By Jan Cheek, MSW, LCSW

Obsessive-Compulsive Disorder (OCD) is a neurobiological disorder that causes a person to have a sense of intense angst and fills their mind with unwanted and intrusive thoughts, often threatening doom if they do not perform extreme repetitive behaviors and senseless rituals. OCD affects about 2.5% of the population — children and adults, male and female. Research indicates that it is likely to have a genetic component and run in families. There is evidence that there is a higher rate of OCD, Tic Disorders and Attention Deficit Hyperactivity Disorder (ADHD) in families with a relative who has been diagnosed with OCD.

OCD is characterized by obsessions and/or compulsions that are impairing, cause distress, time-consuming, interfere with relationships and activities of daily living and normal routines. Obsessions are persistent impulses, thoughts, ideas, or images that invade a person’s thinking and cause extreme worry, angst, and anxiety. Compulsions are the mental acts, repetitive behaviors, or routine rituals designed as a response to the obsessions to prevent or alleviate the worry and anxiety. In many cases, there is an associated intent for the compulsion to magically prevent some dreaded negative event or situation from occurring such as death, horror, catastrophe, or misfortune that might otherwise occur if the behavior or ritual was not performed. OCD can manifest in many different ways for people, but untreated and unmanaged, OCD becomes very consistent over time for a person.

Basic types of OCD symptoms includes those people who are “checkers” and live with an excessive sense of responsibility that possible danger and disaster is looming, thus they must check one more time on the possibility that they left something in an imperfect state. People reportedly check things until it feels “right”, or they check things a magical number of times (i.e.: checking to make sure the door is locked 7 times even though it was securely locked all 6 times before the final 7th check). “Washers/Cleaners” fear contamination by dirt and germs and live in the constant sense of dread that severe harm may come to themselves or others by the spread of germs. Excessive cleaning and hand washing becomes the compulsion and often with less success over time with reducing the angst because the reality of the magnitude of the possibility of contamination becomes reality. “Orders and Repeaters” believe they must arrange things in exact and “perfect” manner or repeat their actions to create symmetry. They become extremely distressed if objects are moved or out of order. They assign meaning to arrangements such that if something is not “just right” there is a fear of harm or unease; or the inverse, when things are “just right”, then people will do well or be safe. People with “scrupulosity” obsess about moral, religious, judicial, and ethical issues. They demand a standard of conduct of themselves and sometimes others that borders on perfection and purity. Their compulsions often involve prayer, meditation, and seeking reassurance from others regarding their moral purity and righteousness. This results in even greater prayer and more reassurance because there becomes a lack of trust in the original prayer and reassurance.

This list of OCD symptoms is only a sampling and is in no way exhaustive. People often suffer from a variety of symptoms with some being more predominant during particular times of their lives. The good news is that OCD can be treated and can certainly be managed successfully. There are a number of ways to address the disorder. Research indicates that the most effective treatment approach is a combination of Cognitive Behavioral Therapy (CBT), with a focused therapeutic intervention known as Exposure and Response Prevention (EPR), along with psychiatric medication management. CBT involves actively challenging and confronting any distorted thinking and beliefs that support and maintain obsessions and compulsions. Therapists trained and experienced in CBT work through an interactive manner with their patient on “cognitive restructuring and cognitive reframing”. Similarly, therapists experienced and trained in the EPR intervention, work purposefully and interactively to reduce the angst, agitation, and discomfort associated with the OCD and anxiety through habituated exposure of some of the stimuli. The intervention takes intense planning and preparation. Psychiatric medication treatment alters the levels of serotonin and assists with the behavioral therapies to reduce the negative sensation of anxiety has proven to be helpful. It often allows the exposure and skill building to be more tolerable. Response Prevention actually means that the person is restricted from resorting to the normal compulsions that have previously worked to reduce anxiety, but have now become associated with OCD signs and symptoms and distorted and irrational thoughts. Instead, the person is purposefully and meaningfully guided in a therapeutic manner to experience the normal emotions associated with exposure to the stimuli.

It is important to find a therapist who understands OCD and is able to effectively assess for OCD and differential diagnoses. In addition, it is critical, that if you suspect that you or someone you care about is suffering from signs and symptoms of what might be OCD or any mental health issue, there is treatment available. Jan Cheek, MSW, LCSW at Behavioral Healthcare Associates, LLC is experienced and highly trained in treating OCD using the modalities noted in this article. John Shin, MD is our Board Certified Psychiatrist (child/adol/general) who provides psychiatric medication management. If you are facing emotional and behavioral challenges and uncertain what to do at this time, Ms. Cheek or one of her colleagues at BHA is trained to evaluate and determine treatment needs. Contact BHA @919-292-1464 to establish an appointment.