Is a Psychodynamic Perspective Relevant to the Clinical Management of Obsessive–Compulsive Disorder?

Obsessive–compulsive disorder (OCD) can be a severe and disabling condition with considerable variability in clinical presentation, course, and treatment response. Based upon demonstrated efficacy in clinical trials, selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) have become the treatments of choice for patients with OCD. By contrast, psychodynamic formulations and treatments are often considered irrelevant or contraindicated. In the present paper, the authors present five clinical cases of OCD where psychodynamic understanding and/or treatment was essential for optimizing outcome. The authors suggest that a careful psychosocial history and dynamic formulation can enrich understanding in patients with OCD and may sometimes point to alternative or supplementary treatments. Psychodynamic interventions may be considered for two subgroups of patients: those with late–onset OCD that coincides with interpersonal stressors, and those having borderline personality disorder, for whom specialized forms of treatment, such as dynamic deconstructive psychotherapy, may be indicated.