Targeted therapies to reduce obsessive-compulsive behaviors, bringing balance to everyday life.
What are Obsessive-Compulsive and Related Disorders?
Obsessive-Compulsive Disorder, Hoarding Disorder, Body Dysmorphic Disorder, Trichotillomania (Hair-Pulling Disorder), Excoriation (Skin-Picking) Disorder, and Olfactory Reference Disorder
People with obsessive-compulsive disorder have obsessions (persistent, recurring, unwanted thoughts and urges) and compulsions (repetitive behaviors or mental acts) that the individual feels driven to perform in response to an obsession.
Other obsessive-compulsive related disorders primarily involve recurring body-focused repetitive behaviors (such as hair-pulling) and repeated attempts to stop the behavior. Related disorders described below include hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and olfactory reference disorder.
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is a disorder in which people have obsessions, which are recurring, unwanted and unpleasant thoughts, ideas, urges, or images. To get rid of the thoughts, people with OCD feel driven to do something repetitively (i.e., perform a compulsion, also called a ritual). The obsessions and compulsions -- such as hand washing/cleaning, checking on things, and mental acts like counting -- are problematic. They are time consuming (for example, take more than an hour a day), cause significant emotional distress, or significantly interfere with a person’s daily activities such as social interactions.
Many people without OCD have distressing thoughts or repetitive behaviors. However, these are not time consuming, distressing, or impairing. For people with OCD, thoughts are persistent and intrusive, and the repetitive behaviors are rigid (it feels as though they must be done). Not performing the behaviors (compulsions, rituals) commonly causes great distress. For example, the person may fear that dire consequences will occur to self or loved ones if the behaviors are not completed. Most people with OCD know or suspect that their obsessional thoughts are not realistic or true, but they nonetheless have difficulty disengaging from the obsessive thoughts or stopping the compulsive behaviors.
OCD currently affects 1-2% of people in the United States, and, among adults, slightly more women than men are affected. OCD often begins in childhood, adolescence, or early adulthood.
Obsessions
Obsessions are unwanted, intrusive, recurrent, and persistent thoughts, urges, or images that cause distressing emotions such as anxiety, fear, or disgust. Most people with OCD recognize that these thoughts are a product of their mind and that they are excessive or unreasonable. However, the distress that these intrusive thoughts cause cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessional thinking by doing compulsions. For example, if they worry that they will be contaminated by touching things like doorknobs, they may compulsively and excessively wash their hands. They may also try to ignore or suppress the obsessions or distract themselves with other activities.
Examples of common content of obsessional thoughts:
Compulsions
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person's distress related to an obsession temporarily, and they are then more likely to do the same in the future. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.
Examples of compulsions:
Treatment
Patients with OCD who receive appropriate treatment usually experience improvement in OCD symptoms as well as increased quality of life and improved functioning. Treatment usually improves an individual's ability to function at school and work, develop and enjoy relationships, and pursue leisure activities.
Cognitive Behavioral Therapy
A type of cognitive-behavioral therapy (CBT) known as exposure and response (ritual) prevention (ERP) is the first-line therapy for OCD. There is more research evidence supporting the effectiveness of ERP for OCD than there is for other kinds of therapy.
During treatment sessions, patients are gradually exposed to feared and avoided situations or images related to their obsessions (exposure) without performing their rituals (ritual prevention). For example, a patient who checks the stove 30 times before leaving the house to prevent a fire learns to gradually cut back on the number of times they check before leaving.
By staying in a feared situation without doing their rituals and without anything terrible happening, patients learn that their fearful thoughts are just thoughts and that the feared outcome doesn’t occur, even without the rituals. People learn that they can cope with their thoughts without relying on ritualistic behaviors, and their anxiety decreases over time.
Using evidence-based guidelines, therapists and patients collaborate to develop an exposure plan that gradually moves from lower-anxiety situations to higher-anxiety situations. Exposures are performed both in treatment sessions and at home. The patient and therapist work collaboratively together, and patients are asked to do things that are challenging but doable. It can be helpful to add cognitive approaches (for example, cognitive restructuring) to exposure and response (ritual) prevention when treating OCD.
Medication
A class of medications known as selective serotonin-reuptake inhibitors (SSRIs) are the other first-line treatment for OCD. Many research studies have shown that these medications are usually effective for OCD, and that they are more effective than other types of medication.
SSRIs available in the U.S. are fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), fluvoxamine (Luvox), and paroxetine (Paxil). Citalopram (Celexa), another SSRI, is not recommended because OCD often requires relatively high SSRI doses, and the maximum dose of citalopram that can be used (the dosing limit is firmer than for other SSRIs) is often too low to effectively treat OCD. Clomipramine (Anafranil) is an SRI (not an SSRI) that is also effective for OCD.
The SSRIs/SRIs are also used to treat depression, anxiety disorders, body dysmorphic disorder, some eating disorders, and many other mental health conditions. Effective SSRI doses for OCD are often higher than those used to treat depression and some of these other disorders. It often takes six to twelve weeks for improvement in OCD symptoms to occur. An SSRI/SRI should be tried for at least 12 weeks, reaching a high enough dose during that time and being sure to take the medication every day. If OCD doesn’t improve enough, it may help to take a dose that is higher than the manufacturer’s maximum dose (but this should not be done with clomipramine or citalopram).
For most people, SSRIs cause no side effects or only minimal side effects that often improve with time. If side effects occur, they can often be addressed with various strategies so they are tolerable or resolve. SSRI/SRIs are not addicting or habit forming.
If a good trial of an SSRI/SRI isn’t adequately helpful, OCD symptoms may improve by adding certain other medications to the SSRI/SRI. Alternatively, patients who do not improve sufficiently with one SSRI/SRI medication may improve with another one.
Patients with mild to moderate OCD symptoms should be treated with either therapy (CBT/ERP) or medication (an SSRI/SRI), or both treatments, depending on patient preference, the presence or absence of associated psychiatric conditions, treatment availability, and other considerations. Severe OCD should be treated with both CBT/ERP and an SSRI/SRI concurrently.
Neuromodulation Treatment
Some newer studies suggest that transcranial magnetic stimulation (TMS) (combined with exposure and ritual prevention) can be effective for OCD. TMS uses magnetic fields to stimulate nerve cells in the brain. It is usually well tolerated. Deep brain stimulation, which involves an implanted device in the brain, has data to support efficacy, but it is invasive and complex to manage, and there are limited providers and hospital systems trained to offer this treatment and provide the long-term support needed by patients who are treated with DBS.
How to Support a Loved One Who Is Struggling with OCD
For people with OCD who live with family, friends, or caregivers, enlisting their support to help with exposure and ritual prevention practice at home is often recommended. In fact, the participation of family or friends may improve the likelihood of treatment success. It is important that family and friends not accommodate the patient’s OCD (for example, it is best to not help the patient do rituals or avoid healthy activities). A therapist can help family members or friends to support their loved one without accommodating their OCD symptoms.
Self-Care
Maintaining a healthy lifestyle by itself is not sufficient treatment for OCD. SSRI/SRI medications and/or cognitive-behavioral therapy (exposure and response/ritual prevention) are needed. But maintaining a healthy lifestyle may help in coping with OCD and has many health benefits. Getting enough good-quality sleep, eating healthy food, exercising, and spending time with others can help to improve overall mental and physical health. Also, using relaxation techniques (when not doing exposure exercises) such as meditation, yoga, visualization, and massage might help with easing the stress and anxiety that OCD causes.
Related Disorders
Source :- https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
