Obsessive-Compulsive Disorder (OCD)

OBSESSIVE-COMPULSIVE DISORDER (OCD)

Obsessive-Compulsive Disorder (OCD) involves the presence of obsessions, compulsions or both. By the time people present for treatment, those with OCD are experiencing significant distress or impairment in their lives as a direct result of their symptoms. In fact, it takes an average of 14 to 17 years after symptoms start for those with OCD to receive proper treatment in the form of Exposure and Response Prevention (ERP).

OBSESSIONS

In general, the term “obsession” means fixation. Within the realm of psychology, though, obsessions are defined as repetitive, distressing thoughts, images and urges that are unwanted. Obsessions sometimes show up as “What if” thoughts that appear in the mind. Other times, people come up against images or urges that are upsetting and that they try to push away. They might worry that the presence of thoughts, images or urges means something bad about who they are. The thoughts, feelings and urges, tend to cause anxiety and doubt. In fact, OCD is called the doubting disease because of the central role that doubt plays in the disorder. 

The content of obsessions varies greatly from one person to the next. Some have thoughts about germs (Contamination OCD) and home invasion (Checking OCD). Others are concerned about the “rightness” of their romantic partner (Relationship OCD) or the authenticity of their sexual identity (Sexual Orientation OCD).

COMPULSIONS

As with the word obsession, the word “compulsion” has a specific meaning in the context of OCD. When people hear the word compulsion, they often think of compulsive gambling or drinking. Here, compulsive speaks to having a strong urge to act that is hard to resist, even when the action causes problems. Compulsions in OCD have this quality, too. That said, OCD compulsions are actions done in order to gain a sense of certainty and/or to alleviate distress or discomfort. Also, compulsive drinking and gambling, like other addictions, often begin because the behaviors are pleasant. In OCD compulsions relieve distress but are not pleasant in and of themselves.

People can engage in both overt and covert compulsions. They might avoid circumstances, or they might engage in activities only to respond with lengthy rituals, like checking or washing. Some seek endless reassurance from those around them about their anxious thoughts. They might even spend long periods reviewing or ruminating to reduce their distress. 

​Within the field, we talk about different subtypes or manifestations of OCD. That said, the diagnosis and treatment are the same across all subtypes. 

TREATMENT FOR OCD

While there are many ways that OCD can present, the treatment of choice for OCD is the same across themes. Research shows that Cognitive Behavioral Therapy (CBT) with an emphasis on Exposure and Ritual Prevention (ERP) is highly effective in helping those with OCD. Acceptance and Commitment Therapy (ACT) is also used to support those with OCD.

EXPOSURE AND RESPONSE PREVENTION (ERP)

In ERP, people face triggers that they have avoided. Many people find this notion scary. This makes sense. Exposures are designed to elicit anxiety. This is so that people can learn how to feel their feelings in a way that supports their life. That said, ERP is a gradual process and can be taken at each individual’s pace. An OCD Therapist will not force anyone to do an exposure. In addition to facing things that they have avoided, people with OCD learn to disengage from compulsions. For example, someone with a fear of home invasion would limit the number of times they checked the door lock to what they and their therapist deemed reasonable. The aim is to accept uncertainty, anxiety and the presence of thoughts rather than letting these experiences dictate behaviors.

ACCEPTANCE AND COMMITMENT THERAPY (ACT)

In ACT, people learn to accept internal experiences that are outside their control. Much of the time, people with anxiety disorders and OCD focus so intently on eliminating anxiety and thoughts that they limit their lives or miss out on experiences. By accepting thoughts and feelings, a person is free to live a life that reflects their goals and values. ACT involves bringing thoughts, feelings and other private experiences along for the ride so that people can live full lives with OCD in tow.

In ACT, people also cultivate values and take actions that reflect these values. This supports an overall experience of contentment. Also, focusing on actions that are meaningful to the a person helps them to remain disengaged from behaviors they don’t want to do, like compulsions.