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Complexity in obsessive-compulsive and body dysmorphic disorder – a functional approach to complex difficulties

Published online by Cambridge University Press:  27 November 2017

Oliver Sündermann  and
David Veale Open the ORCID record for David Veale [Opens in a new window]
Oliver Sündermann*
Affiliation:
Department of Psychology, National University of Singapore, 02-24, 9 Arts Link, 117570, Singapore The Priory North London, Obsessional Disorders Department, London N14 6RA, UK
David Veale
Affiliation:
Department of Psychology, National University of Singapore, 02-24, 9 Arts Link, 117570, Singapore The Institute of Psychiatry, Psychology and Neurosciences, King's College London, De Crespigny Park, London SE5 8AF, UK Anxiety Disorders Residential Unit, Bethlem Royal Hospital, London BR3 3BX, UK
*
*Author for correspondence: Dr Oliver Sündermann, Department of Psychology, National University of Singapore and The Priory North London, UK (email: psymos@nus.edu.sg).
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Abstract

Obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD) can take many different forms of presentations. The term ‘complex’ is common and inconsistently used in both OCD and BDD. Practitioners often refer to complex OCD or BDD when patients present with severe co-morbid problems, often in the context of personality difficulties, dissociation, difficult early relationships and trauma; or when the illness is chronic and debilitating with previous multiple treatment failures. Current best-evidence treatment protocols for both disorders focus heavily on exposure and response prevention (E/RP) but with moderate success, particularly in patients who are deemed ‘complex’, and often those with relevant shame and/or disgust-based past experiences. The aim of the present paper is to (a) describe factors that contribute to complexity in OCD and BDD, and (b) link these with theory and practice. We emphasize the importance of understanding both the function of OCD and BDD-related behaviours (rather than the content of obsessions or compulsion), and the context in which they occur such as the family. We illustrate complexity in OCD and BDD using real case material, using a functional and contextual approach to formulate the client's difficulties, and demonstrate how E/RP can be enhanced successfully with imagery rescripting, family work, and compassion-focused therapy.

Keywords

OCDBDDOCRDtraumaimagery

Information

Type
Special Issue: Complexity within Cognitive Behaviour Therapy
Information
the Cognitive Behaviour Therapist , Volume 10 , 2017 , e15
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Recommended follow-up reading

Sookman, D (2015). Specialized Cognitive Behavior Therapy for Obsessive Compulsive Disorder: An Expert Clinician Guidebook. Routledge.CrossRefGoogle Scholar
Veale, D, Gilbert, P (2014). Body dysmorphic disorder: the functional and evolutionary context in phenomenology and a compassionate mind. Journal of Obsessive-Compulsive and Related Disorders 3, 150–160.Google Scholar
Veale, D, Gilbert, P, Wheatley, J, Naismith, I (2014). A new therapeutic community: development of a compassion-focused and contextual behavioural environment. Clinical Psychology and Psychotherapy 22, 285–303.CrossRefGoogle Scholar

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