Obsessive Compulsive Disorder (OCD)

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What is Obsessive Compulsive Disorder?

The essential features of obsessive compulsive disorder (OCD) are recurrent obsessive thoughts, images and feelings that create anxiety or distress and compulsive urges to behave in ways that provide some reassurance or safety. The type of OCD most familiar to the general public is fear of contamination, portrayed in the TV show "Monk" and the movie "The Aviator." Individuals with this type of OCD, have obsessions about becoming contaminated and compulsions to avoid contamination or to clean and wash excessively. As with many types of OCD there is a bit of truth in the fear of contamination, things certainly can be contaminated and there are bacteria and trace toxins everyplace. In OCD, a very, very small possibility of dangerous levels of contamination is exaggerated into certain catastrophe. It is important to realize that OCD creates feelings, not just thoughts and images. People with OCD usually realize that their thoughts are unrealistic, but this insight provides no relief. They still cannot resist avoiding or performing rituals because of these feelings. For example, if a person with OCD gets the thought that he has touched a deadly contaminant, he will have feelings to match that thought. The emotional impact will be as though he has been contaminated with something deadly.

There are many different types of OCD. They all involve feelings of anxiety or fear but the focus can be on contamination, imperfections, aggressive or sexual thoughts, hoarding or many other variations; most patients have more than one type of obsession and compulsion. Click on the links below for descriptions of common OCD obsessive concerns and compulsive behaviors.

OCD varies in severity; some people have relatively mild or moderate symptoms but OCD can become so severe that it is impossible for the individual to maintain a job or even to carry out the activities needed to function from day to day. Some patients become homebound. Symptoms typically wax and wane, depending on stressors in the patient's life, but a worsening course is common. The more someone performs the compulsive behaviors (for example, avoiding things that are perceived to be contaminated, or washing and decontaminating to restore cleanliness), the more severe the OCD becomes.

OCD concerns are extreme and unrealistic so OCD patients sometimes fear they are going crazy but this insight, the realization that their thoughts do not make sense, or may even be bizarre is typical of OCD and proof, of course, that they are not crazy.

How do you know if you suffer from OCD?

These questions cover some of the typical signs and symptoms of OCD:

Do you have recurrent, persistent thoughts, images or impulses that cause anxiety and distress? Are these similar to those in the table of obsessions? Is it sometimes clear that these are these not simply excessive worries about real-life problems?
Do you perform rituals like any of those in the table of compulsions? Do the avoidance or rituals have a significant impact on your life? Do you avoid things you really should do or would want to do except for your fears? Do rituals cause you to be late to events? Do they interfere with your relationships or your work?
How much time do the obsessions and/or compulsions occupy per day on average? Is it an hour or more?
What effect have the intrusive thoughts and compulsive behaviors had on your life? Have they caused you a lot of distress, torment, or emotional pain? Have they significantly interfered with your social life, your school work, your job, or your ability to function in other important areas of your life?

Treatment for OCD

Effective treatments for OCD are available. Research and clinical experience have shown that cognitive behavioral therapy (CBT) and certain medications (serotonin reuptake inhibitors: SRIs) are effective in treating OCD.

The most effective psychological treatment for OCD is exposure and response prevention, a key technique of CBT. This means facing feared situations and not performing the usual rituals. This seems frightening to many people, but treatment is specifically designed for each patient individually, so can be as aggressive or cautious as desired. Whatever the course chosen, treatment can achieve the same excellent result. Dr. Allen has worked successfully with severe, chronic patients who have not succeeded with other therapists, because in addition to the standard exposure and response prevention, she includes a serious focus on gradually and systematically reducing the rituals that patients perform in their day-to-day lives. These changes in daily rituals are a variation of exposure and response prevention and a particularly powerful way to reduce and eventually eliminate OCD symptoms.

For more information about OCD, its treatment or to set up a consultation, feel free to contact Dr. Allen.