Abstract
This is a neat and slender book that does indeed contain the facts about obsessive–compulsive disorder (OCD). de Silva and Rachman are two very experienced clinical psychologists, based respectively, at the Maudsley, London, and the Psychology Department, University of British Colombia.
Theyinclude manyuseful clinical vignettes, often in the patients' own words, and together, they write extremely well.
Of the 10 chapters in this book, chapters 9 and 10 are clearly directed to the patient, but the language level is still perhaps higher than many patients would comprehend. I would see this book as very useful for someone at my level to refer to, and for me to direct health care students and colleagues to obtain. With patients and their families I would first test out their level of comprehension, and then work through the book with them.
The chapters about OCD symptoms – related disorders, patients with OCD, effects on family work and social life, prevalence and theories and explanations – are followed by very useful chapters on treatment, diagnosis assessment and evaluation and treatment of OCD in children.
The authors describe cognitive behavioural therapy (CBT) in clear detail – at last I think I understand it! It is their treatment of choice and they state that the results of CBT for compulsions, including exposure and response prevention, are quite impressive. There are clear directions on how to help people with obsessions to reinterpret their thoughts more realistically and accurately.
I regarded clomipramine as a standard treatment for OCD, but the authors in this book state that they believe that clomipramine and the other useful antidepressants should mostly be given to patients with OCD who have depression as well as OCD. The depression, otherwise, can limit the OCD patient's capacity to effectively use such treatment as CBT.
The book, and its eight appendices, contain very useful material on how to learn relaxation, interviewing, rating scales, record keeping, questionnaires and inventories, all of which are available for the clinician to copy and use.
There are lists of useful organisations and helpful reading.
After I finished this book I heaved a sigh of relief at now having it in my library to refer to. I will also lend it to my patients and their relatives and ask them to get their own copies.
All through the book the authors have set out a patient, orderly and hopeful approach to OCD, stressing that treatment can take considerable time, but that great things can be expected.