Treatment of obsessive compulsive disorder: psychotherapies, drugs, and other somatic treatment

Abstract

Ninety percent of obsessive compulsive patients can be helped by treatment with behavior therapy and drug treatment, used sequentially or concurrently. The effectiveness of these treatments has been demonstrated in controlled clinical trials and is superior to electroconvulsive therapy and dynamic or cognitive psychotherapies for this disorder. Potent serotonin uptake inhibiting drugs, from the class of heterocyclic antidepressants, are the most effective antiobsessional medications currently available. Although these drugs usually do not induce complete remission, they can reduce obsessive compulsive symptoms by 30% to 42%. Behavior therapy combines exposure and response prevention, which the patient first learns with the therapist and then practices independently. With behavior therapy, patients confront the triggers for their anxiety and then delay, diminish, or discontinue their rituals. Reduction in symptoms with behavior therapy averages 50% or greater. Behavior therapy is usually not effective in patients who are substantially depressed, are delusional, fail to comply, or undermine therapy with covert rituals or avoidance techniques. The rare patient with very severe obsessive compulsive disorder who does not respond to behavior or drug therapy may be a candidate for psychosurgery. Modern psychosurgical procedures are quite safe and can improve symptoms in the majority of otherwise unresponsive patients.