Obsessive-compulsive disorder: efficacy of specific treatments as assessed by controlled trials

There is overwhelming evidence that specific pharmacologic agents are effective in lessening symptoms of OCD in many patients. In addition, considerable evidence indicates that the behavioral techniques of exposure and response prevention are effective. Although complete cure occurs infrequently, the combination of both pharmacotherapy and behavioral treatment optimizes the individual patient's potential for recovery and the majority of patients can now expect to lead relatively normal lives, to work, and to function well in families and in social situations. There is no controlled, and almost no anecdotal evidence, to suggest that traditional psychodynamic psychotherapy or psychoanalysis are effective in treating the symptoms of OCD. However, wise clinicians frequently use psychotherapy as an adjunct to more specific treatments to help deal with other problems that the patient might have. Even though many patients became vigorously opposed to psychodynamic treatments and psychoanalysis after experiencing such treatments for years without any improvement in their obsessions and compulsions, they are now realizing that psychotherapy may have a place in the treatment plan for many patients who, after responding to medication and behavior therapy, need to explore the deeply rooted thought patterns that developed in response to obsessive-compulsive behaviors and to work to free themselves from these patterns. For example, it may no longer be adaptive for the patient to attempt to control others, or to set up a restricted or extremely regimented environment. Even trying to distinguish a "normal" thought or worry from an obsession may require the help of a therapist. There may well be a place for psychodynamic therapies for some patients (often with onset of OCD in childhood) who are left with developmental scars after their OCD is well-treated. Although controlled evidence is lacking, there may well be a role for neurosurgical procedures in the management of very severely-ill OCD patients who have failed to respond to more conventional treatments. With the development of new technologies, controlled trials may now be feasible.