Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-06-01T21:30:24.734Z Has data issue: false hasContentIssue false

Obsessive–Compulsive Disorder

Published online by Cambridge University Press:  02 January 2018

Frank Tallis*
Affiliation:
Department of Clinical Psychology, Charter Nightingale Hospital, London

Extract

Obsessive–compulsive disorder (OCD) has recently undergone a dramatic change in status. Once regarded as a rare example of the neuroses, it now occupies a central position in contemporary psychiatry. The reasons for this renaissance in interest are relatively easy to describe. Firstly, results from the National Institute of Mental Health Epidemiological Catchment Area (ECA) survey indicated that the lifetime prevalence of OCD was 2.5% (1 in 40 people) and the 6-month point prevalence was 1.5%, making it the fourth most common psychiatric disorder in the US (Myers et al, 1984; Robins et al, 1984; Karno et al, 1988). If these figures are applicable to the UK, there may be up to 1 million sufferers. Secondly, the therapeutic efficacy of the selective serotonin reuptake inhibitors (SSRIs) and consistent findings from a number of neuroimaging investigations have stimulated interest in understanding the biological substrates of OCD. Finally, the traditional behavioural account of OCD has been elaborated, with greater emphasis given to cognition and cognitive processes; this revised anatomy of obsessions has, predictably, stimulated the development of specific cognitive therapy strategies.

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 1995 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ackroyd, P. (1991) Dickens. London: Minerva.Google Scholar
Ananth, J., Pecknold, J. C., Van den Steen, N., et al (1981) Double blind comparative study of clomipramine and amitriptyline in obsessive neurosis. Progress in Neuropsychopharmacology, 5, 257262.Google Scholar
Baxter, L. R., Schwartz, J. M., Mazziotta, J. C., et al (1988) Cerebral glucose metabolic rates in non-depressed obsessive–compulsives. American Journal of Psychiatry, 145, 15601563.Google Scholar
Baxter, L. R., Schwartz, J. M., Bergmann, K. S., et al (1992) Caudate glucose metabolic rate changes with both drug and behaviour therapy for obsessive–compulsive disorder. Archives of General Psychiatry, 49, 681689.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford.Google Scholar
Behar, D., Rapoport, J. L., Berg, C. J., et al (1984) Computerised tomography and neuropsychological test measures in adolescents with obsessive–compulsive disorder. American Journal of Psychiatry, 141, 363369.Google Scholar
Benkelfat, C., Nordhal, T. E., Semple, W., et al (1990) Local cerebral glucose metabolic rates in obsessive–compulsive disorder. Archives of General Psychiatry, 47, 840848.CrossRefGoogle ScholarPubMed
Boone, K., Ananth, J., Philpott, L., et al (1991) Neuropsychological characteristics of nondepressed adults with obsessive compulsive disorder. Neuropsychiatry, Neuropsychology & Behavioural Neurology, 4, 96109.Google Scholar
Bouvard, M., Mollard, E., Cottraux, J., et al (1989) Etude preliminaire d'une liste de pensees obsedantes. L'Encèphale, 15, 351354.Google Scholar
Christensen, K. J., Won Kim, S., Dysken, M. W., et al (1992) Neuropsychological performance in obsessive compulsive disorder. Biological Psychiatry, 31, 418.Google Scholar
Cottraux, J., Mollard, E., Bouvard, M., et al (1989) A controlled study of fluvoxamine and exposure in obsessive compulsive disorder. International Clinical Psychopharmacology, 5, 114.Google Scholar
Cox, C. S., Fedio, P. & Rapoport, J (1989) Neuropsychological testing of obsessive–compulsive adolescents. In Obsessive–Compulsive Disorder in Children and Adolescents (ed. Rapoport, J.). Washington, DC: APP.Google Scholar
de Silva, P. & Rachman, S. (1992) Obsessive Compulsive Disorder: The Facts. Oxford: Oxford University Press.Google Scholar
Flament, M. F., Rapoport, J. L., Murphy, D. L., et al (1987) Biochemical changes during clomipramine treatment of childhood obsessive compulsive disorder. Archives of General Psychiatry, 44, 219225.CrossRefGoogle ScholarPubMed
Fontaine, R. & Chouinard, G. (1985) Fluoxetine in the treatment of obsessive compulsive disorder. Progress in Neuropsychopharmacology and Biological Psychiatry, 9, 605608.Google Scholar
Freeston, M. H., Ladouceur, R., Gagnon, F., et al (1993) Beliefs about obsessional thoughts. Journal of Psychopathology and Behavioural Assessment, 15, 121.Google Scholar
Freud, S. (1909) Notes upon a case of obsessional neurosis (the ‘rat man’). In The Penguin Freud Library: Case Histories II (ed. Richards, Angela). London: Penguin.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989a) Efficacy of fluvoxamine in obsessive compulsive disorder. Archives of General Psychiatry, 46, 3644.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989b) The Yale-Brown Obsessive Compulsive Scale (Y-Bocs). I: Development, use, and reliability. Archives of General Psychiatry, 46, 10061011.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989c) The Yale-Brown Obsessive Compulsive Scale (Y-Bocs). II: Validity. Archives of General Psychiatry, 46, 10121016.Google Scholar
Goodman, W. K., Price, L. H., Delgado, P. L., et al (1990) Specificity of serotonin reuptake inhibitors in the treatment of obsessive compulsive disorder. Archives of General Psychiatry, 47, 577585.Google Scholar
Greist, J. H., Jefferson, J. W., Rosenfeld, R., et al (1990) Clomipramine and obsessive compulsive disorder: A placebo-controlled double-blind study of 32 patients. Journal of Clinical Psychiatry, 51, 292297.Google Scholar
Harvey, N. S. (1987) Neurological factors in obsessive–compulsive disorder. British Journal of Psychiatry, 150, 567568.Google Scholar
Head, D., Bolton, D. & Hymas, N. (1989) Deficit in cognitive shifting ability in patients with obsessive–compulsive disorder. Biological Psychiatry, 25, 929937.Google Scholar
Hoehn-Saric, R., Pearlson, G., Harris, G. J., et al (1991) Effects of fluoxetine on regional cerebral blood flow in obsessive–compulsive patients. American Journal of Psychiatry, 49, 690694.Google Scholar
Hollander, E., Schiffman, E., Cohen, B., et al (1990) Signs of central nervous system dysfunction in obsessive compulsive disorder. Archives of General Psychiatry, 47, 2732.Google Scholar
Insel, T. R., Mueller, E. A., Alterman, I., et al (1985) Obsessive–compulsive disorder and serotonin: Is there a connection? Biological Psychiatry, 20, 11741185.CrossRefGoogle ScholarPubMed
Insel, T. R. & Winslow, J. T. (1990) Neurobiology of obsessive–compulsive disorder. In Obsessive–Compulsive Disorders: Theory and Management (eds Jenike, M. A., Baer, L. & Minichiello, W.E.). London: Mosby Year Book.Google Scholar
Jenike, M. A., Baer, L., Summergrad, P., et al (1989a) Obsessive–compulsive disorder: A double-blind, placebo-controlled trial of clomipramine in 27 patients. American Journal of Psychiatry, 146, 13281329.Google Scholar
Jenike, M. A., Buttolph, L., Baer, L., et al (1989b) Open trial of fluoxetine in obsessive–compulsive disorder. American Journal of Psychiatry, 146, 909911.Google Scholar
Jenike, M. A., Baer, L. & Minichiello, W. E. (eds) (1990a) Obsessive–Compulsive Disorders: Theory and Management (2nd edn). London: Mosby Year Book.Google Scholar
Jenike, M. A., Hyman, S., Baer, L. K., et al (1990b) A controlled trial of fluvoxamine in obsessive–compulsive disorder: Implications for a serotonergic theory. American Journal of Psychiatry, 147, 12091215.Google Scholar
Karno, M., Golding, J. M., Sorenson, S. B., et al (1988) The epidemiology of obsessive compulsive disorder in five US communities. Archives of General Psychiatry, 45, 10941099.Google Scholar
Katz, R. J., De Veaugh-Geiss, J. & Landau, P. (1990) Clomipramine in obsessive–compulsive disorder. Biological Psychiatry, 20, 401414.CrossRefGoogle Scholar
Luxenberg, J. S., Swedo, S. E., Flament, M. F., et al (1988) Neuroanatomical abnormalities in obsessive compulsive disorder determined with quantitative x-ray computerised tomography. American Journal of Psychiatry, 145, 10891093.Google Scholar
Machlin, S. R., Harris, G. J., Pearlson, G. D., et al (1991) Elevated medial-frontal cerebral blood flow in obsessive–compulsive patients: A SPECT study. American Journal of Psychiatry, 148, 12401242.Google ScholarPubMed
Markovitz, P. J., Stagno, S. J. & Calabrese, J. R. (1990) Buspirone augmentation of fluoxetine in obsessive compulsive disorder. American Journal of Psychiatry, 147, 798800.Google Scholar
Marks, I. M., Lelliott, P., Basoglu, M., et al (1988) Clomipramine, self exposure and therapist-aided exposure for obsessive compulsive rituals. British Journal of Psychiatry, 152, 522534.Google Scholar
Martinot, J. L., Allilaire, J. F., Mazoyer, B. M., et al (1990) Obsessive–compulsive disorder: A clinical, neuropsychological and positron emission tomography study. Acta Psychiatrica Scandanavica, 82, 233242.CrossRefGoogle ScholarPubMed
Mavissakalian, M. R., Turner, S. M., Michelson, L., et al (1985) Tricyclic antidepressants in obsessive–compulsive disorder: Anti-obsessional or anti-depressant agents. American Journal of Psychiatry, 142, 572576.Google Scholar
Mavissakalian, M. R., Jones, B. & Olson, S. (1990) Absence of placebo response in obsessive–compulsive disorder. Journal of Nervous and Mental Disease, 178, 268270.CrossRefGoogle ScholarPubMed
McFall, M. E. & Wollershein, J. P. (1979) Obsessive–compulsive neurosis: a cognitive–behavioural formulation and approach to treatment. Cognitive Therapy & Research, 3, 333348.Google Scholar
McGuire, P. K., Bench, C. J., Frith, C. D., et al (1994) Functional anatomy of obsessive–compulsive phenomena. British Journal of Psychiatry, 164, 459468.Google Scholar
Myers, J., Weissman, M., Tischler, G., et al (1984) Six-month prevalence of psychiatric disorders in three communities. Archives of General Psychiatry, 41, 959967.Google Scholar
Neziroglu, F. (1979) A combined behavioral pharmacotherapy approach to obsessive compulsive disorders. In Biological Psychiatry Today (eds Oriols, C., Gonzales, M. & Prijol, J.). Amsterdam: Elsevier/North-Holland.Google Scholar
Nordhal, T. E., Benkelfat, C., Semple, W. E., et al (1989) Cerebral glucose rates in obsessive–compulsive disorder. Neuropsychopharmacology, 3, 261273.Google Scholar
Pato, M. T., Zohar-Kadouch, R., Zohar, J., et al (1988) Return of symptoms after discontinuation of clomipramine in patients with obsessive compulsive disorder. Americal Journal of Psychiatry, 145, 15211527.Google Scholar
Perse, T. L., Greist, J. H., Jefferson, J. W., et al (1987) Fluvoxamine treatment of obsessive compulsive disorder. American Journal of Psychiatry, 144, 15431548.Google ScholarPubMed
Price, L. H., Goodman, W. K., Charney, D. S., et al (1987) Treatment of severe obsessive compulsive disorder with fluvoxamine. American Journal of Psychiatry, 144, 10501061.Google Scholar
Rachman, S. (1993) Obsessions, responsibility, and guilt. Behaviour, Research and Therapy, 31, 149154.Google Scholar
Rachman, S. & de Silva, P. (1978) Abnormal and normal obsessions. Behavior, Research, and Therapy, 16, 233248.Google Scholar
Rachman, S. & Hodgson, R. (1980) Obsessions and Compulsions. New Jersey: Prentice-Hall.Google Scholar
Rapoport, J. L. (1990) The Boy who Couldn't Stop Washing: the Experience and Treatment of Obsessive–Compulsive Disorder. New York: E.P. Dutton.Google Scholar
Rapoport, J. L. (ed.) (1989) Obsessive–Compulsive Disorder in Children and Adolescents. Washington, DC: APP.Google Scholar
Renyghe de Voxrie, G. E. (1968) Anafranil (g 34586) in obsessive neurosis. Acta Neurologica Belgica, 68, 787792.Google Scholar
Robins, L., Helzer, J., Weissman, M., et al (1984) Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry, 41, 949958.Google Scholar
Rubin, R. T., Villanueva-Meyer, J., Ananth, J., et al (1992) Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive–compulsive disorder and matched control subjects. Archives of General Psychiatry, 49, 695702.Google Scholar
Salkovskis, P. M. (1985) Obsessional–compulsive problems: a cognitive-behavioural analysis. Behavior, Research, and Therapy, 25, 571583.Google Scholar
Salkovskis, P. M. (1989) Obsessions and compulsions. In Cognitive Therapy in Clinical Practice (eds Scott, J., Williams, J. M. G. & Beck, A. T.). London: Croom Helm.Google Scholar
Salkovskis, P. M. & Harrison, J. (1984) Abnormal and normal obsessions: A replication. Behavior, Research and Therapy, 22, 549552.Google Scholar
Sawle, J. M. G., Hymas, N., Lees, A., et al (1991) Obsessional slowness. Functional studies with positron emission tomography. Brain, 114, 21912202.Google Scholar
Sher, K., Frost, R. & Otto, R. (1983) Cognitive deficits in compulsive checkers: an exploratory study. Behavior, Research and Therapy, 21, 357363.Google Scholar
Salkovskis, P. M., Mann, B. & Frost, R. (1984) Cognitive dysfunction in compulsive checkers: further explorations. Behaviour, Research and Therapy, 22, 493502.Google Scholar
Salkovskis, P. M., Frost, R., Kushner, M., et al (1989) Memory deficits in compulsive checkers: Replication and extension in a clinical sample. Behaviour, Research and Therapy, 27, 6569.Google Scholar
Steketee, G. S. (1993) Treatment of Obsessive Compulsive Disorder. New York: Guilford.Google Scholar
Swedo, S. E., Schapiro, M. B., Grady, C. L., et al (1989) Cerebral glucose metabolism in childhood onset obsessive–compulsive disorder. Archives of General Psychiatry, 46, 518523.Google Scholar
Salkovskis, P. M., Pietrini, P., Leonard, L. H., et al (1992) Cerebral glucose metabolism in childhood-onset obsessive–compulsive disorder. Revisualisation during pharmacotherapy. Archives of General Psychiatry, 49, 690694.Google Scholar
Talus, F. (1992) Understanding Obsessions and Compulsions: A Self-Help Manual. London: Sheldon.Google Scholar
Talus, F. (1993) Doubt reduction using distinctive stimuli as a treatment for compulsive checking: An exploratory investigation. Clinical Psychology and Psychotherapy, 1, 4552.Google Scholar
Talus, F. (1994) Obsessions, responsibility, and guilt: two case reports suggesting a common and specific aetiology. Behaviour, Research and Therapy, 32, 143145.Google Scholar
Thoren, P., Asberg, M., Cronholm, B., et al (1980a) Clomipramine treatment of obsessive–compulsive disorder: A controlled clinical trial. Archives of General Psychiatry, 37, 12811285.Google Scholar
Thoren, P., Asberg, M., Bertilsson, L., et al (1980b) Clomipramine treatment of obsessive–compulsive disorder. II: Biochemical aspects. Archives of General Psychiatry, 37, 12891294.Google Scholar
Toates, F. (1990) Obsessional Thoughts and Behaviour. Wellingborough: Thorsons.Google Scholar
Turner, S. M., Beidel, D. C., Stanley, M. A., et al (1988) A comparison of fluoxetine, flooding, and response prevention in the treatment of obsessive compulsive disorder. Journal of Anxiety Disorders, 2, 219225.Google Scholar
van Oppen, P. & Arntz, A. (1994) Cognitive therapy for obsessive–compulsive disorder. Behaviour. Research, and Therapy, 32, 7987.Google Scholar
Volavaka, J., Neziroglu, F. & Yaryura-Tobias, J. A. (1985) Clomipramine and imipramine in obsessive–compulsive disorder. Psychiatry Research, 14, 8593.Google Scholar
Wegner, D. M. (1989) White bears and other unwanted thoughts: Suppression, obsession, and the psychology of mental control. New York: Viking Penguin.Google Scholar
Yaryura-Tobias, J. A. & Bhagavan, H. N. (1977) L-tryptophan in obsessive compulsive disorders. American Journal of Psychiatry, 134, 12981299.Google Scholar
Zielinski, C. M., Taylor, M. A. & Juzwin, K. R. (1991) Neuropsychological deficits in obsessive compulsive disorder. Neuropsychiatry, Neuropsychology, and Behavioural Neurology, 4, 110126.Google Scholar
Zohar, J. & Insel, T. R. (1986) Drug treatment of obsessive–compulsive disorder. Journal of Affective Disorders, 13, 193202.CrossRefGoogle Scholar
Zohar, J., Mueller, E. A., Insel, T. R., et al (1987) Serotonergic responsivity in obsessive compulsive disorder. Comparison of patients and healthy controls. Archives of General Psychiatry, 44, 946951.Google Scholar
Zohar, J., Insel, T. & Rasmussen, S. (1991) The Psychobiology of Obsessive–Compulsive Disorder. New York: Springer.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.