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OCD includes thoughts (obsessions) & actions (compulsions). The obsessions and compulsions are typically linked. Most of the time, the compulsion is designed to relieve the obsession. One of the hallmarks of OCD is the thoughts are intrusive. The compulsions provide brief relief, but then they quickly strengthen the obsession.
Obsessive Compulsive Personality Disorder is different from OCD in that it does not have the intrusive feature.
OCD is very common. Current estimates suggest that anywhere from 2.5 - 3.4% of people suffer from OCD. OCD can be extremely debilitating. OCD takes a lot of time away from people. Thinking about the behaviors they want to engage in, and then the actions they feel they must follow through with can produce a lot of shame.
Three distinct categories of OCD
Checking: checking stove, checking locks, checking the car door.
Repetition: counting off certain sequences of number(s), tapping, etc.
Order: incompleteness (one can't walk away from something because something is not right or complete), alignment of things or symmetry (arranging stuffed animals in the same way every single day and feel compelled to correct it), and disgust/contamination.
The fine line between obsessions & compulsions generates from anxiety (quicking of breathing, increase of heart rate, visual field narrows). It is what binds the intrusive thought to the compulsion. This is what creates the URGENCY in relieving the sensation.
At the time of the decision to lead into the compulsion, there is a very initial drop in anxiety which then in turn REINFORCES the obsession even further.
Having OCD can lead to depression. You may start to feel less optimistic about life. You can start to have suicidal ideation.
There is a genetic component to OCD but the nature is not fully clear. This does not mean it is directly inherited from the parent. Approximately 40-50% have some genetic component, some mutation, or some inherited aspect.
Understanding the biological mechanisms can be helpful. What is going on in the brain and body chemistry with people who have OCD? The brain has two main functions: to make sure things are functioning properly (digestion, heart is beating, breathing, make sure you can see, hear, smell etc.) then there is the way the brain predicts what will happen next. Our brain devotes itself to predicting what will happen next. We are talking about our knowledge of the past. Our memory systems are designed to bind what is happening and what will happen next. The brain has neural circuits that have been studied while people are having obsessions and compulsions. Many functions of the brain have been found on neuroimaging studies that are at play in obsessions and compulsions . We have the cortex or neocortex which is involved in the perception of what is happening, we have the striatum and the basal ganglia which are involved in generating behaviors (go) and suppressing behaviors (no go), the thalamus which collects all of our sensory experiences in parallel (hearing & touch) and this is encased by the thalamic reticular nucleus which acts as a guard from what can and cannot pass through up to conscious understanding. Any dysfunction in these circuits are involved in what results in OCD. The cortico striatal thalamic loop is active in OCD.
What we will do together to treat your OCD:
Cognitive Behavioral Therapy and more specifically a progressive Exposure Therapy. This is enormously effective for most with OCD. However, for some it must be used in conjunction with specific medications. Together we will work to uncover as much information about your specific OCD and with professional guidance, we will then move on to exposure therapy.
It is VITAL to have and perform homework outside of the therapeutic setting.
Dr. Helen Blair Simpson from Columbia School of Medicine, one of the top leading experts on OCD, says that key procedures are exposures done in person, in real time, with the actual thing that evokes the obsessions. The goal is to gradually and progressively increase the level of anxiety, but then intervene in ritual prevention. We will work to disconfirm fears and challenge your beliefs. Cognitive Behavioral Therapy can have a dramatic reduction in the severity of symptoms. More so than SSRIs on its own.
SSRI's can help, however Cognitive Behavioral Therapy/Exposure Therapy is the most effective treatment. It is more beneficial if you are already on an SSRI and then add on CBT rather than starting with CBT and then adding on an SSRI. SSRI's can have some side effects that can influence appetite, libido so please discuss any type of drug treatment with a psychiatrist who truly understands its psychokinetics.
Please keep in mind, there is a population of those with OCD who do both CBT & SSRIs that do not respond and may need to explore adding on neuroleptics (dopamine/glutamate system).
*Transcranial Electric Stimulation is another treatment path to explore.