TRAINING, RESOURCES AND
Lynne M. Harris
Ross G. Menzies
Obsessive-compulsive disorder (OCD) is an objectively distressing condition for the individual and a costly one for the community. People living with OCD are commonly unemployed or underemployed, report relationship problems and social isolation, and have low self-esteem (Hollander et al., 1996). The distress associated with OCD is severe, and in Hollander et al.'s sample of 419 survey respondents, 13% had made suicide attempts secondary to their OCD symptomatology. The financial cost of OCD to the community is also high, and includes direct health care expenditure as well as indirect costs due to the early, occasional, or complete loss of the person with OCD from the workforce (e.g. DuPont et al., 1995; see also Chapter 2). For most people, the onset of OCD occurs early in life, most often between the ages 6–15 years for males and 20–29 years for females. Only 5% of those diagnosed with OCD can expect complete remission between episodes, and the majority experience a chronic course (American Psychiatric Association, 1994). Hollander et al. (1996) reported a 17-year delay between the onset of OCD symptoms and the commencement of effective treatment for OCD. This lag is probably exacerbated by the early age of onset of the disorder, and by the frequent misdiagnosis of OCD as either generalised anxiety disorder or depression.
Chapters 15–17 of this volume discuss the available biological and psychological interventions for OCD in detail and evaluate their usefulness in treating OCD. Of the biological treatments, the serotonin re-uptake inhibitors (SRIs) are useful for management in slightly more than half of cases (e.g. Munford et al., 1994; Hollander et al., 1996). Psychosurgery, a treatment of last resort when all others have failed (e.g. Sachdev & Sachdev, 1998), is helpful in up to 30% of cases unresponsive to other
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.