compared with other comorbid disorders.(p. 28; paraphrased) Cromer states that "alternatively, it may be that SLEs act through a common vulnerability pathway that leads to a comorbidity phenotype of OCD." (2005 p. 28) the third stated possibility is that OCD in combination with SLE "acts as a trigger for the expression of comorbid disorders." (2005; p.29) Cromer relates that the work conducted by Hasler et al. (2005) relates that "neither hoarding, nor the contamination/cleaning symptom dimensions were strongly associated with mood and/or anxiety disorders." (as cited in Cromer, 2005; p.29) Cromer additionally relates that when comparing individuals experiencing SLE in childhood or adulthood that these individuals "differed significantly from those who reported no SLEs in mood and anxiety disorder comorbidity." (p. 29) These findings partially corroborate evidence from neurobiological investigations relating to hyperactivation of the CRF system nd the HPA axis" (Cromer, 2005; p. 30) in the work of Memeroff (2004).

The work of Bechtel and Ts'erts'man entitled: "The Handbook of Environmental Psychology" states the fact that hoarding behavior is not related to material deprivation with researchers making suggestion of a model that conceptualizes hoarding as an "avoidance behavior tied to indecision and perfectionism." (Bechtel and Ts'erts'man, 2002) Furthermore, sexual abuse "whether it occurs in childhood or adulthood has been a major source of post-traumatic stress disorder and has the focus of an extensive body of research..." which relate that "disassociation occurs both peritraumatically - at the time of the event - and posttraumatically - as a long-term consequence of traumatic exposure." (Bechtel and Ts'erts'man, 2002) Symptoms of disassociation that arises from childhood abuse include: "...depersonalization, derealization, dissociative amnesia, fragmentation of identity and posttraumatic re-experiencing phenomena...

The treatment modules are focused on: (1) assessment, (2) model building, (3) treatment planning, (4) skill building, (5) cognitive therapy, and (6) motivational interviewing. (Boston University School of Social Work, 2007)
The work of Beamish and Hill (2007) entitled: "Treatment Outcomes for Obsessive-Compulsive Disorder: A Critical Review" states that "Behavioral therapy is considered the most effective modality for treating OCD. Behavioral approaches to OCD arrests on the assumptions that compulsions are perpetrated through negative reinforcement. The goals of behavior therapy are to interrupt the association between obsession and subsequent anxiety and to eliminate the connection between completing the compulsion and the reduction of anxiety." (p.1) There are numerous interventions of a behavioral nature used for treatment of OCD. The 'combined treatment of choice is stated to be "exposure and response prevention." (Beamish and Hill, 2007) Other techniques "have not demonstrated such consistent positive outcomes." (Beamish and Hill, 2007) the component of exposure treatment involves clients confronting themselves "with the action, thought, or entity that contributes to their anxiety." (Beamish and Hill, 2007) the component of 'response prevention' involves a delay or minimization of "the compulsion associated with the encountered event, thought, or impulse. Habituation is the process underlying the efficacy of response prevention in that exposure and nonresponding across time result in decreased feelings of anxiety and fear and in habituation to the stimulus. The compulsions will become extinguished as the high level of emotions associated with the obsession disappear and as the reinforcement for engaging in the compulsion is removed." (Beamish and Hill, 2007) Research findings indicate that: "50% to 100% of clients respond positively to exposure and response prevention treatment immediately after treatment and retain the positive response at follow-up assessment at a certain time after treatment." (Beamish and Hill, 2007) There are correlations noted between exposure and response prevention with changes in neurophysiology." (Beamish and Hill, 2007) Behavioral treatments for OCD are stated to be between 72% and 90% effective however making the adjustment of the success rate with considerations of drop-out rates the actual percentage is more likely in the range of 40% to 50%." (Beamish and Hill, 2007)

Group therapy has also been shown to be an intervention that is effective in treating individuals diagnosed with OCD. Beamish and Hill state: "The substantiation of the effectiveness of this approach tends to be theoretical and anecdotal because few empirical studies have explored the impact of group interventions. The general therapeutic benefits of group experiences are well documented in the literature on group dynamics and forces." (2007)

Cognitive Treatment therapy for OCD "rests on the assumption that compulsions are a product of a persistent thought pattern of putting self or others at risk through an action or a failure to act. The thought patterns for clients with OCD tend to include an irrational sense of personal responsibility and irrational perception of threat. Cognitive interventions include challenging excessive responsibility and perfectionist tendencies. Cognitive restructuring also focuses on the specific fear connected with the obsession and the compulsion. Thought-stopping is another cognitive technique during which counselors or clients yell "stop" when the intrusive obsession surfaces in their thinking." (Beamish and Hill, 2007) Little research exists on cognitive therapy's efficacy with clients diagnosed with OCD although some research does indicate a positive change in the thought patterns of an irrational nature however indications are that little difference between behavioral therapy and cognitive…