The assessment and management of obsessive-compulsive disorder

This article describes obsessive-compulsive disorder (OCD) and discusses its diagnosis and its management by behavioural therapy combined with antidepressant medication. Patients with OCD experience recurrent distressing thoughts which may lead them to avoid certain situations and to carry out protective rituals. Behavioural treatment is considered specific. The therapist establishes a relationship with the patient by which he or she can be motivated to cease the thoughts and the avoidance and ritual behaviour. The patient's family can play an important role in the therapy. The treatment is usually easier if the patient can accept taking clomipramine. Patients who, despite severe symptoms, are able to carry out their normal activities usually respond well to treatment. Those who cannot tolerate stress and have had to cease most of their normal activities usually do not respond well and require supportive therapy.