Page 14 of No Safe Place

The Disordered Approach to Diagnosis: a pilot study of the impact of misdiagnoses on young people with complex presentations of obsessive-compulsive disorder, and subsequent group-therapy treatment

Background

Access to a correct early diagnosis may be limited by several factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialised service.

This pilot study describes outcomes for a group-based cognitive-behavioural treatment for OCD in young people who have experienced lengthy misdiagnosis, and explores the impact this delay has had on their subsequent illness.

Method

Five participants, aged 13 to 16 years, received up to 25 hours of CBT per month. This was supported with weekly talking therapy sessions in a group setting. All five participants were hospitalised at the time of the pilot.

Participants

Patient A – ritualistic eating, compulsions around food. Misdiagnosed as body dysmorphic disorder (BDD).

Patient B – severe dermatillomania. Misdiagnosed as generalised anxiety disorder (GAD).

Patient C – harm OCD coupled with severe misophonia. Misdiagnosed as autism-spectrum disorder (ASD) and post-traumatic stress disorder (PTSD).

Patient D – counting and magical thinking. Misdiagnosed as borderline personality disorder (BPD).

Patient E – contamination OCD and magical thinking. Misdiagnosed as GAD.

Results

Improvements were found for OCD symptoms across all informants. All five participants were discharged from hospital care at the end of the pilot, with continued support taking place in the community. Follow-ups will be carried out at 3-month intervals for 24 months.

Conclusions

The findings suggest that group therapy is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people.

This therapy requires further evaluation in randomised, controlled trials to compare effectiveness with one-to-one CBT at the point of the eventual diagnosis, which currently represents the usual care model.

Furthermore, the study highlights the need for greater education of general practitioners and therapy services, to ensure complex cases of OCD are diagnosed effectively and as early as possible.