Page 26 of No Safe Place
‘Write up a summary, and Riley – speak to the Maudsley and see if there’s any record of who these kids were.’ He went to speak, and she cut him off. ‘I know, I know they won’t tell us anything – but just try, okay?’
He nodded.
‘How are we getting on with tracking down Moore’s current patients?’ Field asked.
‘Precisely nowhere.’ Riley huffed, flicking his notebook open. ‘Someone told me that all therapists have something called a “clinical will” – which means Moore had a plan for all his current patients, in case he got ill or – well, died. I’ve asked to see it – but without a court order no one will send me anything. Reckon it’ll be next week, earliest. Patient confidentiality—’
‘Right, okay,’ Field interrupted. ‘Stay on it, anyway.’
The two of them sat forward in their seats, anticipating her next instruction.
Field geared herself up for one of her mentoring monologues.
‘We need to be sensitive,’ she said firmly. ‘There will be press coverage in a case like this – and I don’t want to be accused of jumping to conclusions. OCD is not an illness that usually presents with delusions or violence.’
Field delivered this fact with more confidence than her conversation with Dr Dawes actually afforded her.
‘If anyone we identify as a person of interest does suffer from a mental illness, I still want us to look for a motive.’
Wilson glanced down at the academic paper.
Field leaned forward, directing her next comments to Riley. ‘The whole team – not just us three, everyone – I want us to be mindful that we might not be conducting run-of-the-mill witness interviews. We are dealing with potentially vulnerable people, who may be deeply affected by what’s happened to their therapist.’
Nods all round. It felt like enough arse covering, and enough of a warning.
Chapter 13
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
Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive-compulsive disorder (OCD) in young people. However, research shows young patients with complex OCD presentations (e.g. misophonia, body-focused repetitive behaviours) spend 18–36 months longer seeking a diagnosis and treatment via the NHS. (McLaren, 2008)
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 thepotential 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.
