Obsessive--Compulsive Disorder

Front Cover
M. Mavissakalian, Samuel M. Turner, Larry Michelson
Springer Science & Business Media, Mar 31, 1985 - Medical - 257 pages
Recent advances in behavioral and biological treatments have raised the hopes and expectations of patients and clinicians alike in regard to obsessive-compulsive disorder-one of the most disabling, crippling, and resistant conditions in psy chiatry. In addition to their therapeutic efficacy, these new treatments have also opened new conceptual perspectives, thus complementing the traditional psychological theories of obsessive-compulsive disorder. Therefore, it is timely for these various conceptual frameworks and the treatment modalities they engender to be integrated and synthesized in the pres ent volume. To this end, eminent scholars in their respective areas were invited to contribute to this book, which we hope will symbolize and-in some measure-actualize the spirit of collaboration required if we are to fully comprehend the com plex nature of this disorder as well as to address existing ther apeutic challenges. In Chapter 1, Rachman sets the stage by providing an overview of the conceptual and therapeutic issues of obsessive-compulsive disorder. This is followed by an in depth review of the behavioral interventions from which Foa vii viii PREFACE and colleagues successfully distill the specific therapeutic processes of exposure and response prevention. In the third chapter, Sifneos deals with the psychodynamic factors under lying obsessive-compulsive phenomena and details his in novative technique of brief, anxiety-provoking psychotherapy aimed specifically at the obsessional state.
 

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Contents

An Overview of Clinical and Research Issues in Obsessional Compulsive Disorders
1
COURSE OF DISORDER
5
RELATION TO OTHER DISORDERS
7
GENESIS
10
TYPES
13
PERSISTENCE
15
COMPULSIVE URGES
19
NATURE OF OBSESSIONS
24
Avoidance of Pregenital Characterological Issues
148
Repeated Challenge to the Ambivalence
149
Outcome
151
REFERENCES
154
Comments on the Psychological Treatment of ObsessiveCompulsive Patients
155
Pharmacotherapy of ObsessiveCompulsive Disorder
167
DIAGNOSIS
168
ASSESSMENT
170

TREATMENT
29
SUMMARY
42
REFERENCES
43
Behavior Therapy with ObsessiveCompulsives FROM THEORY TO TREATMENT
49
BEHAVIORAL MODELS
51
CognitiveBehavior Theory
54
CLASSIFICATION
56
BEHAVIORAL TREATMENT
60
Exposure Procedures
61
Blocking Procedures
66
Comparisons between Exposure and Blocking Procedures
70
Summary
71
TREATMENT BY EXPOSURE AND RESPONSE PREVENTION
73
Variants of Exposure and Response Prevention
83
Differential Effects of Exposure and Response Prevention
92
Classification and Treatment
100
Processes during Exposure
101
Success and Failure with Exposure and Response Prevention
111
FURTHER CONSIDERATIONS
115
REFERENCES
119
ShortTerm Dynamic Psychotherapy for Patients Suffering from an ObsessiveCompulsive Disorder
131
PSYCHODYNAMIC EXPLANATIONS
133
Reaction Formation
134
Undoing
135
PSYCHOTHERAPY
136
Developmental History Taking
143
THERAPEUTIC TECHNIQUES OF SHORTTERM DYNAMIC PSYCHOTHERAPY
145
Early Utilization of Positive Transference
146
ParentTransference Links
147
BIOCHEMISTRY
175
PHARMACOLOGICAL TREATMENT
178
Anxiolytics
180
Tricyclic Antidcpressants
181
Clomipramine
183
Combination Treatments
188
Antidepressant Drugs and Behavior Therapy
189
Monoamine Oxidase Inhibitors MAO1
192
Lithium
194
PSYCHOSURGERY
195
Orbital Undercutting
198
Stereotactic Tractotomy
199
Limbic Leucotomy
201
CONCLUSION
202
REFERENCES
203
Future Directions in the Assessment and Treatment of ObsessiveCompulsive Disorder
213
PHENOMENOLOGICAL VARIANCE
214
FUNCTIONAL DIVERSITY
216
UNIFYING CLINICAL CONCEPTS
218
RECENT FUNCTIONAL FORMULATIONS
222
RELATION TO ANXIETY DISORDERS
226
RELATION TO DEPRESSION
232
TREATMENT
235
COMBINED TREATMENTS
239
PREDICTOR VARIABLES
240
ASSESSMENT
243
REFERENCES
244
Index
249
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