Obsessive Compulsive Disorder Treatment

by Dr Becky Spelman on September 17, 2024

What is Obsessive Compulsive Disorder? And What can be Done About it?

People with Obsessive Compulsive Disorder (OCD) experience intrusive thoughts and often feel the need to carry out certain specific actions in response to these thoughts, intended to relieve the terrible distress that they are feeling. These actions, which may be routines involving a series of steps, are typically performed repeatedly.

Anyone can go through a stressful period in their life when they are unusually worried, concerned, and preoccupied by stressors, but OCD differs in that it persists over time, and becomes so severe that it is difficult to live normally, interfering with people’s ability to deal with reasonable levels of risk, engage in effective decision-making, hold down a steady job, have a life partner, or maintain satisfactory relationships with family members or friends.

OCD can develop around a wide range of unwanted, intrusive thoughts, but some of the more common manifestations include feelings of profound anxiety around hygiene, cleanliness and contamination, or an obsession with symmetry and order. You may feel that, if you do not engage in the obsessive repetitive behaviours that have developed in response to the unwanted thoughts that terrible things might happen, to yourself or to others. You might hoard objects in your home or find it difficult to get rid of things. You might struggle with intrusive, unwelcome thoughts about subjects that are considered taboo, such as certain sexual practices, or thoughts relating to religious or other belief systems. You might compulsively engage in behaviour that is or becomes self-harmful, such as washing your hands until the skin cracks and bleeds, picking at your hair, skin, or eyelashes, biting your nails, or engaging in other forms of destructive behaviour aimed at the self.

OCD can manifest in a wide variety of ways, and many people with OCD find that their symptoms ebb and flow depending on what is going on in their lives, or apparently at random. The severity of symptoms may be influenced by factors including external stress, normal hormonal fluctuations as occur in the menstrual cycle or menopause, and shifts in the dynamics of your interpersonal relationships.

Whereas people with many mental disorders are not fully aware that they have a problem, or do not really understand it, people with OCD are often acutely aware that their obsession and their compulsive behaviours are not appropriate and functional, and are typically deeply distressed by the feeling of being unable to control thoughts and actions that are having a devastating impact on their life. Often, they experience profound feelings of shame and distress relating to their OCD, which can be as disruptive of normal living as the condition itself. They may, however, attempt to rationalise their behaviour to others, perhaps stating that they are deeply concerned about external causes of stress such as contamination, a lack of hygiene, or crime or other perceived dangers in their lives. In these cases, the person with OCD may struggle to reach out for help, possibly presenting in the first instance to their GP or other caregiver with physical symptoms relating to the condition, such as cracked or chapped skin resulting from excessive washing.

What Causes OCD?

It is not at all clear why some people get OCD and not others, although research suggests that there may be many factors at play, including a genetic predisposition, and a history of trauma in childhood, possibly linked to child abuse. Generally speaking, the condition tends to begin early in life; it is quite rare for someone to start experiencing OCD for the first time from middle age up, while frequently onset occurs around the time of puberty or in early adulthood.

While both sexes can experience the condition, it is typically more common in women than in men. Often, people with OCD also have comorbidities, or other mental health conditions, such as Attention Deficient Hyperactivity Disorder (ADHD), depression, anorexia or another eating disorder, Tourette’s Syndrome, or an anxiety or personality disorder. OCD can occur in both children and adults, and people whose parents have OCD are more likely than others to suffer from the condition, although it is not clear whether this is largely because of genetics or learned behaviours, or both.

A substantial number of people with OCD also have a tic, with many being diagnosed as having a lifetime tic disorder, which might involve a verbal tic or a physical one, such as shuffling or groaning in response to certain stimuli. People with OCD are much more likely than others to experience suicidal ideation.

Times of unusually high stress levels can be triggers for OCD symptoms in those whose symptoms might usually be mild or under control. For example, the recent COVID pandemic, when there was widespread public messaging about the importance of hygiene, saw a dramatic uptick in people suffering with intrusive levels of OCD.
How can OCD be Treated?
For most people with OCD, their first port of call may be their GP, who is likely to refer them to therapy for assessment and treatment, possibly after ruling out or discussing other underlying issues.

If you feel ashamed and embarrassed of having the condition, know that there is no need: your GP and any therapist you see subsequently will have encountered the condition before, and can reassure you that it is both quite common and eminently treatable.

Often, OCD is treated with a combination of modalities. Some medications, such as anti-depressants, can help in the short term with severe symptoms, and in very severe, treatment-resistant cases specialist treatments like deep brain stimulation may be proposed. For certain patients, these treatments can provide some much-needed relief.

However, for long-term relief and management of the condition, various forms of talk therapy or psychotherapy are available and have been clinically proven to be extremely effective for most people with OCD. Fortunately, as OCD is a relatively common condition, many therapists are very experienced in treating it and have access to a variety of suitable treatment modalities.

Common therapeutic approaches for treating OCD include:
- Cognitive Behavioural Therapy (CBT), which seeks to help you to understand the triggers to your undesired thoughts and behaviours and to replace them, as far as possible, with more useful and productive alternative thoughts and behaviours.
- Acceptance and Commitment Therapy (ACT), which helps you to gain control of your OCD by focusing on helping you to manage your thoughts and emotions more usefully, and to apply techniques such as mindfulness during periods of stress. Mindfulness helps you to remain in the moment, focusing on what really matters and learning how to gradually disconnect from intrusive thoughts and unhelpful behaviours.
- Inference Based Therapy (IBT), which is a form of CBD developed specially to help people with OCD. IBT springs from the observation that people with OCD often feel that something “bad” will happen if they do not engage in their compulsive behaviours. Through the focused application of CBT techniques, you learn how to replace these views with a more rational perspective, while also tackling the intrusive thoughts and compulsive behaviours.
- Exposure and Response Prevention Therapy (ERPT), which helps you to get your obsession and compulsive behaviour under control by exposing you to triggers in a controlled, safe environment, and giving you the opportunity to learn incrementally how to manage your reaction.
- Habit-Reversal Training (HRT) is one approach that is often used to significant effect for those whose compulsive behaviours are causing them physical harm. For example, if the client’s issue is that that they feel the need to repeatedly check all the locks in their home before leaving the house, or to wash their hands repeatedly, with their therapist’s help, they can gradually train themselves to engage in these actions less often, until their behaviour is within or near normal limits and is no longer compromising their ability to live a normal life. Often the therapeutic goal is not to completely eliminate the obsession or the compulsive behaviour – which may prove to be impossible – but to bring it under control and reduce the amount of time and emotional energy that you devote to it.
All of these therapeutic modalities are based on helping you to manage your obsessive symptoms more effectively by learning how to recognise your triggers, what behaviours exacerbate them, and how you can develop more useful behaviours that will help to minimise the impact of the condition on your daily life.

In some cases, particularly when the person with OCD is a child or juvenile, or when the OCD symptoms appear to flare in association with certain dynamics in the family, family therapy may help to unpick collective behavioural patterns that may be contributing to the condition. Group therapy is also a viable option for many people with the condition.

If the OCD is causing you to engage in harmful behaviours – such as picking at your skin or obsessively washing your hands – it may also be necessary to treat any physical health problems relating to this behaviour, while also engaging in practical measures to cease it or at least mitigate against the negative impacts, until the OCD is better under control.

Because people with OCD are much more likely than average to also suffer from a range of psychiatric conditions – often a depressive condition – this should also be treated in parallel, as is more than likely that the two (or more) morbidities are inextricably interlinked.

As substance abuse is more common among people with OCD than others, it may also be useful to address issues relating to the abuse of alcohol or of other legal or illegal substances, in parallel with a treatment programme for the OCD.
What is the Long-Term Outcome for People with OCD?

It is important for people with OCD to get the professional help they need, because the condition is unlikely to resolve on its own. However, for those who know that they have OCD, accept that they have a problem, and engage with therapy, the prognosis for the successful management of the condition is generally excellent.

By engaging positively with their therapist, and integrating new habits into their daily lives, most people will find that their OCD symptoms will decrease dramatically – often relatively quickly, too – and will stop having such a destructive impact on their life. They will also become keenly attuned to external and personal factors that can trigger a flare-up of the condition and will know when it is time to seek help.

Many people with OCD may find that joining a support group for others with the condition can help them to manage it in the longer-term and can discuss with their therapist whether this is a good approach for them, and what groups are available in their locality.

Through therapy, most people with OCD learn that they have nothing to be ashamed of. Anyone can experience mental ill-health, and OCD is a relatively common phenomenon that is quite well-understood. If you suffer from the condition and are prepared to engage with your therapist to better understand it and learn how to manage it more effectively, there is every reason to feel confident that you can gain a much higher level of mastery over it, and will be able to live a useful, productive, and happy life.
References

Angelakis I, Gooding P, Tarrier N, Panagioti M (July 2015). “Suicidality in Obsessive Compulsive Disorder (OCD): a Systematic Review and Meta-analysis,” Clinical Psychology Review, 39, Pergamon Press: 1–15. Link

Fenske JN, Schwenk TL (August 2009). “Obsessive Compulsive Disorder: Diagnosis and Management,” American Family Physician, 80 (3): 239–245. Link

Goodman, Wayne K., Grice, Dorothy E., Lapidus, Kyle A.B., Coffey, Barbara K. “Obsessive-Compulsive Disorder,” Psychiatric Clinics of North America, Volume 37, Issue 3, 2014, 257-267. Link

Stern ER, Taylor SF (September 2014). “Cognitive neuroscience of obsessive-compulsive disorder”. The Psychiatric Clinics of North America. 37 (3): 337–352. Link

Twohig, Michael P.; Abramowitz, Jonathan S.; Bluett, Ellen J.; Fabricant, Laura E.; Jacoby, Ryan; Morrison, Kate L.; Reuman, Lillian; Smith, Brooke M., “Exposure Therapy for OCD from an Acceptance and Commitment Therapy (ACT) Framework,” Journal of Obsessive-Compulsive and Related Disorders, Volume 6, 2015, 167-173. Link