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Blue Mountains

Obsessive Compulsive Disorder


Q. What is Obsessive Compulsive Disorder and how is it treated?

A. Obsessive compulsive disorder is an anxiety problem. You will see or hear it referred to as OCD. Anxiety problems often erupt after a period of stress, so most treatment professionals draw a correlation between stress and the onset of OCD. Stress can be psychological in nature or the stress may be in the form of an illness or a period during which a debilitating demand is made on our physical resources or it may be a combination of psychological and physiological stress. The majority of individuals who have consulted me have had OCD at varying degrees of severity for years. Some are surprised to find the seeds of their present problem rooted in childhood. OCD in childhood or adolescence does occur.

Before outlining treatment, a brief description of the disorder may be helpful: both obsessions ( unwanted repetitive thoughts) and compulsions ( repetitive behaviors ) are experienced by OCD sufferers although the problem has unique patterns for each person who suffers from it.

Some of the common categories ( although not a comprehension listing)
of OCD are:

Repeaters and Ruminators: counting or thinking in a repetitive and even ritualized sequence

Checkers: doubt plays a leading role for checkers: did I turn off the stove? lock the door? Or just checking for errors: did I add that column correctly? put the letter in the envelope? So they check again and again. The more they check the stronger the urge to check becomes.

Illness Obsessions: an unfounded ( based on evidence), but extreme fear of contracting or passing on a disease such as AIDS for example.

Contamination Obsessions: an unfounded ( based on evidence) but extreme fear of coming into contact with “contaminated” areas which results in excessive cleaning, washing or avoiding. Public rest rooms are avoided, kitchens, bathrooms and other areas in the house may be scrubbed and sanitized excessively; hands are washed again and again with harsh disinfectants sometimes being used; Chemicals such as pesticides are locked up and avoided.

Orderers: line up cans in the kitchen cabinets, items sit in precise places on surfaces such as a coffee table for example

Hoarders: not only tend to be compulsive buyers but once something is acquired it is very difficult for a variety of reasons to get rid of it

Obsession with of Violence to Others: the obsession concerns the thoughts described and a kind of “urge” that can seem overpowering although it never happens; did I hit someone with my car ( and do I need to go back around the block and look for a body?), will I throw my baby out the window? stab my mother? yell obscenities at my neighbor?

The fear generated by the obsession is so intense the individual does not risk ignoring it. Behavior that relieves the terror emerges. The knives may be wrapped up and locked in a box and the key given to a family member. A person who fears he hit someone with his car may compulsively go over the episode again and again in his mind until he has some relief; or the individual may compulsively circle the block again and again to be sure no one has been hit. Sometimes the compulsion ( behavior) that is set up to neutralize the fear ( obsession) is another thought and there is no compulsion acted out on the environment.

The gold standard for treatment: is exposure to the feared situation without performing the compulsion. A hierarchy of fears is set up going from fears that vary from less to more intense. Techniques to get over the obsessions and compulsions are taught. Practice sessions are planned and implemented in systematic, gradual steps or exposure experiences. Cognitive and behavior therapy is used. I also use body calming techniques because that also helps.

Please note that almost all individuals with OCD do function normally in some or many areas of their lives. They know their thoughts and behaviors are strange. They are not crazy. Most, but not all, are able to hide their OCD from bosses and co-workers, neighbors and even to varying degrees from family. Dealing with severe OCD tends to create isolation which leads to loneliness, depression…and an exacerbation of the problem.

I think using both medication and specialized therapy is preferable. New research in brain plasticity has helped us understand the mechanisms involved in OCD and has implications for treatment.

If you suffer from OCD seek help. It is treatable.