OCD (Obsessive-Compulsive Disorder) Therapy
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Obsessive-compulsive disorder (OCD) manifests itself in a variety of ways, from hoarding to handwashing to constantly monitoring the stove. It is an anxiety disorder that traps people in a cycle of repeating thoughts and behavioral habits that can be completely incapacitating.
According to the National Institute of Mental Health, approximately 2% of the population suffers from OCD, which is more than those who suffer from other mental diseases such as schizophrenia, bipolar disorder, and panic disorder. OCD can begin in childhood, but it is more common throughout adolescence or early adulthood. Scientists believe that unwanted, intrusive thoughts and compulsive activity patterns that placate those unwanted thoughts are caused by both a neurological predisposition and environmental variables.
Although the severity of the symptoms may wax and wane over time, the disorder is typically chronic, lasting years, if not decades. Both pharmaceutical and behavioral therapies, particularly Exposure and Response Prevention, have proven to be successful treatments for people with OCD, allowing them to live happy and fulfilling lives.
According to the DSM-5, the two essential elements of OCD are obsessions and compulsions. Obsessions are persistent unwanted thoughts, desires, or pictures that cause distress and that the individual tries to suppress or combat. Compulsions are repetitive behaviors or mental activities performed by an individual in reaction to an obsession with the purpose of neutralizing the threat or easing distress. Obsessions or compulsions must also impede an aspect of everyday functioning, be time-consuming, and not be caused by another mental health disorder or substance use in order to be diagnosed.
Obsessions and compulsions that characterize OCD can revolve around a variety of topics. Obsessions are classified into five types:
- Fear about contamination (germs, viruses)
- Fear of harm (unlocked doors, electrical outlets catching fire)
- Excessive concern for order or symmetry (even picture frames, general neatness)
- Body obsessions or physical symptoms (breathing, swallowing)
- Unwanted, intrusive thoughts (going to hell, harming family members)
People suffering from OCD will therefore perform compulsions such as hand washing or lock checking because they feel that doing so will prevent those negative events from occurring.
OCD is most likely caused by a combination of factors, including a biological predisposition, contextual factors such as childhood experiences and attitudes, and erroneous thought patterns.
The fact that many OCD patients respond to SSRI antidepressants suggests that the serotonin neurotransmitter pathway is dysfunctional. Ongoing research suggests that there may be a flaw in other chemical messenger systems in the brain.
OCD may coexist with depression, eating disorders, or attention-deficit/hyperactivity disorder, and it may be linked to disorders like Tourette’s syndrome and hypochondria, however, the nature of the connection is debatable.
The basal ganglia, a group of structures beneath the cortex that assists coordinate movement, is one region thought to play a role in OCD; when the basal ganglia malfunctions, unwanted, involuntary motions can follow.
The basal ganglia connect with the prefrontal cortex, which is involved in planning, thinking, and awareness, in addition to the motor cortex, suggesting that the basal ganglia may play a part in enabling wanted thoughts and suppressing unwanted thoughts. As evidence for this theory, brain activity in the cortex and basal ganglia differs between OCD and typical-OCD persons, and activating a part of the basal ganglia can alleviate OCD symptoms.
For OCD, either psychotherapy or medicine, or both, may be recommended, and evidence suggests that a combination of the two is frequently the most effective strategy, particularly for young people.
These drugs are typically selective serotonin reuptake inhibitors (SSRI). The SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) have been specifically licensed to treat OCD. These drugs have been proven to diminish the frequency and severity of obsessions and compulsions in more than half of patients, while withdrawal of drugs frequently results in relapse.
Behavioral therapy for OCD, such as Exposure and Response Prevention, has a long-term benefit. Psychotherapy typically focuses on two parts of the disorder: unraveling the disorder’s irrational thoughts and progressively exposing sufferers to the dreaded object or idea until they are desensitized to it and can tolerate anxiety without engaging in compulsive rituals.
Simply trying to suppress uncomfortable thoughts does not work. In a well-known experiment, psychologist Daniel Wegner ordered research participants not to think about white bears—and unsurprisingly, all they could think about were white bears.
Instead, a few cognitive methods can help in the treatment of obsessive thoughts in OCD. One method is to demonstrate that thoughts do not govern reality by exposing yourself (or your thoughts) to your fear, which is a component of OCD exposure therapy. Preventing Exposure and response. Another option is to “float” your preoccupation; rather than trying to get rid of it, imagine it floating down a river and shrinking as you focus on your breathing.
The pandemic has upended treatment for OCD, as it has in all other aspects of life, because the gold standard of treatment, Exposure and Response Prevention, is an interactive and hands-on kind of therapy. As a result, therapists’ approaches have shifted. They may have altered patients’ exposure plans based on which acts are caused by the pandemic and which are not, focused on how the patient spends their time to avoid expanding the time devoted to obsessions and compulsions and considered administering medication when necessary.
A return in OCD, or the temporary or partial reemergence of symptoms such as compulsive behaviors, can be caused by stress, life transitions, or new circumstances that elicit an obsession. However, lapses do not have to lead in a complete relapse. To avoid relapses, people might figure out what triggered the setback and devise a situation for dealing with it in the future. Maintaining recovery also requires continuing to practice CBT and/or ERP.
Obsessions are the early symptoms of OCD—unwanted ideas or urges that recur repeatedly and are aimed to drive out anxieties, frequently of harm or contamination. “I shall get a fatal ailment” or “My family will suffer.”
Following that, compulsions emerge—repetitive behaviors such as handwashing, lock-checking, and hoarding. These behaviors are intended to lessen fear and the danger of harm. However, the effect is short-lived, and the unwanted thoughts soon return. Obsessive-compulsive disorder people may also experience motor tics or repetitive motions such as grimacing and jerking.
Sufferers may recognize the uselessness of their obsessions and compulsions, but it is no defense against them. OCD can grow so severe that it interferes with a person’s work or relationships, or even prevents them from leaving the house.
A prevalent misperception is that compulsions must be physical in nature, such as trying every seat on the train or touching your toes 20 times. Compulsions, on the other hand, can be conducted mentally, such as repeating words or phrases, generating mental lists of items, or praying incessantly. In OCD, mental compulsions can be just as stressful as physical compulsions. However, because mental compulsions are more hidden by nature, people who suffer from them may avoid detection and go longer without seeking help.
People frequently describe themselves as “very OCD,” indicating a propensity for cleanliness, order, or perfection. However, there are significant differences between the two, and they should not be confused. The key difference is that OCD becomes a disorder when symptoms interfere with or hinder a person’s capacity to function socially, professionally, or academically.
Someone with OCD, for example, may be habitually late for work and possibly fired if compulsions prevent them from leaving the house. In a family setting, someone with OCD may avoid being at home alone with their children for fear of inadvertently harming or killing them.
Obsessions and compulsions in OCD are frequently traced with a stressful event or life transition that resulted in increased obligations, such as a new job, the birth of a child, or even puberty. These occurrences can heighten a person’s sense of responsibility, causing anxiety and a desire to guarantee that they do not fail themselves or others by allowing awful things to happen. Case studies show that compulsions can vanish in a hospital or lab setting when the patient believes the burden of responsibility has been transferred to others.
Infection can play a role in psychiatric diseases, and evidence suggests that rare cases of OCD can be traced back to problems from a strep throat infection. Psychiatric symptoms such as intrusive thoughts or urges and the inability to stop compulsive behaviors developed as a result of the infection may be triggered by the child’s immune reaction. This suggests that this rare route for OCD is contagious.
It’s possible that the pandemic triggered OCD in some people who were already prone to it, but COVID-19 did not cause an “epidemic of OCD.” A fundamental contrast is that the worry of contracting or transmitting COVID-19 is a legitimate cause for concern, although the disorder’s intrusive thoughts are not. Extra hand-washing and sanitizing have not, in most circumstances, resulting in impairment or malfunction in daily life. In contrast, someone suffering from OCD may begin to wash their hands so frequently that they become raw or bleeding.
If a loved one has OCD, there are some important steps to take—and some important steps to avoid. Do not help the person in carrying out compulsions, even if it appears reassuring, and do not tell them to “just stop it” or imply that they are lazy or lack willpower—these are a few fallacies regarding OCD. Instead, educate yourself on the disorder and know that OCD is treatable with therapy and medication and that there are alternative options if the first treatment attempt is unsuccessful. You can then begin a kind but strong talk about receiving help.
The first-line treatment for OCD is exposure and response prevention (ERP). ERP is a type of cognitive-behavioral therapy in which the patient is securely exposed to the feared stimuli (exposure) while avoiding the typical ritual they would do in response (response prevention).
For example, if a patient’s fixation with contamination causes him to get a fatal infection, the therapist may assist him in touching a sink, door handle, or floor, and then have him eat lunch without being allowed to wash his hands. Although this causes anxiety at first, it teaches the patient that their dread will not come true.
Two hypotheses are proposed to explain why ERP is effective. According to the habituation model, being accustomed to the feared stimulus influences behaviors, which in turn alter beliefs, which in turn alter the emotions involved. The inhibitory learning model suggests that the connection has not been severed, but that patients develop cognitive and emotional flexibility in the midst of the feared stimulus.
In some circumstances, early identification and treatment might lead to a full recovery. While many people’s obsessions and compulsions do not totally disappear, treatment permits them to live a fulfilling life. And having realistic recovery expectations can help; people who hope to completely eliminate their OCD may be dissatisfied with their doctor, themselves, and life. People who expect “OCD will occupy a smaller part of my life” or “it will annoy me occasionally, but I’ll have the skills to deal with it” set themselves up to be happier and more satisfied.
What is the next step?
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