Obsessive Compulsive Disorder
Obsessive Compulsive Disorder is one of the most under-reported and
under-treated anxiety disorders. Most people who suffer from it know
that they have a peculiar set of symptoms, but manage to cope
with them. They come in for treatment when their symptoms have
become difficult to manage or when they interfere with work or family life.
People with OCD can have either of two types of symptoms, obsessions
or compulsions. Most have both.
Obsessions are disturbing thoughts,
images, or impulses that intrude into consciousness repeatedly,
despite attempts to block them. They can be frightening, morally
repugnant or just disgusting. They may have clear psychological meaning
to the patient, or they may seem almost random.
Compulsions are repeated behaviors or mental acts that people
with OCD feel driven to perform. Some of the
common behaviors are hand washing, placing things in order, and
checking locks, lights, or the stove. Common mental acts include
counting, praying, or repeating a phrase silently.
Compulsions often have a rigid, ritualistic quality. Things have to be
done in a certain way or they don't count. This is especially true for
compulsions that don't directly relate to the content of an obsession
(for example repeating a phrase silently) and compulsions that exist
without a recognizable obsession.
In most cases, compulsions are aimed at reducing the distress caused by
an obsession or preventing some feared, but often unlikely, event.
However, the actions are clearly excessive and may be unrelated to any
real form of prevention. The person often knows this, but feels too much
anxiety to simply stop.
The obsessions and compulsion of true OCD cause real suffering, and they
can take hours out of the day. They are distinct from the worrying that
people feel with
Generalized Anxiety Disorder or anxiety about having panic attacks
in Panic Disorder.
Please remember that self-diagnosis is never 100% accurate. If this
description matches you, even loosely, you should probably get
treatment sooner rather than later. Even if your problems don't meet the
criteria for OCD, a trained professional can help you get much needed
relief.
You may also want to look up my pages on:
Generalized Anxiety Disorder (GAD),
Panic Disorder & Agoraphobia, and
Post Traumatic Stress Disorder (PTSD).
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Short-term Therapy for OCD
Not so long ago, the standard treatment for OCD involved years of
psychological exploration, searching for the source of the anxiety
manifested as an obsession or compulsion. This form of treatment
was neither efficient nor effective. As a result, many people with OCD
have given up on psychological treatment.
Current short-term, symptom-focused treatment methods have an
outstanding record for curing OCD. If you come in for treatment today,
you can do so with with the expectation of being much better or
symptom free within six months.
We may not know how an obsession or a compulsion starts, but we
know how these symptoms are maintained as a problem. This has
led to the development of the treatment protocol called Exposure with
Response Prevention or ERP.
People
with OCD are almost always anxious about the recurring, intrusive,
disturbing, thoughts, images or impulses that make up their obsessions.
They try to push these out of their minds, but they keep coming back.
It's a bit like the children's joke: "Try not to think of a purple elephant
in a ballerina costume, dancing in the living room." The trick is that
when you try not to think about it, you automatically wind up bringing
it into your mind.
In order to counter the anxious monitoring that brings obsessions into
our thinking, we take a paradoxical approach. Patients are asked to
deliberately think of their obsessions and to keep them in mind for a time.
While their obsessions may be disturbing at first, over a few minutes they
begin to lose their power. By deliberately bringing them to mind, we
become less sensitive to them. This is practiced
until the obsession is no longer bothersome.
The key elements here are (1) deliberate exposure to the disturbing
obsession and (2) refusing to respond to it (either by pushing it out of
mind or with a ritualized act).
The same thing is done with compulsions, even when obsessions aren't
obvious. We trigger the compulsion deliberately, and wait for the anxiety
to subside over time.
If this sounds like a rough treatment, it is. Patients get ready for it by
practicing relaxation techniques and other ways of coping. We begin
in the office with lots of support from the therapist.
As rough as it sounds, Exposure with Response Prevention is extremely
effective at getting rid of OCD. Patients who work hard on the problem
usually succeed. In clinical trials, up to 85% of patients have been
successful, without medication.
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