Suggestions from acceptance and commitment therapy for dealing with treatment-resistant obsessive-compulsive disorder

Introduction and definition Obsessive-compulsive disorder (OCD), classied as an anxiety disorder, is characterized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (American Psychiatric Association, 2000) by distressing intrusive thoughts and unwanted repetitive behaviors that cause functional interference. A functional relationship exists between obsessions and compulsions, with almost 90% of people with OCD engaging in the compulsion in response to the obsession (Foa & Kozak, 1995). Current estimates indicate that 1% of the U.S. population (or 2.2 million people) meet criteria for OCD each year (Kessler, Chiu, Demler, & Walters, 2005). The age of onset ranges between early adolescence and early adulthood, usually with an earlier onset in men than women (Rasmussen & Eisen, 1992); a slightly greater percentage of women are diagnosed with OCD, although pediatric clinical cases show a 2:1 male-to-female ratio (Hanna, 1995). Approximately 50 to 75% of those diagnosed with OCD are simultaneously diagnosed with another psychological disorder, with anxiety and mood disorders being the most common (Antony, Downie, & Swinson, 1998). Other psychological disorders that may commonly co-occur with OCD include substance dependence, eating disorders, body dysmorphic disorder, and Tourette’s disorder and other tic-related disorders (Antony et al., 1998).