Obsessive Compulsive Disorder in Adults

Treatment of OCD

Prior to studies in the 1980's, the usual view of OCD was that it was a relatively rare disorder with a poor prognosis. However, in addition to it being now recognized to be much more common (2-3% prevalence rate), it is generally seen to be treatable, with some 60%–80% of patients showing at least some response to treatment.

It is generally thought that the serotonin system in the brain is involved in the pathology of OCD, since the pharmacological agents that have been shown to be effective in the treatment of ocd generally increase the availability of this neurotransmitter. These include the serotonin re-uptake inhibitors: clomipramine, fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram.

Behavioral therapy - specifically ERP [Exposure and Response Prevention] - has been successfully used for the treatment of OCD. The idea behind ERP is that compulsions provide only a temporary reduction of the anxiety produced by obsessions. Furthermore, the only way to experience more permanent relief is to habituate (grow tolerant of…"used to") the anxiety caused by the obsession without performing the compulsion. Habituation is the key factor, and clinicians proceed by first identifying triggers for and situations that bring on obsessional thoughts and compulsive behaviors and then developing a graduated hierarchy of anxiety based on the patient's report. The patient "challenges" him- or herself with the least anxiety-provoking items first and then moves up the hierarchy. In addition to exposure, the patient is instructed to refrain from carrying out the associated rituals

Heidi was afraid of germs and dirt. She felt very uncomfortable whenever she had to go into a bathroom. She carried tissues with which to open the bathroom door, and had to wash her hands several times before leaving the bathroom. The door was then opened with a paper towel. If she accidentally touched the door, she had to wash all over again.

For her ERP treatment, Heidi was told to spent 10 minutes sitting on a chair in her bathroom without washing her hands. This was to be repeated each day for a week. Initially she felt very uncomfortable, and greatly wished to clean her hands. She found herself thinking of the dirt and "germs" that she felt must be everywhere in the bathroom. However with much effort she was able to tolerate this. Once she had 'mastered' this she was told to increase the time from 10 to 20 minutes. She was still uncomfortable, but was a bit surprised that spending twice as long didn't mean being twice as uncomfortable. Indeed after about 10 minutes, she felt somewhat relieved that nothing terrible had occurred. Further extending the time to 30 minutes simply led to her feeling that nothing was going to happen if she spent more time not washing. Once Heidi had mastered this, she was told to touch the inside of the sink, and not wash her hands for 10 minutes. Since she regarded the sink as one of the moderately dirty places in the bathroom, this presented a new challenge for her. As she mastered one level of discomfort, she was moved on to the next more challenging level, until she finally was able to use the bathroom without intolerable anxiety and without her usual rituals.

An added benefit of behavioral treatment is its long-term efficacy. Unlike pharmacotherapy, whose beneficial effects do not last in the great majority of patients after medication is withdrawn, behavioral therapy has shown continued efficacy in follow-up studies ranging from 1 to 6 years, although booster sessions may be required.

Summary

Obsessive Compulsive Disorder is more common than generally believed 20 years ago. It appears to be largely a neuropsychiatries condition, rather than a product of overly strict upbringing (as was once believed). Although OCD can have a paralyzing impact if not properly diagnosed and treated, there are fortunately behavioral and pharmacological approaches available that can help many of the sufferers from this potentially devastating illness.

Obsessions may often involve thoughts which seem unacceptable to the individual, so that he or she feels ashamed. Because of this, many people keep their thoughts a secret and suffer silently. In the past decade, there have been advances in the behavioral and pharmacological treatment of Obsessive Compulsive Disorder. For helpful mental health links, please see the links below.

About the author: Glenn Brynes, Ph.D., M.D. is Board-Certified in Adult and Geriatric Psychiatry and in private practice in Baltimore, MD.

More Links related to OCD

• Obsessive Compulsive Disorder
  This site has information on medication, diagnostic issues, behavioral treatments, and other resources.
• Obsessive-Compulsive Foundation This organization is by and for individuals with OCD. The site contains information on medication, psychotherapy and support for individuals with OCD. There is a chat room and a message board.
• On-Line Y-BOCS This is a well-known screening measure for OCD (Not a substitute for a complete psychiatric evaluation)

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