East Asian Arch Psychiatry 2013;23:168
Book Review
Editor: Joseph Zohar
John Wiley & Sons, Inc.
USD 100.00; pp358; ISBN: 978-0470711255
We could not deny the fact that each and everyone of us have experienced some kind of obsessions or compulsions during our lives. A proportion of the population will experience obsessions or compulsions severe enough to meet the criteria for obsessive-compulsive disorder (OCD). Obsessive-compulsive disorder has a worldwide lifetime prevalence ranging between 1 and 3%. Thanks to the media and the celebrity effect, OCD is no longer a rare disease for the public. One of the famous examples would be David Beckham, a well-known English footballer, who revealed to media that he had to line up everything into a straight line and made everything in pairs in order to make ‘everything perfect’.
If a history of OCD is to be traced, in Europe, it could date back to the 14th to 16th century. At that time, people with OCD who presented with obsessive thoughts about sexual themes were thought to be possessed by devils. In the 1910s, Sigmund Fred regarded OCD as a subconscious conflict manifesting as symptoms. While psychiatrists still regarded OCD as a rare disorder and refractory to treatment in the 1970s, the research and revolution in regard to this disorder have been moving forward at an extremely fast pace in the past 25 years. In the book Obsessive Compulsive Disorder — Current Science and Clinical Practice, Dr Joseph Zohar brings us into the world of OCD and gives us a detailed picture on the OCD revolution in progress in the 20th century.
The first section of the book provides essential knowledge about the disorder. It introduces the diagnostic criteria and assessment tools for diagnosing OCD, as well as approaches to treat the condition pharmacologically and psychologically. Interestingly, it described more and more promising research results pertaining to deep brain stimulation and transcranial magnetic stimulation for treating severely affected, treatment-refractory patients.
The second section delved into some clinical spotlights about OCD. As we all know, OCD has several subtypes and overlaps with a spectrum of related disorders (body dysmorphism, hypochondriasis, some eating disorders, and even impulse control disorders). The author therefore explores the heterogeneity and homogeneity of these disorders in terms of the content of their respective obsessions, patient characteristics, and treatment responses. In this section, the lengthy discussion on whether compulsive hoarding was an OCD subtype, an OCD spectrum disorder, or just a dimension of OCD, caught my attention.
The last section of the book broadened my horizon on recent research developments on the neurocognitive and neuropsychiatric aspects of OCD. Neuroimaging studies have shown that increased activation of the caudate nucleus and anterior orbital frontal cortex were specific to OCD. Moreover, genetic studies lead us to genetic risk factors for OCD, including some genome-wide association studies or whole genome sequencing studies necessary to elucidate OCD risk genes. In the search for endophenotypes of OCD, strikingly, there were cognitive abnormalities (reduced activation in orbitofrontal, prefrontal, and parietal regions) in some patients and their relatives. This points to future research on exploring the relationships between the endophenotypes and treatment response.
Overall, the book provides detailed, concise information on OCD. Dr Zohar concluded that “the future for OCD patients is brighter”. Indeed, owing to the various technologies and new skills available nowadays, more innovative research can be undertaken and more effective treatments can be provided.
Lilian Yan-Tung Lo
(email: ytlilian@gmail.com)
Department of Psychiatry
Tai Po Hospital
Hong Kong SAR, China