Presentation and treatment of complicated obsessive-compulsive disorder.

Some of the most common complicating factors for clinicians treating a person with obsessive-compulsive disorder include suicidal obsessions, dangerous compulsions, overvalued ideation, and low motivation. When a patient reports suicidal thoughts, clinicians must assess whether these thoughts are ego-syntonic or ego-dystonic because patients with ego-dystonic suicidal obsessions have less risk of imminent harm. For individuals whose compulsions are dangerous, clinicians must determine the best type of treatment facility to reduce the risk of harm. Patients with overvalued ideation may require unique interviewing approaches and the support of family members. Finally, clinicians should assess for health problems that can cause low energy and fatigue and consider motivational interviewing and additional therapies for patients who have low motivation to continue treatment.