Obsessive Compulsive Disorder

OCD is characterized by distressing, unwanted thoughts that increase anxiety (called “obsessions”) and repetitive behaviors or mental acts that decrease the anxiety (“compulsions”). Some of the most common obsessions in OCD involve:

• Fear of being contaminated by germs, infections, or environmental factors, or fear of contaminating others. Washing or cleaning rituals, or throwing away contaminated objects, are among the compulsive behaviors that follow.

• Repeated doubt about doing things the “right” way, which can result in perfectionistic behaviors such as excessive checking, counting, or arranging.

• Taboo thoughts of an aggressive, religious, or sexual nature, such as fear of doing harm to someone or fear of acting out sexually. These obsessions, which often threaten the person’s sense of morality, can lead to repeatedly asking for forgiveness or constantly seeking reassurance from others.

OCD often can go undiagnosed or misdiagnosed. The shame and fear associated with these obsessions makes people hesitant to talk about what’s bothering them. 

Not seeking a diagnosis can be harmful. Why? Because every time a person needs to perform a compulsive behavior—to reduce their anxiety around the obsession—the obsession actually gets worse.

People with OCD are likely to experience extreme difficulty in work and social situations. Early recognition and treatment of OCD can greatly improve quality of life.

OCD affects around 2% of the U.S. adult population. The average age at which OCD appears is around the age of 20, which is younger than the average age of onset for most anxiety disorders. It more commonly affects boys in childhood. But among adults, OCD is about equally common in women and men.

Some groups may be more susceptible to OCD. There has been a reported link between pregnancy and development of obsessive-compulsive symptoms. These sometimes can involve disturbing thoughts around doing harm to the baby.

It is believed that up to 3 of every 4 people with OCD also have another behavioral health problem. The most common disorders that can be present with OCD in adults are social anxiety, major depression, and alcohol misuse. Having another disorder often will reduce quality of life more than just having OCD alone.

At Eappen Clinic, we understand the anxiety involved in seeking treatment for OCD. We know it can be difficult to discuss the thoughts that are disturbing you and the repetitive behaviors that are disrupting your life. We’re here to help you make your treatment experience a partnership that works for you.

Many people with OCD will benefit greatly from a combination of behavioral therapy and medication.

The preferred psychological treatment is a form of cognitive-behavioral therapy called exposure and response prevention (ERP).  A therapist will walk the patient through information about OCD and ERP, and the two will compile an inventory of obsession triggers, compulsive behaviors, and ratings of patient distress.

The patient and therapist then will collaborate to come up with a series of exposure exercises. In the exercises, the patient tries not to do the usual ritual or repeat behaviors. 

For example, a patient who fears germs might be encouraged to touch a doorknob until the fear subsides. These exercises can be done both in the therapy session and later in homework assignments.

For people with more severe OCD symptoms, therapy alone may not be enough. In this case, medications known as selective serotonin reuptake inhibitors (SSRIs) may need to be used in combination with therapy. 

In cases of severe OCD, use of one of these medications may be needed to ensure that the patient can remain engaged with therapy.

Neither therapy nor medication will produce an immediate effect, but each will help you develop the skills needed to lead a life no longer hindered by fear. ERP generally requires at least a dozen sessions, with some homework assignments. 

Sometimes an additional form of motivational therapy might be needed to help those who initially find exposures too distressing. The key is working together with your clinical team on the best treatment for you.

The effects of medication also develop over time. A person with OCD who requires medication as part of the treatment plan generally will have to take at least a moderate dose of an SSRI for several weeks. You also may need to adjust the dose after a time.

Individuals whose obsessions involve unwanted thoughts of an aggressive, religious or sexual nature may require a longer time in treatment. But it’s important to know that OCD is treatable.

If your recurrent thoughts have little to no impact on your life and aren’t preventing you from engaging in your favorite activities, you may not need treatment. You could benefit from relatively simple mental exercises such as meditation or mindfulness to help you replace those unwanted thoughts and behaviors.

But if obsessive thoughts have you paralyzed with fear and you feel like you can’t control the compulsive behaviors that accompany them, treatment can help you feel well again. You do not have to live with all that disruption in your life.

At Eappen Clinic, we can help you understand your symptoms and whether they suggest OCD, or even perhaps another disorder. Your first appointment with us is a detailed evaluation. At the end of your evaluation, you’ll know the next steps.

Let’s work together to help you feel well again.