Obsessive-Compulsive Foundation

Book & Movie Reviews
(Page 2 of 2)

I recommend Dr. Morrison's book to patients being treated with antidepressant medications and to their families. Above all, I find the book to be reassuring and informative. Reading this book or the sections which pertain to one's own situation can go a long way to reassure one that he or she is being treated appropriately and that there is real expectation for improvement. Similarly, it can help those who are not being treated appropriately and optimally to recognize this and seek a second opinion.

In addition, the book is a very informative guide for clinicians, both the prescribing physician and the therapist. None of these clinicians knows everything and most of them treat more than just your disorder. One can go a long way in improving one's own treatment by showing particular portions of this book which seem to pertain to one's case to the clinician. Discussing the particular sentences, paragraphs, or chapters which you think pertain to your situation will help you to learn more about your disorder and will help your clinician optimize your treatment. (This book is not a replacement for a clinician, but is a great adjunct for you and your treating professional.)

Uncertainty is one of the biggest challenges to overcome for the patient with OCD, other anxiety disorders, and/or depression. Dr. Morrison addresses uncertainty very well. First, he encourages clinicians to be open and honest with each patient, telling the patient his or her diagnosis and treatment plan. This, he points out, helps greatly to alleviate the patient's anxiety so that one's anxiety does not impede or delay one's recovery. Also, he provides patients and their family members with answers to many of the nagging, recurring, and anguishing questions that arise when one is suffering from OCD, other anxiety disorders, and/or depression. The book provides a reference point against which to measure one's own therapy.

1.	Why should I expect a medication to help a disorder of the brain?
2.	What should I expect from the medication?
3.	Is this the right medication for me?
4.	Might I do much better on a different medication?
5.	What constitutes a fair trial of one medication so that I neither continue jumping from medicine to medicine without getting much improvement nor restrict myself to one medicine when another might help me considerably more?

1.	Be encourage (to overcome pessimism).
2.	Understand the biochemical nature of one's disorder.
3.	Be compassionate toward oneself.
4.	See taking medication as appropriate treatment and not a sign of mental weakness (have permission to be on medication).
5.	Establish reasonable expectations including reasonable time frames.
6.	Remain patient while allowing the medication and therapy to combine to bring significant relief.
7.	Be reassured that he or she is being treated appropriately and optimally The book educates and is a "very friendly read." The author includes numerous "Case Examples" which make reading this book a personal experience and illustrate the individuality of diagnosis and response from case to case.

One of the most promising developments in non-drug treatment for OCD over the past decade has been the finding that, for many patients, cognitive therapy techniques -- similar to those used by Dr. Aaron Beck for treating depression, but modified to address the particular cognitive distortions common in OCD -- are equally effective for exposure and response prevention treatments.

Dr. Lata McGinn of Albert Einstein College of Medicine/Montefiore Medical Center in New York and Dr. William Sanderson of Rutgers University in New Jersey are clinical psychologists with extensive experience in using behavior therapy techniques and cognitive therapy techniques for various anxiety and depressive disorders. Their book is intended as a treatment manual to teach practitioners how to integrate the newer cognitive restructuring approaches for OCD with the older and better-established exposure and response prevention treatments for this disorder. The authors have succeeded admirably in achieving their goal.

Clinicians with no experience treating OCD, or those seeking information about integrating cognitive therapy for this disorder, will find the step-by-step instructions, along with the simulated therapy session transcripts provide a clear introduction to this method. Some shortcomings of the book are the lack of discussion of standard rating scales clinicians should use to assess OCD severity and progress, such as the Yale-Brown Obsessive Compulsive Scale (YBOCS), and focusing only on the use of cognitive techniques and exposure techniques for classic OCD symptoms such as contamination and harming fears, without discussing complicated OCD-related problems often seen in clinical practice including body dysmorphic disorder, complex tics, and fixed beliefs interfering with treatment, including fixed religious beliefs. The lack of discussion of these issues means that this book should be used by the clinician as a supplement to other more comprehensive treatments of OCD-spectrum disorders rather than standing alone as a comprehensive guide to treating these disorders.

Although this book is not intended as a self-help guide for patients, the OCD sufferer interested in learning more about this treatment approach might find it helpful, despite the technical jargon that is unavoidable in any book intended for professionals.

As all of the readers of the OCD Newsletter well aware, Obsessive-Compulsive Disorder (OCD) represents one of the more chronic and pernicious conditions facing individuals, families, and clinicians today. This book seeks to help all of us begin to unravel the complexity of OCD by viewing it within a broader perspective. The authors, each respected scientist-practitioners in their own field (psychiatry and clinical psychology), are well-known to the OCD Foundation's circle of advisors.

They have spent much of their professional careers building bridges across professional boundaries, conducting "state-of-the-art" research, publishing their findings, and co-directing a major center for the treatment of OCD in Great Neck, New York.

The unique combination of scientist-practitioner, complemented by a 2,000-plus patient base provides three dimensions to their work. This, their most recent book, enlightens those who would believe OCD to be a singular diagnostic entity akin to simple phobia rather than as a spectrum of disorders, each individually and in combination presenting Herculean clinical diagnostic and treatment challenges, not withstanding the core OCD itself.

Managed-care providers beware, you will not like what you read. Their book just justifiably supports longer treatment regimens.

Likewise, professionals who still hold that they alone hold the secrets, take heed: Global warming is occurring; you will no longer be able to hide behind the jargon. However, patients rejoice, for you and your treatment team may be able to use the research contained in this book to challenge any session restrictions that managed-care organizations and the like might impose on you.

The book is divided into three sections, with a total of 13 chapters. The first section is devoted to OCD. The first chapter explores its history, clinical presentation, epidemiology, and cultural issues from a worldwide perspective.

This chapter ends with an important discussion of differential diagnosis.

Chapter two focuses on treatment, and integrates behavioral and pharmacological interventions.

Interestingly, behavioral myths are outlined in a unique fashion. Chapter three reviews OCD in children, including a discussion of mental retardation, ADHD, and autism.

Chapter four reviews assessment across behavioral, psychological, neurobiological, and neuropsychiatric dimensions. The first section provides a complete and thorough understanding of OCD. Section II is composed of eight chapters, the spectrum if you will, of kindred conditions. Each of the following is presented: schizophrenia, major depression and manic-depressive illness, alcoholism and substance abuse, somatic conditions, body dysmorphic disorder, eating disorders, self-mutilation, and neurological disorders. In each of these chapters, the authors provide a thorough understanding of the condition as well as its treatment. Liberal use of case examples adds depth. Noteworthy here is their use of treatment failures as well as successes.

Finally, the last section focuses on clinical and experimental research. The authors review philosophy, neurobiology, biochemistry, anatomy, and physiology along with each attendant model. They end with a unified theory of OCD. This chapter is the most difficult to read, not because of the writing, but instead because of the diversity and breadth of the material they seek to integrate they successfully accomplished their mission. This chapter is not meant for the fast-food generation, seeking a quick meal; it deserves conceptual dining, as does the treatment of OCD.

Psychiatrists might find it to be too behavioral, and its heavy biological base might threaten psychologists. Shame on both, because the condition requires a confluence of each of your skills and integrated research.

Read, therefore, outside of your comfort zone.

This book is must reading for graduate students in our OCD clinic. Individuals with OCD might find the writing to be too technical and not focused on the "how to's."

However, being able to view your condition as part of a spectrum instead of a single entity will likely support your own experience and give you solace for struggling as hard as you have. It wouldn't be a bad idea for your therapist to have this book.

The authors are not the only scientists advocating for OCD to be viewed as a spectrum; however, I am hard pressed to find a more complete and thorough job at supporting the argument. Where else can one find Kant, Hegel, or Hume referenced with Foa Emmelkamp, or Jenike. Their volume, with its plethora of references and in-depth analysis, supports a perspective of OCD as a spectrum of disorders interlocked around a central OCD core.

In conclusion, this is a very good book. I am afraid, however, that if you accept the argument, as I have, you must reject homogenized amnualized care for this condition. It argues for robust interdisciplinary treatments coordinated by sophisticated clinical decision-making processes, like those proposed by Nezu, et al (1997).

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Checking, Counting, And Other Strange Signs ..., Valery N. Morphew's account of her secret struggle with classic OCD symptoms, should be of special interest to those who are similarly afflicted.

The compact 52-page book presents, in unadorned and candid language, the author's successful battle with her lifelong OCD. Ms. Morphew, an assistant professor of education and science at Longwood College in Virginia, has also included many helpful suggestions for OCDers, parents, educators, clinicians, and clergymen.

With the advent of viable treatment through serotonin medication and improved behavioral techniques, Morphew urges that renewed attention be paid to observing children's habits. She has carefully detailed the early signs that may betray a child's obsessive-compulsive tendencies - subtle cues that too often go unnoticed.

The author also offers hints for those adults who may sense, yet not truly acknowledge, their own OCD or grasp its impact on their lives. After a discussion of denial strategies and of the hesitancy to reveal one's problems even to a clinician, Morphew reminds readers: "Because he can rationalize his thoughts and actions, the OCDer may deny he has a problem at all. And he just knows that no one else would understand, so why tell anyone!"

Finally, having overcome her own years- long hesitancy to seek help, Ms. Morphew, now married and in her thirties, consulted an enlightened GP, just two years ago. She was prescribed the tricyclic medication, Anafranil (clomipramine). The results were surprisingly swift and dramatic. Combining her own accumulated medical and psychological knowledge with an obviously improved serotonin balance, she was able, in the weeks and months that followed, to re-experience feelings of normalcy and optimism that she had not known since the age of five.

"My whole life seems brand new," writes the author, who is nearly symptom-free. "I've become reacquainted with myself, learning what parts of my past were me and what parts were OCD. Sometimes I'm happy with what I learn, and sometimes I'm not. Some things I blamed on OCD are just a part of my personality. But over- all, it's been great ... I have my life back again. I know life has ups and downs, but at least I'm beginning with a level playing field. I'm so glad my secret, my life with OCD, is out."

For decades, Morphew had endured the ordeal of checking and contamination fears - with all the disguised defensive strategies, compulsive acts, and private humiliations that can attend them. Although friendly and outgoing by nature, she would withdraw socially when her compulsions became too urgent to conceal.

With Anafranil, she is no longer a slave to her OCD. She is at last free to respond normally to the world around her. "I stopped looking down all the time when I walked with my husband," says Morphew, and "I noticed things that I should have noticed before. A beautiful holly tree. A small ornamental one."

The author reminds readers that we all differ in our precise neurochemistry and our backgrounds. Although 125 mg Anafranil daily, combined with a trained, scientific eye for self-observation, brought about her own release from obsessive- compulsiveness and its spectrum effects, she notes that for many OCDers, healing may also be achieved through one of the other popular serotonin-specific meds properly dosed - in combination with the use of behavioral therapies and techniques when advisable.

The OCD community will surely find Ms. Morphew's book a very helpful addition to its biographical literature.

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"Learning to Live with Body Dysmorphic Disorder" is a clearly written and needed booklet for the general public about a still-misunderstood and under-recognized condition. Once thought to be rare, BDD is now estimated to affect millions of men, women, and children. However, as described in the booklet, getting the correct diagnosis and treatment continues to be a challenge.

BDD is a disorder that is characterized by a preoccupation with an imagined or trivial physical defect. The authors emphasize that it can become so severe that sufferers may withdraw from family and friends, neglect or stop school or work, and in some cases, attempt suicide.

Unfortunately, out of desperation or shame as well as lack of insight into the psychiatric nature of what they are experiencing, many of those with BDD seek help from professionals. Because they are worried about being thought superficial, vain, or even "crazy," the BDD sufferer often will not confide in their significant others. Because family members and friends don't see anything wrong, they may react with anger and frustration once they become aware of why the sufferer is having problems. Conversely, they may become drawn into a bottomless pit of providing reassurances and other forms of well-intentioned but backfiring support. The authors note that, as of yet, the cause of BDD is not known, but it is generally considered to be related to Obsessive-Compulsive Disorder.

This booklet conveys up-to-date information about this complex condition by a group of highly experienced and knowledgeable authors (The first author, Dr. Katherine Phillips, wrote the book "The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder" that is recommended to the reader desiring in-depth information). Newly diagnosed BDD sufferers or those wondering whether they have this condition will find the case examples and hopeful tone of the booklet particularly helpful. The booklet is also a useful resource for hospitals and clinics to offer for a quick orientation to BDD patients and/or their significant others.

The booklet spends a good deal of time providing helpful tips for significant others, including what to do when the BDD sufferer refuses help. This emphasis on the concerns of family members and friends is especially welcome, as so often it is they who make the initial inquiries about this condition. The authors review the major forms of BDD treatment, including anti-obsessional medication such as Anafranil and Prozac, and cognitive-behavior therapy. An illustration of how a BDD sufferer learns to challenge his/her fears about the appearance of his/her skin with behavior-therapy techniques makes this form of treatment easily understood. A brief section concerning guidelines for coping with child and adolescent BDD is also provided.

Overall, "Learning to Live with Body Dysmorphic Disorder" is highly recommended to both BDD sufferers and those who are concerned about their welfare.

Clinicians treating BDD will find it to be a helpful and practical resource for patients and their families.

1. Bezurigkym F.A., and Yaryura-Tobias, J.A. (in press). A review of cognitive-behavioral and pharmacological treatment of BDD. Behavior Modification.

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Brain Lock by Jeffrey Schwartz, M.D.

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Reviewed by Jan Jablonsky

Is it possible that Dr. Schwartz has devised a new method of treating Obsessive-Compulsive Disorder? And more importantly for individuals with OCD, can this new approach significantly reduce obsessive-compulsive symptoms? These are questions that make Brain Lock essential reading for the millions who are virtual slaves to this horrendous disease, an affliction I've endured most of my life.

An individual must develop the ability to distinguish between what is real and what is OCD, becoming able to believe that his or her obsessions and compulsions are meaningless unwanted thoughts.

Why do I have these unpleasant urges? Because OCD is caused by a biochemical imbalance in the brain. OCD's compulsive urges are false signals sent by a malfunctioning brain.

Do something else. Engage your brain in a more constructive activity. Anything else. It's best to choose something you enjoy: reading, watching a movie, going for a walk, or participating in your favorite sport. When you live in the present, OCD fades into the background.

Once you successfully perform the first three steps, revalue. OCD is a worthless annoyance, not worth a micro-second of your time. By revaluing, individuals with OCD can distance themselves from their disorder. By employing the four steps, individuals unlock the brain's paralysis, what Dr. Schwartz refers to as being, "stuck in gear." Are the four steps genuinely new? Yes! Dr. Schwartz continually emphasizes the intense effort that is needed to employ his program. It's not going to be e asy, and individuals with OCD will have to endure, at the beginning, a great deal of anxiety. Other OCD self-help books fail to prepare the individual for the difficult journey ahead.

Brain Lock contains numerous personal testimonies. These accounts will enable individuals with OCD to realize that they are not alone. Often, this realization is the first step on the road to recovery. In his chapter on OCD and the family, Dr. Schwartz details painful experiences of family members who learn to cope and understand OCD.

I wish Dr. Schwartz had elaborated more on the benefit that is derived when one individual with OCD helps another. This could have been accomplished by including examples from his OCD treatment group at UCLA.

By de-emphasizing the role of exposure and response prevention, Dr. Schwartz may provoke controversy. I applaud Dr. Schwartz's viewpoint on the use of medication to treat OCD. While acknowledging that it's sometimes necessary to use medication, Dr. Schwartz utilizes high-tech brain pictures, or PET scans, to show how an individual can change his or her brain chemistry by using his four step method or by taking an anti-OCD medication.

There is no doubt that Brain Lock is not a perfect book. No book dealing with OCD can achieve perfection. To me, Brain Lock is simply the most intelligent and insightful OCD-related book. The four steps are not a cure, but Brain Lock will greatly benefit individuals with OCD who read it.

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In Phantom Illness, Carla Cantor, in consultation with Brian Fallon, M.D., takes as her subject the complex mystery and experience of "hypochondria." To say that she succeeds is to vastly understate her result.

Actually, Phantom Illness triumphs on two often incompatible counts: It is at once utterly accessible, even stunningly written, while being ceaselessly deep and stimulating. In fact, I found myself stopping continuously as I read through it (true, a bit obsessively) to marvel at its abundant, beautifully written passages.

More importantly, every page of this absorbing book expresses meaningful insights into the psycho/social/medical implications of "hypochondria." Depending on what personally most interests one on this subject (whether as sufferer or therapist/physician/family member dealing with the former), one is sure to find one's particular concerns and curiosities satisfied deeply by Cantor's comprehensive investigation.

In Phantom Illness, Cantor richly explores the historical response to (and understanding of) "hypochondria" and "hypochondriacs," reviewing its evolutionary development in flowing, interesting detail. She unfolds this in such a way as to make for exciting, not leaden, reading. She also examines in depth the complex and reciprocally influential relationships of sufferers and those living with and/or treating them, drawing sensitive conclusions and offering practical advice.

For me, as one who has suffered hypochondriacal worry and now clinically treats obsessively agonized individuals, a distinguishing feature of Phantom Illness is its unwavering sensitivity to and probing grasp of the difficult and painful predicament of the hypochondriac. Certainly, there is balanced discussion of the current means available (psychotherapeutically and psychopharmacologically) to treat this condition.

Wisely, Cantor expresses neither personal bias nor presumptuous conclusions regarding which treatment protocols are most helpful in treating hypochondria.

Always, though, transcending the ample and eloquently translated research that undergirds Phantom Illness, Cantor's empathy and respect for hypochondria sufferers are vividly, even psychotherapeutically, felt.

In the book's epilogue, Cantor meditates profoundly on "hypochondria's" deeper possible relationship to the existential anxiety all of us face (hypochondriacs and non-hypochondriacs alike).

She writes: "For as perverse and destructive as hypochondria can be, it is more than a disturbance of the mind-body relationship; it is also a natural response to the human condition... If you are a sensitive, intelligent and thinking person, you have to be at least a tad hypochondriacal merely by being alive. Otherwise, you are oblivious, in denial, an automaton."

Of her personal struggle with hypochondria, Cantor shares, "..While the dark terror of hypochondria no longer held a grip on the major fabric of my life, its friendship spirit was never far away."

The epilogue alone is so beautiful and profound as to merit purchase of this book. However, the success of Phantom Illness stands on every chapter comprising it, none of which tires, repeats, or fails to offer something fresh and insightful.

Ironically, on finishing this book, I sought the right word to describe the good feeling it left me with, and came up with "reassured."

The book, especially if you suffer from hypochondria, is reassuring. And while we know, and Cantor addresses, that "reassurance" typically fades fast for hypochondriacs, leaving them soon desperate for another dose, the soothing impact of this book still persists for me -- and I frankly don't foresee its fading.

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