Complex Cases

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One of the major specialty areas of NBI is “complex cases.” Many patients struggle to find the help they need when they don’t fit exactly

into the mold of standard treatment protocols. Other cases are complicated to treat because they present numerous challenges or the patient

has trouble engaging the therapy.

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Examples of our complex cases include:

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OCD combined with an Autism Spectrum Disorder (ASD) or personality disorder

ASD combined with TICS and ADHD

Any diagnoses combined with a Substance Use, Eating Disorder or Personality Disorder

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Severity or duration of symptoms should not be equated with “complexity” per se. There is no single answer to this question, but here are five

possibilities.

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What Makes a Case Complex?

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One reason a case may be considered complex is that there are co-occurring diagnoses. Having more than one clinical condition can result in

a synergistic effect in which each one feeds into and complicates the other(s). This makes it difficult to set priorities and organize an effective

treatment plan.

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Another reason for a case being complex is that it defies clear diagnostic understanding. Some cases are “a little of this and a little of that,”

which can add up to a whole lot of complexity that is far more difficult to address than the sum of its parts. Sometimes the best that can

be done is to place the case into a “diagnostic ballpark” and work from there instead of painstakingly searching for the one most “apt” diagnosis.

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The third reason that makes a case complex is that standard treatment protocols have not been successful despite being well designed and

implemented.

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A fourth reason is that the “best practice” approach to treatment is not acceptable to the patient and/or their significant others. This is not

uncommon when treatment is counter-intuitive or involves discomfort, fear, or logistical concerns. This certainly can be the case with

exposure-based behavioral therapies or recommendations for intensive treatment or inpatient/residential care.

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Finally, some cases are complex more because of their context than their clinical factors. Examples of complicating contexts include lack of

accessible resources in the patient’s vicinity and the presence of others in the patient’s environment that impede their progress. This can be

a family member who is involved in substance abuse or legal problems, or at the other end of the spectrum, a significant other with whom

the patient is so enmeshed that making improvements in their presence is unlikely (even if that person has the best of intentions).

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We Are Proactive About Finding Solutions?

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No matter how complex a case is, every patient deserves dedicated help from a knowledgeable professional. At NBI, we have helped patients

from a variety of backgrounds and experiences. We are committed to finding the best course of treatment, whether it’s with us or another trusted

behavioral expert.