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This paper provides an overview of the growing convergence among psychodynamic and cognitive-behavioral approaches of Obsessive-Compulsive Disorder (OCD). From a traditional psychoanalytic point of view, OCD is mainly conceptualized in terms of a constant conflict between feelings of love and hate. More recent psychodynamic theories of OCD, such as the object-relational model, focus on the role of ambivalent mental representations or cognitive-affective schemas of self and others. This notion of mental representations or schemas links psychodynamic formulations to cognitive-behavioral approaches of OCD. Moreover, there is increasing overlap between psychodynamic and cognitive-behavioral models concerning the core dynamics involved in OCD. Implications of this convergence for future research and clinical practice are discussed. (Bulletin of the Menninger Clinic 71[4], 291-308)
Obsessive-Compulsive Disorder (OCD) is an incapacitating disorder with a lifetime prevalence of approximately 2 % to 3 % ( Samuels &c Nestadt, 1997). In the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1994), OCD is mainly conceptualized in terms of obsessions and compulsions. Obsessions are defined as persistent thoughts, ideas, images or impulses, experienced as ego-dystonic (DSM; APA, 1994). Compulsions, in turn, are understood as repetitive behaviors or mental acts aimed at reducing the distress and anxiety which is often caused by preceding obsessions (DSM; APA, 1994). OCD shows considerable comorbidity with other disorders, including depression, other anxiety disorders, and cluster C personality disorders, in particular Obsessive-Compulsive Personality Disorder (OCPD) (e.g., Denys, Tenney, van Megen, de Geus, & Westenberg, 2004; Tenney, Schotte, Denys, van Megen, & Westenberg, 2003).
Theory and research concerning the etiology of OCD ranges from genetic (e.g., Grados, Walkup, & Walford, 2003), neuropsychological (e.g., Greisberg & McKay, 2003), and neurobiological approaches (e.g., Saxena, Bota, & Brody, 2001) to psychosocial approaches, including psychodynamic (e.g., Esman, 2001; Rice, 2004) and cognitive-behavioral theories (e.g., Whittal, Rachman, & McLean, 2002). The present paper focuses on the growing convergence among psychodynamic and cognitive-behavioral approaches of OCD in the context of the ongoing dialogue between both theoretical approaches (e.g., Luyten, Blatt, &C Corveleyn, 2005; Westen, 2000). First, traditional as well as more contemporary psychodynamic approaches of OCD are discussed, followed by an overview of cognitive-behavioral views of OCD. Next, similarities and differences between psychodynamic and cognitive-behavioral approaches of OCD are addressed, focusing on more recent...