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Integrates modern science and medicine with alternative and self-help therapies. Updates current knowledge on obsessive-compulsive disorder (OCD)-offering practical advice for specific and appropriate patient care. Obsessive-Compulsive Disorders covers spectrum illnesses, including somatoform, dissociative, eating, schizo-obsessive, neurological, and impulse-control conditions defines and assesses OCD with DSM-IV and other instruments discusses causative factors of OCD examines and proposes improved naturally occurring veterinary animal models details new pharmacological and combination/augmentation treatments and serotonin-reuptake inhibitors provides a mind-brain interaction paradigm based on metabolic changes resulting from cognitive behavioral self-treatment charts the growth of nonpharmacological and behavioral as well as alternative therapies, such as group and family support strategies and yoga meditation and more.
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Edited By Eric Hollander The Mount Sinai School of Medicine New York, New York Dan J. Stein University of Stellenbosch Tygerberg, South Africa
MARCEL DEKKER, INC. NEW YORK BASEL HONG KONG
Page aa
Medical Psychiatry Series Editor William A. Frosch, M.D. Cornell University Medical College New York, New York
1. Handbook of Depression and Anxiety: A Biological Approach, edited by Johan A. den Boer and J. M. Ad Sitsen
2. Anticonvulsants in Mood Disorders, edited by Russell T. Joffe and Joseph R. Calabrese
3. Serotonin in Antipsychotic Treatment: Mechanisms and Clinical Practice, edited by John M. Kane, H.-J. Mller, and Frans Awouters
4. Handbook of Functional Gastrointestinal Disorders, edited by Kevin W. Olden
5. Clinical Management of Anxiety, edited by Johan A. den Boer
6. Obsessive-Compulsive Disorders: Diagnosis Etiology Treatment, edited by Eric Hollander and Dan J. Stein
ADDITIONAL VOLUMES IN PREPARATION
Bipolar Disorder: Biological Models and Their Clinical Application, edited by L. Trevor Young and Russell T. Joffe
Dual Diagnosis and Treatment: Substance Abuse and Comorbid Medical and Psychiatric Disorders, edited by Henry R. Kranzler and Bruce J. Rounsaville
Page ii
Library of Congress Cataloging-in-Publication Data
Obsessive-compulsive disorders : diagnosis, etiology, treatment/edited by Eric Hollander, Dan J. Stein. p. cm. -- (Medical psychiatry ; 6) Includes index. ISBN 0-8247-9856-2 (alk. paper) 1. Obsessive-compulsive disorder. I. Hollander, Eric. II. Stein, Dan J. III. Series. [DNLM: 1. Obsessive-Compulsive Disorder--diagnosis. 2. Obsessive-Compulsive Disorder--etiology. 3. Obsessive-Compulsive Disorder--therapy. W1 ME421SM v.6 1997 / WM 176 0143 1997] RC533.0276 1997 616.85'227--dc21 DNLM/DLC for Library of Congress97-11363 CIP
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Copyright 1997 by Marcel Dekker, Inc. All Rights Reserved.
Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Current printing (last digit): 10 9 8 7 6 5 4 3 2
PRINTED IN THE UNITED STATES OF AMERICA
Page iii
Series Introduction
Thirty-five years ago, when I was just entering psychiatry, obsessive-compulsive neurosis (sic) was something we read about in Freud and heard about from our elders, but did not see in practice. It was rare and elusive; some thought it illusory, merely a symptom of impending schizophrenia. We did see bits and pieces of itnormal phase-related obsessiveness in young children, character traits of orderliness and hyperscrupulosity, and quasidelusional preoccupations that at that time were always interpreted as features of psychosis.
When we evaluated the frequency of obsessive-compulsive disease, we underrated the impact of the ego-alien qualities of the symptoms. Truly delusional patients believe in the reality of their experience, and are often willing to talk about it. On the other hand, obsessive-compulsive patients know that their thoughts and acts are senseless and crazy, and they feel shame and humiliation and hesitate to tell family members, friends, physicians, or others what they are compelled to think or do.
As Drs. Hollander and Stein describe, it is now understood that there is a biology of the illness, and we are beginning to accumulate some knowledge of the details of that biology. Thus, it does not surprise us that we have discovered a number of effective biological treatments. However, it is also true that there are a number of focused psychotherapeutic treatments that appear to be more or less equivalently effective. It may be that the old biopsychosocial model of psychopathology will turn out to be correct! These findings have uncovered a significant population of previously undiagnosed, formerly untreatable, and certainly untreated patients. Seeing numbers of such patients impresses us with
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