You would be surprised to learn how many of my clients have unusual habits, compulsions or thoughts that are suggestive of OCD, yet that’s not what brought them into my office. OCD is a very misunderstood diagnosis. Unfortunately too many people equate OCD with being a “germophobe” or a “neat freak” or engaging in excessive handwashing. These behaviors likely do not represent OCD.
I like to say, OCD is not defined by handwashing, or any other behavior. It’s more a matter of what happens when you try to NOT engage in that behavior. In reality it’s very common for clients to tell me that there are certain things they HAVE to do a certain way. And if they don’t it just nags at them or bugs them until they do it, often repeatedly, until it is done just right. This can be anything from making a sound or saying a phrase, to counting or acting in multiples of certain numbers, to touching a body part a certain way, to sorting things or doing things in a certain order. Often these behaviors feel like superstitions because we feel convinced that if we DON’T do them something bad will happen. Other times the “something bad” that happens it that the anxiety builds until it’s intolerable and we just have to do it.
A long time ago when seizures were called “fits” they were felt to be a mental disorder. As time passed we have come to see that they are in fact a neurological disorder, and the same may be true of OCD. It may be that OCD happens because of something hardwired in our nervous system, although many people acknowledge that it gets worse in times of anxiety change or stress. But one thing is clear, these compulsions are not easily ignored and you shouldn’t feel like a failure because you can’t resist them. Will power alone likely won’t help you, and people who think you should be able to just stop using your willpower likely don’t understand the nature of OCD.
No. Another form of OCD has to do with intrusive thoughts. These are thoughts that just won’t get out of your head, kind of like that song that gets stuck in your thoughts, but much worse. Often the thoughts are non sensical or simply not true. It’s not uncommon to have intrusive thoughts about somewhat taboo topics. In my practice I have had patients who had very disturbing intrusive thoughts wondering if someone had molested them or if they had molested someone (when in fact neither had occurred). Other intrusive thoughts may take the form of thoughts or images of grave harm coming to oneself or one’s loved ones. Some of these are quite graphic and disturbing. I have even had patients who had intrusive repetitive thoughts about grabbing a knife and harming someone yet they insist they bear that person no ill will, are not angry, and not a violent person. These thoughts can be terrifying. And sometimes people are reluctant to come in for treatment for OCD with a Psychiatrist because they fear the therapist will think they are violent, dangerous, or homicidal.
OCD is such a private and often shameful diagnosis that many people have never discussed or revealed the behaviors thoughts or beliefs they live with every day. I often find that once I start asking the right questions, people are relieved to be able to share a trove of thoughts and behaviors they have not discussed before. It can be a real relief to learn that these thoughts and behaviors are quite common, they don’t always mean what it would appear they mean, and that they are often characteristic or typical of certain categories of OCD symptoms.
OCD treatment starts with thorough diagnostics and review of history and symptoms.
I will want to know when the symptoms started. Many people noticed symptoms dating back to childhood. Do others in your family have OCD as there are often strong genetic links. I will want to hear what you have already tried that has helped or not helped. What has made the OCD symptoms worse or better. How you hide the behaviors. What accommodations you have had to make to function around them. Do you engage other people to do things for you that would be too triggering or do you need other people to engage in behaviors or say or do things to dispel the anxiety you are feeling?
Also, OCD co-occurs with several other disorders and we will want to carefully screen for them. Although it’s just as common that someone comes in for treatment for another disorder and significant OCD is discovered as well.
Many people live with a significant degree of rituals and compulsive behaviors or intrusive thoughts and don’t want or need treatment. It all comes down to how much it’s impacting your life, your work, your health or your relationships.
It’s important to discuss how your symptoms and behaviors affect those in your life. How do your loved ones engage regarding your OCD? Do they make accommodations? Should they? What else can they do to help you? What about when intrusive thoughts involve another person? What are they to make of all of this? In treatment for OCD I will often have family members join us for a session to provide psychoeducation, help them cope with the impact, and advise them of what they can do to help you overcome your symptoms of OCD.
The primary type of therapy that helps OCD is geared at helping you tolerate the anxiety that mounts as you attempt to refrain from indulging in the behavior. Anything that reduces anxiety in general is also helpful. The goal is to eliminate some of the avoidant behaviors that can happen so that your life doesn’t become small and limited due to OCD. But this is a subtle and delicate art. Because if the steps you take to try to expose yourself to something challenging are too big, you will fail and become demoralized. People don’t always understand how hard, how impossibly hard, it is to resist the urges. I get it. So we will take micro steps.
Well, you are not alone. Most clients with significant OCD symptoms find that without some medication on board they simply can’t resist the urge to act on a certain behavior. There’s a good reason they are called compulsions!
The good news is that medications, typically SSRI antidepressants, can really help reduce OCD symptoms and often allow the therapeutic skills and behaviors to work.
Also, many people who start medications for OCD discover that they help with anxiety in a variety of ways that are not even what brought you in for treatment. Sometimes we see sleep improve, skin picking or hairpulling improve or resolve and a decline in fretting, ruminating and catastrophizing.
You may have heard that OCD is hard to treat, and this is true, in the sense that it often requires higher doses to get a response than it does for depression or anxiety. And if your OCD is severe, we may not be able to make it all go away. But take heart. I am armed with evidence based treatment decision-trees that give us LOTS of options of various approaches and medications to try.
You should know that some patients actually get quite a bit of relief at low doses. And also, even if your symptoms only improved 40% for example, that can represent all the difference in the world! Sometimes with a reduction in symptoms you can now apply therapy skills that just didn’t work before, or maybe this reduction allows you to join family or friends on a trip, or get your symptoms under control enough that you’re no longer late, or so that you can keep them more private and not draw attention.
Are you ready to make an appointment with a Psychiatrist specializing in OCD?
