Everything You Need to Know About OCD by Dr. Lynne M. Drummond with Laura J. Edwards is, as the title suggests, a comprehensive book covering OCD and its treatment. The lead author clearly has considerable clinical expertise working with clients with hard-to-treat OCD.
The book looks at the processes involved in OCD, including distressing thoughts increasing when one tries to suppress them, and thought-action fusion (the belief that having a thought is the moral equivalent to performing the act that the thought relates to—I’ve got a blog post coming up on that). It covers different types of OCD as well as common co-occurring conditions. Autism spectrum disorder is one of the co-occurring conditions mentioned, and the author explains how to differentiate between autistic rituals and OCD rituals.
There’s a chapter devoted to medication treatments, side effects, and commonly asked questions about med use. I found it interesting that the author chose to use the term “dopamine blockers” rather than “antipsychotics.” Dopamine blocker is actually a more accurate term than antipsychotic, but the choice definitely seemed like an acknowledgement of the associated stigma. There’s also a chapter on emerging research that looks at the role of treatments like neurosurgery (a far cry from the icepick lobotomies performed back in the day) and deep brain stimulation (which is also used for depression)
The book gives a lot of attention to exposure and response prevention (ERP). The author recommends constructing a hierarchy for exposures, but not for compulsions. She writes, “It can often be tempting to gradually reduce compulsions or even place these on a hierarchy. In reality, this rarely works because it is extremely difficult to cut down on such behaviours. It is much better and easier in the long term to stop the compulsive behaviours entirely.” For exposures to be most effective, the author recommends doing them three times a day and for long enough each time for the anxiety level to drop by half, which she says initially might take a couple of hours. There’s definitely no promising an easy fix here.
A lot of the example exposures the book offered are things that are more extreme than what a “normal” person would typically do. The author explained this in terms of a treatment pendulum. If OCD is at one end and extreme risk-taking is at the other, exposures should swing past normal into risk-taking territory to make people less likely to return to the slippery slope back to OCD.
In the chapter for family and caregivers, the book emphasizes the importance of not going along with OCD compulsions and reassurance-seeking. The author recommends calling the police if not going along with the OCD results in threats or violence. The fact that this was mentioned a few times hints at how profoundly unwell her patients are.
There are lots of case examples throughout the book, and many of these involve patients who were extremely debilitated by their illness. Many of these examples include ERP programs, and there are a number of these for each different OCD theme (e.g. contamination, symmetry, taboos like pedophilia, and fear of harm to self/others through either thoughts/actions or failure to act).
The author explains that the term pure-O OCD that’s sometimes used is actually inaccurate, as obsessive rumination has two parts: the distressing thoughts (obsessions) and mental compulsions to ward off harm from distressing thoughts, reduce distress, or put things right. She writes about how to differentiate these two parts and offers strategies to overcome the fact that mental compulsions can occur involuntarily even if one tries not to do them.
The author is based in the UK, so some of the discussion about treatment availability won’t be relevant to readers outside of the UK, but I don’t think that detracts from its suitability for an international reader base.
This book isn’t a light read. The language used isn’t difficult, it’s laid out well, and there are concise point-form summaries at the end of each chapter, but it’s packed with facts. There are lots of details, but they’re relevant rather than extraneous. The book would be a great choice if you’re wanting to learn a lot about OCD or if you’re looking for information related to difficult-to-treat OCD. For people whose OCD is on the milder side and isn’t causing a massive disruption in their lives, some of the other books on OCD that I’ve reviewed would probably make a better starting point, but if you’re looking for a really comprehensive resource, this is it.
Everything You Need to Know About OCD is available on Amazon (affiliate link).
I received a reviewer copy from the publisher through Netgalley.