Abstract
Well, there have been so many recent books on obsessive compulsive disorder (OCD) that one really does need to question whether the market has space for them all. Is this book better than any others, or does it address areas others don't? Not really, it must be said, but it does bring together the cognitive and cognitive-behavioural views of the disorder in a fairly comprehensive way. It is part of Wiley's ‘Series in Clinical Psychology’, and is very much a psychologists' book. As such, it deals with some aspects of OCD very well indeed, notably psychological aetiological theories and treatments; but other areas are less well covered, such as biological parameters in aetiology. There is a reasonably comprehensive chapter on biological treatments, but there is nothing there that cannot be gleaned from many other publications. It is a shame that the otherwise excellent psychological treatment chapters do not articulate more explicitly how biological treatments can be used in conjunction, to good effect.
The whole area of classification and diagnosis also takes a very ‘psychological’ approach. To me, one of the most interesting aspects of OCD is the phenomena themselves, and the fact that they can occur in a number of psychiatric and neurological disorders. In this book, there is in the main a rather bland assumption that OCD does exist and is a fairly common and discrete psychiatric disorder. I would have liked to see much more space given to a discussion of what has been referred to as the ‘internal and external boundaries’ of OCD [1]. What really makes us label one person with the disorder, and another as just having traits? What are the extent of ‘distress’ and ‘disability’ that make us consider this a disorder, and who should be making these judgements (the patient, the practitioner, the family?) and what about the OC spectrum? There is a chapter on this latter topic, but mostly it deals with just one member of the putative spectrum, namely body dysmorphic disorder. and nowhere did I find a considered evaluation of the potential virtue of moving away from a categorical to a dimensional approach to the conceptualization of the putative spectrum [2].
The section on ‘theoretical accounts’ is also very psychological. Not that this is a bad thing, or lacking in interest; it is just that coverage of the biological aspects is not provided. Also, the authors do rather push their own theoretical barrow; obsessionally, I counted how many times the authors of these chapters quoted themselves to support their assertions: an interesting exercise! The editors admit in their Preface to not having sought uniformity of view among their contributors; as they say, on some levels this is a strength, but it can also be confusing and contradictory for the naïve reader.
The section on clinical subtypes is thorough. In particular, the chapters on primary obsessional slowness and compulsive hoarding are useful in that these are presentations that are very difficult to deal with clinically. There are useful clinical pointers here, and sensible suggestions about techniques and variations that might be used with such patients.
The section on treatments is again useful and expert, though one is left wondering where the field was before the CBT ‘magic bullet’. Details are provided of techniques for exposure/response prevention, and cognitive therapy. The chapter on treatment resistance concentrates exclusively on psychological techniques (biological aspects are addressed in the chapter on biological treatments): it is of interest to contrast this approach with that adopted by psychiatrists writing on this topic [3]. The comprehensive ‘worked’ case examples are informative. A deficit is the consideration of families in the treatment of people with OCD.
Overall, then, this is a good book for what it is, but is lacking in terms of coverage of a number of key areas, meaning that it would need to be read in conjunction with another text for a truly comprehensive account of current thinking on this most fascinating of conditions.