Characteristics of OCD
- OCD in one form of severity or another is very common.
- OCD is characterized by cycles of Obsessions (intrusive thoughts such as germophobia) and corresponding Compulsions (ritual behaviors like hand washing)
- It is best understood as an Anxiety Disorder
- It can be extremely painful and debilitating
- It can be effectively treated with medication and Cognitive Behavioral Therapy.
OCD is an anxiety related condition which occurs widely. It is common in the United States and Europe and in many cultures and countries around the world. At its heart lies an exaggerated fear of impending harm and an equally exaggerated belief that it is the sufferer’s responsibility to avoid this harm from happening. Recurrent intrusive thoughts (obsessions) torment the sufferer and over time certain specific behaviors or rituals (compulsions) are performed in an attempt to alleviate the painful anxiety generated by the obsessions. The compulsive rituals are incapable of defeating the anxiety, though they often ameliorate the suffering in the short term. This relief is inadequate but soon becomes the most accessible remedy, imperfect as it is, and is therefore reinforced and more heavily relied on. Invariably, the anxiety and obsessions return, creating a recurrent loop of obsessions and compulsions which is the hallmark of the condition.
The most common varieties of OCD are all based on an exaggerated fear of potential catastrophe in the following areas. Please note, OCD occurs on a continuum. This list describes OCD in its more extreme versions, but sufferers may experience these symptoms in a far more reduced but still painful and problematic way.
- Fear of Contamination: Obsessions – worry about germs and dirt though contact with others or objects. Compulsions – repetitive washing or cleaning
- Fear of Forgetting: Obsessions – worry that undone task will lead to disaster. Compulsions – Repetitive checking, doors, locks, knobs, dials etc.
- Fear of Disorder: Obsessions – worry that disorder will lead to chaos and catastrophe. Compulsions – Relentless pursuit of order and symmetry and doing things in perfect sequence.
- Hoarding: Obsessions – worry about losing something important or not having what is needed: Compulsions – keeping all objects, refusing to discard
- Fear of loss of Health: Obsessions – persistent worry of contracting illness or disease. Obsessions – ongoing checking of body and search for signs of illness
- Fear of “going crazy” and doing harm to self or others including to loved ones. Compulsions – pursuit of repetitive thoughts such as counting or praying to prevent dangerous behavior
- Fear of committing sin: Obsessions – thinking one is unworthy and has offended God. Compulsions – persistent pursuit of absolution from Clergy and others for perceived sins against God
The good news about OCD is that it is often highly treatable with the proper course of action. Often, a combination of medication and various forms of Cognitive-Behavioral Therapy is the most effective form of treatment. Medication used is very often from a family called SSRI’s (Selective Serotonin Re-uptake Inhibitors) which can address an imbalance of serotonin levels in the brain. This imbalance is often associated with OCD symptoms. Please consult with your doctor or better yet a psychiatrist with a focus on OCD to learn more.
Types of Cognitive-Behavioral Therapy for OCD Treatment
Cognitive-Behavioral therapy, in its most direct form helps the patient to identify and actively challenge the destructive beliefs they harbor and to work, over time and in a supportive and safe environment, to restructure these thoughts.
ERP: Exposure and Response Prevention
In another form of CBT called Exposure and Response Prevention or ERP, the patient faces the unreasonable fears directly in order to necessitate learning other ways to deal with obsessive thoughts rather than seeking the very temporary relief offered by their familiar compulsive behaviors. With ERP, it is often useful to think of OCD as a bully and a liar. It taunts and lies to you about the threats that you face. It is a Doomsayer that is always proclaiming that disaster is just around the corner.
The ERP approach is easy to learn but requires a high level of commitment as it asks the patient to face painful fears very directly. Exposure and Response Prevention therapy or ERP therapy involves looking the Doomsayer in the eye and telling him “I hear what you are saying about danger and risk, but I am going to live my life anyway.” ERP puts you in an ongoing exposure to upsetting thoughts and feelings and conditions with no outlet, which leads to habituation to the feared object or circumstance, which in turn causes distress levels to decrease. In their book, Coping with OCD, authors Bruce M. Hyman, PhD, LCSW and Troy DuFrene describe this by saying that staying in the fear provoking situation without resorting to escape and avoidance ritual or other compulsive safety behaviors leads the parasympathetic system to turn off the activation and thus lowers the anxiety without necessitating a compulsive ritual. OCD symptoms persist because the sufferer over-learns and over-relies on a dysfunctional habit such as washing or checking to shut down the anxiety rather than allow the natural relief provided by our brain and three million years of evolution to automatically shut off the anxiety once the threat has passed.
Acceptance and Commitment Therapy
Another version of CBT that can be very effective is called Acceptance and Commitment Therapy. In this version, the patient learns to observe distressing and disturbing thoughts without reacting to them or fusing with or overly identifying with them. The act of liberating one’s sense of self identity from these disturbing thoughts is powerfully therapeutic and healing. Learning and understanding what it means that “I am not my thoughts” can be a great relief and a liberating experience. Acceptance and Commitment Therapy further asks the patient to identify what they most deeply value and what qualities they want to be at the heart of their life. It asks the patient to commit to act in ways which brings those values to life which will in turn enhance meaning to life and also ease pain and suffering.
OCD Can be Managed
Recognizing and accepting OCD is difficult. It can feel shameful and embarrassing. But as improvement occurs it can be seen not as a pox or stigma but just another part of life which can in fact be managed and dealt with very effectively. OCD is a bully and a liar. It threatens and lies to you about the degree of danger that you face. It is often useful to personalize it this way as a bully or a Doomsayer and to develop a way of pushing back against it. Responding differently to OCD changes how you feel. With courage and work in therapy, the debilitating and painful effects of OCD can be faced and managed. Although it may never be fully vanquished and symptoms may recur or intensify from time to time, particularly when one is under unusually high levels of stress or change, improvements can be significant and the experience of OCD can change change from a crippling impediment to a happy life, to a minor occasional annoyance and nothing more.
Further OCD Resources
Links to all posts at BETA about Obsessive Compulsive Disorder