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Book Forum: CLINICAL TOPICS   |    
Obsessive-Compulsive Disorder: Theory, Research, and Treatment
Am J Psychiatry 1999;156:1108a-1109.
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Florence, Italy

edited by Richard P. Swinson, Martin M. Antony, S. Rachman, and Margaret A. Richter. New York, Guilford Publications, 1998, 478$55.00.

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Books on obsessive-compulsive disorder (OCD) continue to appear, amply justified by the epidemiology and the renewed hope kindled by the integration of increasingly effective therapies. Obsessive-Compulsive Disorder: Theory, Research, and Treatment contains impressive epidemiologic data that, unlike the data in many other reports, are not presented as being nonproblematic. On the contrary, problems are highlighted and suggestions made about how these data can be interpreted.

The book includes a clear and comprehensive psychological section, with hypotheses about cognitive mechanisms and an unusually thorough specification of some of the manifestations of compulsive behavior, with numerous examples such as compulsive urges, compulsive reassurance seeking, covert neutralization, exaggerated sense of responsibility, and psychological fusion of thoughts and actions.

There is a well-developed discussion of personality, where at last there is historical recognition of the contribution made by Pierre Janet to the description of the obsessive personality. This section also contains a review of recent studies on categorical definitions and the phenomenon of comorbidity, which is of considerable significance for therapeutic choices, particularly in terms of balancing the dimensions of compulsivity and impulsivity.

Due attention is devoted to the effects of the family and marital relationships and their influence on the dynamics of symptom development and outcome, and there are useful suggestions for specific methods of evaluation.

The first section contains detailed examinations of three other areas: biological models, including a description of the specific receptors that may have an important role in OCD and the serotonin-dopamine balance; an update on genetic studies; and a careful examination of the relationship between OCD and anxiety disorders.

An exhaustive survey of psychometric evaluation and psychosocial concerns opens the therapeutic section of the book, which points to the fact that a balance between risk and benefit is always necessary for a disorder that begins in adolescence. Then a good section on pharmacological treatment covers both general issues and therapeutic strategies and provides didactically useful clinical outlines for specific agents, fruit of the extensive experience of authors Pato, Pato, and Gunn. One chapter compares cognitive behavior therapy with integrated treatments.

Some authors present theoretically founded definitions of the concept of spectrum, but, as often happens, others use the term loosely and in an undefined way, reducing the concept to the term "related." There is a need for a definition of the concept of an OCD spectrum that is not only operationally effective but conceptually explains the necessity for understanding the concept of spectrum as a model. Otherwise, the concept of an OCD spectrum, despite its undoubted clinical use, runs the risk of sinking without trace, as has already happened with other spectrums.

Finally, I would like to add to the resource information in the appendix that the Gruppo Italiano per l’OCD, whose president is L. Ravizza, has been part of the World Psychiatric Association Committee for OCD since February 1996.

This new book on OCD is outstandingly good; it is both practical and thought-provoking and, one suspects, destined to become a classic of its kind.




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