Obsessive-compulsive disorder: theory, research, and treatment

Abstract

Obsessive-Compulsive Disorder: Theory, Research, and Treatment Richard P. Swinson, Martin M. Antony, Stanley Rachman, and Margaret A. Richter (Eds.). London: Guilford Press (www.guilford.com). 1998, 478 pp., $50.00 (hardcover). Obsessive-compulsive disorder (OCD) is associated with some of the worst impairment observed among anxiety disorders patients and can cause sufferers severe torment as well as problems such as chronic unemployment and relationship difficulties. Recent research advances have increased our knowledge of OCD in a wide range of realms. Such research provides a more complex and multidimensional understanding of its cognitive phenomenology, as well as its developmental and physiological correlates, and approaches to assessment and treatment. It is timely, then, for a book that brings together this rapidly expanding wealth of information. This excellent edited volume provides a state-of-the-art review of OCD and its multifaceted complexity. In this 18-chapter book, which is divided into three sections, a stellar list of contributors presents an up-to-date summary of knowledge and research findings. The first section of the book, which deals with the descriptive psychopathology and theoretical perspectives of OCD, contains almost half of the chapters. Thus, the first section provides a conceptual foundation for the book and has as its prime focus the manifold nature of OCD itself. These chapters provide an excellent summary of the state of knowledge in a variety of converging disciplines and areas of study. The second section, which has seven chapters, has a more applied, clinical emphasis and addresses assessment and treatment issues. The third section has two chapters and addresses the question of OCD spectrum disorders. The book also has a useful Appendix which lists resources (such as national organizations) for OCD. As the editors suggest, recent years have seen great advances achieved in the understanding and treatment of OCD. The present book succeeds admirably in bringing much of this work together. The first section of the book on psychopathology and theoretical perspectives begins with a strong chapter by Antony, Downie and S winson that addresses diagnostic issues and the epidemiology of OCD. Their chapter reviews findings on the impairment in living that is often associated with the disorder, as well findings on the comorbidity of the disorder, demographic correlates, onset patterns, and prevalence. In the second chapter Salkovskis presents a cogent rationale for proposing cognitive conceptualization to obsessional problems. As he points out, research suggests that the contents of the intrusive thoughts of normal or nondisordered individuals are virtually indistinguishable from those of patients with OCD. Cognitive theories, such as those of Salkovskis and of Rachman, assume that the origins of obsessions are to be found in normal intrusions and dysfunctional meanings that individuals with OCD give to these intrusions. In the next chapter, Rachman and Shafran present a superb review of the research literature on the cognitive and behavioral aspects of OCD. Their chapter contains an excellent discussion of information processing in OCD, and of cognitive biases such as exaggerations in the sense of responsibility, and thought-action fusion. A chapter by Summerfeldt, Huta, and Swinson provides a scholarly review of the literature on personality and OCD. They argue that categorical approaches to personality disorder have been unproductive, whereas dimensional approaches (e.g., to perfectionism, indecisiveness, harm avoidance) have been fruitful. An excellent chapter by Steketee and Pruyn turns attention to a different domain-the families of individuals with OCD. They offer a compelling description of the adverse impact of the disorder on families and show that many families become dysfunctional because one of their members has OCD. Their chapter also discusses the implications of family involvement for practice and treatment. …