Obsessive Compulsive Disorder (OCD)

When many of us think about OCD, we think of the most well-known symptoms, such as excessive hand-washing or keeping things in order. However, there are many ways in which OCD manifests and can be addressed in treatment.

Obsessive Compulsive Disorder (OCD) is characterized, just as the name suggests, by two parts: obsessions and compulsions.

Obsessions are thoughts, images, or impulses to do something that repeat over and over again. They are generally unwanted, distressing, or disturbing, and get in the way of doing important things, such as job responsibilities, schoolwork, parenting, and participating in relationships. Obsessions are often accompanied by intensely uncomfortable feelings, such as fear, anxiety, doubt, disgust, and persistent worry.

Compulsions are the behaviors that one may do in order to neutralize, satisfy, or otherwise reduce their obsessions and the uncomfortable feelings that come along with them. Compulsions include doing things over and over and/or in a certain ways, thinking certain thoughts to counteract the obsessions, asking repetitive questions to other people in order to obtain reassurance, and avoiding things or situations likely to trigger obsessions.

Like obsessions, compulsions typically take up a significant amount of time, can get in the way of doing important things, and can also be embarrassing. Many people with OCD will find that doing their compulsions does help at least to some degree in the short-run, keeping their obsessions at bay or reducing them. But the obsessions typically come back as strong as ever, reinforcing an escalating cycle of obsession, compulsion, obsession, compulsion, and so on.

When many of us think about OCD, we think of the most well-known symptoms, such as excessive hand-washing or keeping things in order. However, there are many ways in which OCD manifests and can be addressed in treatment. Common reasons why people with OCD seek treatment include, but are not limited to:

The most effective form of psychotherapeutic treatment for OCD is a type of CBT called Exposure and Response Prevention (ERP). In the exposure aspect of ERP, the individual works together with the therapist to confront the thoughts, people, things, and situations that are the focus of their obsessions and trigger their discomfort. The key element of this treatment is the response prevention aspect, in which the individual makes the choice – in the service of improving their lives in the long run – to refrain from doing the compulsions that they typically rely on, whether it be washing, performing a ritual, asking questions, repeating things, or trying to push thoughts away or otherwise deny them.

By breaking this cycle of obsessions and compulsions, most individuals will find that their anxiety and discomfort will eventually decrease without having to do the compulsion. At the outset, this may take longer. But by repeating these exercises over time, individuals build up a level of comfort with the situations that were previously thought to be unbearable. As this happens, individuals may begin to think differently about their obsessions, finding that these warnings of inescapable danger that the OCD insists upon are exaggerated, and that the situations are in fact survivable and less threatening than initially feared. As this comfort level grows, individuals with OCD can begin to reclaim the hours of their lives occupied by the condition.

To some, this approach may sound counterintuitive at first. Many seek treatment to make these thoughts and feelings just go away rather than to confront them. However, it is often because of desperately wanting to feel better and think differently that many get stuck in that escalating cycle of obsessions, compulsions, and worse obsessions. ERP is a choice to take a different approach from the one many are stuck in, one that may be quite challenging at first, but life-altering and positive in the long-run. An essential ingredient of the process is an experienced and compassionate therapist who will work with the individual to move along at the right pace, provide support, and troubleshoot potential obstacles.

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