Obsessive Compulsive Disorder
Obsessive-Compulsive Disorder is likely to affect 2% of the population at some point in their life. The disorder is equally common in males and females.
- Recurrent or persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress;
- The thoughts, impulses, or images are not simply excessive worries about real life problems;
- The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action;
- The person recognizes that the obsessional thought, impulses, or images are a product of his or her own mind.
- Repetitive behaviors (for example, hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly;
- The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
- At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
- The obsessions or compulsions cause marked distress, are time consuming (take more than one hour a day) or significantly interfere with a person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.
Adapted from the Diagnostic and Statistical Manual of Mental Disorders – IV-TR.
Obsessions are distressing and persistent thoughts that are associated with anxiety. Obsessive thoughts frequently have a theme of contamination (germs or dirt), or doubts over something that was said or done. Obsessive thoughts may have a religious theme or ideas of feeling unacceptable or immoral. Many people have obsessive thoughts that have to do with perfection, order or preciseness.
Compulsions, on the other hand, are behaviors or actions that are designed to reduce the anxiety associated with the obsessive thought. Compulsive behaviors are repetitive actions (behaviors) that are also designed to prevent a dreaded consequence from occurring. Compulsive behaviors include repetitive washing or cleaning, showering or doing some other activity in a particular order, checking, double-checking and triple-checking, etc., repeating phrases or thoughts or redoing actions. Compulsive behaviors frequently result in a reduction of anxiety and a temporary sense of feeling good. The most common compulsive behaviors are washing and checking.
Treatment of Obsessive Compulsive Disorder
The behavioral treatment of Obsessive-Compulsive Disorder consists of two components – exposure and response prevention. Exposure involves systematic, gradual contact or exposure to events in which the obsessive thoughts and -compulsive behaviors are likely to occur. For example, a person with a fear of contamination from germs might decide that it could be helpful to gradually come in contact with germs via petting a dog or a cat. This could be combined with the response prevention component of the treatment which is to not engage in the usual compulsive activity which, in this example, may be hand washing. Variations on response prevention include response delay or response restriction. Response delay means delaying immediately washing the hands for longer and longer periods of time. Response restriction, means limiting the amount of time that the hands are washed. One of the purposes of the exposure and response prevention is to see if the fear or anxiety diminishes with time and without the compulsive behavior. For most people with OCD, this a difficult and scary proposition, as their anxiety initially increases; however, many people report surprise and relief when they discover that their anxiety dissipates and disappears with time.
The cognitive component of treating OCD involves assessing and understanding the result of the exposure and response prevention exercises described above. For example, how does one make sense of the fact that no disease was contracted despite touching the dog or cat, and not washing for a significant period of time? Does this new experience cause one to rethink their assumptions about their vulnerability and the purpose of their compulsive behaviors? The cognitive therapy component of treating OCD is also designed to teach people new thinking methods and strategies that can help them identify and alter the interpretations that they have of their obsessions.
Treatment of OCD also involves learning, practicing and implementing anxiety management strategies including progressive muscle relaxation, mental imagery or deep breathing. Becoming proficient in these relaxation strategies can make it easier to approach feared and anxiety producing situations.
Cognitive behavioral therapy has shown to be effective in the treatment of Obsessive-Compulsive Disorders. Exposure and response prevention is classified by the American Psychological Association Division 12 Task Force on Promotion and Dissemination of Psychological Procedures as a well established, empirically supported treatment for OCD.