Obsessive Compulsive Disorder is one of the most under-reported and under-treated anxiety disorders. Most people who suffer from it know that they have a peculiar set of symptoms, but manage to cope with them. They come in for treatment when their symptoms have become difficult to manage or when they interfere with work or family life.
People with OCD can have either of two types of symptoms, obsessions or compulsions. Most have both.
Obsessions are disturbing thoughts, images, or impulses that intrude into consciousness repeatedly, despite attempts to block them. They can be frightening, morally repugnant or just disgusting. They may have clear psychological meaning to the patient, or they may seem almost random.
Compulsions are repeated behaviors or mental acts that people with OCD feel driven to perform. Some of the common behaviors are hand washing, placing things in order, and checking locks, lights, or the stove. Common mental acts include counting, praying, or repeating a phrase silently.
Compulsions often have a rigid, ritualistic quality. Things have to be done in a certain way or they don't count. This is especially true for compulsions that don't directly relate to the content of an obsession (for example repeating a phrase silently) and compulsions that exist without a recognizable obsession.
In most cases, compulsions are aimed at reducing the distress caused by an obsession or preventing some feared, but often unlikely, event. However, the actions are clearly excessive and may be unrelated to any real form of prevention. The person often knows this, but feels too much anxiety to simply stop.
The obsessions and compulsion of true OCD cause real suffering, and they can take hours out of the day. They are distinct from the worrying that people feel with Generalized Anxiety Disorder or anxiety about having panic attacks in Panic Disorder.
Please remember that self-diagnosis is never 100% accurate. If this description matches you, even loosely, you should probably get treatment sooner rather than later. Even if your problems don't meet the criteria for OCD, a trained professional can help you get much needed relief.
Not so long ago, the standard treatment for OCD involved years of psychological exploration, searching for the source of the anxiety manifested as an obsession or compulsion. This form of treatment was neither efficient nor effective. As a result, many people with OCD have given up on psychological treatment.
Current short-term, symptom-focused treatment methods have an outstanding record for curing OCD. If you come in for treatment today, you can do so with with the expectation of being much better or symptom free within six months.
We may not know how an obsession or a compulsion starts, but we know how these symptoms are maintained as a problem. This has led to the development of the treatment protocol called Exposure with Response Prevention or ERP.
People with OCD are almost always anxious about the recurring, intrusive, disturbing, thoughts, images or impulses that make up their obsessions. They try to push these out of their minds, but they keep coming back.
It's a bit like the children's joke: "Try not to think of a purple elephant in a ballerina costume, dancing in the living room." The trick is that when you try not to think about it, you automatically wind up bringing it into your mind.
In order to counter the anxious monitoring that brings obsessions into our thinking, we take a paradoxical approach. Patients are asked to deliberately think of their obsessions and to keep them in mind for a time.
While their obsessions may be disturbing at first, over a few minutes they begin to lose their power. By deliberately bringing them to mind, we become less sensitive to them. This is practiced until the obsession is no longer bothersome.
The key elements here are (1) deliberate exposure to the disturbing obsession and (2) refusing to respond to it (either by pushing it out of mind or with a ritualized act).
The same thing is done with compulsions, even when obsessions aren't obvious. We trigger the compulsion deliberately, and wait for the anxiety to subside over time.
If this sounds like a rough treatment, it is. Patients get ready for it by practicing relaxation techniques and other ways of coping. We begin in the office with lots of support from the therapist.
As rough as it sounds, Exposure with Response Prevention is extremely effective at getting rid of OCD. Patients who work hard on the problem usually succeed. In clinical trials, up to 85% of patients have been successful, without medication.