Is Psychoanalytic Psychotherapy Relevant to the Treatment of OCD?

There has been a profound reconceptualization of obsessive-compulsive symptomatology during the last 15 years. Substantial scientific advances have broadened our understanding of the epidemiology, etiology, diagnosis, and treatment of obsessive-compulsive disorder (OCD). As has been true of other psychiatric disorders throughout this century, initial etiologic explanations were based on psychoanalytic findings and constructs. Now, however, positron emission tomography of patients with OCD has yielded exciting new findings such as demonstrations of increased metabolic activity in the caudate nucleus that can be reduced through psychotherapy. Behavioral therapy focused on exposure and response prevention, in conjunction with the use of selective serotonin reuptake inhibitors (SSRIs), has emerged as the treatment of choice for OCD. As a result, there is rather strong condemnation of the use of psychodynamic psychotherapies in treating OCD. Although there is general agreement that psychoanalytically oriented psychotherapies are ineffective in extinguishing intensive rituals, does there remain any usefulness to this approach for those suffering from OCD? This Grand Rounds will address this clinical question by describing the intensive treatment of a young man with OCD who failed to respond to behavioral and psychoanalytic psychotherapy and who initially was unable to take medication. The Beginning of Treatment