Obsessive-Compulsive Disorder

Someone with obsessive-compulsive disorder (OCD) experiences obsessions, compulsions, or both. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive or unwanted. Along with these thoughts, you may have feelings of extreme discomfort and strong urges to ignore, suppress, or neutralize the obsessions. Compulsions (repetitive behaviors or mental acts) are used to try to prevent or reduce distress or some dreaded situation. The compulsions can become quite rigid, excessive, and time consuming. Ultimately, the thoughts and not being able to control the thoughts causes significant anxiety and interferes with usual functioning and goals

What are OCD subtypes?

Some types of OCD are more commonly known than others. Obsessions related to germs/contamination and symmetry/orderliness seem to be more often represented in the media. Other obsessions might include fears related to something bad happening, losing control, or harming oneself or others. Unwanted and excessive thoughts/doubts related to one’s behavior, relationships, sexual orientation, religion, and health are also subtypes of OCD. The need for things to be just right, certain, and perfect might also be the focus of obsessions.

More well-known compulsions include hand washing, cleaning, and arranging excessively. Other compulsions include checking, repeating, and reassurance seeking. Oftentimes, there are rigid rules or routines that need to be followed, for example, having to repeat an action until it is completed perfectly or feels just right. Compulsions that are performed mentally (praying, repeating words/phrases, counting) are used as a way to neutralize an obsession. Avoidance is also used as a way to try to control or reduce triggering obsessions.

What does treatment for OCD look like?

The gold standard treatment for OCD is a combination of cognitive-behavioral therapy (CBT) and medication. Providers at BASE utilize CBT and coordinate with medical providers who prescribe medication when recommended. The first part of treatment for OCD includes education. The more you understand about the way OCD works, the more you can gain insight into your own patterns and learn what to do about them.

The main component of CBT for OCD is exposure and response prevention (ERP). When someone has an obsession, they become distressed and feel compelled to perform a compulsion as a way to reduce their discomfort as quickly as possible. However, compulsions start to interfere with our ability to function and ultimately do not make the fear go away. Exposure practice means facing the obsession, which will cause similar distress and urges to ritualize, and then refrain from completing the compulsion (response prevention) in order to break the habit of ritualizing. Repeating practice helps us to create new learning opportunities and correct distorted beliefs. We learn we can tolerate discomfort and see the ineffectiveness of compulsions in the long run. Exposure and response prevention is hard work and it is the most effective way to help you learn that anxiety can decrease without compulsions and allow you to get back to your life.