Obsessive Compulsive Disorder (OCD)
Most people are not correctly diagnosed and treated for Obsessive Compulsive Disorder. for at least 9 years. In other words, they suffer needlessly and are misunderstood. And they often misunderstand themselves, adding to their pain.
We do not know what causes OCD but there seems to be a genetic component in that it runs in families. One in 100 adults in the United States has OCD, and approximately one in 200 children. OCD can begin at any age, but it most often geins between ages 8 and 12 or between late teens and adulthood.
OCD is a disorder of the brain and behaviors, causing severe anxiety. OCD causes the body's warning (anxiety) to give "false alarms," as though there is a catastrophe when there is none. OCD includes Obsessions and Compulsions.
Obsessions are unwanted and disturbing thoughts, images, or impulses that come repeatedly and out of nowhere. Obsessions make the person feel very anxious and as though they are losing control or losing their mind. They often make the person think they must do things "just right." Common themes of obsessions are contamination, losing control, harm (to self or others), unwanted sexual thoughts, religious obsessions (not just religious thoughts), and perfectionism.
Lee Baer, PhD says in The Imp of the Mind:
"You are not so abnormal as you think. Every human being is visited from time to time by the Imp of the Perverse,
who makes you think the most inappropriate thoughts at the most inappropriate times."
In a survey, for example, of normal college students almost all of them had one or more of these thoughts occasionally:
- thought of acts of violence in sex
- thought of sexually punishing a loved one
- wishing or imagining that someone is hurt or harmed
- impulse to violently attack a dog
- blasphemous thoughts during prayers
- impulse to engage in sexual practices that cause pain to the partner
- sexual impulse toward attractive females, known and unknown
- impulse to sexually assault a female
- repetitive blasphemous obscene images of the Virgin Mary
Common compulsions include washing and cleaning, checking, repeating, mental compulsions, repeating (such as re-reading or re-writing), and hoarding (although hoarding is not always due to OCD). Compulsions are the ways that you try to escape from the anxiety or discomfort of the obsessions. Compulsions are ways that you keep the vicious cycle going, and so the compulsions need to be gradually blocked.
Gail Steketee, PhD (1993) summarized the cognitive distortions that are common among OCD sufferers:
- Risk/Harm--overestimation of risk or harm
- Doubt/Uncertainty--doubting perceptions and memory, a need for certainty, difficulty making decisions, problems categorizing
- Perfectionism--overconcern with precision
- Guilt/Responsibility--Overly responsible and guilt-ridden
- Rigidity/Morality--May be overly rigid and moralistic
ERP (Exposure and Response Prevention) is used for Obsessive Compulsive Disorder. Lee Baer, PhD says that ERP is based on habituation, which is the body's ability to become accustomed through practice. If someone dives into a pool of water, for example, they will often feel cold. But if they stay in the water (even though they want to get out!), their body will somehow naturally adjust and they will feel more comfortable. Similarly, if the OCD sufferer systematically and regularly faces the worst obsessions (thoughts or images), he will almost always find them less disturbing even though still unwanted.
In work with ERP, we systematically and gradually expose you (with your permission!) to the situations you have been avoiding until your fear eventually subsides. We work together closely on this, so that the work is challenging but not overwhelming. At the saem time, we block your understandable tendency to avoid or ritualize.
Edna Foa (1979) found that clients with "overvalued ideation" (fixed beliefs) did not benefit from Exposure and Response Prevention. In other words, their mistaken beliefs about the dangerousness of obsessional situations interfered with habituation of fears. Clients with panic disorder may need to be treated for panic prior to undergoing treatment for OCD, or it can be treated concurrently. If OCD sufferers have obsessional traits in which they take pride, they may find it difficult to undergo treatment for OCD if the OCD is in some way connected to the traits. Compulsive personality traits might need to be treated prior to treating OCD.