Obsessive-Compulsive Disorder

Prior to 1987, obsessive-compulsive disorder (OCD) was thought to be quite rare and not very treatable. Then in 1987 with the development of the group of antidepressants called SSRI’s (selective serotonin reuptake inhibitors) all that changed. The first one to be released was prozac in 1987, followed by Zoloft, paxil, luvox, celexa and lexapro. In addition to being effective for depression, this group was found to be the first medications that were effective in treating OCD.

As often happens when illnesses become more treatable, more people sought treatment and now it is known that OCD is far from rare and occurs in 3% of the population or about 10 million people in the United States alone.

OCD is a biological illness caused by a chemical imbalance in the caudate nucleus in the brain. It can present in many different ways. Here is an example: A burst of anxiety is associated with a thought (the obsession). Let’s say the thought is, “My hands are dirty.” Part of you knows that the thought is not true, or irrational, and the other part of you is not sure. You know your hands are clean because you just washed them. But then another thought pops into your mind: “What if I missed a spot?” More anxiety.

Now, all you have to do to get rid of that anxiety is to go into the bathroom and wash your hands. But here is the catch. It will only relieve your anxiety temporarily and it will come back even stronger because by “giving in” to the urge (the compulsion) you are fueling the power of the OCD.

We all have some OCD symptoms. We all have asked ourselves the question, “Did I lock the door? Did I leave the oven on?” But what if you can’t get to work in the morning because you have to go back a dozen times to see if you locked the door. That is a problem. Severe OCD can be truly disabling.

The content of the obsession and compulsion can be anything but they often revolve around the themes of contamination, checking, orderliness, religion and sex.

OK, so if “giving in” to the urge only takes away your anxiety temporarily and makes the underlying process worse, what do we do? Of course, you don’t give in. Simple concept, hard to do.

Medications are very effective with even severe depression and anxiety. OCD is a bit tougher. Keep in mind that usually the higher doses are needed and it can take up to 3 months to get the full effect. And even then, a 50% reduction in the strength of the urges is considered a very good response. So, the meds aren’t going to work

all by themselves, but they will make it more likely that the psychotherapy will work.

What has made OCD more treatable in the past few decades, is the use of medications and therapy, together.

The first step in therapy is to be able to admit that the content of the obsessions is irrational. You can’t go any further if you don’t master this step. If I have the thought, “my hands are dirty and I must wash them again,” I have to be able to say that the thought has nothing to do with my hands and has only to do with my OCD.

Then I’m likely to have a “what if” thought. “What if I missed a spot the last time I washed them?” “What if it isn’t due to my OCD and my hands really are contaminated?”

This is when you have to try to take a leap of faith and believe and listen to that rational part of your brain. Now, if you do it correctly, what will happen to your anxiety, initially? If giving into the urges (which we don’t want to do) will take away your anxiety, not giving into it will increase your anxiety. Yes, this is what we want! This is why OCD is tough.

If you can resist giving into the urge, your anxiety will increase, but after a while, perhaps 20 to 30 minutes, it will decrease and that is what breaks the spell of OCD. You have to tolerate that anxiety, not get rid of it. Distraction can be very helpful. Try to get yourself involved in anything other than the OCD symptom of the moment.

In the beginning this will probably not go so well. That is OK. If you can only resist the urge for a few moments, that is fine. Tomorrow, try to resist for a little longer. Slow steady progress will add up.

To make it even more challenging, just when you think that you have one symptom under control, a brand new one pops up. Just deal with the new one in the same way. Just remember, the fundamental basis of treatment is admitting that the thoughts are irrational. You really aren’t going to contaminate your whole family if you don’t wash your hands again. And never, ever, try to argue with your obsessions. You will not win. You cannot apply rational arguments to thoughts that are not rational. As one of my patients put it: It’s like trying to nail jello to the wall.

With proper medication, and the right attitude in therapy (a sense of humor greatly helps!) significant improvement can be expected. A support group, to be around other people who are going through the same thing, can be invaluable. See the home page.

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