Obsessive Compulsive Disorder (OCD): What It Is and How to Treat It
Have you ever had a thought that would not go away? Do you have a tendency to become preoccupied or to persistently dwell on things? Do you feel the need to touch or to count things over and over again in order to feel calm?
If you answered yes to any of these questions you may be dealing with a form of OCD, Obsessive Compulsive Disorder.
Most people get preoccupied or obsess about something, a thought or feeling, once in a while. A student might obsess about a test, a parent about the safety of a child, a working person about the possibility of losing a job.
We are all capable of being obsessive. It is when obsessive thoughts and compulsive behaviors (rituals) control a person’s life that a diagnosis of OCD may be justified.
Over the past several years OCD has gotten a lot of exposure in the press, on television and even in the movies (Back in 1997, Jack Nicholson starred in the film, “As Good As It Gets”). The public has become more aware of the anguish this mental health illness can cause its victims and their families.
Obsessive-Compulsive Disorder (OCD) is one of several types of anxiety disorders. It is characterized by obsessive thoughts and compulsive behaviors that a person feels compelled to repeat. These behaviors become ritualized in an often futile attempt to cope with anxiety. It is as if one is stuck in first gear, unable to accelerate or move forward until the ritual is completed.
The compulsive behaviors are driven by obsessions, thoughts or impulses that are irrational and uncontrollable. They intrude into a person’s mind causing excessive worry and preoccupation. These thoughts, often disturbing and unwanted, pierce the protective psychological filters and crowd the mind, literally taking over one’s will. They distract from more productive thought and often drain one’s psychological resources.
Obsessions give rise to unwanted and intrusive thoughts that are mostly fearful and irrational.
People with OCD may become consumed with worry about being contaminated or contaminating others with germs or dirt. They may become obsessed with causing harm to others or themselves. They may develop religious or moral obsessions that become rigid and extreme. They may focus on being perfect, having to get everything exact or right every time. They might ruminate about a particular part of their body or become preoccupied with developing an illness. These thoughts can surface and affect almost any aspect of a person’s life.
Compulsions and compulsive (ritualized) behavior is an attempt to manage the anxiety brought on by an obsession or obsessive thoughts. Therefore a person who repeatedly washes his hands is likely to be worried or obsessed that he might be contaminated.
In the movie, “As Good as It Gets” the leading character played by Jack Nicholson, had several compulsive behaviors including unlocking and locking his door 5 times. This was an attempt at dealing with his obsessive worry and the subsequent anxiety brought on by the fear that he might otherwise leave his door unlocked. He also felt compelled, upon entering his house, to wash his hands 5 times using a new bar of soap each time (germ obsession). Nicholson’s character is ultimately helped by medication; however medication alone is often not enough.
Although a ritual or compulsive behavior is meant to manage or relieve anxiety, it can be the cause of even more anxiety. A ritual can become excessive, even all-consuming and dominate much of the person’s life.
People with OCD, often diagnosed in their teens, may spend extraordinary amounts of time involved with their rituals. They are often embarrassed by what they know to be irrational ritualized behavior, but feel powerless to change.
As with many illnesses, no cure has yet been found for OCD. There are some effective treatments, however, that can significantly improve a person’s life by reducing the occurrence of unwanted thoughts and behaviors.
Exposure and response prevention (ERP) therapy, a form of behavior therapy, is often the treatment approach of choice for OCD sufferers. Here the patient is repeatedly exposed to the feared object (obsession) but must learn to tolerate his anxiety without engaging in a compulsive ritual.
This therapy is very controlled and well structured, requiring the therapist and patient to work together systematically. As the patient’s anxiety is provoked and his ritual or response to it is prevented the patient effectively becomes more and more desensitized to the fear. If the treatment works well, there is also a corresponding reduction of his obsessions.
Cognitive therapy targets the patient’s irrational and catastrophic thoughts. The person is taught to increase awareness of his thoughts and confront them. OCD sufferers tend to catastrophize or overemphasize the level of importance, threat or urgency a thought might create.
The patient is taught to challenge his intrusive and misinterpreted thoughts and ultimately re-evaluate whatever the fear is that drives his obsession. For example if a person tends to wash his hands excessively thinking that he will die from exposure to germs, he would be taught to challenge his thought as untrue and irrational. Confronting one’s irrational thoughts can help to change unwanted behaviors.
Anti-depressants, the ones known as Serotonin Reuptake Inhibitors (SSRIs), are the most commonly used drugs for the treatment of OCD. The anti-depressant drugs apparently found to have been most effective are: Fluvoxamine (Luvox), Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa), and Clomipramine (Anafranil), but new medications come to market every year.
The higher doses of these medications are often necessary to produce some relief of symptoms. It is very important for a patient to work closely with both a psychiatrist and a therapist in order to correctly gauge the effect of a medication.
Meditation training can be very useful to the OCD patient. It helps a person to quiet the inner noise, relax the mind and become calmer. Meditation practice has been shown to be effective in the treatment of anxiety and stress related disorders.
For more information on OCD and its’ treatment you can go to any of the following websites:
National Institute for Mental Health
Obsessive Compulsive Foundation
About the Author
Dr. Stan Hyman is a licensed psychotherapist and life coach in private practice in Miami, Florida. He specializes in treating Anxiety Disorders (including Panic Disorder, Social Anxiety Disorder, ADD, GAD and OCD) stress and depression