A clinical developmental perspective on the understanding and treatment of obsessive-compulsive disorder
Gisela Röper
A chronic sense of insecurity is pointed out as playing a majur role in the acquisition of the disorder.
Obsessive compulsive symptoms are seen as a way of striving to gain some sense of inner hold on
managing daily tasks, which have become a major challenge. Since rituals usually have to be conducted
despite knowing that they are unnecessary or exaggerated, OCD patients suffer from the well-known shame
or guilt of not being able to resist the urge to ritualise. This means a permanent undermining of self-esteem.
From a clinical-developmental perspective, trajectories of different themes of insecurity will be
described and how they combine into a sense of insecurity. A developmental stance is proposed
as leverage to underpin cognitive-behavioural treatment methods. Attention must also be given
to general self-esteem as an ongoing focus throughout treatment to provide a base for a lasting
treatment effect. Two case vignettes illustrate the inclusion of a developmental perspective into the
cognitive-behavioural treatment.
Keywords
Obsessive-compulsive disorder, cognitive-behavioural therapy, clinicaldevelopmental
psychology, acquisition of obsessive-compulsive disorder.
