Specialist OCD/BDD Programme

The hospital offers intensive treatment programmes for adolescents and adults with obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), health anxiety or a specific phobia of vomiting (SPOV). These are offered on an inpatient, day patient, or outpatient basis. All such programmes are based on NICE treatment guidelines that recommend adolescents or adults with OCD or BDD should be offered cognitive behaviour therapy (CBT), which includes exposure and response prevention.

Clinical lead

Dr David Veale has an international reputation in the field of BDD and OCD having published both academic and self-help material on the subject. He was a member of the NICE working group that produced guidelines on treating OCD and BDD. He is a Consultant Psychiatrist in CBT at the South London and Maudsley NHS Foundation Trust. He has also published articles on SPOV.

For more information visit www.veale.co.uk

Assessment

An initial assessment for suitability and treatment planning is offered with Dr David Veale and sometimes one of the therapy team. This gives an opportunity for a treatment plan to be jointly agreed with the patient prior to admission. If this is not possible, then an initial assessment may be conducted as a home visit or over the telephone. The admission criteria can be provided on request. A formal assessment of response to treatment is completed on the ward within the first 2 weeks. This assessment is focused on the patient’s ability to engage in treatment. Medication may also be reviewed.

Inpatient service

Individuals with OCD or BDD, both adults and adolescents, are normally admitted when they have failed to make progress with outpatient treatment, when their handicap is too severe for outpatient care or for geographical reasons. In some cases, additional diagnoses such as depression, schizophrenia, or disordered eating may make outpatient treatment more complex. Others again may be housebound, be very underweight, have a reversal of their sleep pattern or suffer from obsessional slowness so that attendance as an outpatient has become almost impossible. Adolescents (aged 12 to 17) may be admitted to the adolescent unit.

Individuals receive a thorough psychological understanding of how their solutions have become their problem in order to fully appreciate the implications for successful treatment. The programme is therefore designed to maximise understanding and engagement in the early stages, following which patients are expected to conduct exposure or behavioural experiments at least three times a day, undertake homework diaries daily and complete weekly ratings of outcome. In addition, all staff may model exposure or participate in behavioural experiments to help test out a patient’s beliefs.

Inpatients receive:

• Up to three individual sessions of CBT with their key therapist
• Support from nursing staff in doing exposure and behavioural experiments
• Group CBT sessions which are specific to OCD or BDD
• A range of groups for related problems such as depression, low self–esteem and social anxiety
• Regular monitoring of progress, which is used to audit outcome
• Medication is also reviewed and, since CBT may sometimes have a better outcome when combined with an SSRI or clomipramine, augmentation medication may be offered.

National Commissioning Group

The National Commissioning Group for Highly Specialist Services (NCGHSS) has commissioned the Priory Hospital North London to provide an enhanced service for the treatment of refractory OCD in adolescents or BDD in adolescents and adults. The funding for such patients is by the Department of Health. Details of the consortium and criteria for funding can be found at www.iop.kcl.ac.uk/ncg . Patients who do not meet such criteria can still be referred by the normal process and can be funded through private medical insurance, self pay or through their PCTs.

Outpatient or day patient service

Patients may also be treated with a once weekly or more intensive outpatient programme of CBT based around the same treatment philosophy as the inpatient programme.

Family therapy

Partners and relatives are encouraged to meet with the therapy team. The team will want to assess their involvement in the OCD or BDD and they will be advised on how best to support a patient’s treatment.

Local involvement

We aim for patients to be able to travel (if necessary with a relative or friend) so they may return home on therapeutic leave as soon as possible at weekends to practise in their own environment. NHS patients must have an identified local care co-ordinator who can discuss follow-up arrangements and attend a CPA meeting with a family member. There should be follow-up by a local cognitive behaviour therapist who would preferably act as the care co-coordinator. Alternative follow-up arrangements including telephone consultations and day patient or outpatient care can also be arranged.

Literature

OCD patients are encouraged to read the book ‘Overcoming Obsessive Compulsive Disorder’. BDD patients are encouraged to read ‘Overcoming Body Image Problems’. People with SPOV and health anxiety should read ‘Overcoming Health Anxiety’. All books are by David Veale and Rob Willson and published by Robinson Self help groups.

We provide premises for OCD and BDD self help groups, which meet monthly at the Priory Hospital North London.

Attendance is free. For further information contact northlondon@priorygroup.com

Self help groups

We provide premises for OCD and BDD self help groups which meet monthly at the Priory Hospital North London:

The OCD support group - meets on the first Sunday of every month from 7pm – 9pm. They offer support to OCD sufferers, carers family and friends.

The BDD support group - meets on the third Sunday of every month from 4pm -6pm. The group is led by clinical psychologist Martin Anson and is open only to the BDD sufferer.

Attendance to both groups is free. For further information contact northlondon@priorygroup.com

Click here for Explanation of National Commissioning Group contract