Clinical Round Table 16 - Severe and Complex OCD: Multidisciplinary Approach to Behavioral Treatment

Exposure and response prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD), as evidenced by a wealth of randomized controlled trials. Generalization of these findings to clinical practice has been problematic in some cases, however, as cases seen in practice may be more severe or more diagnostically complex than are those enrolled in clinical trials. Multiple diagnoses can interact to create unique symptom presentations and responses to treatment. As such, little is known about the process and outcomes of behavioral treatment for patients with high levels of OCD severity and multiple co-occurring diagnoses such as autism spectrum disorder, severe personality disorders, and substance use disorders. We suggest that such patients require careful assessment; a more intensive and prolonged ERP, often including a supportive living environment; ERP that is adapted to accommodate comorbid conditions; as well as additional attention to illness aspects such as executive dysfunction, nutritional deficits, and supported employment.

In this clinical roundtable, we will hear from experts in a multidisciplinary approach, with expertise in the fields of clinical psychology, neuropsychology, clinical research, and applied behavior analysis. They will describe their approach to these challenging cases, and how these fields can work together to achieve positive clinical outcomes. Challenges and treatment “failures” will be discussed, along with what clinicians can learn from these experiences.