Today’s column is about a new generation of Obsessive Compulsive Disorder treatments. Before learning about OCD treatments, let’s briefly discuss basic facts about OCD:
1. OCD is composed of two specific parts — the obsession (a thought) causes the person to perform a compulsion (the behavior or action). Let’s use this example — a fear of contamination by dirt or germs. The obsession is “my hands are contaminated by germs,” which drives the compulsion, washing hands over and over.
2. The second part of the OCD equation, the compulsion, decreases the anxiety generated by the first part, the obsession. That is, the OCD sufferer has a sense of control over anxiety by doing the compulsion.
3. OCD behaviors are called “rituals” because they are carried out and performed in the same rigid and precise manner (washing hands over and over).
4. OCD is a type of anxiety disorder. OCD rituals help the person reduce anxiety. The problem is, OCD rituals become stronger and stronger, and grow bigger, and bigger. When this happens, the OCD patient loses control over daily activities (work, bathing, dressing, eating). When OCD becomes out of control, the person’s life is riddled with rituals.
5. OCD first starts in childhood. But, since it is kept a secret, and the full-blown disorder takes time to develop, the most common age of OCD appearance is 25-44 years old.
6. Common obsessions include: Contamination by dirt, germs or dangerous chemicals; a need for perfection; a need to order, arrange or tap objects; a fear of illness, diseases or that some terrible disaster will happen; a fear of hurting others.
7. Common compulsions include: Excessive hand washing, bathing, or grooming; checking the stove, door locks; removing household contaminants; hoarding; cleaning; tapping.
8. Stress increases OCD rituals.
You are now ready to learn about OCD treatments.
First, you need to know some bad news:
1. OCD is often missed because the patient is never asked specific questions, which would have revealed their hidden — and to them, shameful — disorder.
2. OCD treatment often occurs 10-15 years after the symptoms first begin.
3. OCD treatments often fail for the simple reason that the wrong treatment is used.
4. Few professionals have received specific training in OCD treatments.
Now, the good news. OCD, when properly diagnosed and treated with effective methods, can be reduced and managed, just like other chronic medical disorders, such as diabetes or asthma.
OCD treatments with proven effectiveness are as follows:
1. Exposure with Response Prevention. This highly focused behavioral treatment teaches the patient powerful cognitive (thinking) skills to reduce and manage surges of anxiety, without performing the OCD ritual. In this treatment, patients are exposed to the sources of their fears, and by using cognitive skills, they can prevent the OCD ritual from occurring.
2. SSRI’s (Selective Serotonin Reuptake Inhibitors). These medications help decrease the suffering of OCD. They work by decreasing the power of the obsessions like turning down the volume of a radio that is too loud.
I was fortunate to receive training in my clinical internship at Riley Hospital in both of the above treatments. In addition, I also learned another OCD treatment specifically designed for children and adolescents. This OCD treatment, developed by John March, MD, is a behavioral program which allows children to learn how to reduce OCD thinking, and to eliminate OCD rituals. It is skill based and once the child learns the skills, they can apply them throughout their lives.
In summary, OCD is a disorder caused by a combination of genetic vulnerability, stress and neurobiological factors. It can be effectively treated. In children, if diagnosed early, exciting advances have been made which allow kids to learn the skills to “kick the OCD monster” out of their lives.
The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
