Understanding and Treating OCD


Obsessive-compulsive disorder (OCD) can interfere with your daily life because of intrusive thoughts and ritualized behaviors that try to banish them. Understanding your condition is the first step to treating it successfully. We’ve got more on that here.

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts and repetitive rituals that can be annoying at best and completely debilitating at worst. According to the Harvard Medical School National Comorbidity Survey (NCSSC), the lifetime occurrence of OCD among US adults was 2.3%. Of those, 14.6% experienced mild impairment, 34.8% moderate impairment, and over one half (50.6%) serious impairment. At Aura Psychiatry, PLLC, Farheen Makani, PMHNP-BC and the staff have extensive experience treating people with OCD at their Allen, Texas, office. While each person’s symptoms are unique, the disorder can be broken into general categories that make understanding and treating OCD possible and effective. Understanding OCD Obsessive-compulsive disorder is composed of two parts: unwanted ideas, thoughts, or sensations (obsessions); and repetitive behaviors (compulsions) performed to help banish the obsessions. A lot of people have distressing thoughts or repetitive behaviors, but they typically don’t disrupt daily life. For people who have OCD, though, the thoughts are persistent, and the behaviors are rigid. Not performing the behaviors, or not performing them in the exact way “necessary,” causes great distress, panic, and a feeling that something is terribly wrong. Many people living with OCD know their obsessions aren’t realistic, but they feel compelled to perform the rituals anyway to make the world “right.” An OCD diagnosis requires the presence of obsessions and/or compulsions that are time-consuming (more than one hour a day), cause significant distress, and interfere with work or social functioning. General categories of obsessions include:
Fear of germs
Fear of being “contaminated” by people or the environment
Disturbing sexual thoughts or images
Fear of blurting out obscenities or insults (Tourette’s syndrome)
Extreme concern with order, symmetry, or precision
Intrusive thoughts of recurrent sounds, images, words, or numbers
Fear of losing or discarding something important
General categories of compulsions include:
Excessive or ritualized hand washing, showering, brushing teeth, or toileting (even to the extent of rubbing the skin raw)
Repeated cleaning of household objects (tables, chairs, door handles)
Ordering or arranging things in specific ways
Repeatedly checking locks, switches, or appliances
Constantly seeking approval or reassurance
Repeatedly counting to a certain number
It’s possible to have multiple types of obsessions and compulsions, such as arranging objects while counting their number, then cleaning them off and starting again. Many people with OCD are embarrassed by or feel shame about their condition, so they get very good at hiding their rituals from other people. That allows the disorder to progress to an advanced state before anyone realizes they need help. Treating OCD OCD isn’t curable, but it can be controlled with medication and/or some form of psychotherapy. Medication The class of drugs known as selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, can also be effective at treating OCD, though the dosage usually needs to be higher than that used for depression. Patients who don’t respond to one SSRI sometimes respond to another. In addition, other psychiatric medications, such as SNRIs and even some antipsychotics, can be effective. It’s important to understand, though, that it can take 6-12 weeks before the medication reaches a therapeutic level, so if you’re not seeing a result right away, don’t give up. Psychotherapy Two types of therapies are effective for OCD: cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP). CBT is based on several principles, including:
Mental health problems are based, in part, on faulty or unhelpful ways of thinking.
Mental health problems are based, in part, on learned patterns of unhelpful behaviors.
People living with mental health problems can learn better ways of coping with them, which relieves symptoms.
CBT treatment therefore involves efforts to change thinking patterns. During ERP treatment sessions, patients are exposed to feared images or situations that reflect their obsessions; it’s understood this will initially lead to increased anxiety. Patients are instructed to avoid engaging in their usual compulsive behaviors (response prevention) for as long as possible. When they stay in a fearful situation without anything terrible occurring, it helps them learn that their fearful thoughts are just thoughts, not reality. It also helps them learn that they can cope with their obsessions without needing to perform ritualistic behaviors. As a result, their anxiety decreases over time. Using evidence-based guidelines, therapists and patients together create an exposure plan that gradually moves from lower-anxiety situations to higher-anxiety situations; it means confronting their anxieties again and again, but it results in greater and more lasting relief when they learn they can endure these situations. While people with mild to moderate OCD may be able to get by on medication alone, for those with severe OCD, we recommend both psychotherapy and medication. Are you trapped in endless obsessions and ritualized behaviors? Do you feel there’s no way out? Aura Psychiatry, PLLC can help. Call our office at 469-599-2872 to set up a consultation, or book online with us today.

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