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Obsessive-Compulsive Disorder (OCD)

OCD is one type of anxiety disorder and is characterized by intrusive and unwanted thoughts or images, called obsessions, usually followed by a strong need to do something, which is the compulsion.

Obsessions:  Worries, doubts, or superstitious beliefs are common, but obsessions are involuntary, seemingly uncontrollable thoughts or images that occur over and over again in your mind, causing you much distress. You may even recognize that such thoughts are probably irrational. Common obsessions include excessive worries about germs or contamination, fears of being harmed or of harming someone or something else, forbidden sexual thoughts or urges, doubts about sinning or doing something immoral, violent thoughts or images, fears of letting go of certain types of things (like catalogues, newspapers, magazines, etc.), focusing too much on things considered lucky or unlucky, or thoughts about how things “should” be. These obsessions cause you to feel highly anxious until you can make the anxiety go away or diminish by performing a compulsion.

Compulsions:  Compulsions are behaviors or rituals that you feel driven to do over and over again, and they often take up a lot of your time and may even interfere with your daily routine, job, or relationships. At first doing the behavior helps you feel less anxious, but soon the obsession or worry thought comes back, and you need to repeat the compulsion. If you fear contamination, you may spend a lot of time washing and cleaning. You may even throw away a contaminated article, even though it is perfectly good otherwise. Your hands may be red, dry, and cracked from having to wash them so much. You may have to double-check things such as locks, ovens, appliances, or switches. Perhaps you have to check on loved ones to be sure they are safe, or you have to say prayers or do rituals to ensure their safety when they leave. You may be unable to keep knives or cleaning materials in sight for fear of hurting someone. Perhaps you need to go back and check when driving to be sure you haven’t hit or hurt someone. If your obsessions are religious in nature, you may pray excessively, to the point that time for other things is squeezed. You may need to keep things in a particular order or have to do things in a particular way. Perhaps you need to count, tap, repeat certain words, or do other senseless things to reduce anxiety. You may accumulate old newspapers, magazines, empty food containers, or other things that are outdated or no longer needed.

Treatment:  Research shows that the most effective treatment for OCD is a combination of behavior therapy involving exposure and response prevention (ERP), cognitive therapy, and medication. Medication alone is rarely effective. Attending a support of other OCD sufferers can also be helpful. Some people with OCD find meditation or yoga to be helpful.

ERP:  The exposure part of therapy, or ERP, involves actually confronting or being repeatedly exposed to the source of your obsession and anxiety, and then refraining from doing the compulsive behavior you’d usually perform to reduce your anxiety. Often ERP must be done outside the therapist’s office. For example, if you were my client and you were afraid of germs or contamination, we might start first with an anxiety-producing situation that is not too bad for you. Perhaps I would accompany you as you touch door handles in my building that you think could be a source of germs. After successes in gradually confronting more and more fearful situations, I might eventually suggest we go together to a public restroom and that you touch the things in the restroom that cause anxiety. During such ERP sessions, I would be checking with you about your level of anxiety and keeping you focused on our work. With repeated sessions, discomfort in touching the contaminated item no longer produces as much anxiety or discomfort. ERP gradually causes the link between the obsession and the compulsion to weaken and eventually resolve. Of course, you and I together decide on how to tackle your OCD, and we move at a pace that is both effective and acceptable to you.

Cognitive Therapy: For the cognitive part of therapy, my job is to educate you about the causes of OCD and how to recognize your particular obsessions and then to “talk back” to OCD, without making such cognitions into just another form of compulsion behavior. In this part of the work, we may also develop a “script” for weakening the hold of OCD. Therapy helps you understand that OCD is a probably related to a biochemical imbalance in the brain and not your fault, but you can retrain your brain.

Medication:  As a psychologist, I cannot prescribe medication. Only someone with an M.D. can do that. Generally, a psychopharmacologist (a psychiatrist whose main emphasis is on psychotropic medications) is the best choice. Usually an antidepressant that has been shown to be effective with OCD is prescribed.

For additional information, check the following websites:

• www.ocfoundation.org
• www.abct.org

Dr. Joyce Nash, PhD    (650) 329-1000