Chapter 20 - Special Topics and Challenges in Treatment

Summary

The co-occurrence of EDs and OCD presents specific treatment challenges. The severity of illness is an important factor to consider when treating this presentation as it can impact treatment planning and prognosis. Having this comorbidity decreases the rates of treatment completion for OCD. The degree of insight is also crucial when considering treatment and outcomes. A prior treatment history can also impact compliance and outcome in several ways for both EDs and OCD. Clinicians have no control over any type of messaging or interventions that patients were exposed to by other providers, and bad treatment can be worse than no treatment at all as it leaves more for the new clinician to “undo” to optimize outcomes. Religious and cultural variables should be taken into consideration and managed in the most ethical and culturally sensitive manner. Families and social support are crucial for the treatment process, particularly for adolescent and young adult patients. When these supports are lacking or problematic, it can create additional challenges for the clinician and may require adjustments to the treatment plan as issues arise.