Obsessive Compulsive Disorder (OCD)


Obsessive Compulsive Disorder is made up of two components: obsessions and the compulsions. Obsessions are intrusive anxiety provoking thoughts that are repetitive, and create tremendous anxiety. They are involuntary thoughts, and feelings. Obsessions are a result of a core fear.  Some common examples of debilitating fears:

  • Germs
  • Bugs
  • Going crazy
  • Infidelity
  • Losing Control
  • Bad things happening to loved ones
  • Making a mistake (eg. typo in an essay)
  • Being negligent (eg. not locking the door),
  • Doing bad things to other people
  • Death
  • Abandonment
  • Failure
  • Embarrassment
  • Getting fat
  • Looking old
  • Getting sick
  • Being unattractive
  • God and hell

Fears begin to cause repetitive and intrusive thoughts for individuals with OCD and the anxiety that accompanies them is intolerable. In order to ward off a panic attack or a sense of dread, the OCD sufferer begins to engage in actions that decrease that anxiety. These actions are called Compulsions.

Compulsions are repetitive, difficult to control actions that temporarily decrease anxiety. For example, if the fear of the OCD sufferer is of infidelity, he or she will develop a ritual of asking their partner questions about their day, who they saw and where they went. Once these questions are answered to their satisfaction, the fear of infidelity is decreased, and the anxiety level reduces. This ritual can become lengthy, often taking hours, causing frustration and anger among partners, and inevitably lead to the demise of the relationship. Another example of anxiety reduction through compulsion occurs in individuals that are afraid of bugs. They may check their beds for bugs, their kitchen, their bathrooms. Each night they may take hours checking these areas to their satisfaction. Their nightly rituals may become so long and involved that they are not able to get to sleep on time, may check late into the night, miss work, and neglect their obligations.

There is a type of OCD that appears on the surface to not have any compulsions. This is called Purely Obsessional OCD. Purely Obsessional OCD presents as an intrusive, unwanted thought that is typically of a violent or sexual nature. This could be a fear of death, stabbing someone, self harm (ei, jumping in front of a car, jumping off a building), committing suicide, molesting a child, exposing ones self in public, raping someone. There are a lot of “What if?” statements that accompany these obsessions. For example: What if I just threw myself out of this car right now?, What if I slit my wrist with this knife? What if I touched my son’s private parts? What if I stabbed my child? The individual imagines terrible scenarios that in reality they would never carry out, and fear that they will carry them out. As a result of these obsessions they might avoid any situation that poses a risk. They lock up all the knives in the house, they stay away from their children, they don’t drive a car or develop a fear of tall buildings.

Scrupulosity is the term used for obsessive impure thoughts. People that suffer from Scrupulosity experience unwanted, intrusive sexual or “immoral” thoughts, and will often repent silently and constantly throughout their days.

People that suffer from OCD are conscious of the fact that their obsessions are irrational, and that their behaviors are a detriment to their lives. They feel powerless against their symptoms. This can also cause secondary depression, low self esteem and self worth, feelings of inadequacy, isolation from others, and drug abuse.

OCD is an anxiety disorder. Like all other psychological disorders OCD will crop up when stress level increases to the point where it is unmanageable by the individual. An individual may be successfully treated for OCD and be 95% symptom free for many years, but a difficult life situation may cause a relapse into OCD. In these cases the individual may have to seek treatment again to get back on track.

Treatment for OCD

Behavioral Therapy

A specific type of behavioral treatment called Exposure and Response Prevention is most effective for Obsessive Compulsive Disorder. The individual is very slowly, gradually, and safely exposed to fear provoking objects or situations that are anxiety provoking and lead to compulsions. For example, an individual with fear of germs would be encouraged to put their hands on something they find dirty and then not wash their hands.  Exposure to anxiety provoking objects or situations can be “in vivo” meaning in real life, or “imaginal” meaning in the imagination.  The therapist will work with the individual to develop a fear hierarchy, where fears are listed and rated on a scale of 1-10 in terms of intensity.  The therapist will start at the bottom of the list with the easier fears and gradually build up to the scariest items on the list.

Cognitive Therapy

Dr. Jeffrey Schwartz concretized four basic principles in his method, a type of Cognitive Behavioral Therapy for OCD. These four steps are repeated upon encountering obsessions that might lead to compulsions.

Relable- The act of being mindful of the obsessions and compulsive urges, and understanding them for what they are: obsessions and compulsions. Nothing more. The individual takes a step back from their own experience and becomes a scientist of his own thoughts and behaviors. Relabeling statements are: “This is my OCD that is making me uncomfortable right now” or This is a compulsive urge.” “This feeling is a false alarm, it has no basis in reality”.

Reattribute-“It’s not me, its my OCD” and the thoughts and urges are not meaningful, rather the result of a biological dysfunction in the brain.

Refocus-In a sense, distraction from the urge to carry out a compulsion. This means focusing on anything else that you can find to do, and for longer and longer periods of time. This is the most difficult part of this treatment and takes a great deal of willpower and follow through on the part of the individual.

Revalue-Understanding that the OCD thoughts have no value, are empty and false. They don’t deserve your attention, and are just background noise.

Medication

The first line of defense for OCD are the SSRI medications (Selective Serotonin Re-uptake Inhibitors). Medications approved by the FDA specifically for the treatment of OCD include the following:

  • Clomipramine (Anafranil)
  • Fluvoxamine (Luvox)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)

Eye Movement Desensitization and Reprocessing (EMDR)

OCD may have been triggered by a trauma or series of traumas. In these cases, EMDR, a trauma therapy for those specific trauma memories that have triggered OCD could be very helpful.  However, in addition to EMDR, behavior therapy is still required for most cases of OCD.