Are you or a loved one suffering from obsessive-compulsive disorder and wondering what is the best treatment for OCD? Let’s find out. But first, it’s important to understand what it is and its effects.
Who does OCD Affect?
Obsessive-compulsive disorder (OCD) affects roughly 1.2 percent of US adults. Women are more likely to develop OCD than men, at a rate of 1.8 percent versus 0.5 percent. More people diagnosed with OCD have a serious or severe impairment (50.6 percent) than mild (14.6 percent) or moderate (34.8 percent) impairment.
In other words, OCD is a condition that is not just misunderstood but incredibly prevalent and highly disabling. Seeking treatment for OCD can help reintroduce crucial quality of life into the lives of millions of Americans. But it’s also important to understand how OCD treatment works and how you might be able to help your loved one through the process.
What is OCD?
OCD is characterized by two sets of interconnected symptoms: invasive, unwanted thoughts and compulsive behavior. Both are linked to overwhelming anxiety and discomfort. The typical cycle for OCD goes as such: a person experiences a disturbing intrusive thought and feels compelled to perform a repeated or ritualistic behavior to soothe their anxiety. These symptoms wax and wane in severity depending on other factors, such as external stressors.
Some OCD symptoms have become popular and stereotyped, but they aren’t prevalent in all cases of OCD. Some people with OCD do engage in excessive handwashing or flip a switch an exact number of times. Some of them are obsessed with perfect symmetry or arranging physical objects.
But they don’t do these things for no reason or feel compelled to do so as a personal tick. These are maladaptive coping mechanisms created irrationally based on irrational fears founded on unwanted intrusive thoughts.
Sometimes, these thoughts take the form of overwhelming and surprisingly violent fantasies, spurning shock, and self-hatred. Sometimes, it’s a sudden and irrational fear of contamination, such as imagining all your pantry items being infested with insects and consequently throwing out your food.
These obsessions do NOT result in follow-through actions of the same nature – a person with OCD and sexual obsessions won’t assault someone as they do in their mind. Instead, they will feel extreme discomfort and shame and must soothe these feelings with compulsive behavior. In general, OCD’s obsessions and compulsions can be categorized between:
- Harming/violent thoughts (towards themselves or others).
- Sexual thoughts (often taboo, such as sexual assault fantasies, anxieties about being a pedophile without knowing it, sudden incestuous thoughts, or worrying about sexuality and gender identity).
- Religious thoughts/scrupulosity (extreme religiosity, fearing sin, being judged by a deity or higher being, feeling shame for every potential blasphemy).
- Contamination anxiety.
- Hypochondriac thoughts.
- Extreme perfectionism.
- Anxiety about “losing control” (worrying about thinking about driving into a crowd, or insulting their boss, or doing something illegal).
- Repeated checking.
- Repeated counting.
- Excessive cleaning.
- Repeating a behavior or strict routine.
- Requesting reassurance constantly.
- Repeating mantras or phrases.
- Performing behaviors in certain multiples.
Obsessive-compulsive disorder symptoms are often intertwined, i.e., an obsession with contamination may lead to excessive cleaning. Worrying thoughts about hurting others may be answered by counting everything on your desk in a certain order or rearranging your surroundings. Compulsions are meant to soothe obsessions, but they create a cycle where both feed into each other.
How Is OCD Treated?
The primary concern of an OCD treatment plan is to break the cycle and help a person overcome their obsessive thoughts with a healthier coping plan while reducing the impact these thoughts have on them. This is achieved through a combination of talk therapy and medication.
We all have intrusive thoughts. These are normal, to a degree. Everyone carrying a pot of boiling water will have had a thought flash across their mind about what would happen if they dropped it on themselves or someone else. Everyone with a thousand hours spent behind the wheel will have imagined what it would be like if they suddenly veered off the road for a split second. But these fleeting moments do not affect the average person and do not make us do these things nor worry excessively about them.
OCD treatment helps people with OCD slowly learn to feel the same way about their obsessions. But it takes time. And the right treatment plan.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) was developed from a combination of different techniques and behavioral models over the years, culminating in its modern form sometime in the 1970s. The core tenet of CBT is that unwanted or intrusive thoughts are responsible for unwanted or disordered behavior and that we can address these thoughts in a therapeutic setting, effectively “relearning” how to think about certain things and challenging what we know to be untrue. CBT allows a person to tackle their inner voice.
But it is not always helpful in the treatment of OCD. A therapist applying CBT may engage an OCD patient’s obsession and ask them to explain it. Then they might try to help them find a rational way to overcome this obsession, but this will usually be met with two potential reactions: the patient will either be unable to apply the rational refutation to their inner anxious reaction, or they use it as ammunition to feed their compulsion.
Key to helping a patient with OCD find a better way out through CBT is to help them confront their obsession by accepting their premise and learning to be okay with it.
We all “irrationally” take into consideration that certain risks are unavoidable. We live with the fact that we experience a strange thought or risk contamination and disease with every human interaction. We continue to drive despite car accident rates and automobile fatalities. We choose to accept and reasonably mitigate risk. But how do we help someone with OCD soothe the anxieties that come at the cost of trying to accept these things? Through exposure and response prevention.
Exposure and Response Prevention Therapy
Exposure therapy is commonly used in the treatment of anxiety disorders to help people become less anxious with the object of their fear.
If a person fears germs, exposure therapy would slowly help them learn to live a more normal and less debilitating life by making experiences with the world without each of their germophobic precautions, such as eating with cutlery provided by a restaurant while eating out or shaking someone’s hand.
These steps are always tailored to an individual’s concerns and obsessions, and progress is made slowly, incrementally. When their defense mechanism springs up, the therapist works with them to respond more healthily by preventing them from performing their compulsions. First, they might only ask a patient to delay their compulsion by a minute. Over time, it might be an hour. Until they’re finally able to stop altogether in response to a certain situation.
Antidepressants for OCD
Antidepressants tend to be the only kind of medication used in the treatment of OCD. They may help reduce the severity of symptoms, but most of the legwork still comes in the form of talk therapy. Nevertheless, SSRIs and, in some cases, older antidepressants like tricyclic antidepressants help OCD patients move forward with their therapy.
What is the Best Treatment for OCD?
Exposure and response prevention therapy are considered a gold standard in the treatment of OCD. But people can react differently to different techniques.
It is important to discuss your situation with a professional psychiatrist and find a treatment plan that best suits you. In most cases, learning to stop your compulsions will ultimately remain key.