Abstract
Obsessive–compulsive disorder (OCD) is now recognized as a major cause of psychiatric morbidity and the relatively recent discovery of effective treatments has led to a burgeoning interest and literature in this area. Much of this has been provided by psychiatrists and psychologists from North America and while the Oxford group have written extensively on theoretical constructs of OCD using cognitive–behavioural models, this book is one of the first where UK and European psychiatrists present their opinions regarding this disorder and its treatment.
The book is relatively short and most of the chapters are packed with recent research findings in aetiology and treatment as well as some discussion and speculation about innovative treatments. The editors' brief was to write a book for clinicians and this might explain the brevity of some of the chapters and the book in general. There is a sense with some chapters that the editors have ruthlessly cut them to the bone in order to fit them to this concise format. Of course there are some advantages of this approach and there is considerable contrast to a number of recent US texts on OCD that have stretched up to 800 pages [1].
Unfortunately, while this is supposed to be a book for clinicians, there is insufficient concentration on practical treatment aspects of the condition as opposed to theoretical discussion about the cause of the disorder, the role of genes, neuroanatomy and pathophysiology. To my mind, this may put the book in a literary no man's land, being too scientific for clinicians, but too brief and lacking in discussion for academics researching OCD or scientists working in this area. The other general criticism involves the lack of case history material, leaving the book with a very scientific and impersonal general feeling. Too often the impression is of academics discussing the best evidence-based medicine and there appears to be little understanding of nuances and subtleties involved in the long term treatment of this chronic and disabling condition.
Despite this, some chapters are quite useful. The chapters on pharmacotherapy are sensible, concise summaries and some of the information provided in the chapter on treatment of refractory OCD is also helpful, although there is a major bias towards medications and against cognitive–behavioural strategies. Similarly, the chapter on psychotherapy in OCD reviews the literature well, although there is very little practical information on how to use cognitive or behavioural techniques in the treatment of OCD. In fact, there is a significant bias against cognitive–behavioural therapy (CBT) throughout the book with no chapter on the cognitive conceptualization of OCD, little practical information on CBT for OCD, and a general assumption that pills are the only really effective treatment and definitely first choice in management. This is surprising given the extensive work done by Salkovskis and his coworkers in the UK [2].
The chapters on assessment, theoretical constructs, unusual symptoms, genetic and neuroanatomical features of OCD are generally acceptable if uninspired. Some of these chapters flood the reader with findings from recent research studies without really tying these together or offering any critical comment. The chapter on neuroanatomy in particular, is a bare accounting of the facts without any criticism or conclusion.
All in all, this is a book with only limited appeal. The provision of factual information is generally good, but much of this information will be of only passing interest to clinicians, except in the rare case where a patient may request an up to date review of OCD research in one area. It is hard to escape the fact that this book sets itself to be useful for the clinician, but does not quite achieve that. Practical hands-on information useful in the ongoing treatment of patients with OCD is more likely to be found in some of the excellent and recently released empirically-based treatment protocols for patients and clinicians [3], while some of the OCD self help books [4, 5] remain excellent resources for both patients and psychiatrists.