OCD

Obsessive Compulsive Disorder (OCD)

OCD is the fourth most common psychiatric condition. It consists of obsessions and compulsions that take up an excessive amount of time and cause significant distress.   Obsessions are unwanted thoughts relating to the fear of something bad happening or other upsetting thoughts. Many worry about being contaminated, getting sick, and dying. Others may just dwell on the obsession, although more often, the obsession is followed by a compulsion. Individuals often realize that the worries are excessive and not based in reality. In order to manage these worries, a person generally follows it with a compulsion, that is a behavior to diminish the worries. The person feels strongly that he/she does not do it, that the worries will actually happen. Again, people often realize that the worries are excessive. OCD tends to worsen in times of greater stress. While it may wax and wane, it is a chronic condition and generally will not go away on its own.

The two major treatments proven effective are cognitive-behavioral therapy and medications. Medications primarily used are higher doses of newer anti-depressants, such as Prozac and Paxil. For more information on mediations, click on NIMH link below. Frequently, a combination of the two are used. While it used to be considered a very difficult condition to treat, great strides have occurred over the past 20 years. Brain scans have shown people successfully treated with medications result in normal scans after treatment. More interesting is that those successfully treated with behavior therapy and no medications ALSO had normal scans after treatment.

Behavioral and Cognitive Treatments

Behavioral therapy consists of exposure and response prevention (erp). This means exposing the individual to the feared situation and preventing them from engaging in the compulsion. For example, someone afraid of germs might take something out of the trash and then NOT wash their hands. This is generally extremely difficult to get people to do. The trick is starting at a point where they can be successful, even though they frequently feel that they cannot. The presence of a therapist often is needed to begin the task. Sometimes medications are needed in order to help a person begin erp.

A cognitive strategy that can help over time is respond to obsessions with statements like "that's just my OCD lying to me" or "that's just my brain misfiring." Watch a 34 minute video of Jeffrey Schwartz explaining this technique from his book Brain Lock.

I have had good success with some children in trying “experiments.” One girl had a ritualized way of reading to her dolls. One by one, we successfully had her do this leaving off one of the conditions, like having the basement door closed.

Recommended Reading:

Here are some excellent books that can be used as aid to therapy or as self-help, on their own:

For kids: What to Do When Your Brain Gets Stuck. Dawn Huebner GREAT book for kids!
Brain Lock. Jeffrey M. Schwartz    Video
Stop Obsessing. Edna Foa
The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder. Bruce M. Hyman PhD. and Cherry Pedrick
Talking back to OCD : the program that helps kids and teens say "no way"-- and parents say "way to go." John S. March, with Christine M. Benton

OCD Guides   (Guides for children, teens, college students, and adults)

NIMH OCD Information

OC Foundation

Hoarding

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