Overview

     Obsessive-Compulsive Disorder, or OCD, is a common and chronic psychiatric disorder in which a person has unwanted, intrusive and reoccurring thoughts, images or impulses (obsessions).  These obsessions cause anxiety and prompt behaviors that he or she feels the urge to repeat over and over to reduce the anxiety (compulsions).


Symptoms

OCD is more than simply wanting to have a clean room or liking things organized.  The disorder is characterized by the following diagnostic symptoms:

Obsessions:

  1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action.

Compulsions:

  1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


Types

     Most individuals with OCD have both obsessions and compulsions, but there are some that have only the obsessions.  The most common types or categories of obsessions and compulsions are aggressive or violent, sexual, religious, superstitious, hoarding or contamination related.  


Common self-help treatments

     The most important thing to remember about OCD is that the thoughts are NOT WANTED.  It is not an indication of who you are, or what your darkest desires are. In fact, it is often true that the topics or themes of the obsessive thoughts have to do with issues or people you feel the strongest about (e.g. fear of being evil or insufficient repentance for highly religious people; thoughts of harming one’s spouse or children for individuals that have a strong bond with their family).

     As individuals start to identify these patterns of thoughts and behaviors, they can engage in the following:

  1. Relabel
  2. Reattribute
  3. Refocus
  4. Revalue

Relabel: Learn to Relabel intrusive thoughts and urges in your own mind as obsessions and compulsions - and to do so assertively. Start calling them that; use the labels obsession and compulsion. For example, train yourself to say, "I don't think or feel that my hands are dirty. I'm having an obsession that my hands are dirty."

Reattribute: "It's not me--it's my OCD." Remind yourself that OCD thoughts and urges are not meaningful, that they are false messages from the brain. The key to the Reattribute step is to realize that the awful intrusiveness and ferocious intensity of OCD thoughts are due to a medical condition. Underlying problems in brain biochemistry are causing these thoughts and urges to be so intrusive. That is why they won't go away.

Refocus: Work around the OCD thoughts and urges by shifting attention to something else, if only for a few minutes. You may choose some specific behavior to replace the compulsion. Any constructive, pleasant behavior will do. Hobbies are particularly good. For example, you may decide to take a walk, exercise, listen to music, read, play a computer game, knit, or shoot a basketball.

     Refocusing isn't easy, but only by learning to resist OCD symptoms can you change the brain chemistry. To help you manage this task, consider the fifteen-minute rule. Delay your response to your urge to perform a compulsive behavior by letting some time elapse--preferably at least fifteen minutes--before you even consider acting on the urge or thought. In the beginning or whenever the urges are very intense, you may need to set a shorter waiting time, say five minutes, as your goal. Never perform the compulsion without some time delay.

Revalue:  Do not take the OCD thought at face value. It is not significant in itself. You place a much lower value on--devalue--the OCD feeling.  Anticipate and Accept. When you use these two A's, you are doing Active Revaluing.  Anticipate means "be prepared," know the feeling is coming, so be ready for it; don't be taken by surprise.  Accept means don't waste energy beating yourself up because you have these bad feelings. Know that you can move with the feelings, rather than become caught in a struggle with them.  Consider the analogy of a tug-of-war. You can try to win, by struggling against the thoughts with all of your might, or you can simply let go of the rope.


Where to go for help

     Because OCD is often a significant mental health problem which causes notable impairment in the person’s life, you may want to seek professional help.  Counseling can aid individuals with OCD in understanding what it is, removing the guilt behind the thoughts and behaviors and working on reversing some of the brain chemistry that caused it in the first place.  Sometimes medications can reduce the severity of the thoughts, so that the individual can more effectively resist them.

     Behavioral treatment for OCD is called Exposure and Response/Ritual Prevention or ERP.  This is a systematic process of triggering the obsessive thoughts and then resisting the consequent behavioral urges or compulsions.  Numerous studies have shown that ERP is an effective treatment for reducing the intrusiveness of the triggering obsessions and avoiding the compulsions all together.

     You DO NOT need to be in counseling for the rest of your life!  Once you learn the stages of treatment and feel comfortable implementing them on your own, your therapist will no longer need to coach.  In fact, most individuals with OCD start to feel a reduction in their symptoms after only a few sessions.

     Psychiatric medications may help.  Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms. Some of these are Prozac (fluoxetine), Luvox (fluvoxamine) and Zoloft (sertraline).  SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.


How to help others

     Learn about OCD!  You will need to understand what your loved one goes through with this frequently debilitating disorder.  It is not simply a lack of will power. The person often knows that their thoughts or feelings are irrational, but there is such pain or discomfort with resisting the thoughts that they eventually feel compelled to give in.  It can be tempting to oversimplify the process, but learning about OCD will help you develop empathy, even if you don’t have the disorder yourself.

     Help your loved one find appropriate treatment for OCD and encourage him or her to actively participate in the therapy process.  Effective treatment is the most important step in gaining relief.

     Stop enabling OCD in your household or in your relationship.  Participating in rituals with your loved one or accommodating avoidance behavior does not help.  In fact, the effect can be just the opposite.

     Try to establish a positive emotional climate.  How you communicate with your loved one as well as the level of support you provide cannot be overemphasized.

     Take care of yourself: Unless you first take care of yourself, you won’t be able to help others.  Yet this fundamental idea is frequently ignored by those who know someone with OCD. Research has indicated that family members and loved ones report some – if not severe – distress adjusting, but they seldom seek the help they need.  You may find professional help useful, but at the very least, learn to manage self-care and recharge. The person with OCD will not fall apart if you take time for yourself.


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