Advances in Psychiatric Treatment (2009) 15: 332-343. doi: 10.1192/apt.bp.107.004705
© 2009 The Royal College of Psychiatrists
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Risk assessment and management in obsessive–compulsive disorder

David Veale, Mark Freeston, Georgina Krebs, Isobel Heyman and Paul Salkovskis

David Veale is an honorary senior lecturer and a consultant psychiatrist in cognitive behaviour therapy at the NIHR Biomedical Research Centre for Mental Health, The South London and Maudsley NHS Foundation Trust, King’s College London, and The Priory Hospital North London. Mark Freestonis Professor of Clinical Psychology at Newcastle University, Newcastle upon Tyne. Georgina Krebs is a clinical psychologist working in the service for young people with obsessive–compulsive disorder at the Maudsley Hospital, London. Isobel Heyman is an honorary senior lecturer at the Institute of Psychiatry, King’s College London, and a consultant child and adolescent psychiatrist working in the service for young people with obsessive–compulsive disorder at the Maudsley Hospital, London. Paul Salkovskis is Professor of Clinical Psychology and Applied Science at the Institute of Psychiatry and Clinical Director of the Maudsley Hospital Centre for Anxiety Disorders and Trauma.

Correspondence: Correspondence Dr David Veale, Centre for Anxiety Disorders and Trauma, Maudsley Hospital, 99 Denmark Hill, London SE5 8AF, UK. Email: David.Veale{at}iop.kcl.ac.uk

Some people with obsessive–compulsive disorder (OCD) experience recurrent intrusive sexual, aggressive or death-related thoughts and as a result may be subjected to lengthy or inappropriate risk assessments. These apparent ‘primary’ risks can be dealt with relatively easily through a careful understanding of the disorder’s phenomenology. However, there are other, less obvious ‘secondary’ risks, which require more careful consideration. This article discusses the differentiation of intrusive thoughts and urges in people with OCD from those experienced by sexual or violent offenders; assessing the risk of self-harm and suicide; discussing the nature of repugnant obsessions with a patient; assessing risk of harm and violence to the dependents and family living with someone with the disorder; and assessing the lack of insight and the use of the Mental Health Act. Issues specifically related to children and young people with OCD are also highlighted.