Obsessive-Compulsive Disorder

What is OCD?

Obsessive-compulsive disorder (OCD) is characterized in two parts: obsessions and compulsions. Obsessions are unwanted and intrusive thoughts or feelings that begin to cause anxiety and distress that interrupt daily tasks. In response to these thoughts or feelings, the person begins to engage in repetitive behaviors that reduce the anxiety, called compulsions or rituals. The compulsion is used to neutralize or counteract the anxiety. Although most sufferers recognize that their obsessions are irrational the compulsive behavior feels gratifying and causes the individual to feel less anxious and distressed.

Approximately 1-2% of the general population suffers from OCD, a condition that typically presents in adolescence or early adulthood, but symptoms present in very young children as well. Symptoms often flare-up during periods of increased stress. Many OCD sufferers do not seek treatment, often citing feelings of shame or embarrassment about the nature of their obsessions and/or compulsions. Studies suggest that OCD sufferers go between 12-17 years from the onset of symptoms before getting treatment from an ERP (Exposure and Response Prevention) specialist.

Obsessions may include:

  • Fear of dirt, germs, or illnesses
  • Getting things just right
  • Self-harm or harm to others
  • Anxiety about order, symmetry and/or lack of
  • Undesirable thoughts such as profanity, sexual, or religious
  • Magic numbers or sequences of movement with superstitious avoidance
  • Perfectionism
  • Excessive doubt

Compulsions include:

  • Decontamination and excessive bathroom routines
  • Checking locks, appliances, and doors
  • Mentally reviewing situations
  • Rearranging and ordering things in special ways
  • Reassurance seeking
  • Ritualistic religious behaviors
  • Counting
  • Tapping, blinking, and touching objects repeatedly

Treatment for OCD:

The gold standard, most effective treatment of OCD is called Exposure and Response Prevention (ERP). Treatment is particularly important for people who have developed ritualized, repetitive behaviors such as compulsions. ERP is a necessary component of CBT for most anxiety conditions, particularly OCD. The two components include exposures – facing fears in a systematic, gradual, and purposeful manner to elicit anxiety – and response (or ritual) prevention – actively resisting safety behaviors and other avoidant strategies that only offer a short-term reduction of symptoms but maintain the cycle of anxiety and avoidance in the long-term. Both elements are critical for effective ERP. Through the ERP process, the individual overcomes fears, gains corrective information, and retrains the brain to no longer elicit a fight or flight reaction in the face of these “false alarms.” Our therapists will guide you to progressively face the situations and thoughts that provoke your OCD while learning how not to react with rituals, compulsions, reassurance seeking or avoidance.

We also offer an “Intensive Outpatient Program” (IOP) for OCD sufferers in cases where no available ERP specialists are in your geographic area, when services are simply not easily accessible, or because symptom severity is too high for weekly outpatient therapy. The treatment is customized to meet the level of need, availability, and readiness for change to address current symptoms and get the individual to a higher level of functioning whereby more traditional outpatient therapy can be the level of care. The goal of an IOP is to complete treatment with 4-6 weeks and therefore typically requires sessions back to back days, several hours per day, and sometimes over the weekend.

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