October 13th – October 19th is National OCD Awareness Week and we think it’s important to answer the question, What is Obsessive Compulsive Disorder? So often it goes misdiagnosed, and individuals suffering with OCD do not get the treatment they need. In this post we cover the symptoms, diagnosis, and common treatments for OCD.
Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people from all walks of life. It has been estimated that about 1 in every 100 adults and 1 in every 200 children and adolescents struggle with OCD in the United States.
Obsessions
OCD is characterized by obsessions, which are thoughts, images, or urges that are unwanted and disturbing. These obsessions can be related to contamination, aggressive behaviors or harm falling on self or others, symmetry, sexual behaviors, or religion (referred to as scrupulosity). Obsessions are accompanied by uncomfortable feelings such as fear, anxiety, disgust, doubt, or a feeling that things have to be “just right.”
Compulsions
In order to relieve the uncomfortable feelings, certain behaviors are carried out. Rituals are repetitive and excessive behaviors that are meant to neutralize obsessions and make the distress caused by them to go away. These compulsions can be observable behaviors, such as cleaning or washing, repeating behaviors a certain amount of time of until it feels “just right”, or checking. There are also compulsions that are carried out mentally. Mental reviewing, praying, counting, and replacing bad thoughts with good ones are examples of covert rituals.
Avoidance
Individuals with OCD also tend to engage in significant avoidance behaviors in order to lessen the uncomfortable feelings. For example, someone with intrusive thoughts related to pedophilia might avoid all situations where children may be present. For someone with contamination-related obsessions going into public restrooms would be extremely uncomfortable and thus avoided. OCD is also often characterized by excessive and frequent reassurance seeking. This might involve asking loved ones the same question repeatedly or calling someone multiple times to make sure they are okay.
Unhelpful Thinking
Research has shown that people with OCD often hold dysfunctional beliefs that may play a role in development and maintenance of the disorder. These beliefs include an inflated sense of responsibility and tendency to overestimate threat. For a person holding these beliefs, any situation is dangerous until proven safe and they might believe that it is their responsibility to make sure that nothing bad happens. Perfectionism and intolerance of uncertainty is also characteristic of individuals with OCD. Over-importance of thoughts and the need to control thoughts are common in people with OCD as well. For example, someone with harm-intrusive thoughts might believe that having a thought about stabbing someone means that they are more likely to do it and might engage in mental rituals to try to control those thoughts.
What causes OCD?
It is not clear what causes OCD but hereditary and environmental factors seem to play a role. OCD can start at any age but usually first symptoms are seen during late teenage years. OCD affects individuals from all ethnicities, races, and backgrounds. Symptoms usually start gradually but sudden onset does also occur. Individuals with OCD often experience symptoms related to other anxiety disorders, depression, and tic disorders.
It has been estimated that it takes 14-17 years for individuals with OCD to receive appropriate treatment. Shame and stigma can prevent people from seeking treatment. Also, in many areas there are no treatment providers that specialize in treating Obsessive Compulsive Disorder. However, once connected to appropriate treatment, majority of people with OCD benefit from therapy, medicine, or a combination of the two.
What is the Treatment for Obsessive Compulsive Disorder?
Research has shown that the most effective treatments for OCD are Cognitive Behavioral Therapy (CBT) with or without medication. Specifically, Exposure and Response Prevention (ERP) is the treatment of choice for OCD currently because it is evidence-based and multiple studies have proven its’ effectiveness. ERP involves systematically facing the feared outcome or trigger through carefully crafted exposures without engaging in the compulsions that are usually used to alleviate discomfort.
What is Exposure and Response Prevention?
Exposure and Response Prevention can be conducted in either outpatient or inpatient setting. In outpatient setting, ERP happens once or multiple times per week with a therapist. The therapist first carefully assesses the obsessional content as well as the corresponding compulsions. A hierarchy of triggers is then constructed, which involves ranking the feared stimuli from least to most anxiety-provoking. The therapist and client will then systematically work on facing the fears inside and outside of the therapy office.
Exposure and Response Prevention can seem difficult and scary. It also requires a lot of courage and determination. For best results, exposures are not only conducted during therapy sessions but also independently between sessions. Having a support network during this challenging process can make a big difference. Family support can be extremely helpful and luckily there are support groups for individuals with OCD both in-person and online.
When ERP is carried out correctly and individuals are able to follow the treatment plan, the results are remarkable. Individuals notice that the time previously taken up by rituals can now be used to live a valued life. When fear no longer gets in the way, it is possible to see the future and make plans to achieve the things that really matter, instead of living a life governed by anxiety.
Medication and Obsessive Compulsive Disorder
OCD can also be treated with medication, either in conjunction with ERP or independently. The medications that usually work best for individuals with Obsessive Compulsive Disorder are antidepressants called serotonin reuptake inhibitors (SRI’s). Medication should also be prescribed and managed by a psychiatrist who ideally works together with the treatment provider conducting the ERP.
How to Find Help for Obsessive Compulsive Disorder
If you are struggling with OCD or anxiety, please know that you are not alone. There are millions of people struggling just like you. Even though it might seem hopeless and scary, help is available. The International OCD Foundation (www.iocdf.org) is a great resource that connects individuals with OCD with treatment providers. Are you ready to face your fears and start living your life according to your values?
Houston Center for Valued Living provides Cognitive Behavioral Therapy and Exposure and Response Prevention Treatments for OCD in the greater Houston area. We offer outpatient and intensive outpatient options. To learn more about how our therapists can help you, visit our about us page. Please reach out to us with any questions by calling 713-331-5538 or email us info@hcfvl.com
Eeva Edds is a Licensed Professional Counselor Intern currently working towards full licensure under the supervision of Michael D. Soderstrom, MA., LPC-S. Eeva has a passion for working with teens and adults experiencing anxiety and Obsessive Compulsive Disorder. She provides individual therapy as well as intensive outpatient therapy at Houston Center for Valued Living.