OCD resources

[MidWestLass]

Hello! I would love your expert recommendations for best books/literature for treating OCD, especially for working with complicated cases. While I have a pretty solid background treating anxiety and I have a couple OCD manuals to guide me, I am working with a patient grappling with significant OCD symptoms and pronounced paranoia so I could use more resources. Thank you!

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[MiniLop]

If you're interested in learning a new approach, I'd highly recommend Clinician's Handbook for Obsessive Compulsive Disorder: Inference-Based Therapy by O'Connor.

 

[Fan_of_Meehl]

Hello! I would love your expert recommendations for best books/literature for treating OCD, especially for working with complicated cases. While I have a pretty solid background treating anxiety and I have a couple OCD manuals to guide me, I am working with a patient grappling with significant OCD symptoms and pronounced paranoia so I could use more resources. Thank you!

First, do you mean 'paranoia' as, literally, a psychotic/delusional process? OCD-related obsessions are (I believe) definitionally 'ego-dystonic.' For instance, an OCD patient who is 'paranoid' (outrageously preoccupied) with contamination fears would simply be an OCD patient with contamination fears.

Does the patient have OCD but also some separate process like paranoid delusions (of grandeur or persecution) due to a co-morbid psychotic or mood disorder (schizophrenia, schizoaffective disorder, bipolar disorder)?

If co-morbid with a psychotic disorder, I think there's been some recent publications on treating, say, PTSD with exposure-based protocols when the patient has a co-morbid psychotic disorder. Just do an online search for that literature and attempt to generalize to the co-morbid OCD/'psychotic disorder' patient, maybe.

 

[smalltownpsych]

Hello! I would love your expert recommendations for best books/literature for treating OCD, especially for working with complicated cases. While I have a pretty solid background treating anxiety and I have a couple OCD manuals to guide me, I am working with a patient grappling with significant OCD symptoms and pronounced paranoia so I could use more resources. Thank you!

Second what @Fan_of_Meehl said. Getting better clarity of what is going on from a conceptual and diagnostic sense is going to guide the treatment. Also keep on mind that the more severe cases typically don’t respond well to trying to implement a protocol. They don’t fit and then that gets frustrating for everyone involved. I have had these patients referred to me after being discharged from top notch OCD programs because a highly individualized approach is necessary for the complex folk. Sometimes I wonder what the non-complex patients look like since it seems all I ever work with are the multiple comorbidities types.

 

[clausewitz2]

First, do you mean 'paranoia' as, literally, a psychotic/delusional process? OCD-related obsessions are (I believe) definitionally 'ego-dystonic.' For instance, an OCD patient who is 'paranoid' (outrageously preoccupied) with contamination fears would simply be an OCD patient with contamination fears.

Nah, DSM-V allows for OCD with specifier for absent insight or delusional beliefs. It's a complicated question but suffice it to say that there are a lot of people with OCD who are prepared to say that yes, probably their fears are somewhat excessive or not very plausible in a comfortable office would have a much harder time endorsing that proposition when actively triggered. It fluctuates and there is a cohort of people where OCD shades pretty smoothly into psychosis. Some people have argued for a "schizo-obsessive" disorder.

OCD compulsions around contamination/cleanliness that are motivated chiefly by disgust also often end up being more syntonic than you might expect; some folks will be quite adamant that they are taking reasonable precautions. Similar with harm obsessions sometimes.

re: "paranoia", there are people who I have worked with who endorse content that sounds like really classic persecutory delusions (someone has implanted cameras in my outlets to spy on me) to the extent of even taking apart the wall panels to check for them, but they are perfectly capable of acknowledging evidence against this proposition and it turns out it is motivated by the fear of the consequences of it being true rather than an inexplicably strong belief that it is true.