• OCD is a neurobiological disorder. 
• It is not your fault, and it is not your parents’ fault.
• OCD is not due to a “neurosis” or some other “deep” psychological issues. 
• OCD is much more prevalent than previously thought: one out of 50 people in the United States suffers from OCD. 
• Nowadays OCD is generally treatable. 
• Unfortunately, most people with OCD have spent an average of 9 years searching for a therapist before being properly diagnosed with OCD. (It is only after a correct diagnosis that effective therapy can begin.)
• OCD often worsens with stress.
• About half the time OCD begins as a child or adolescent.
• Some children get sudden onset OCD after strep throat. This is called PANDAS. 

What Is OCD?

Obsessions are unwelcome ideas, thoughts, images, or impulses that seem to come out of nowhere and cause distress: 

• Recurrent thoughts, images or impulses
• Experienced as inappropriate
• Causing lots of distress or anxiety
• Not just excessive worries
• Recognized as the product of one’s mind

These often have themes of fears of :

• contamination (most common),
• impulses (sexual, or harm to self or others),
• mistakes,
• and impulsive actions.

Compulsions are actions (including prayers and mental acts or thoughts) that feel driven and lessen temporarily the distress of obsessions. Common compulsions:

• Checking (locks, driving, appliances, etc.)
• Washing (over and over again)
• Ordering and arranging (in an extreme)
• Hoarding or collecting useless things

OCD is reinforced by learning. Obsessions cause distress and/or anxiety, and then compulsions or avoidance reduce the anxiety/distress. We call this negative reinforcement. The reduction in distress is temporary, and then the cycle begins again:

Obsession -→ anxiety/distress-→ compulsion/avoidance-→ temporary decrease in anxiety distress but OCD worsens !

OCD takes up a person’s time (at least an hour a day), causes distress, and interferes with social and/or occupational functioning.

Comorbid conditions: Psychiatric conditions which often accompany OCD:

            Depression

            Phobias

            Social Phobia

            Panic Disorder

            Tourette’s Syndrome

            Sleep Disorder

            Eating Disorder

            Bulimia

Disorders similar to OCD (Sometimes called OC Spectrum Disorders): 

            Trichotillomania (hair pulling)

            Skin Picking

            Body Dysmorphic Disorder (BDD)

People often speak of other illnesses as “compulsions” but these are really not OCD (because there is some pleasure):

            Compulsive spending

            Sexual compulsion

            Compulsive gambling

Treatment for OCD

Treatment with cognitive behavior therapy for OCD (particulary ERP) is as effective for most people as medication, without the side effects. If you cannot tolerate the therapy without medication, then I will refer you to a psychiatrist for a medication consultation.

Treatment begins with psychoeducation, or learning about the function (or dysfunction) of compulsions. A hierarchy is developed of Subjective Units of Distress (SUDS) as part of a plan of attack on OCD. This hierarchy is based on how distressful situations are to you.Then we work together to gradually expose you to your obsessions without allowing the compulsions to reduce the anxiety. We call this Exposure and Response Prevention (ERP). For example, if you have obsessions about germs, we would develop a hierarchy of what are your most feared situations with germs and what are your least, and we would start with some place on the hierarchy which you could stand but which would be challenging. Once you get accustomed to that situation (and the SUDS is low), then we could move onto a more challenging situation. This is not pleasant work but it beats living with OCD, and it is generally just as effective as medication. At the end of our work, you have tools to combat OCD on your own whenever it bothers you. And you can take pride in winning the battle over your worst fears!

How long does Exposure and Response Prevention take to work? Generally at least 20 hours, and the sessions are often double sessions ( one and a half to two hours) and at least twice weekly works best. 

Medications used to treat OCD:

clomipramine (Anafranil)

fluoxetine (Prozac)

fluvoxamine (Luvox)

sertraline (Zoloft)

quetiapine (Seroquel)

risperidone (Risperdal)

Books for More Information on OCD:

Baer, Lee. Getting control: Overcoming your obsessions and compulsions. Rev. ed. New York: Plume Books, 2000.

Baer, Lee. The imp of the mind: Exploring the silent epidemic of obsessive bad thoughts. New York: Dutton, 2001.

Foa, Edna & Wilson, Reid. Stop obsessing. New York: Bantam Books, 1991.

OCD Therapy Group

• Psychoeducation
• Development of hierarchy for treatment based on subjective units of distress (SUDS)
• Homework assignments
• Exposure & response prevention
• Enhanced motivation & support
• Evidenced based treatment