Obsessive-Compulsive (OCD)

Obsessive-compulsive disorder (OCD) is an offshoot of the more general anxiety disorders, and so is a bit less common, impacting about 3-5% of us at any given point in time.  OCD may seem mysterious, but it can also be simply understood to be a phobic reaction to one’s thoughts. In most cases, OCD begins with some nasty thought entering our minds, such as being contaminated or contaminating one’s loved ones, hurting ones loved ones in other more violent ways, having one’s sexual orientation suddenly change, or any number of other extremely distressing yet highly creative thoughts. These feared thoughts are called “obsessions.” 

In most situations, such thoughts stay below the radar of consciousness, or if they pop into awareness the reaction is:  “Wow! That was a nasty thought…” and then they naturally move on to other things. But with OCD, a person falls into a pattern of trying to avoid these thoughts.  Here is where the trap ensues, because trying to avoid a particular thought almost always will backfire over time: (a) leading one to have more of those thoughts, not less; and (b) leading the body’s fight or flight reaction to become increasingly linked with that particular nasty thought.  In many situations, a person will find some other thought or some behavior that they can do, which will sometimes work as a distraction from the nasty thought. These distracting habits tend to develop into compulsions, becoming highly repetitive and very hard to resist with time. Sometimes, are troubled mostly by compulsions, which serve to ward off some vague sense of doom rather than a specific obsessional thought.  

Fortunately, OCD is just as responsive to psychotherapy as the general group of anxiety disorders as a whole.  In fact, it can often respond even better to brief psychotherapy (12-20 sessions), with many studies reporting relapse rates at around 80%.  The most recommended approach to treatment is known as Exposure and Response Prevention (ERP), and I have seen dozens of clients who have wasted time, effort and money doing non-ERP therapy and not seeing any results.  Exposure and response prevention techniques aim to help people to work at their own pace to gradually face their unwanted obsessions, while resisting acting out compulsions.  It is challenging work, and so resting control of the process with my clients, not with me, is key. ERP is a very simple, very effective set of techniques. On the other hand, the specific effectiveness of ERP techniques does not mean that it is a one-size fits all approach.  The real art of psychotherapy for OCD is tailoring interventions to fit a particular client’s situation, and also making sure that treatment is always a partnership process. When all of that works, therapy tends to be very efficient and very effective, with results unfolding within a few weeks.  

Unfortunately, stigma is an even greater barrier to treatment for OCD than it is for other anxiety disorders, with obsessions by definition being extraordinarily embarrassing.  The International OCD Foundation is one excellent source for more information, for advocacy, for research, and for breaking down this unhelpful and unwarranted stigma.