Have you or someone you care about been diagnosed with obsessive-compulsive disorder (OCD)? OCD is a psychiatric disorder that affects approximately 2.3% of Americans during their lifetime.
While there are different severities and causes of the disease, if left untreated it can become debilitating socially, academically, occupationally, and economically. OCD can also be accompanied by other disorders such as anxiety, depression, tics, eating disorders, and bipolar disorders, to name a few.
Usually, OCD starts in childhood or adolescence and can persist throughout life if it is not treated. The good news is that treatment can be very effective, with some therapies being successful in more than 80% of those who receive it.
Let’s talk about some of the most effective treatments for OCD and where you can go for professional help.
What Is Obsessive-Compulsive Disorder?
As the name suggests, those who have obsessive-compulsive disorder experience obsessions, compulsions, or both.
Obsessions are repetitive, persistent, and irrational thoughts. For example, someone may be obsessively worried about contamination, violence, or trauma, or they may have intrusive urges toward violence or other destructive behavior.
Compulsions are excessive rituals or repetitive behaviors that are performed in order to try to prevent whatever persistent worries the person may have. For example, repeatedly washing hands or food, cleaning surfaces to prevent contamination, repeating words, checking locks, or rearranging things over and over again are all examples of compulsive behavior.
These obsessions and compulsions can become very intrusive in a person’s life, preventing them from completing tasks on time, or even avoiding situations altogether that they believe they cannot control. Without treatment, someone with OCD may have a greatly reduced quality of life as they accommodate for their obsessions and compulsions.
Treatments that Work for OCD
While some treatments seem to have greater overall success than others, each person with OCD is different – so treatment should be tailored to their individual needs. The two most commonly prescribed and effective treatments for OCD are medications and cognitive-behavioral therapy (CBT). A combination of the two sometimes creates the best results.
When treatment is being determined for someone with OCD, it is important to note the person’s insight into their own illness. For example, someone with good insight will recognize that their beliefs (obsessions) are probably not true, whereas someone with poor insight will think that their obsessional beliefs are probably true, while someone with a total lack of insight will absolutely believe that their obsessions and related compulsions are absolutely true and necessary. The most effective treatment will take the person’s level of insight into account.
What Is Involved in Cognitive-Behavioral Therapy?
Cognitive-behavioral therapy is a type of psychotherapy that involves techniques to help people with OCD change their unrealistic thought processes and behaviors in order to lessen their emotional distress. It includes education, cognitive therapy techniques, exposure therapy, and response prevention.
Its success in treating OCD requires that the person is able to understand the treatment, has moderate to good insight by realizing that their thoughts and actions are not based entirely on reality, and is willing to try this approach to treatment.
Successful CBT gives the person confidence and teaches them new behaviors to address their fears or anxiety. Each session with CBT for people with OCD has a specific agenda and required “homework” to be done before the next session.
This treatment should include three components:
Psychoeducation will involve letting you know how this therapy works, what activities to expect, and why you will be engaging in the activities. This step is very important because many of the planned activities are going to cause anxiety.
You will learn new ways of thinking and reacting to anxious situations. Your therapist will help you do this by acting through the situations that cause you anxiety while teaching you to replace old obsessive-compulsive behaviors with new ways to handle stress.
Exposure and Response Prevention is the most important component of CBT for people with OCD. This involves repeated and prolonged exposure to fears that you have obsessed about in the past, while being guided by your therapist on how to refrain from compulsive behavior. These activities may include low-risk experiences, such as riding escalators that you have been avoiding or leaving home quickly without going back to check the stove or the locks.
Cognitive Therapy can improve exposure and response prevention techniques. This is your opportunity to work through the beliefs that are causing you anxiety. By talking with your therapist, you will learn to judge whether your beliefs are realistic. Sometimes it is as simple as being guided through understanding why you believe what is causing anxiety, and how that compares to reality.
The pie technique actually allows you to identify all variables that may lead to a disastrous outcome that you fear. For instance, if you are afraid of your apartment burning down, you can identify all the possible causes of this type of fire, including anything you might do that would cause it, and assigning each potential cause an estimated percentage of plausibility via a pie chart.
By creating a pie chart that represents each possible cause of fire, you will come to understand that your actions or inactions (not performing specific rituals) have a very small probability of causing any fire in your apartment building. In other words, cognitive therapy helps you address your obsessions or fears with critical thinking tools.
Medications to Treat OCD
There are three primary types of antidepressant medications that are used to treat OCD. Each type of medication has potential side effects which may discourage some people from choosing this treatment, such as a potential increased risk of suicide.
Selective Serotonin Reuptake Inhibitors (SSRIs) work by increasing the activity of serotonin. Serotonin is a naturally occurring neurotransmitter in our bodies that affects mood, thinking, learning, and memory. This class of medication, which includes paroxetine or fluoxetine, has been found to be the most helpful in treating OCD. Side effects are usually mild and can include nausea, diarrhea, agitation, problems sleeping, a lowered sex drive, and increased sweat.
Clomipramine is a tricyclic antidepressant that also regulates serotonin, and it also regulates norepinephrine – which is the neurotransmitter that can cause the “fight or flight” response you may feel when you are startled. This medication has been found to be very effective in treating OCD, but the side effects can be more difficult to tolerate than with SSRIs. As your doctor will explain, the potential side effects include drowsiness, dry mouth, constipation, urinary retention, and dizziness.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), such as venlafaxine, work similarly to the medications listed above but may not be as effective. Common side effects include nausea, constipation, dizziness, trouble sleeping, drowsiness, and loss of sexual drive.
It should be noted that while each of these medications can be helpful in the treatment of OCD, they ultimately are controlling symptoms, not the underlying problem. It may therefore be beneficial to add CBT to your medicinal treatment to achieve the most effective improvement in your OCD symptoms.
Professional Treatment for OCD
If you are having symptoms that sound similar to those described above, your best course of action is to seek the expert advice and treatment of an experienced psychiatrist. This type of medical doctor is dedicated to improving your emotional health and helping you achieve your highest quality of life, and they have the legal authority to write prescriptions to treat your condition as necessary.
Dr. Mark Stracks of Psy-Visions is a licensed and board-certified psychiatrist with extensive experience and training. He practices in New York City and Connecticut.
For questions or to schedule an appointment, you may contact our New York City office at (718) 887-2918 or our Southbury, CT office at (203) 405-1745, or send us a secure message online now. We also offer telepsychiatry services. We look forward to hearing from you.