A Complex Case of Obsessive-Compulsive Disorder (OCD)

  • Lynne DrummondEmail author
  • Andrew Roney


Despite being amongst the commonest psychological problems seen in both adults and children, treatment of OCD is often misunderstood and poorly administered. This is disappointing as, correctly treated, OCD responds well to treatment with either psychological treatment involving graded exposure and response prevention (ERP) or with relatively high doses of drugs acting on the serotonin system. The first-line treatment of OCD is outlined in this chapter. A small percentage of people do not respond to these first-line treatments and, in these cases, there is evidence for either combining drug treatment with ERP or additionally adding in an agent which acts on the dopamine system. More recent work from highly specialist centres have also demonstrated efficacy for using selective serotonin reuptake-inhibiting drugs in above licensed doses for the small percentage of patients who fail to respond to more conventional treatment.


Obsessive-compulsive disorder OCD Selective serotonin reuptake inhibitors SSRI Graded exposure Exposure response prevention ERP 


Disclosure Statement

“The authors have nothing to disclose”.


  1. 1.
    Thoren P, Åsberg M, Cronholm B, Jörnestedt L, Träskman L. Clomipramine treatment of obsessive-compulsive disorder: I. A controlled clinical trial. Arch Gen Psychiatry. 1980;37(11):1281–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, Welton NJ, Baxter H, Kessler D, Churchill R, Lewis G. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry. 2016;3(8):730–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bloch MH, McGuire J, Landeros-Weisenberger A, Leckman JF, Pittenger C. Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Mol Psychiatry. 2010;15(8):850–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Issari Y, Jakubovski E, Bartley CA, Pittenger C, Bloch MH. Early onset of response with selective serotonin reuptake inhibitors in obsessive-compulsive disorder: a meta-analysis. J Clin Psychiatry. 2016;77(5):605–11.CrossRefGoogle Scholar
  5. 5.
    Fineberg NA, Pampaloni I, Pallanti S, Ipser J, Stein DJ. Sustained response versus relapse: the pharmacotherapeutic goal for obsessive–compulsive disorder. Int Clin Psychopharmacol. 2007;22(6):313–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Soomro GM, Altman DG, Rajagopal S, Oakley Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews 2008;1: DOI:
  7. 7.
    Marks IM, Hodgson R, Rachman S. Treatment of chronic OCD two years after in vivo exposure. Brit J Psychiat. 1975;127:349–64.CrossRefPubMedGoogle Scholar
  8. 8.
    Foa EB, Goldstein AJ. Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis. Behav Ther. 1978;9:821–9.CrossRefGoogle Scholar
  9. 9.
    Ougrin D. Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry. 2011;11(1):1.CrossRefGoogle Scholar
  10. 10.
    Tyagi H, Drummond LM, Fineberg NA. Treatment for obsessive compulsive disorder. Curr Psychiatr Rev. 2010;6(1):46–55.CrossRefGoogle Scholar
  11. 11.
    Whittal ML, Thordarson DS, McLean PD. Treatment of obsessive–compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behav Res Ther. 2005;43(12):1559–76.CrossRefPubMedGoogle Scholar
  12. 12.
    Cottraux J, Note I, Yao SN, Lafont S, Note B, Mollard E, Bouvard M, Sauteraud A, Bourgeois M, Dartigues JFA. Randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychother Psychosom. 2001;70(6):288–97.CrossRefPubMedGoogle Scholar
  13. 13.
    McLean PD, Whittal ML, Thordarson DS, Taylor S, Söchting I, Koch WJ, Paterson R, Anderson KW. Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. J Consult Clin Psychol. 2001;69(2):205.CrossRefPubMedGoogle Scholar
  14. 14.
    Drummond LM. The treatment of severe, chronic, resistant obsessive-compulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments. Br J Psychiatry. 1993;163(2):223–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Drummond LM. CBT for adults: a practical guide for clinicians. London: Royal College of Psychiatrists; 2014. p. 93–111.Google Scholar
  16. 16.
    McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, Matthews K, Veale D, Accreditation Task Force of The Canadian Institute for Obsessive Compulsive Disorders. Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res. 2015;227(1):104–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Erzegovesi S, Cavallini MC, Cavedini P, Diaferia G, Locatelli M, Bellodi L. Clinical predictors of drug response in obsessive-compulsive disorder. J Clin Psychopharmacol. 2001;21(5):488–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JFA. Systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006;11(7):622–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatr. 2005;162(1):151–61.CrossRefPubMedGoogle Scholar
  20. 20.
    Simpson HB, Foa EB, Liebowitz MR, Ledley DR, Huppert JD, Cahill S, Vermes D, Schmidt AB, Hembree E, Franklin M, Campeas RA. Randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatr. 2008;165(5):621–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Wheaton MG, Schwartz MR, Pascucci O, Simpson HB. Cognitive-behavior therapy outcomes for obsessive-compulsive disorder: exposure and response prevention. Psychiatr Ann. 2015;45(6):303–7.CrossRefGoogle Scholar
  22. 22.
    Boschen MJ, Drummond LM, Pillay A, Morton K. Predicting outcome of treatment for severe, treatment resistant OCD in inpatient and community settings. J Behav Ther Exp Psychiatry. 2010;41(2):90–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Boschen MJ, Drummond LM. Community treatment of severe, refractory obsessive-compulsive disorder. Behav Res Ther. 2012;50(3):203–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Simpson HB, Foa EB, Liebowitz MR, Huppert JD, Cahill S, Maher MJ, McLean CP, Bender J, Marcus SM, Williams MT, Weaver J. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiat. 2013;70(11):1190–9.CrossRefGoogle Scholar
  25. 25.
    Pampaloni I, Sivakumaran T, Hawley CJ, Al Allaq A, Farrow J, Nelson S, Fineberg NA. High-dose selective serotonin reuptake inhibitors in OCD: a systematic retrospective case notes survey. J Psychopharmacol. 2010;24(10):1439–45.Google Scholar
  26. 26.
    Vaughan, R, O’Donnell, C and Drummond, L.M. Blood Levels of Treatment Resistant Obsessive-Compulsive Disorder Patients Prescribed Supra-normal Dosages of Sertraline Faculties of Child & Adolescent Psychiatry and General Adult Psychiatry. Annual Conference 2016 06–07 October 2016. The ICC, Birmingham.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.National and Trustwide Services for OCD/BDD, SW London and St. George’s NHS TrustLondonUK

Personalised recommendations