Obsessive-Compulsive Disorder (OCD) is an anxiety disorder, in which the person experiences intrusive and repetitive thoughts, impulses, and images called obsessions. These disturbing thoughts increase the person’s anxiety and in order to reduce these feelings of tension, the person may perform senseless repetitive behaviors called compulsions, which temporarily reduce the anxiety. Obsessions and compulsions take many forms,but most people exhibit these common themes:
- Fear of contamination – Leading to excessive washing
- Fear of hurting others – Leading to checking if someone was hurt.
- Fear of repugnant thoughts – Attempting to control thinking
- Fear of safety and illness – Leading to checking and avoiding
- Need to keep things excessively neat – repeated arranging
People can spend unreasonable time checking locks, stoves and file cabinets, scrubbing themselves raw in the shower, repeating a prayer over and over until it feels right, mentally repeatedly counting, reviewing, making lists etc.
Rituals and repetitive mental actions are performed to reduce the intensity of the fear that ‘something bad is going to happen’ as well as reduce physical tension. These rituals and repetitive behaviors bring only temporary relief to the person and act to further reinforce the obsessions.
Treatment of OCD
There are two approaches to treating OCD; Behavioral Therapy and Medication. In many instances, a combination of both is used. Research shows that using Behavioral Therapy alone, greatly helps about 75% of patients who are then able to return to normal patterns of living.
A specific type of Behavioral Therapy called Exposure Therapy and Response Prevention (ERP) is an effective approach used in the treatment of OCD. The therapist introduces anxiety provoking stimulus in a gradual and systematic manner and helps the patient sustain the anxiety produced by this stimulus without performing their typical compulsive behavior. The goal of ERP is to habituate the patient to a level of anxiety and eliminate their need to perform senseless ritualistic behaviors, such as washing or checking. In tangible exposure, the therapist may introduce an allegedly contaminated object as the anxiety provoking item and in imagined exposure, the therapist may elicit distressing thoughts into the patient’s mind and teach the patient to tolerate being mildly contaminated and resist the desire to wash.
This treatment involves systematic , gradual exposure of the obsessions along with teaching the patient alternative responses that are incompatible with the compulsions. The technique is introduced in the safe environment of the therapy room with the constant support of the therapist.
Treatment length varies with the average being six consecutive months. Relapse rate is low after the patient has gone through successful behavioral treatment.
When a patient does not respond well to behavioral treatment after several months, medication should be added. The combination of medication and and behavioral treatment increase the chances that the patient would be able to cope with the obsessive thoughts in a more effective manner that reduces the intensity of the anxiety previously produced. Patients learn to apply more effective coping skills to manage any level of anxiety they experience.
For many people, medication alone may be sufficient treatment strategy. The most commonly used medication are the Tricyclics, Clomipramine (Anafranil) or SSRI’s, such as Fluoxatine (Prozac). However, patients show a high rate of relapse once they come off the medication. The recommended way of preventing this relapse is a gradual tapering of the medication, along with intensive behavioral program of Exposure Therapy and Response Prevention to help maintain the gains.
