Obsessive-compulsive disorder (OCD) is a common but often misunderstood mental illness. If you or a loved one suffers from OCD, you know that it is more serious than simply being concerned about cleanliness and hygiene. It is a complex illness that can have a severe, disruptive impact on your life. Fortunately, OCD treatment can help manage or eliminate the symptoms. Once it has been diagnosed, there is a good chance treatment will help you.
What exactly is OCD and which OCD treatment will work for you? Here is everything you need to know.
What is OCD?
OCD is a psychiatric disorder, with both psychological and physical roots, that affects millions of adults in the United States. A person with OCD experiences obsessive thoughts and images, which are intrusive and unwanted, and cause distress and anxiety. The person feels compelled to do certain behaviors to suppress the thoughts. While a person suffering from OCD generally recognizes that their obsessions are not based on fact, they nevertheless cannot quiet or prevent them.
Signs and Symptoms
Obsessions refer to the recurring thoughts and images, accompanied by anxiety and distress, that someone with OCD experiences. Compulsions refer to the urges the person feels compelled to do in order to stop the thoughts and calm the anxiety.
Common obsessions include anxieties about safety, cleanliness, contamination, symmetry, and aggressive impulses. Common compulsions, which generally echo the obsessions, include urges to clean, arrange items, or to check over and over again that ovens, heaters, and the like are safely switched off.
Children are not necessarily aware that their obsessions are not rational. Signs that a child is suffering from OCD include anxieties that do not subside as well as repetitive behaviors.
The appropriate OCD treatment depends on the severity of the symptoms, as well as the age and characteristics of the sufferer.
First Line Treatments
OCD is considered a mental illness, but like most mental illnesses, it has a physical foundation. Research suggests that OCD may be a brain disorder, caused by problems in communication between the front part of the brain and deeper structures of the brain. The positive effect of antidepressant medication supports this.
First line OCD treatment therefore includes both medication and psychotherapy.
OCD is associated with low levels of serotonin in the brain – a neurotransmitter used by the brain structures connected with OCD. Medication prescribed for OCD patients therefore increases serotonin levels. These medicines are called serotonin reuptake inhibitors (SRI). These are traditionally used as antidepressants, and in cases where OCD is accompanied by depression, SRIs serve as both depression and OCD treatment.
It is estimated that about half of OCD patients stop using their medication at some point, due to side effects or because their symptoms have disappeared. This can be dangerous, and a doctor should always be consulted if an individual wishes to stop taking their medication.
Exposure and Response Prevention (ERP)
The most common therapy used in OCD treatment is called exposure and response prevention (ERP). ERP is a type of cognitive-behavioral therapy (CBT). CBT is based on the axiom that one can change thoughts and behaviors by targeting and challenging the distortions. One of the main components of OCD is distorted thinking – obsessions.
Cognitive distortions for someone suffering from OCD are far more disruptive and rigid than for most sufferers of anxiety. ERP, therefore, takes a very strong approach to deal with the thoughts, as opposed to simply challenging them by testing them against reality. After all, most OCD patients understand that their thoughts are not rational. Reinforcing that understanding is simply not enough.
ERP asks the patient to expose themselves to the thoughts, images, objects, and situations that make them anxious and are the subject of their obsessions. They are guided to not respond to the anxiety or obsessions, i.e. response prevention. Rather than accede to the compulsions to try and assuage the anxiety, they make a choice not to perform the compulsive behavior. This is done under the guidance of a therapist, at least in the early stages.
Anyone who suffers from OCD knows that simply “not responding” to the compulsions is not an effective strategy. But in ERP, they make the commitment not to respond, and the therapist helps them stick to that commitment. Over time, the person’s anxiety levels in response to the thoughts will drop, as they become habituated to the fact that the worst case scenario does not occur.
Medication and ERP make up an effective treatment regime for many OCD patients. They learn to reduce and manage their symptoms with 45-minute sessions once or twice a week. This is referred to as “outpatient” treatment, as the individual is not admitted to a hospital or treatment center.
However, for some OCD sufferers, traditional outpatient therapy is not effective enough. They need more intensive therapy to reduce their symptoms to the point at which they are capable of living life undisrupted by obsessions and compulsions.
For these people, OCD treatment may consist of the following:
In intensive outpatient therapy, patients still do not enter a clinic or treatment center. However, they attend groups and individual therapy multiple times a week. They may even attend day programs, during which they spend full days at a treatment center.
Partial hospitalization refers to treatment that takes place in a mental health hospital. Treatment regimens are more holistic and intensive.
Patients may choose to enter a three to six-week voluntary inpatient program, during which they live at the mental hospital. This gives them the opportunity to focus completely on their mental health for an extended period of time. In the early stages, they will be isolated from their normal work and social environment, so that their only concern is getting well. As the program progresses, they begin to reintegrate into their normal environments.
Since they have entered treatment voluntarily, they are permitted to leave the program at any time.
Individuals who have demonstrated behavior that indicates they are a risk to themselves or others may be admitted involuntarily into an inpatient program. In this case, the treatment is provided in a secured mental health facility. They are not allowed to leave until the hospital has deemed that they are no longer a danger. Some people enter this sort of arrangement voluntarily, choosing to temporarily give up their autonomy in order to force themselves to see the program through.
Patients may be ordered to enter inpatient treatment by legal authorities. This is usually the result of a close relative or friend initiating a legal process on the basis of perceived danger. The individual will then be assessed to establish whether they are indeed a danger to themselves or others.
Individuals who have been taken into custody after committing a crime may also be ordered into inpatient treatment if it is established that the crime was a result of their disorder.
Some patients do not benefit from the aforementioned treatments, or do not benefit enough. In cases in which their functioning is still severely disrupted, they may choose other approaches. These alternative approaches target the brain directly, either through surgery or non-invasive procedures.
Deep Brain Stimulation (DBS)
Deep brain stimulation (DBS) is an OCD treatment that has been used with some success since the early 1990s. DBS involves surgically opening the skull to place electrodes in targeted areas of the brain. They are then connected by wires under the skin beneath the collarbone. The doctor sends controlled pulses through the skin.
DBS was originally designed for movement disorders such as Parkinson’s disease. There is evidence that DBS is effective for approximately 61.5% of OCD patients who choose to undergo this therapy.
Since it requires opening the skull, it is not recommended except in the most severe cases when traditional treatments do not work.
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is another OCD treatment that targets the brain. However, unlike DBS, TMS does not require invasive surgery. It uses electromagnetic currents to change brain activity. These currents are applied externally to the skull, and pulses travel through hair, skin, muscle, and bone. Sessions last about 20 minutes and occur on a daily basis. It has been shown to be safe, and there are no side effects. The patient can continue their day as normal after the treatment.
TMS is still relatively new, and there is therefore not a wealth of evidence that it works. However, the studies that have been carried out have shown positive results and proponents are optimistic that its efficacy will be proven in the coming years.
Gamma knife is another non-invasive treatment for OCD that targets the brain. It uses gamma rays to pass through the skull and destroy targeted brain tissue. While it does not require surgery, the fact that it works by destroying brain tissue makes it less likely to be recommended than DBS or TMS.
Find a Therapist Now
When seeking OCD treatment, you will likely need to see both a psychiatrist and a therapist. A psychiatrist can diagnose the condition and prescribe medication. A therapist will work with ERP as a therapeutic treatment. If you’re choosing a therapist for OCD treatment, you should look for a specialist. While ERP is a type of CBT, not all therapists are trained in it, even those who are trained in CBT.
Studies have shown that teletherapy can be effective in treating OCD. Since online therapy today is more accessible, this can be an excellent choice for many. ThriveTalk provides therapists trained in a range of specialties, including OCD. The online system will match you with the right therapist for you, and making an appointment is seamless. At the appointed time, you just have to go online. No time is wasted in waiting rooms or in transit.
Traditionally, therapy has been done in physical proximity, but that is no longer always practical. Since video calling brings you face-to-face with your therapist, physical proximity is not as crucial as it once was.
OCD is a complex mental illness that can be extremely disruptive to a person’s life. OCD treatment has not always been readily available, but it has now evolved to a point at which the first line treatments are very successful. There’s reason to be very optimistic about the process. If traditional treatments are not effective, more intensive treatment is available. Treatments which target the brain directly are also available in particularly resistant cases.
OCD treatment is more available than ever, especially with online therapy as a cheaper, more accessible option. Find a therapist now, and get right on track towards recovery.