Obsessive-Compulsive Disorder (OCD)

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a common, and chronic disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

Is OCD Treatable?

With the right help, Yes! OCD is treatable and people do get better. Have you been living with OCD but not seeking treatment? Now is the time! You can change, and it isn’t as hard as it seems! Susan has experience in treating hundreds of people with OCD, and she can help you too!

Signs and Symptoms

People with OCD may have symptoms of obsessions and compulsions. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting, repeating phrases, rationalizing or other mental rituals

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

 

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

As stated earlier, obsessions are repeated thoughts, urges, or mental images that cause anxiety. You may also call them “fears” or “worries.” You may even call them “thoughts,” and they may come into your mind as images and impulses instead of words.  One reason they can be very distressing is that they don’t seem to fit your image of yourself or your personality, which is important to remember, because you are right!

Let’s look at an extremely disturbing example to clarify; if you are OCD, you might imagine molesting a child repeatedly and fear you will do this heinous act. However, your therapist will show you through treatment that you will not actually ever follow through, it is all part of the OCD. The person who actually commits such acts has a different way of thinking. People with OCD do not commit these acts.

For greater understanding, let’s look at how these fit into general categories of obsessions.  Areas of Obsession and Compulsion include:

Harm

  • You obsess about harming yourself or others in physical, emotional, spiritual, or moral ways, even though you consider yourself a good/nice person.
  • You obsess about killing yourself or others
  • You obsess about running someone over
  • You obsess about committing a violent act
  • You obsess about harming someone you love

Sexual

Unwanted sexual thoughts, or images characterize this cluster of obsessions. They are typically found in people who hold conventional sexual attitudes and engage in socially acceptable practices. It is important to recognize that people with sexual obsessions find their thoughts immoral and do not wish to act them out. Their thoughts differ from fantasies, in that they find them unpleasant and do not act them out. These people do not have criminal histories, and do not end up committing crimes.

  • You obsess about molesting a student or someone in your care
  • You obsess about doing molesting a child or family member
  • You obsess about raping a family member, friend or stranger
  • You may also obsess about being gay, when you are not

Washing and Cleaning

  • Avoid touching certain things because of possible contamination
  • Difficulty picking up items that have dropped on the floor
  • Clean household excessively
  • Wash hands excessively
  • Take extremely long showers or baths
  • Overly concerned with germs and disease

Checking and Repeating

  • Check repeatedly that something is done correctly, or that its condition is satisfactory
  • Difficulty finishing things because you repeat actions
  • Repeat actions in order to prevent something bad from happening
  • Excessive concern about making mistakes
  • Excessive concern that someone will be harmed because of me

Ordering

  • Must have certain things set in a specific order
  • Important that my bed is straightened out perfectly
  • Need to arrange things in special patterns

Thinking Rituals

  • Mentally repeat certain words or numbers
  • Review certain things to myself to feel safe
  • Spend a lot of time praying
  • “Bad” thoughts force me to think about “good” thoughts
  • Rationalize to myself that my fears won’t come true
  • Try to mentally convince yourself these things aren’t true and that you are fine

Pure Obsessions

  • You don’t engage in physical rituals
  • Just have upsetting thoughts that come into my mind against my will.
  • Little control over upsetting thoughts.

Treatments and Therapies

OCD is typically treated with medication, psychotherapy or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to medication. Exposure and Response Prevention is currently the best evidence-based treatment for OCD. ERP is the” best practice” for the treatment of OCD, according to the American Medical Association.

For many patients EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms. However, ERP should be tried in all cases, so that people gain the skills needed to manage the disorder. This is important because symptoms can return when medication is stopped.

Sometimes people with OCD also have other mental disorders, such as another anxiety disorder, depression, and body dysmorphic disorder. It is important to consider these other disorders when making decisions about treatment.

Medication

Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms. Examples of a few of the medications that have been proven effective in both adults and children are “selective serotonin reuptake inhibitors” (SSRIs), including:

  • fluoxetine
  • fluvoxamine
  • sertraline

SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

If symptoms do not improve with these types of medications, research shows that some patients may respond well to a second line treatment such as an antipsychotic medication (such as risperidone). Although research shows that an antipsychotic medication may be helpful in managing symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

If you are prescribed a medication, be sure you:

Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you’re taking.

Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to “rebound” or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.

For basic information about these medications, you can visit the National Institute of Mental Health (NIMH) Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website.

Read more about CBT here

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