How We Treat Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder (OCD) is a prevalent and enduring mental health condition characterized by uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) that the individual feels compelled to repeat persistently. These obsessions and compulsions are intense, often consuming significant amounts of time each day and severely impairing various aspects of daily life, including work, social interactions, and personal routines. OCD is diagnosed when these behaviors become severe enough to disrupt normal functioning, distinguishing it from the milder, non-disruptive behaviors that many people experience, such as double-checking locks or appliances.
While certain OCD-like behaviors, such as adhering to "lucky" numbers or specific routines, are common and generally do not constitute a disorder, they only become a concern when they dictate a person's actions and lead to significant anxiety if not followed.
How OCD Symptoms Vary
OCD symptoms can vary significantly from one person to another. While some may experience intense contamination fears, others may struggle with intrusive thoughts of harm or intense symmetry and orderliness. This variability can make OCD particularly challenging to understand and manage. Here are some of the many ways OCD may manifest:
Contamination OCD: Individuals fear contamination from germs, dirt, or other pollutants. Example: Excessive hand-washing or cleaning of surfaces to avoid germs.
Harm OCD: Fear of causing harm to oneself or others, often through negligence. Example: Repeatedly checking that the stove is off to prevent a house fire.
Symmetry and Ordering OCD: A need for things to be perfectly aligned or ordered. Example: Arranging books in a specific order and becoming distressed if the order is disrupted.
Hoarding OCD: Compulsive gathering and storing of items, often perceived as having potential future use or value. Example: Collecting newspapers or household items to an excessive degree.
Ruminations/Intrusive Thoughts OCD: Persistent, unwanted thoughts that are often disturbing. Example: Obsessive fears about acting on violent impulses despite no desire to do so.
Checking OCD: The need to check repeatedly to prevent perceived danger or harm. Example: Checking doors multiple times to ensure they are locked.
Doubt and Double-Checking OCD: Persistent doubt leads to compulsions to check repeatedly. Example: Repeatedly checking emails sent for fear of mistakes.
Purely Obsessional OCD (Pure O): Characterized by intrusive thoughts without visible compulsions. Example: Constantly worrying about a loved one's safety without any physical checking behaviors.
Sexual Orientation OCD: Obsession about one's sexual orientation. Example: A heterosexual individual repeatedly questioning their sexual orientation.
Relationship OCD (ROCD): Obsession about the suitability of a romantic partner or the quality of a romantic relationship. Example: Continuously doubting one's affection for their partner and their partner's affection for them.
Social OCD: Obsession with social interactions and the appropriateness of one's behavior in social settings. Example: A person might excessively analyze their actions and conversations after social events, worried that they may have said something offensive or embarrassing.
Religious or Scrupulosity OCD: Obsessive religious or moral doubts and compulsions. Example: Excessive praying or ritualistic behaviors stemming from fear of divine retribution.
Sensorimotor OCD: Hyper awareness of bodily sensations or processes. Example: Obsessive focus on breathing patterns or blinking.
These types of OCD illustrate the disorder's complexity and the wide range of thoughts and behaviors it can encompass. Each type can significantly impact daily functioning and quality of life, making effective treatment crucial.
Goals of Treating OCD
The cornerstone of managing Obsessive-Compulsive Disorder (OCD) lies in addressing the symptoms in a manner that does not reinforce the disorder itself. This nuanced approach is crucial across all age groups, albeit with tailored strategies to suit each demographic.
For teens and adults, the therapeutic focus is on regaining control over the intrusive obsessions and compulsions that characterize OCD. This is primarily achieved through cognitive-behavioral therapy (CBT), Exposure and Response Prevention (EXRP), and, in many cases, medication. CBT and EXRP encourage patients to directly confront their fears and systematically reduce avoidance behaviors, a process that can be both challenging and liberating. The aim is to empower individuals to recognize and resist the compulsions, rather than seeking temporary relief through them.
For parents of younger children, the guidance shifts towards creating a supportive environment that does not accommodate or reinforce OCD behaviors. This involves structured therapy and implementing at-home practices that encourage children to face their fears without succumbing to compulsive rituals, thereby preventing the reinforcement of the disorder.
Understanding OCD as a small, albeit vocal, part of the brain that acts as a bully, monopolizing the individual's attention, offers a powerful metaphor for treatment. The key to diminishing the power of this 'bully' lies in deliberately ignoring its demands, which, in turn, reduces its influence, making the OCD voice softer over time. This approach is not just metaphorical but has a neurological basis; by consistently choosing to not engage with the compulsive demands, new neuronal pathways are formed. These pathways are less likely to feed into the OCD part of the brain, gradually weakening the disorder's hold on the individual. This process of neuroplasticity—where the brain's neural networks alter as a result of growth and reorganization—is central to the therapeutic journey in overcoming OCD. It underscores the importance of perseverance in treatment, as each act of defiance against the disorder strengthens the individual's mental resilience and paves the way for a life less dominated by OCD.
Read our blog here for more on the specific therapies that address OCD.
Medications for OCD
In the treatment of Obsessive-Compulsive Disorder (OCD), a nuanced and comprehensive approach is essential, given the complexity and variability of the condition.
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are often the first and second lines of pharmacological treatment, respectively. SSRIs, including Lexapro, Zoloft, Prozac, and Luvox, are widely recognized for their efficacy in managing OCD symptoms.
SNRIs, such as Pristiq and Cymbalta, offer an alternative for patients who may not respond as well to SSRIs.
It's noteworthy that the dosages for these medications in treating OCD often exceed those typically used for depression, underscoring the need for a tailored treatment plan that may involve gradually increasing doses to achieve optimal outcomes.
Beyond SSRIs and SNRIs, a range of other medications and supplements have shown promise in augmenting OCD treatment.
For instance, Clomipramine may be the one medication that is stronger than the rest in treating OCD, but it comes with unique side effects.
Mood stabilizing neuroleptic medications such as Abilify, Seroquel, and Risperdal show benefits in OCD, alone and on top of SSRIs and SNRIs.
Amantadine, used as a supplement with SSRIs, has demonstrated benefits in reducing OCD symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Similarly, Memantine and the serotonin supplement 5-HTP have shown significant benefits over placebo, particularly when used in conjunction with SSRIs, without increasing the risk of serotonin syndrome.
Other treatments, such as Pregabalin and L-carnosine, have also been associated with substantial reductions in YBOCS scores, indicating their potential as adjunctive treatments in OCD management.
Additionally, innovative approaches like Transcranial Magnetic Stimulation (TMS) and the use of stimulants such as Adderall and Methylphenidate have been explored, with some studies suggesting benefits in speeding up recovery and enhancing the efficacy of SSRIs.
Read our related blogs for more on: SSRIs, Lexapro, Zoloft, Pristiq, Clomipramine, Abilify, Memantine, Pregablin,
Supplements for OCD
N-Acetylcysteine (NAC): NAC is a supplement that helps by modulating glutamate and replenishing glutathione, an antioxidant. NAC can help treat OCD, Trichotillomania, & Skin picking. Please go to this blog to find out more about it and for links to where to buy it.
Inositol: May help in reducing symptoms by affecting serotonin levels. Read our blog about inositol here for more on dosing and side effects.
Helpful Books on OCD
Books for Adults & Teens
The OCD Answer Book: A professional guide offering insights into Obsessive-Compulsive Disorder management and treatment.
Stop Obsessing! How to Overcome Your Obsessions and Compulsions: Practical advice and strategies for those struggling with OCD to regain control.
The Mindfulness Workbook for OCD: Combines mindfulness practices with therapy techniques to manage OCD symptoms effectively.
Books for Parents
Talking Back to OCD: The Program That Helps Kids and Teens Say 'No Way' - and Parents Say 'Way to Go': A guide for young individuals and parents to tackle OCD effectively.
It’s Only a False Alarm: A Cognitive Behavioral Treatment Program Workbook: Workbook offering CBT strategies for children dealing with OCD.
Family-Based Treatment for Young Children with OCD Workbook: Focuses on family involvement in managing OCD in young children.
What to do When Your Child Has Obsessive-Compulsive Disorder: Strategies and Solutions: Provides strategies and solutions for parents of children with OCD.
Obsessive-Compulsive Disorder: Helping Children and Adolescents: A resource for aiding youth in understanding and overcoming OCD.
Books for Children
Up & Down the Worry Hill: A Children’s Book about Obsessive-Compulsive Disorder and its Treatment: A children's book that explains OCD and its treatment in an accessible way.
Podcasts on OCD
For Teen & Adult Patients:
Regaining Control Over OCD is an amazing one hour introduction to OCD by McLean Hospital.
"The OCD Stories" podcast offers interviews with experts and individuals with OCD, sharing strategies and personal stories.
For Parents of Children with OCD:
The Parenting Survival podcast has many episodes on both OCD and anxiety.
Sources
National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
International OCD Foundation: https://iocdf.org/
"Talking Back to OCD" by John S. March: https://www.amazon.com/Talking-Back-OCD-Program-Parents/dp/1593853556
"Freeing Your Child from Obsessive-Compulsive Disorder" by Tamar Chansky: https://www.amazon.com/Freeing-Your-Child-Obsessive-Compulsive-Disorder/dp/0812931173
