OCD Treatment

• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
• Compulsive counting

• Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
• Spends at least 1 hour a day on these thoughts or behaviors
• Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviors

• Aggressive or sexual thoughts. A common type of obsession is related to a fear of causing harm to others, of lashing out violently, or having violent, aggressive images that won’t go away. These kinds of thoughts may also be sexual, such as fearing behaving in a sexually inappropriate way or experiencing recurring, troubling sexual imagery. These types of obsessions are often coupled with seeking reassurance of one’s goodness, but there may be other accompanying compulsions.
• Harm to loved ones. For some people, the fear is not necessarily that they will harm someone but that some type of harm will come to their loved ones. For instance, someone may obsess over the thought that their child will get hurt in a car accident. Compulsive behaviors could be anything but are often used to prevent the harm from occurring.
• Germs and contamination. A fear of germs and a need to wash hands compulsively is often what people associate with OCD, and it is a common feature. Many people diagnosed with OCD are afraid of germs or other types of contamination and may avoid situations and activities because of this fear. Compulsive hand-washing and cleaning are also typical.
• Doubt and incompleteness. OCD can cause recurring thoughts that a person hasn’t done something correctly or completely. An example might be someone who doubts they have locked the door when leaving the house. This type of obsessive thought usually triggers compulsive checking behaviors, like going back to the door multiple times to be sure it is locked.
• Sin, religion, and morality. Some people worry obsessively about being immoral or sinning. They may use prayer compulsively or ask for forgiveness over and over again.
• Order and symmetry. Having objects ordered “just so” is a fairly common type of obsession with OCD. People with these thoughts spend an inordinate amount of time arranging and ordering objects or visualizing symmetry. They may also have specific superstitions about numbers, patterns, and symmetry.
• Self-control. A fear of losing control and doing something inappropriate characterizes many individual experiences with OCD. Some people may worry about shouting something in public, while others may be worried about harming someone, which ties into the aggressive or sexual type of obsessions. Any type of compulsive behavior may follow, but this kind of obsession can also lead to isolation, as a person may avoid being around others.

• Family history – You’re more likely to develop OCD if a family member has it. Possibly because of your genes.
• Differences in the brain – Some people with OCD have areas of unusually high activity in their brain or low levels of a chemical such as serotonin.
• Life events – OCD may be more common in people who have been bullied, abused or neglected. In this case, it sometimes starts after an important life event, such as childbirth or a bereavement
• Personality – Neat, meticulous, methodical people with high personal standards may be more likely to develop OCD. Also, people who are generally quite anxious.

How is OCD diagnosed? 

Steps to help diagnose obsessive-compulsive disorder may include:

• Psychological evaluation. This includes discussing your thoughts, feelings, symptoms and behavior patterns to determine if you have obsessions or compulsive behaviors that interfere with your quality of life. With your permission, this may include talking to your family or friends [3].
• Diagnostic criteria for OCD. Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
• Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.

Diagnostic Challenges

It’s sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it’s possible to have both OCD and another mental health disorder. Work with your doctor so that you can get the appropriate diagnosis and treatment.

OCD Inpatient Treatment 

OCD Inpatient treatment programs are for people who may be in danger of harming themselves or others and need immediate care. Admission to the hospital for a select period of time helps keep the person safe, addresses the crisis, and gets the patient on the right track and on to the next step of treatment. In this phase of treatment, actively addressing the OCD symptoms is not generally attempted.

Exposure Therapy or Exposure with Response Prevention (ERP) 

Exposure is a procedure in which you purposely confront objects or situations that prompt distress. You stay in those situations long enough for your anxiety to decrease by itself. It is a form of behavioral therapy that involves gradually confronting a feared situation while resisting compulsions. Compulsions are behavioral responses aimed at getting certainty about an obsession and relief from distress associated with the obsession.

 An obsession, such as “I might be contaminated,” could be responded to with a compulsion like excessive hand washing. ERP for this obsession would involve voluntarily engaging in planned behaviors that make the sufferer feel contaminated, such as touching a public surface (exposure), while resisting the urge to wash, avoid, or do other rituals (response prevention). Over time, two things occur:

1. The compulsive hand washer in this example begins to habituate to the discomfort (meaning, the pain associated with feeling contaminated diminishes), and 
2. The brain learns to separate the feeling of contamination from the demand to wash or do other compulsions (a process called inhibitory learning).

Imaginal Exposure 

For many people struggling with OCD and related anxiety disorders, one of the most beneficial treatment tools is imaginal exposure. In order to best understand this technique, it is first necessary to understand the basic idea of Exposure and Response Prevention (ERP). 

One key reason for using imaginal exposure is that it allows the client to be effectively exposed to obsessional thoughts for which there may not be any outwardly observable compulsions. There are three additional reasons for which imaginal exposures may sometimes be the best approach to exposure:

• Standard behavioral exposures cannot always be easily created for some thoughts. For example, if someone with Existential OCD fears non-existence, it is virtually impossible to create a behavioral exposure that actually replicates not existing.
• Some thoughts cannot be acted on for legal or ethical reasons. We cannot assign someone to kill someone or to molest a child. But we can assign them to write a story about those things.
• For some people, certain thoughts provoke too much anxiety to face with standard behavioral exposures. Some clients are so overwhelmed with anxiety about a particular event, situation or thing that writing a short story about what they fear may be a good intermediate step that helps them to eventually face that fear more directly.

Regardless of the reason, if and when the client feels ready to write and use imaginal exposures, this technique can have a profound impact on their OCD.

Cognitive Behavior Therapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals.

Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) – spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing) – is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication. 

Psychotherapy can be an effective treatment for adults and children with OCD. As with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy. 

OCD Medication 

Medicines – usually a type of antidepressant medicine that can help by altering the balance of chemicals in your brain. You may need medicine if psychological therapy does not help treat your OCD, or if your OCD is severe. The main medicines prescribed are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). An SSRI can help improve OCD symptoms by increasing the levels of a chemical called serotonin in your brain. You may need to take an SSRI for 12 weeks before you notice any benefits