Obsessive-compulsive disorder (OCD)

Obsessive-Compulsive Disorder is part of the anxiety disorders spectrum. It is a more severe manifestation of a concern, a fear, or a preoccupation with something physical or psychological, or with a relationship, whose symptoms rise to the level of pathology. What makes it pathological is the severity of the symptoms, i.e. the persistence and intrusiveness of the obsessions, and the frequency and intensity of the compulsions. It is not a disorder that will disappear by itself if left untreated.  If you or someone you love appear to suffer from OCD, it will be necessary to confirm the diagnosis through specific testing and a diagnostic interview, and then seek treatment with a recommended approach such as CBT (possibly combined with medication.)

What is OCD?

Obsessive Compulsive and related disorders include obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair- pulling disorder), excoriation (skin-picking) disorder, substance/medication-induced obsessive-compulsive and related disorder, obsessive-compulsive and related disorder due to another medical condition, and other specified obsessive-compulsive and related disorder and unspecified obsessive-compulsive and related disorder (e.g., body-focused repetitive behavior disorder, obsessional jealousy). OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Some other obsessive-compulsive and related disorders are also characterized by preoccupations and by repetitive behaviors or mental acts in response to the preoccupations. Other obsessive-compulsive and related disorders are characterized primarily by recurrent body-focused repetitive behaviors (e.g., hair pulling, skin picking) and repeated attempts to decrease or stop the behaviors.–American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

How is it treated?

According to participants in a recent NIMH consensus conference on OCD, participants in the International Obsessive Compulsive Disorders Conference (IOCDC), members of the Obsessive-Compulsive Foundation Scientific Advisory Board, and other published clinical researchers, the treatment of OCD patients with either CBT alone or with a combination of CBT and SRI or SSRI medication is the most likely to succeed. The likelihood that medication will be included in the recommendation varies with the severity of the OCD and the age of the patient. In milder OCD, CBT alone is the recommended initial choice. As severity increases, the experts are more likely to add medications to CBT as the initial treatment or to use medication alone. In younger patients, the experts are more likely to recommend treatment with CBT alone.
According to the expert’s definition, Mild OCD (Yale-Brown Obsessive-Compulsive Scale 10-18) causes distress but not necessarily dysfunction; help from others is usually not required to get through the day. 
Moderate OCD (YBOCS 18 -29) causes both distress and functional impairment. 
Severe OCD (YBOCS = 30 or above) causes serious functional impairment requiring significant help from others.

Get help

To make an appointment with Dr. Z, call (678) 554-5632 or fill out the online appointment request. We can go over your current situation, identify the ways in which high levels of anxiety, obsessive thoughts and compulsive behaviors are affecting your life and that of your loved ones, or are impairing important relationships. We will put some dimensions to the problem, and identify your current resources that may be applied toward meaningful and lasting change.If additional resources and skills are needed, we will treat your severe symptoms with CBT and help you feel calmer and increase your ability to choose the most appropriate response to each situation. Treating OCD is feasible, it’s proven to be effective, and has helped many people who had a variety of different symptoms and challenges. Call (678) 554-5632, make your appointment today and we can get started!

Treatment details

Cognitive Behavioral Therapy involves the combination of Behavior Therapy (E/RP) and Cognitive Therapy (CT). Behavior therapy for OCD (BT in CBT) most specifically involves Exposure (E) and Response or Ritual Prevention (RP). Exposure (E) capitalizes on the fact that anxiety usually attenuates after sufficient duration of contact with a feared stimulus. Thus, patients with obsessions related to germs must remain in contact with “germy” objects until their anxiety is extinguished. Repeated exposure is associated with decreased anxiety until, after multiple trials, the patient no longer fears contact with the specifically targeted stimulus. In order to achieve adequate exposure, it is usually necessary to help the patient block the rituals or avoidance behaviors, a process termed response or ritual prevention (RP). For example, patients with germ worries must not only touch “germy things,” but must also refrain from ritualized washing until their anxiety diminishes, a process termed exposure and response prevention (E/RP). Cognitive therapy (CT), which may be added to E/RP, addresses such things as faulty estimation of danger or the exaggerated sense of personal responsibility often seen in OCD patients. Other techniques such as thought stopping and distraction (which involve suppressing or “switching off” OCD symptoms) and contingency management (which emphasizes rewards and costs as incentives for ritual prevention) are generally thought to be less effective than standard CBT. The recommended treatment protocol includes weekly, individual CBT sessions and homework assignments or therapist assisted out-of-office (in vivo) exposure and response prevention. Group CBT or behavioral family therapy are second line alternatives. A dosage of 13-20 sessions is the appropriate number of CBT treatments for the typical patient. When speed is of the essence or OCD is particularly severe in adults, intensive CBT (daily CBT for 3 weeks) may be preferable.