5 Therapist-Recommended Treatments for Obsessive-Compulsive Disorder
“HE’S JUST OCD.”
While it’s tempting to use that phrase to describe a neatnik friend or someone who likes to have everything just so, obsessive-compulsive disorder (OCD) is a serious mental illness. It brings chronic anxiety and causes people to experience unwanted and recurring thoughts and sensations that drive them to perform repetitive actions.
“Obsessive-compulsive disorder can wreak havoc on someone’s life,” says Judith Zackson, Ph.D., licensed clinical psychologist and founder and clinical director of Zackson Psychology Group. “There’s nothing silly or jokey about it.”
People are likely quick to toss the OCD label around because the condition is often portrayed in movies and TV inaccurately or in a lighthearted way. In reality, OCD can interfere with a person’s daily activities and social interactions, according to the American Psychiatric Association (APA).
As its name suggests, OCD has two components: obsessions and compulsions. People have unwanted thoughts, ideas, or sensations that recur, referred to as “obsessions.” To deal with the obsessions, they feel the need to perform a repetitive task, known as “compulsions.” The task can be anything—cleaning, handwashing, counting, or checking on things, like whether you left your stove on.
“It’s a very sad place to be caught up,” Zackson says. “It feels powerless. If your mind is focused on cleanliness, you’re unable to eat, go to work, or focus on anything because your mind is focused on cleaning.”
OCD symptoms can occur at varying degrees, and the condition is difficult to treat. But Zackson says several obsessive-compulsive disorder treatments are available that can make living with it much more manageable.
What Is OCD?
OCD is much more than wanting your home to be clean and orderly or having a few quirks, says Kerry Heath, LPC-S, NCC, CEDS-S, a licensed professional counselor and owner of Hope Counseling and Eating Disorder Recovery Center of Arizona.
“OCD is a condition in which a person suffers from unwanted recurring thoughts or images that leads to engaging in repetitive behaviors to reduce related anxiety,” she says. “This condition can impact all aspects of a person’s life, such as work, school, and personal relationships.”
Everyone has distressing thoughts sometimes and may engage in repetitive behaviors, but they don’t have OCD, according to the APA. For people with OCD, the thoughts are persistent and intrusive, and the behaviors are so rigid that not performing them causes significant anxiety and distress.
“These symptoms can cause a person much distress and anxiety,” says Amy Kaplan, LCSW, a therapist with the virtual health platform PlushCare. “Symptoms can fluctuate based on the situation.”
Scientists aren’t exactly sure what causes OCD, but it often appears in childhood, adolescence, or early adulthood. Zackson says childhood trauma is one cause, where someone feels powerless, and it’s so overwhelming they start to focus on other things to take their mind off of it. Those can end up becoming compulsions.
Death of a loved one, a history of abuse, change in living situations, illnesses, work or school problems, or changes in the brain are other possible causes, according to Cleveland Clinic.
People Experience OCD in Different Ways
OCD symptoms occur at varying degrees of severity, Heath says. People might also have other conditions, like anxiety, depression, or body dysmorphic disorder. “A person with co-occurring disorders may experience more severe symptoms or have a more difficult time managing their condition,” she adds.
Just about everyone has some degree of OCD. “A little is good—it gets you going, makes you set goals, helps you focus,” Zackson says, “On the other side of the spectrum, it doesn’t let you live. That’s where it’s an illness. Where it’s healthy is in the middle.”
To diagnose OCD, someone must present with obsessive thoughts and compulsions that occur more than an hour a day, cause significant distress, and impair daily functioning, according to the APA.
People might experience unwanted fears, such as germs, dirt, order, neatness, causing harm, doubt, or disgust, and have a need for constant reassurance, according to the Cleveland Clinic. Some compulsive behaviors include:
- Arranging things in a specific order
- Bathing, cleaning, or washing your hands repeatedly
- Checking things, like a front-door lock or stove, repetitively
- Collecting items or hoarding
- Performing tasks in a certain order, like eating
- Checking constantly that you haven’t done someone harm
- Experiencing tics, like blinking, sniffling, or jerking
“People with OCD often feel shame,” Zackson says. “It’s difficult for people when they think someone knows they have it. So, there’s a lot of secrecy which brings undue anxiety.”
What Are the Treatments for OCD?
People should seek treatment for OCD when it’s causing distress and interfering with everyday activities, relationships, and work or school, Kaplan says. “People who are experiencing a decline in the quality of their lives as a result of OCD ought to seek out professional assistance to help manage their condition,” Heath says.
Treatment for OCD is often a two-pronged approach, Zackson says. “On one hand, you want to lower their symptoms so that they can start living and make life easier. On the other hand, you also have to help them understand why they even have it.”
Common OCD treatments include:
1. Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT), a type of psychotherapy, can help someone understand why they might have OCD and what function it serves in their life, Zackson says. During sessions, you’ll talk to a therapist to help you examine and better understand your thoughts and emotions. After several sessions, you’ll eventually stop negative habits and learn to replace them with healthier behaviors.
2. Exposure Therapy
A type of CBT, exposure and response prevention (ERP) therapy exposes patients to their feared situations and instructs them to avoid performing their typical compulsive behaviors. “So if I have a fear of having dirt in my bedroom, we would have them purposefully put dirt there and have them sit with it,” Zackson says.
ERP is done in a hierarchical way, starting with things that cause mild symptoms and then progressing to situations that cause more severe symptoms. When they stay in a fearful situation without something bad happening to them, patients learn that “their fearful thought are just thoughts,” according to APA.
To deal with the anxiety of being exposed to an obsession during therapy, Zackson says patients are taught to use mindfulness, breathing exercises, grounding exercises, and relaxation techniques.
Sometimes medication, such as a selective serotonin uptake inhibitor (SSRI), is prescribed for patients with OCD, Heath says. The dosage is usually higher than what’s used to treat depression, according to the APA. A combo of CBT and SSRIs is usually used to treat OCD, especially if the symptoms are severe.
4. Transcranial Magnetic Stimulation
A newer and less-common treatment for OCD, transcranial magnetic stimulation (TMS) uses magnetic devices placed on the head that send electrical impulses to the brain. These impulses trigger the brain to release chemicals that can improve mood. “This is usually a treatment that’s added when a client hasn’t responded as well as desired to more traditional therapies,” Heath says.
The surgical procedure gamma ventral capsulotomy has been shown to benefit people with OCD, especially individuals who haven’t responded well to other treatments and have a severe impairment. The procedure involves creating lesions in certain parts of the brain. The APA says the treatment is “invasive and complex to manage,” and providers trained to perform the procedure are limited.
Is OCD Curable?
OCD isn’t curable, Zackson says. “But, it becomes very functional.”
Therapy can provide helpful tools to manage symptoms, Heath adds. People just have to stick to treatment long-term. If someone stops using the skills they learned in therapy or taking their medication, the symptoms might return.
“It is possible to improve the quality of one’s life greatly with the use of therapy and medication,” Heath says.
Erica Sweeney is a writer who mostly covers health, wellness and careers. She has written for The New York Times, HuffPost, Teen Vogue, Parade, Money, Business Insider and many more.
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